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i
^>m
Boston
Medical Library
8 The Fenway
-cr*' y
/#- -^y-:!;
^j^oiCATu
THE
MEDICAL RECORD
A Weekly yournal of Medicine and Surgery
EDITED BY
GEORGE F. SHRADY, A.M., M.D.
SURGBON TO THB PKESBYTERfAN AND ST. FRANCIS HOSPITALS; CONSULTING SURGBON TO THB HOSPITAL FOR RUPTURBD
AND CRIPPLBD, NEW YORK; AND PRESIDENT OF THE N. Y. PATHOLOGICAL SOCIETY.
^alumje 26
JULY 5, 1884 — DECEMBER 27, 1884
i\
NEW YORK
WILLIAM WOOD & COMPANY
1884
Trow's
Printing and Bookbinding Company,
201-213 East I2ik Streety
New York.
LIST OF CONTRIBUTORS TO VOL. XXVI.
Agnew, Dr. C. IL, New York.
Am)rews, Dr. Joseph A., New York.
AvERiLL, Dr., Campello, Mass.
Baird, Dr. W. T., Albany, Tex.
Baker, Dr. Henry B., Lansing,
Mich.
Baker, Rev. Geo. S., New York.
Baldwin, Dr. Benjamin I., Mont-
gomery, Ala.
Baldwin, Dr. D. A., Englewood,
N.J.
Baruch, Dr. Simon, New York.
BiNNiE, Dr. John, Poynette, Wis.
BODENHAMER, Dr. WiLLIAM, NeW
York.
BoRCHEiM, Dr. L. E., Atlanta, Ga.
BoswoRTH, Dr. Franche H., New
York.
Boyland, Dr. G. Halsted.
Bradner, Dr. Wm. B., Warwick,
N. Y.
Brown, Dr. K Wood, Kansas City,
Mo.
Browning, Dr. Wm., Brooklyn, N. Y.
Buck, Dr. Albert H., New York.
BuNDY, Dr. A. D., St. Ansgar, Va.
Burke, Dr. John, New York.
Canfield, Dr. H. A., Gillmore, Pa.
Campbell, Dr. S. K, South Bay
City, Mich.
Carhart, Dr. J. W., Tampasas, Tex.
Carman, Dr. J. H., South Amboy,
N.J.
Carpenter, Dr. Wesley M., New
York.
Case, Dr. Meigs, New York.
Cai;ij>well, Dr. C. M., New York.
Chamberlain, Dr. Wm. M., New
York.
Chapin, Dr. Henry Dwight, New
York.
Cheesman, Dr. W. S., Auburn, N. Y.
Childs, Dr.S. B., Brooklyn, N.Y.
Christian, Dr. E. P., Wyandotte, Wis.
Cowan, Dr. George, Danville, Ky.
Crawcour, Dr. J. L., New Orleans,
La.
Crothers, Dr. T. D., Hartford,
Conn.
Crudeli, Dr. Conrad Tommasi,
Rome, Italy.
Cuming, Dr. James, Belfast, Ireland.
Dana, Dr. Chakfs L., New York.
Dana, Dr. S. W ., Now York.
Davis, Dr. G. G., Trewsbury, N. Y-
Dickinson, Dr. D., U.S.N.
Doughty, Dr. W. H., Augusta, Ga.
Dumm, Dr. S. C, Columbus, O.
DwiGHT,*Dr. Francis M., New|York.
Earle, Dr. Charles W., Chicago,
111.
Edson, Dr. Benjamin, Brooklyn,
N.Y.
Edson, Dr. Cyrus, New York.
Ellingwood, Dr. Finley, Manteno,
111.
Elliott, Dr. A. A., Steubenville, O.
Epley, Dr. F W., New Riclimond,
Wis.
Evans, Dr. S. A., Conway, N. H.
FiSK, Dr. Samuel Aug., Denver, Col
FoTHERGiLL, Dr. J. MiLNER, Lon-
don, Eng.
Fowler, Dr. Geo. B., New York.
Free, Dr. Spencer M., Dagus
Mines, Pa.
French, Dr. C. H., Waterbury, Conn.
Fuller, Dr. Eraser C, New York.
Fuller, Dr. S. E., Brooklyn, N. Y.
Gardiner, Dr. Henry K., Provi-
dence, R. I.
Gatchell, Dr. Edwin A., Asheville,
N. C.
Garrigues, Dr. H. J., New York.
Geddings, Dr. W. H., Aiken, S. C.
GiDDiNGS, Dr. W. P., Gardiner, Me.
GoLDSMrra, Dr. Middleton, Rut-
land, Vt.
Good WILLIE, Dr. D. H., New York.
Graves, Dr. Thomas, Virginia.
Green, Dr.'EowARD H., U. S. Navy.
Groat, Dr. F. A., Fremont, O.
Hamilton, Dr. Allan McLane,
New York.
Harlan, Dr. A. W., Chicago, 111.
Harris, Dr. M. L., Chicago, 111.
Harris, Dr. R. B., Savannah, Ga.
Hawes, Dr. Jesse, Greeley, Col.
Heineman, Dr. H. N., New York.
Henry, Dr. Morris H., New York.
Hepburn, Dr. N. J., New York.
HEUEL,'Dr. Franz, New York.
HoLDEN, Dr. Edgar, Newark, N. J.
Holt, Dr. L. Emmet, New YorK.
HoRTON, Dr. W. P., Jr., Cleveland, O.
HoRwiTZ, Dr. Lloyd Norris, Phila-
delphia, Pa.
Howe, Dr. J. Morgan, New York.
Humphreys, Dr. C. H., Dayton, O.
Hunter, Dr. James B., New York.
Jarvis, Dr. Willlam Chapman, New
York.
Jones, Dr. S. S., New York.
JuDKiNS, Dr. William, Cincinnati, O.
Kales, Dr. J. W., Franklinville, N. Y.
Kelly, Dr. J. D., Utica, N. Y.;^
KiDD, Dr. George H., '^Dublin, Ire-
land.
King, Dr. Samuel T., New York!.
Kinnicutt, Dr. Frank P., New York.
Klingensmith, Dr. I. P., Blairsville,
Pa.
Knapp, Dr. H., New York.
KoRTRiGHT, Dr. James L., Brooklyn,
N.Y.
Kretschmar, Dr. Paul H., Brook-
lyn, N.Y.
I^NCASTER, Dr. R. A., Gainesville,
Fla.
Leake, Dr. Henry K., Dallas, Tex.
Leonard. Dr. William R., New
York.
Lewis, Dr. Daniel, New York.
Lincoln, Dr. Rufus P., New York.
McCoy, Dr. George T., Columbus, O.
McLean, Dr. Leroy, Troy, N. Y.
Mackenzie, Dr. John N., Baltimore,
Md.
Mackenzie, Dr. Morell, London,
Eng.
Major, Dr. George W., Montreal,
Canada.
Mammen, Dr. Ernest, Bloomington,
111.
Marsh, Dr. E. J., Paterson, N. J.
Marshall, Dr. John S., Chicago, 111.
Marvin, Dr., East Saginaw, Mich.
Meier, Dr. G. C. H., New York.
Millard, Dr. H. B., New York.
Minor, Dr. James L., New York.
Moore, Dr. A. M., U. S. Navy.
IV
CONTRIBUTORS TO VOL. XXVI.
Moore, Dr. William Oliver, New
York.
Mulhane, Dr. John D., Steuben-
ville, O.
MuNDf , Dr. Paul F., New York.
Murray, Dr. R., U. S. Army.
Nelson, Dr. C. E., New York.
Newcomb, Dr. J. E., New York.
Nolan, Dr. E. M., Jacksonville, Fla.
North, Dr. N. L., Brooklyn, N. Y.
Noyes, Dr. H. D., New York.
Oliver, Dr. N. E., Thornton, 111.
Ord, Dr. William M., London, Eng.
Otis, Dr. F. N., New York.
Page, Dr. A. C, Truro, N. S.
Page, Dr. K Channing M., New
York.
Palmer, Dr. J. G., Oakbowery, Ala.
Panum, Dr. P. L., Copenhagen, Den-
mark.
Park, Dr. Roswell, Buffalo, N. Y.
Park, Dr. G. C., Murraysville, Pa.
Parker, Dr. J. B., U. S. Navy.
Parker, Dr. William S., Piqua, O.
Parker, Dr. W. Thornton, Fort
Union, N. M.
Parks, Dr. N. O. D., Ashton, R. I.
Parmenter, Dr. John, Buffalo, N. Y.
Pbck, Dr. Edward S., New York.
Percy, Dr. Samuel R., New York.
Perry, Dr. Alfred W., San Fran-
cisco, Cal.
Peters, Dr. John C, New York.
PiNKNEY, Dr. Howard, New York.
Polk, Dr. W. M., New York.
Prendergast, Dr. P. J., Brooklyn,
N. Y.
Redfrrn, Dr. Peter, Belfast, Ire-
land.
Reynolds, Dr. Walter B., Washing-
ton, D. C.
Riley, Henry A., Esq., New York.
Roane, Dr. James, Yankton, Dak.
RoBBiNs, Dr. C. W., Marinette, Wis.
Rockwell, Dr. A. D., New York.
Rodenstein, Dr. L. A., New York.
RoosA, Dr. D. B. St. John, New
York.
RowE, Dr. Frank H., Cummins-
ville, O.
Saundby, Dr. Robert, Birmingham,
Eng.
ScuDDER, Dr. H. Martyn, Chicago,
111.
SAe, Prof. Germain, Paris, France.
Sexton, Dr. Samuel, New York.
Shafer, Dr. J. P., Parkersburg, W.
Va.
Sheardown, Dr. T. W., Knoxville,
Tenn.
Sheardown, Dr. Thomas W., Wino-
na, Minn.
Shears, Dr. C. H., New York.
Shrady, Dr. Geo. F., New York.
Shillock, Dr. P. T., Chaska, Minn.
Sizer, Dr. A. B. de S., Brooklyn,
N. Y.
Smiley, Dr. D. B., Middletown, N. Y.
Smith, Dr. Andrew H., New York.
Smith, Dr. Eugene, Detroit, Mich.
Smith, Dr. F. W., Syracuse, N. Y.
Smith, Dr. H. Lyle, Hudson, N. Y.
Smith, Dr. J. Lewis, New York.
Smith, Dr. Samuel W., New York.
Smyth E, Dr. G. C, Greencastlc, Ind.
Sohlin, Dr. Charles, St. Paul, Minn.
Sperry, Dr. S. B., Delafield, Wis.
SprrzKA, Dr. E. C, New York.
Stanton, Dr. John G., New London,
Conn.
Sternberg, Dr. Geo. M., U. S. Army.
Stevens, Dr. B. N., Chillicothe, Mo.
Stickler, Dr. J. W., Orange, N. J.
Stimson, Dr. Lewis A,, New York.
Stockard, Dr. C. C, Columbus,
Miss.
Stone, Dr. R. M., Omaha, Neb.
Streeter, Dr. F. B.
Streeter, Dr. H. W., Rochester,
N.Y.
Tauszky, Dr. Rudolph, New York.
Taylor, Dr. W. H., New Bedford,
Mass.
Teller, Dr. S., New York.
Thayer, Dr. C. C, Clifton Springs,
N. Y.
Thompson, Dr. John H., New York.
Tyson, Dr. James, Philadelphia, Pa.
Uhler, Dr. J. R., ^Baltimore, Md.
ViDAL, Dr. Etienne C.
Wackerhagen, Dr. G., Brooklyn,
N.Y.
Wallian, Dr. Samuel S., Blooming-
dale, N.Y.
Ward, Dr. E. B., Greensborough,
Ala.
Weber, Dr. Leonard, New York.
Webster, Dr. David, New York.
Weisse, Dr. Faneuil D., New York.
Weld, Dr. G. W., New York.
Wendt, Dr. Edmund C, New York.
White, Dr. Leonard D., Uxbridge,
Mass.
Wilder, Dr. Burt G., Ithaca, N. Y.
WiLFERT, Dr. H., Cincinnati, O.
Williamson, Dr. C. H., Steamer
Acapiilco.
Wilson, Dr. F. M., Bridgeport,',Conn.
Winters, Dr. Joseph E., New York.
Wright, Dr. J. W., New York.
Wylie, Dr. W. Gill, New York.
Wyman, Dr. Hal C, Detroit, Mich.
Zenner, Dr. Philip, Cincinnati, O.
Institutions and Societies from which
Reports have been received.
American Gynecological Society.
American Ophthalmological So-
ciety.
American Otological Society.
American Public Health Associ-
ation.
Berlin Society of International
Medicine.
Biological Society of Paris.
British Medical Association.
Cook County Hospital, Chicago,
III.
Hospitals Medical Society of
Paris.
German Naturalists and Physi-
cians.
Imperial Medical Society of Vi-
enna.
International Medical Congress
Medical Society of Berlin.
Medical Society of the County of
New York.
Medical Society of Virginia.
Michigan State Medical Society.
New York Academy of Medicine.
New York Eye and Ear Infir-
mary.
New York Hospital.
Northwestern Medical and Sur-
gical Society.
New York Neurological Society.
New York Pathological Society.
New York State Medical Associ-
ation.
Paris Academy of Medicine.
Philadelphia Hospital.
Practitioners* Society of New
York.
Roosevelt Hospital.
St. Catherine's Hospital, Brook-
lyn, N. Y.
Surgical Society of Paris.
Therapeutical Society of Paris.
The Medical Record
A Weekly yournal of Medicine and Surgery
Vol. 26, No. I
New York, July 5, 1884
Whole No. 713
®ri0itml J^rticles.
SOME REMARKS ON AFFECTIONS OF THE
HEART.
Bv J. MILNER FOTHERGILL, M.D. Edin., Hon. M.D.,
Rush Med. Coll., Ilu
ASSOQATB FOLLOW OP THB COLLBGB OP PHYSICIANS OP PHTLADBLPHIA, PHYSICIAN
TO THE QTY OP LOKDON HOSPITAL POR DISEASES OP THB CHEST.
I.
GROSS MIjSCULAR CHANGES.
A PREUMiNARY word is desirable about these articles in
order to prevent misconception. In a special treatise
the matter must be thoroughly gone into from the bottom
upward, as many readers will approach the subject in
simple ignorance o^it. But here it is assumed that the
reader already possesses a fair text-book acquaintance
with the heart and its various affections. With this ex-
planation no mistake ought to occur.
The heart is liable to undergo certain changes of form
known familiarly as hypertrophy and dilatation, and also
atrophy in wasting disease. The latter needs no consid-
eration here ; it is but part, and not an important part,
usually, of a general condition.
Dilatation, or elongation of the muscular fasciculi of
the heart, is found in conditions where the chambers
yield ; conditions which vary considerably, viz., the
heart-fibres yield under undue distention (which they are
unequal to overcome), or are themselves weakened and
so deprived of their normal vigor. Whether in a case of
high arterial tension hypertrophy or dilatation takes place
is a question of tissue-nutrition.
Hjrpertrophy is usually described as a muscular devel-
opment to overcome some obstacle, as stenosis at the
aortic orifice, or high arterial tension, as in the gouty
heart. In both cases there is an obstruction offered to
the ventricular systole, which the muscle meets by en-
largement ; a very intelligent action on the part of the
heart, it must be admitted. But this view of some <^ in-
telligence" in the heart, by which its nutrition is modi-
fied to meet emergencies, is misleading. Is there some
intelligence in the arm-muscles of the blacksmith, or in
the mascles of the calf of the leg of a ballet-dancer ?
None that I ever heard of. What then is the explana-
tion of these well-known facts ? It is this : motor nerves
are linked with trophic nerves ; the message to the mus-
cle to contract is accompanied by another message along
the trophic nerve, which dilates its associated blood-ves-
sels, and increases its blood supply. Consequently, in-
a-eased functional activity in a muscle is followed by
increased growth in it. This is spoken of as ** hyper-
trophy," and whether it depends upon growth in existing
fibnllas or increase in the number of fibrillae need not
detain us here. But if the general nutrition is deficient,
great action of a muscle leads not to hypertrophy, but
to wasting, as seen in the well-known case of the top-
sawyer so graphically described by T. King Chambers,
in his famous " Clinical Lectures," in the chapter on
•* Atrophy of Muscles." His appetite suddenly failed,
and his " shoulder muscles," those in most use by him,
grew soft and weak from malnutrition. The reader who
has this work at hand can profitably consult it at this
pobt He will see that great use of a muscle may lead
to atrophy as well as to hypertrophy, according to the
demand upon the muscle, and its nutritive supply. This
is the great lesson which I desire the reader to take to
heart, about hypertrophy and dilatation of the heart ; and
after this has been thoroughly realized it will not be diffi-
cult to put the subject of gross muscular changes in the
heart-walls before him in a manner which will explain
them without any hypothesis of "intelligence" in the
heart.
The muscular structure of the heart-wall is ruled by its
own ganglia in the heart itself. The primitive pulsatile
sac has a nerve-centre with an afferent and an efferent
nerve-fibril. By the afferent nerve-fibril the sense of dis-
tention is conveyed to the centre, whereupon an efferent
message is despatched to the muscle to contract. Such
a heart is a simple hollow muscle with its ruling nerve-
centre. When the sac is full it contracts by means of
the simple nerve-mechanism. The human heart is a
very complex hollow muscle, with valves to economize
power \ while its primitive nerve-ganglia have connec-
tions with the rest of the nervous system by which the
condition of diastole and systole — filling and emptying —
is regulated according to the wants of the system. These
are m the vagus inhibitory and also accelerator nerve -
fibrils. The first come into action and to hold back the
ventricular systole when the arterial system is full — the
slow stroke of high arterial tension. The latter is found
in action with a low blood-pressure — the fast, easily com-
pressible pulse, which contrasts with the opposite condi-
tion.
Still, the great matter to bear in mind is the primi-
tive hollow muscle with its nerve-centre and its afferent
and efferent fibrils. The sense of distention is followed
by a contractile action. When the hollow muscle is un-
wontedly distended a proportionately vigorous contrac-
tion follows. That is one matter. If the nutrition is
well sustained the muscle waxes greater, in other words,
becomes hypertrophied. That is another. It is the dis-
tention which leads to the muscular growth ! That is
the predominant idea to be borne lucidly in mind ; and
then why dilatation should occur in one case, while hy-
pertrophy without perceptible enlargement of the ventric-
ular chamber is seen in a second, and a blend of the two
is encountered in a third case, becomes a matter readily
and easily comprehended.
The heart-chambers are not of fixed size, they vary
according to circumstances. This is readily seen by
taking a spare, muscular subject, fixing the precise spot
of the heart's apex-beat, and placing the tip of the finger
thereupon. The heart can be felt at each systole quite
distinctly. Then tell him to hold his breath. What is
the result ? As the right ventricle becomes more and
more distended and intervenes as a " water-cushion *' be-
twixt the heart's apex and the chest-wall, the apex-beat
is lost. As soon as the right ventricle is relieved by the
respirations being resumed, it recovers its normal size,
and the apex-beat is quickly as palpable as before.
The heart, then, undergoes changes of form, and may
be temporarily distended. This may be observed by
causing a man to make an effort (as with a health-lift,
for instance), and examining the heart while the effort is
being made. Dilatation of the heart is prolonged dis-
tention. But at what point the condition of distention
will be arrested by compensatory growth in the muscular
wall depends upon the circumstances of each individual
case.
In one case (a well-nourished person), the compensa-
THE MEDICAL RECORD,
[July 5, 1884.
tory growth will be set up so early that no perceptible dila-
tation occurs. In another, a condition of distinct dilata-
tion is reached before hypertrophy's arresting hand can be
brought to bear. In a third, there is dilatation without
perceptible growth or thickening in the muscular walls.
According to the amount of hypertrophy in proportion
to the extent of the dilatation will be the amount of
vigor in the heart. We speak of this muscular growth in
the terms : i, complete compensation ; 2, incomplete
compensation ; and 3, no compensation. With the first
the patient possesses peat vigor, with the second some
vigor, and with the third he, or rather she, is a crippled
being. Why do I here say " rather she," not being a
person in the habit of speaking of the " weaker *' sex in
a derogatory manner ? Because dilatation of the heart is
usual with women under circumstances where hypertro-
phy is rather the rule with men. In this sense of tissue-
nutrition women are " weaker " than men. Take the
gouty heart, for instance, with all its concomitants (to be
discussed in a later article), with men we commonly find
pure hypertrophy ; with women there is, as a rule, dilata-
tion, with more or less (and often less) hypertrophy.
The question of when, and at what point, the process
of dilatation will be checked by compensating muscular
growth, is mainly a matter of tissue-nutrition. There is
another factor in action, however, and that is "time;"
in other words, the urgency of the demand upon the
heart-walls, the call for hypertrophy. If it come quickly,
as, for instance, when an aortic valve cusp is torn down
by a violent effort, some dilatation is inevitable, no mat-
ter what the nutritive powers of the individual. When
the aortic valves are being soldered together slowly by a
sclerosing valvulitis in an elderly, well-fed man, the de-
mand is so gradual that the h)rpertrophied wall is found
practically without any enlaigement of the ventricular
chamber. So the problem rests on the urgency of the
demand versus the nutritive powers of the organism.
Having grasped this main idea, the reader will experience
no difficulty in recognizing the proportion of hypertrophy
to that of the dilatation in any case which comes before
him. Or in realizing the fact that the two are found to-
gether in every possible proportion, like the mixing of
" old rye " and water. Or in understanding how, when the
system is unequal to setting up complete compensatory
hypertrophic growth of itself, it may be much aided by
reducing the demand upon the heart (by rest in the re-
cumbent posture), and by increasing the energy of the
ventricular contractions (by remedied agents possessing
such action) and improving the general nutrition. The
malady and the means of remedying it, so read, are clear
and unmistakable — to my mind at least.
When the heart-muscle has been temporarily weakened
by acute disease, whether a general condition of pyrexia
or the causal condition is one of myocarditis accompany-
ing pericarditis or endocarditis, it is apt to become di-
lated ; temporarily, certainly, in all cases. But whether
the condition of dilatation will remain permanently or be
removed, and at what rate it will be recovered from, will
depend upon the amount of the demand upon the heart
{Le.y the extent to which effort must be made), and the
amount of rest which can be given to it, as one matter,
and the assimilative processes, aided by agents which in-
crease the energy of the ventricular contractions, as the
other.
By time, patience, and well-directed measures (suppos-
ing the patient to be able to command all), the system
may be enabled to build up compensatory hypertrophy
where, when unguided by knowledge and unaided by art,
it is unequal to such effort. Such at least has been my
personal experience.
It may now be well to proceed to discuss the circum-
stances under which such gross muscular changes are
usually found, viz., obstruction to be overcome or an in-
crease in the distending force to be resisted. Two mat-
ters which produce somewhat different results.
To commence with the aortic orifice. With stenosis
or obstruction at this orifice the left ventricle is ordinarily
found simply h)rpertrophied ; sometimes, in women
mainly, there is some dilatation. We can understand
this readily when we remember that the lesion is slowly
developed, allowing ample time for the building up of
the compensating hyperplasia ; and, to my mind still
more, no great increase in the distending force. Here
all that is required is some addition to the driving-power
of the ventricle by which a normal bulk of blood may be
driven in a normal time through a narrowed orifice. It
is a slow process altogether, and the comparatively small
hypertrophy is well maintained.
Far otherwise is the history of aortic regurgitation.
Here the free edges of the valve-cusps are affected, with
or without some dilatation of the aortic conus, and a
regurgitant current of blood is driven backward into the
left ventricle by the aortic recoil. It may be but a thin
riband of blood, but it is sent into the chamber by a very
different force to that which pours its current into the
ventricle through the mitral orifice. The latter wells in
rather, while the regurgitant current is driven in by the
powerful recoil of the elastic arteries distended by the
ventricular systole. Forcible distention of the muscular
wall follows, and that brings with it, in its turn, hyper-
trophic growth, and we find a massive, powerful ventricle.
So far so good. If the valvular mischief be the result of
an acute valvulitis, and the mutilation of the valve be at
once small and static, and the muscijlar development is
in proportion to it, years may roll over the patient's head
without perceptible change for the worse. Such, how-
ever, is not the usual history of a case of aortic regurgi-
tation. Rather is it as follows: The enlarged ventricle
is capable of throwing its contents into the arterial system
with much energy, while in consequence of the enlarge-
ment of its chamber the amount of blood ejected at each
systole is much above the normal amount ; the distended
elastic arteries recoil with an energy proportioned to the
distending force, and a powerful current is driven back-
ward into the ventricle. More distention of the muscular
chamber leads to more hjrpertrophy, and then the huge
cor bovinum of aortic regurgitation is foand ; but the
limits of compensatory growth are at last reached. The
huge muscle is insufficiently fed, and in time it undergoes
degenerative change ; and then the heart comes to a
standstill in diastole, the decayed fibrillae being unable to
contract on full distention. From this we can compre-
hend the prognostic difference betwixt aortic stenosis and
aortic insufficiency in regard to time. In the one there
is only an obstacle to be overcome ; in the other a new
distending force is in action. In the one hypertrophy is
moderate and well sustained ; in the other it is huge and
soon wears out.
Now let i}s consider the results of morbid action in the
mitral valves. In stenosis the lefl ventricle is of normal
size, or even below it, for the narrowed orifice obstructs
the blood-fiow into the chamber. But if the obstruction
be slight, little change will be found in the left ventricle.
Far otherwise is it in mitral regurgitation. Here the left
ventricle has no obstruction to overcome ; indeed there
are two outlets for the blood now instead of one, and yet
it is enlarged. How is that ? Because the blood enter-
ing it on diastole is sent in with abnormal force from the
gorged pulmonic circulation, plus the enlarged left auricle.
There is no obstruction to the blood-flow offered at the
mitral ostium, and the more powerful current dilates the
left ventricle, with the consequence of increased muscular
growth.
When the pulmonic circulation is impeded, whether by
mitral disease or disease in the respiratory organs, the
right ventricle enlarges. Incompletely emptied on systole,
the swollen veins behind it pour in their contents, and
distention follows, with enlargement of the muscular
wall. As there is always an increase in the distending
force in the case of the right ventricle, so there is always
enlargement of the chamber, as well as a thickening of
its muscular wall. But here again the proportions of
July 5, 1884.]
THE MEDICAL RECORD.
dilatation to those of h3rpertrophic growth vary according
to the urgency of the demand and the powers of nutrition.
The same measures are to be adopted here as were
recommended in the case of the enlarged left ventricle,
viz,, rest, good food, and agents which increase the en-
ergy of the cardiac contractions.
Such, then, are the ordinary circumstances under which
the walls of the heart undergo changes in form. The
dilating process comes first, and, if the powers are equal
to it, hypertrophic growth follows. At what stage of the
dilating process the compensating growth begins to be
efficient varies in each and every case ; depending upon
causes sketched out here in bold outline rather than in
detail. To include the latter would be to extend this
article beyond any limits that can be furnished by a
journal. But that is no reason why the reader, having
grasped effectively the outline here provided, should not
work out the details in those cases which come imme-
diately under his notice.
Rest, digitalis, and iron (with some strychnia), with
good food, form a good line of treatment when nature
cannot surmount her difficulty single-handed ; but what
must be done in each case depends upon its own require-
ments, of which the medical man in attendance can alone
be the judge.
PRACTICAL OBSERVATIONS ON THE HUMAN
EAR AND ITS DISEASES, WITH ILLUSTRA-
TIVE CASES.
By SAMUEL SEXTON, M.D.,
AURAL SUKGBON TO THK NEW YORK EYB AND BAR INFIRMARY.
I. — ^The External Ear.
(Continued from Vd. xxv., p. 374.)
HiEMATOMA AURIS.
Synonym. — Othaematoma ; Perichondritis Auriculae.
Hamaioma auris is a disease of the cartilage and
perichondrium of the auricle, with consequent formation
of a cyst containing blood or varying portions of its
constituents. These sanguineous cysts, as they are
sometimes called, may be limited to a slight extrava-
sation scarcely distinguishable from deep congestion, or
they may consist in a tumor of greater or less dimensions.
The tumor, although not always containing pure blood,
has generally received the designation of blood-tumor.
It may be produced either by severe contusion of the
auricle, or it may, it is alleged, take its origin from idi-
opathic causes alone ; most frequently, however, it seems
to be due to violence, even where a predisposition to its
occurrence exists. It is characterized by more or less
inflammation of the cartilage and perichondrium of the
ear, and by the sudden escape of sanguineous fluid be-
tween the cartilage and perichondrium, and, it is said,
into the substance of the cartilage itself. The size of
tiie tumor varies from that of a Lima bean to an egg ;
its formation is usually rapid, and the contents, at first
fluid, show a marked tendency to become clotted, and
quite often, unless incised, spontaneous rupture takes
place.
In the milder attacks extravasation is so slight that it
has been characterized as a serous oedema. The disease
most frequently occurs in the insane, and produces such
characteristic deformities that it is well known in insane
institutions as the " insane ear," " shrivelled ear," and
*' asylum ear." The inflammation in this disease is gen-
erally adynamic in character ; in certain cases, however,
inflammation is liable to be more active. In a very
considerable number of cases there is a strong tendency
shown to spontaneous recovery.
HISTORY.
^ Traumatic othematoma. — The ancients were very
familiar with this morbid condition of the auricle, since
it was the necessary result of boxing-matches, which
then constituted the favorite mode of combat. Among
the Greeks and Romans pugilism was considered an es-
sential part of education, as it increased the strength and
developed boldness of character in their youth. Defence
and assault with the fist or cestus were then extremely
common, and combats for amusement eveh were the
fashion of the day ; the Grecian boxers, who were justly
renowned, had for their titulary deity Pollux himself.
The -^neid abounds in praise of these barbaric contests ;
thus in the combat between Eutellus and ^neas —
" A storm of strokes, well meant, with fury flies.
And errs about their temples, ears, and eyes—
Nor always errs, for oft the gauntlet draws
A sweeping stroke along the crackling jaws."
The implement employed by the classic slugger in these
auricle-cracking feats was the cestus, a formidable
gauntlet composed of thongs of several thicknesses of
raw hide strongly fastened together and loaded with lead,
iron, or brass, and bound to the arm by thongs. Four
varieties of this crushing implement are known to have
been in use, the least deadly being more dangerous even
than the modem assassin's '* brass knuckles," and capable
of administering a fatal blow. These murderous weapons
were known to Virgil as the *' gloves of death.*' Paulus
^genita refers to the aural injuries produced by this
weapon as contusions of the ear, and Hippocrates de-
scribed them as fractures of the auricle, adding that the
injury was a common one in his day. " The combat
with the cestus," he says, " was a favorite amusement
of the ancients, and a blow about the ears was reckoned
a master-stroke, sometimes being fatal." At a later date
the amphotides, a helmet or headguard, was worn to pro-
tect the temporal bones, arteries, and ears. It was con-
structed with thongs and ligatures made of the hides of
bulls, studded with knobs of iron, and thickly quilted
inside to dull the concussion of blows. The pugilists
and the pancratiasles, armed with the cestus, were in
the habit of producing such disfigurement of the ears that
it became a customary plastic ornament in antique
sculpture, which thus affords abundant evidence of the
results of these practices; for example, the heads of
Hercules, PoUus, Hector, and other warriors have been
represented with ears having this typical deformity of
ancient contestants.*
The ancient custom of boxing has been continued by
the Anglo-Saxon race, especially in Great Britain, where
for a long time past it has been encouraged as a national '
amusement and has a literature of its own. During this
period of time, however, the unprotected fist has been
employed in combat, and the occurrence of the more
serious aural injuries has in consequence diminished.
Pugilism has now everywhere fallen into disrepute, and
its votaries are principally confined to low resorts,
where the boxers enter the lists with gloved fists and go
through the forms of a ** mill " for the amusement of the
audience. Even here, however, we find that some vig-
orous blows about the head are demanded, and the ear
is frequently struck, especially in "cross counter," in
which the left ear sufiers most. The frequent pounding
of the left auricle in this manner often gives rise to
othaematoma. A very considerable number of persons
are at present engaged in this occupation for a livelihood,
and most of them have characteristically deformed auri-
cles.
The tendency to violent contests has shown itself in
other pastimes where the ear does not always escape
injury ; thus Farquharson ' describes several cases of the
disease under consideration, coming on suddenly, with
oval swelling of the auricle, as a consequence of playing
the game of foot-ball at Rugby, where there is much
forcible butting with the head in " tight scrimmage."
*^ Idiopathic'' othcematoma, — The first description of
othaematoma, in which mental and other nervous dis-
i Vide Gudden : Haematic Swelling of Ae Ears of the Insane. Allg. ZetL ffir
Psychlatrie, Bd. xvii. Med. Critic, January, x86i. Banking's Absi., vol L, p.
43. i86z.
s British Medical Journal, voL ii., p. 59, 1873.
THE MEDICAL RECORD.
[July 5, i884*
turbances play so important a part, was, I believe pub-
lished fifty years ago by Dr. Frederick Bird,* then
connected with the asylum at Sieburg. Bird gave a
very good account of six cases coming under his ob-
servation, and drew attention to the intimate relations of
the disease to insanity. The suggestions thrown out by
Bird finally received the attention of other writers ; M.
Ferris, a Frenchman, gave the subject his attention in
1838, and ten years later (1848) the valuable essay on
the subject by Franz Fischer * was written. The obser-
vations of alienists were naturally limited to the occur-
rence of the disease in insane persons ; in 1852, how-
ever, an Englishman, Mr. S. Ozier Ward, drew attention
to^the liability of the mentally sane to the trouble."
Numerous contributions have been made to the liter-
ature of the subject during the past thirty years. In
1858 an interesting paper was published by Stiff, " On
Simple Sanguineous Cyst of the Ear in Lunatics,*'* and
in 1859 the distinguished} labors of M. A. Foville were
made known.*
It will be found on consulting the " Index Catalogue
of the Library of the Surgeon-General's Office " • that,
although incomplete as yet in respect to this subject, fif-
teen monographs and forty-six journal articles and other
papers pertaining to othaematoma were published between
the years 1848 and 1879 by German, English, Italian,
and American authors.
When it became known that mentally sound persons
were obnoxious to the affection otologists soon gave the
subject attention. Wilde ^ regarded it, however, as " a
rare form of disease in man," and classified it among tu-
mors of the auricle. The case cited by him, with clini-
cal history and illustrative wood-cut, portrays a well-
marked instance of the trouble in a mentally sane person.
Recognizing the similarity of his own case to the dis-
ease described by Bird as occurring in the insane, but
having no experience in the latter affection himself, he
made inquiries among a number of medical friends con-
nected with lunatic asylums; from their statements,
which, however, "varied as to its existence and cause,"
he considered that it was established that the disease af-
fected a particular class of the community. Toynbee "
afterward described the affection more fully than Wilde
had done, and while regarding it as most generally con-
fined to the insane, he himself had seen a case in a
boxer, due to a blow upon the car.
ETIOLOGY OF OTHAEMATOMA.
Of purely traumatic othaematoma no mention need be
made here, but in regard to the origin of the so-called
idiopathic variety there has been much difference of
opinion.* Bird was at a loss to account for its origin,
never having traced it to outward injury, but in five of his
six cases it is noted that there was active congestion of
the head. Subsequently, Franz Fischer and others pur-
sued the subject further and determined that the causes
must ultimately be sought in pathological states of the
nervous system.
One cannot witness the intense congestion of the
ears, sometimes accompanying great cerebral excite-
' Upon a Curious Sort of Inflammation of the Outer Ear Occuiring in Insane
Patients. Frederick Bird. Graefe's and Waltlier's Journal, B. 19, p. 361. See
Abs. M. Ch. Rev., vol. xxiv., p. aoi, 1834.
* Die Ohrblutgeschwulst der Seeleneestdrten nebst einer Blobachtung derKoph-
Uutgeschwulsc bei einem solchen Kranken. AUg. Ztschr. f. Psychiat., etc., BerL,
1&481 V. i. Also Dr. Arlidge's translation, Asylum Journal, 1854, pp. 45-107.
' Medical Times and Gazette, voL ii., p. 295, 1852.
* B. and F. Med. Chir. Rev., voL xxi.. pp. 169-174. Am. Ed., 1858.
* Recherches sur les tumeures sanguines du pavUlion de Toreillc chez ali^n^s.
Ann. M^d.-psych., Par., 1859, 3. S., v. 390-408. Also : Gaz. hebd. de m^d.,
PV'f i859« vi. 450, 460. Also : transl. Am^ J. Insan., Utica, N. Y., 1859-60,
zvi., 184-aoo. Vide also, H^matdme du pavillion de I'oreille chez un ali^n6.
Union m^d. de la Seine-inf.. Rouen, 1877, xvi., 24, 37.
* VoL i.. Government Printing Office, Washington, x88o.
T Diseases of the Ksur. Phila., 1853.
•Ibid. Phila., i860.
* The writer's own experience in othaematoma having been limited to cases oc>
curring in the mentally sane, it was deemed advisable to observe the disease in
the insane. Ample facilities for this were kindly afforded by Dr. T. M. Franklin,
Medical Superintendent of the New York City Lunatic Asylum (for females),
BlackwelPs Island, and by Dr. A. E. MacDonald, Medical Superintendent of the
New York City Asylum for the Insane (males), Ward's Island. To Assistant
Superintendents Dent and Troutman, and other members of the staff of these insti-
tutions, the author's acknowledgments are hereby extended for courteous atten*
ment in the insane, without belief in the possibility
of spontaneous extravasation of blood taking place be-
neath the perichondrium ; and it is probable that where
tissue changes, to be immediately referred to, have al-
ready taken place in the cartilage and perichondrium
othaematoma may sometimes thus occur. These nutritive
changes in the auricle, believed to pave the way to
extravasation, so to speak, will first demand our atten-
tion. They seem to be mainly brought about through
the agency of the nervous system, although some authori-
ties lay much stress on the influence of blood dyscrasias
in producing changes in the blood-vessels of the part.
The weight of evidence, however, leads to the conclusion
that they most frequently depend on a morbid state of
the brain, especially on congestion of the organ. Func-
tional disturbance of the brain, or of the cerebrospinal
centre, giving rise to disorder of the cervical sympathetic,
may, by reason of the dominance thus exercised on the
vessel regulating nerves distributed to both intercranial
ganglia and the auricle, set up hyperaemia in the former,
and vascular changes in the latter.* When othaematoma
occurs in the course of general paralysis, it would
seem that aural congestion took place in consequence of
general degeneration of the sympathetic ; and it has
been suggested that in inflammation of the brain the
aural disease becomes advantageous to the patient, since
the hemorrhage is thus spent upon the posterior auriculars,
coming from the middle meningeal.'
But while centric morbid conditions are justly regarded
as of greatest importance, other impressions, propagated
by morbid processes in other organs through the sympa-
thetic system, are worthy of consideration ; thus in the
examination of insane subjects having this affection, the
almost universal prevalence of nasal catarrhs, diseased
teeth, and in the female of uterine disease, is notable, and
it is well known that the irritation due to these influences
is transmitted through the nerves, and may not only ex-
asperate cerebral disease itself, but is liable to also affect
the organ of hearing.
The predisponents believed to have an important re-
lation to othaematoma require consideration somewhat in
detail :
Agf. — Othaematoma seldom occurs before adoles-
cence ; in regard to its appearance in the insane, it may
be said that insanity is not obnoxious to youth, nor is
degeneration of the cartilage liable to occur at this early
age. Cases of contusion of the auricle are not frequently
met with in children, but doubtlessly may occur at any
age. Of the numerous cases reported as occurring in
extreme youth, many of them were probably incorrectly
diagnosed. Langenbeck reports a case occurring in a
girl twelve years of age, who was said to be wild. Blau *
describes a case observed in a gymnast, aged fifteen
years, where there was no pschyco- nor neuropathic family
history. The case had, it is said, no history of trauma,
but it is signiflcant that otorrhoea existed. Schwartze
has seen a case in a child fourteen years of age, and
Julius Erhard * speaks of cases arising in nurslings from
rough handling or injury, causes from which the writer
has never seen the affection arise. If the disease ever
exists in young children, its occurrence seems to be
quite exceptional. I have myself never seen such a case.
The disease, moreover, has not been to my knowledge
ever reported in extreme old age, which would seem to
confirm the view that degeneration in structure alone is
not a sufficient cause, but that its occurrence must be
looked for in the active period between adolescence and
the decline of life.
Insanity. — All forms of mental disease seem to be
predisposing, but the conditions most favorable to
othaematoma are present in acute dementia where long-
existing vaso-motor disturbances are followed by parox-
ysms of excitement*
> Vide Robertson, Glasgow M. J., voL viL, July, 1875.
3 Bonnet : Annales Medico-Psychologiquet, 1877. A. J. O., vtrf. L, p. 68.
• Arch. f. Ohrenheilk.. B. xix., Hft. 4, pp. 203, 904.
* VortrSge iiber^der Krankheiten der Onres, p. 132. Leiprig, 1875.
July 5, 1884.]
THE MEDICAL RECORD.
When the trouble occurs in the mentally sound, pre-
ceded bj slight contusion, cerebral or other nervous
disturbance has most likely existed, giving rise to trophic
changes in the affected part. A tendency to insanity in
such cases, however, is by no means always to be* sus-
pected.
Intemperance, — Intemperance in the use of alcoholic
stimulants has a strong predisposing influence ; I have
repeatedly witnessed this in my own practice.
Cachexia. — A dyscrasia commonly attends cerebral
disturbances in both insane and intemperate persons,
and although othaematoma by no means always appears
in such subjects when the bodily health is most impaired,
yet must we not entirely ignore a perversion of general
nutrition, since this state may be in some degree predis-
posing. The scorbutic or rheumic diathesis may thus
tend to impair the texture of the coats and laceration of
the blood-vessels of the cartilage and perichondrium,
when passive hemorrhages would more realdily take place
under undue excitement. Thus Dr. Wallace,* super-
intending physician of the Insane Asylum at New Rup-
pen, assumes a cachectic condition in conjunction with
trauma as composing the etiological factors in othaema-
toma..
Sex. — ^Writers are generally in accord respecting the
greater frequency of othaematoma in the male. Mr.
Nicol," who examined the ears of a considerable number
of the inmates of the Sussex Asylum, found in 24 of them
more or less deformity of the auricle, in several of them
the disease being in progress. Of the 700 patients in the
institution two women only were affected. Of the 249
asylum patients examined by Stiff— viz. : 124 men and 125
women — he found the cartilage of the ear more or less
thickened inn?, probably the results of othaematoma;
of these 12 were males and 5 were females. In the six
cases reported by Dr. Bird,' all of them were females.
Lennox Browne * examined 1,424 cases in the West
Riding Asylum, 707 of whom were males, and 717 were
females. He found that of the 32 patients affected 24
were males and 8 were females, making 3.39 per cent, of
the males and i.ii per cent, of the femsdes affected — an
average of 2.24 per cent. M. Foville, in alluding to
this subject, says the affection occurs most frequently in
males. Hun * reports 24 cases of the disease, 23 of them
being males and one of them a female. The writer him-
self found in the statistics kindly furnished him by the
Blackwell's and Ward's Island institutions for the insane,
that among 1,309 females, 16 cases of othaematoma were
found, while in 1,269 males 14 cases were found, this
inclusive of ears previously affected, as shown by deform-
ity of the auricle, and those in progress at the time the
examinations were made. This shows a percentage of
1.14 in females, and i.io in males. It will thus be seen
that the greater number of cases occurred among fe-
males. In the opinion of some alienists female lunatics
are more violent than males, and the observations of Dr.
Backe, of the Asylum at London, Canada, would seem
to verify such a belief. In a recent report, in referring to
the restraint required in an average population of 372
men and 394 women, he says that 25 men were restrained
and secluded 4,079 hours, and 68 women 20,324 hours.
The reporter offers no explanation for this, but states
that on the whole females are more unmanageable than
males.
Women are said to enjoy considerable immunity from
the general paralysis of the insane, and consequently to
€scape the frequent paroxysms of excitement which char-
acterize this phase of mental disease. On the other
hand, women are subject to a monthly aggravation of
symptoms during the menstrual period, since the men-
;eben von dem Veretn fllr Heilkunde in Preussen, 1844.
Rev., No. xci..
* Med. Zeituae, herausgcffcben von dem Veretn fllr Heilkunde 11
No. 3a, p. 147. Ibid., t84S, No. 45, p. an. Obs, by Dr. Rupp.
« OihaemattMiia, or the Asylum £ar. B. and F. Med. Chir.
Jialy, 1870.
'LocdL
* Oduematoaia, or the Insane Ear. West Riding Lunatic Asylum Reports,
•oL ▼., p. 149. 1875.
* Hannamma Auris. A. J. I., July, 1870. Reprint
tally sane even are more irascible [and nervous at this
time.
The treatment of female lunatics, moreover, is more
gentle than that of males, since their attendants are
usually of their own sex, and less liable than male nurses
to injure the ear in handling violent and idiotic patients.
The ears of female lunatics are somewhat protected by
their hair and head-dressings.
Traumatic agencies, — In the mentally sane the affec-
tion is most commonly met with among prize-fighters,
gymnasts, persons given to violent sports, and among
drunken and disorderly persons, where blows and falls
are frequent
As regards the insane there has existed much diversity
among writers as to the cause. M. Bouteille, who does
not absolutely reject the influence of predisposing causes,
believes that othasmatoma never appears without vio-
lence to the auricle, and, in alluding to an epidemic of
othaematoma which occurred at Lyons in 1879, states
that the trouble disappeared by simply changing attend-
ants.* But it is believed that the ear is now less fre-
quently injured by violence than fonnerly, since mechan-
ical restraints are less in vogue, and an amelioration in
the general management of the insane has gradually
taken place. Not long ago it was not unusual for at-
tendants to lead resisting patients by the ear, and other*
wise maltreat the organ.
In some of the institutions for the insane where the
writer has made inquiries concerning the prevalence of
othaematoma it would seem to be of infrequent occur-
rence ; in one asylum a case had not been observed in
" three or four years," and in respect to this matter in
another institution the superintendent writes that the case
books show that the " phenomenon has been regarded as
a curious incident worthy of mention, but without suf-
ficient importance in the history of the insane individ-
ual to merit description."
From a careful study of the subject the author has
come to believe that othaematoma is almost always due
to violence inflicted upon the auricle. Asylum super-
intendents, however, have been on the whole, perhaps,
rather disposed to undervalue the importance of mechan-
ical causes, since it might be construed to imply undue
restraint or rudeness in the management of their patients.
It is true that the trouble does not always supervene
during paroxysms of violence, but it is difficult or im-
possible even to trace physical injury in all cases, or to
show per contra that violent patients have not injured
themselves. Othaematoma is of quite common occur-
rence among those who give exhibitions of sparring and
contuse the auricles by frequent blows with the gloved
hand, and lunatics themselves injure their ears in like
manner by self-inflicted blows. The extent to which this
is carried by these unfortunate people, whose ears are, as
a matter of fact, much less sensitive than normal, is much
greater than would seem possible to any one unfamiliar
with their habits. It is not uncommon for any one to
strike with the fist upon a region of the body where a
morbid process gives rise to slight pain, and I have seen
sane persons pull and rub the auricle violently under cer-
tain conditions. The insane carry this much farther,
especially when under excitement. One should not lose
sight of the fact that the insane are liable to experience
much discomfort in the ears from diseases of the organ,
to many of which they are particularly subject, but
mental disturbances from delusions and hallucinations
are frequently so associated with tinnitus aurium and
autophonia that the patient's attention is continually
drawn to the ear. They have delusions respecting the
presence of persons and things in the head, and concerning
fancied attempts of " evil spirits *' to gain admission there-
to ; they are in constant dread when awake because of the
abusive and threatening language which they imagine to
be spoken into the ears. Frequently the patient's voice be-
* Annales M^dico-PsychoIogiques» Juillet, 1878. Abst. A. J. O.. vol. L, p. 69.I
THE MEDICAL RECORD.
[July 5> 1884.
comes autophonous, when the ears and head seem " empty "
or " cavernous ;*' it then becomes yet more difficult for
the patient to not imagine or believe that abominable
and dangerous occupants have taken possession of the
disordered and void dormitory of the mind. Autopho-
nia, which is an expression intended here to embrace the
various forms of tinnitus as well as autophonous vocal
and respiratory sounds, gives rise to hallucinations in
mentally sane subjects even, especially in the aged and
feeble.
Worthy of mention in this connection is the distressing
itching and burning sometimes set up in the ear in neu-
rotic subjects, relief from which is sought by constantly
pulling, pounding, rubbing, and pinching the external
parts. I have known sane persons to endeavor to get
some relief from the torture of pruritis of the ear by treat-
ing the organ with much violence ; a lady under my care
at the present time often finds herself involuntarily scratch-
ing the auricle and temple on account of " creeping sen-
sations" in the ear, and another patient, a clergyman, has
the habit of thrusting a large pin deep down into the
external auditory canal to scratch the parts ; he also rubs
the auricle at times until it becomes intensely injected.
Lunatics often thrust objects like wool, rags, etc., into
the external auditory canal to get rid of disagreeable
noises in the ears and head. The organ is frequently in-
jured in this way ; I have, for example, seen a case where
much damage was inflicted by thrusting the rough end of
a china doll's leg into the ear, and in another instance, a
large abscess was produced on the inner surface of the
auricle by rubbing and contusing it with a stone. In
some instances, the insane strike the head against some
object with great violence, the injuries thus produced
leaving the auricles abraded and scratched ; others thrust
their fore-fingers into the ears and furiously shake and
pull the organs — in one case seen a papillary growth was
developed at the entrance of the external auditory canal
in consequence, and the auricles were greatly enlarged.
It will thus be seen that insane persons very frequently
have a fancy that the organ of hearing constitutes the
portal of the mind, and we need not wonder, therefore,
that it is so firequently assailed.
Among other numerous causes may also be enumerated
the violent movements of certain insane persons when
in bed ; their pillows, frequently consisting of materials no
softer than straw or husks, are liable to injure their ears,
especially during their struggles under restraint. Again,
when forcibly fed, while the head k held in the strong
embrace of the nurse, the ears are liable to injury. In-
sane paralytics, if allowed to remain too long without
change in position, may sufifer from an interference in
the process of nutrition on account of the undue pressure
upon the ear, and rude handling of the head, as often
practised by attendants, may likewise injure the auricle.
Sloughing of the auricle from long-continued pressure in
lying upon the organ in cases of fever not unfrequently
occurs in the mentally sane.'
Othaematoma has been described by writers on the ear
as due to bites, bums, dentition, etc. Urbantschitz ' re-
ports the case of a woman where both ears were believed
to be thus a£fected by a bite of some kind, and Kipp '
reports the case of a child, considered to be thus afifected,
where both auricles were injured by a burn. Cases sup-
posed to be due to dentition are related by Frank,^ who
says, '* During dentition, this condition is often observed
to occur, usually in scrofulous subjects." The writer,
whose experience in this disease has been considerable,
has never seen othsematoma arise from any of these
causes, and it seems probable that in some of them at
least phlegmonous inflammation only may have been
present.
In reviewing the causes of othsematoma, it would seem
that it has no special preference for either sex or for any
one form of insanity, and that it may be produced in the
> Williams' Treatise on the Ear, p. 108. J^ndon. 1840. > I>ehrbuch, p. 89.
* Trans. A. O. Soc., 1867, p. 79. * Ohrenkranlcheiten, p. 348.
mentally sane by contusion of the auricle. That it
depends almost exclusively upon traumatic influences in
all cases seems a warrantable deduction.
Occurrence, — The more frequent occurrence of othae-
matoma in the left ear has been the subject of much
speculation. Stiff* drew attention to this preference; he
found that in 1 7 cases the left ear was aflected in 6 cases,
the right ear in 4, and both ears in 7. Of the 24 cases
reported by Lennox Browne, the left ear was affected in
19, the right ear in 2, and both ears in 11 ; when both
ears were aff"ected the left was first attacked. The ex-
perience of some observers has been the reverse of the
authorities above quoted, thus Hun^ in his 24 cases
found the right ear to be the seat of the trouble in 9
cases, the left in 5, both ears in 9, and in one the history
was incomplete in this regard. In the cases where bodi
ears were affected it is not stated which side was first at-
tacked.
The greater frequency of occurrence in the left ear
does not seem to hold good in the mentally sane with the
exception of pugilists, who more frequently contuse the
left auricle.
Vaiious theories have been advanced in explanation of
this peculiar manifestation. Thus it has been suggested
that the near position of the left carotid artery to the
heart affords a more direct blood supply to the left ear,
and that, furthermore, the left pinna is oftenest affected
because pulling or striking the organ is more liable to
be done with the right hand, the left ear receiving the in-
jury. The left ear, it is said, is also more lia)>le to in-
jury than the right in forcible feeding, since in holding
the patient the arm of the nurse usually presses it with
more or less violence against the head."
An explanation of the greater frequency of left-sided
othsematoma, however, must be sought in some other di-
rection, since the above apply to mechanical agencies
only. It seems probable that some very intransient
influence must exist to cause the trouble to appear
so frequently on the left side, and could this be
discovered, much light would doubtlessly be thrown
not only on the etiology of othsematoma, but also
on other aural diseases. It has occurred to the writer
that probably some vaso-motor influence might be found
to lie at the bottom of the difficulty. It is a fact that
unilateral sweating about the head is not an uncommon
occurrence ; and, moreover, in bilateral chronic catarrh
the left ear is seemingly much more rapidly invaded
than the right in a notable number of instances — a con-
dition due, in all probability, to some vaso-motor disturb-
ance whereby the nutritive process is interfered with
much more on the left than on the right side. While
this agency may be found to lie in some cerebral or cere-
bro-spinal condition, there exists a prominent irregularity
in the distribution of the sympathetic nerves which it
occurs to the writer might bring about such a result. Ref-
erence is had to the peculiar arrangement of the nerves
extending upward from the cardiac plexus to the two
sides of the head. According to anatomists there is to
be found here an important irregularity. Thus, while an
unvarying connection is maintained with the right side
through the superior cervical ganglion, a comparatively
imperfect and varying connection exists on the left side
— the left superior cardiac nerve and the inferior cardiac
branch of the pneumogastric only occasionally affording
communication between the cardiac plexus and the left
superior cervical ganglion.
Of course other but less direct communications exists
which bring the cardiac plexus into relationship with the
left ear, nevertheless the asymmetrical distribution
above described might be the means of diminishing the
vaso-motor dominance, in respect to the circulation in
the left ear. Granting the correctness of the hypothesis,
which, however, is by no means held to be indisputable,
> I.0C cit, « Loc. dt.
^ * llie u-riter*s attention was drawn to this latter explanation by Dr. Craic As-
sistant Surgeon New York Asylum for the Insane.
July 5, 1884.]
THE MEDICAL RECORD.
the disparity in the vascularity of the two ears would
finally produce distinguishing nutritive changes in the
tissues of the parts — alterations especially well marked in
the tympanic membranes in otitis medio catarrhalis chron-
ica^ where the membrane of the left tympanum will fre-
quently be found to be quite parchment-like and lustre-
less, while the right membrane is yet in a fairly normal
condition. It is thus difficult to see why nutritive changes
may not affect the cartilage of the left ear more fre-
quently than the right, and give rise to the greater fre-
quency of othasmatoma on the left side.
Othematoma is frequently bilateral, very often de-
veloping equally on both sides. It may develop rapidly
and disappear again as rapidly as it came. This bilateral
invasion is suggestive of centric nervous origin.
Othaematoma has been observed to occur during preg-
nancy. Gruber alludes to a case which came to his clinic
in the fourth month of pregnancy.
YELLOW FEVER ON THE UNITED STATES
STEAMSHIP PORTSMOUTH.^
By a. M, MOORE, M.D.,
SURCBON U. S. NAVY.
Endemic influence, — ^The only morbid influence of this
nature that came under my observation was that of in-
termittent and remittent fevers at St. Thomas, W. I.
These diseases prevail here every year, and all the year
round. According to the statistical report of Dr. Ma-
gens, King's Physician, for the year 1883, there were 742
classified under this head, out of a total number of dis-
eases of all kinds of 1,793 — population estimated at 15,-
000. That they were light, however, is shown by the
£act that there were only 4 deaths out of this number,
the total number o( deaths from all causes for this period
being 415. The period of their greatest activity is that
which covers the months of October, November, and
December, the so-called rainy season. This term, it is
obvious, is merely relative, as abundance of rain falls at
all seasons ; the mean annual amount being 46.8 inches.
This **' influence " was felt on board ship in Uie form of
mild intermittents, two or three cases of which were
under daily treatment during a twelve-days' sojournment
of the ship at that place, but which promptly disappeared
upon our departure. It is an interesting fact that the
conditions under which these fevers exist here are not
such as are generally conceded to be required for the
production of malarial diseases. These conditions are
best indicated by the names which have been applied to
the whole class — '* paludal, ** ''swamp,*' and ''marsh"
fevers. Now, this Island is a mass of trappean rock, de-
void of vegetation except some species of cactus and a
few small and hardy shrubs, and trees that can scarcely be
dignified with the name. There is an entire absence of
stagnant water, or even of fresh- water springs and streams,
the rain which falls running rapidly down the mountain
side into the sea. Again, malaria is rural, and not urban ;
it selects as its favorite habitation the fresh-water fens
of the interior, and shuns salt water. But malarial fevers
are endemic here, where the conditions are of a nature
to lead one to expect to find, rather, yellow fever ! Does
not this circumstance suggest the possibility of intercon-
vertibility under certain favorable influences ? As a
matter of fact, when an unacclimated person indiscreetly
exposes himself to the miasmatic emanations here, he
may possibly be stricken mih yellow fever.
Report of three ccues of yellow fever. — In order to
complete and illustrate the remark under the head
of ''Endemic Influence," the anachronism is com-
mitted of reporting with the first quarter some cases
of the above-named disease which occurred during the
second. It is believed that this incongruity in time
is justified by the increased value, if there be any, which
> From the report o< sick for the first quarter, 1884.
will be thus obtained by placing in juxtaposition re-
ports so closely related that one might be taken- as a
sequence of the other. Whatever may be the degree
of relationship between malarial fevers and yellow fever,
the fact is potent that, at a time when, according to the
reiterated assurances of the American consul and king's
physician, St. Thomas was, and had been for four years,
entirely free from the last-mentioned disease, this disease
was propagated from thence to persons on board this
vessel. Such being the case, it becomes a serious ques-
tion whether it is ever judicious, from a sanitary point of
view, to send ships of this kind, with a crew composed
largely of boys, who might become easily demoralized, to
this port. In this connection it may be proper to state
that every precaution was taken at this place to preserve
the health of the ship's company short of absolute de-
privation of liberty, which, indeed, was restricted to four
hours during daylight. In view of the best information
obtainable as to its good sanitary condition, this limited
liberty was not considered injudicious. It is proper also
to observe that at the military hospital visited there was
no case that resembled in the remotest degree yellow
fever. In addition to the three cases reported, there was
another of a suspicious nature, which appeared on the
14th, and which was isolated with the rest, but as the sub-
ject of it, a marine, had not been ashore in St. Thomas,
it is not included in the report.
Case I. — The ship sailed from St. Thomas, bound for
Hampton Roads, Va., early on the morning of April 5th,
and, as before stated, the few cases of febriculas disap-
peared very soon thereafter. About 3.30 p.m. of the 9th,
four days out. Commander W. C. W , who was last on
shore for about four hours on the afternoon of the 4th,
was taken sick — ^his illness being initiated by rigors, fol-
lowed in about an hour by headache and fever. Tem-
perature at 7 P.M., 103.5° ; pulse, 90. Was put to bed,
and 0.7 grm. quinia administered.
April loth. — ^Temperature at 8 a.m., 101° ; pulse,
90 ; at 7 P.M. : temperature, 102.2° ; pulse, 7a ; vom-
ited copiously in the morning a dark liquid, about the
color of weak coffee, repeated in smaller quantity twice
during the afternoon ; vessels of conjunctivae deeply in-
jected ; frontal headache and dizziness ; pain in back,
" as if it would break in two ; " skin of forehead hot to
the touch ; face flushed ; no epigastric pain or tender-
ness ; marked hebetude ; complete anorexia ; specific
gravity of urine 1032, scanty, dark colored, acid, with no
trace of albumen.
April nth. — ^Temperature at 8 A.M., 102,2°; pulse,
72 ; at 7 P.M.: temperature, 102.9° ; pulse, 72 ; urine al-
buminous ; vomiting of yellowish- white matter at inter-
vals ; is heavy, and sleeps much.
April i2th. — Temperature at 8 a.m., 101°; pulse, 55 ;
at 7 P.M. : temperature, 100.9°; pulse, 47, weak and
compressible ; specific gravity of urine 1026, albuminous
and scanty ; continues to vomit at intervals small quan-
tity of whitish matter ; no reciurence of "black vomit**
since second day.
April 13th. — Temperature at 8 A.M., 98.4°; pulse, 54;
at 7 P.M. : temperature, 99.2° ; pulse, 56 ; specific gravity
of urine, 1024, highly albuminous ; several copious and
spontaneous dejections of dark green matter ; heat of sur-
face and headache less intense ; ferrety appearance of
eyes disappearing.
April 14th. — ^Temperature at 8 A.M., 99°; pulse, 56 ;
at 7 P.M. : temperature, 99° ; pulse, 58 ; urine albuminous,
acid, specific gravity, 1026 ; headache and lumbar pain
gone.
April 15th. — Temperature at 8 A.M., 98.5° ; pulse, 60 ;
at 7 P.M. : temperature, 99° ; pulse, 60 ; urine highly albu-
minous, acid, specific gravity 1023, quantity increasing ;
great languor.
April i6th. — Temperature at 8 a.m., 99° ; pulse, 58
and weak; at 7 p.m. : temperature, 98.5° ; pulse, 50 ; al-
bumen continues in undiminished quantity in urine;
conjunctivae jaundiced.
8:
THE MEDICAL RECORD.
[July 5, 1884.
April 17th. — Temperature, normal; pulse, 54; urine
albuminous ; amount voided during last twenty-four hours
360 C.C. (12 oz.), being the largest daily quantity during
the illness ; specific gravity 1024 ; tinct. iodinii shows
grass-green reaction of biliverdine. (This reagent was
preferred to nitric acid, on account of the confusion of
color produced by the latter on precipitated albumen.
Pettenkofer's test failed to reveal the presence of the
biliary substances proper, although great care was taken
in its application — a specimen of urine being evaporated
to dryness, the solid residue redissolved in alcohol, and
a precipitate obtained by addition of ether, which was
redissolved in distilled water, 10 which the test was ap-
plied. The failure to obtain any evidence of their pres-
ence may have been due, however, to lack of skill in
manipulation.) Skin and conjunctivae profusely jaundiced.
April 1 8th. — Temperature at 8 A.M., 97.4° ; pulse, 47,
with more volume ; at 7 p.m. : temperature, 98** ; pulse,
54 ; albumen decreasing in urine, specific gravity 1025 ;
amount voided during twenty-four hours, 620 c.c. —
marked increase.
April iQth. — Temperature at 8 a.m., 97°; pulse, 47;
at 7 P.M.: temperature, 96.6°; pulse, 48; quantity of
urine, 610 c.c. ; specific gravity 1020, albumen decreasing
in quantity ; skin and eyes remain deeply jaundiced.
April 20th. — Temperature at 8 a.m., 97.2° ; pulse, 54;
at 7 P.M. : temperature, 98°; pulse, 48 ; amount of urine
voided during past twenty-four hours, 720 cc ; specific
gravity 1024, albumen entirely disappeared.
April 24th. — Since last entry patient has improved
greatly^ and now sits up the greater part of the day ; like
Oliver Twist, he *' wants more'* to eat, and his diet is
being cautiously increased daily. The yellow tint of
skin and eyes, though still quite manifest, is daily pass-
ing away.
Case II. — On the morning of April 12th, Justin P.
Q- — , bugler, a native of France, aged about forty-two
years, reported sick, with a temperature in axilla of
1 00. 2°, violent headache with dizziness, face flushed,
eyes bright and deeply congested, lower eyelids dark and
swollen, as if by effusion of disintegrated blood into sub-
cutaneous cellular tissue, heat of skin marked ; tongue
coated and is protruded with a tremulous motion ; there
is complete anorexia, though no pain or tenderness of
epigastrium or back is apparent. States that he has
been feverish, with headache, for last two days, which
makes the commencement of his illness the loth. Was
ashore in St. Thomas from morning of March 29th till
afternoon of next day, when he returned aboard " drunk
and dirty."
April 13th. — ^Temperature, 101°; pulse, 90; urine
straw-colored, scanty, acid, and free from albumen ;
headache and congestion of face and conjunctivae con-
tinue ; eyes closed by swelling of lids, which have a ten-
dency to agglutination ; facial aspect repulsive ; odor of
breath musty and highly offensive ; anorexia continues,
though no pain or irritability of stomach is complained of
April 14th. — Temperature at 8 a.m., 101°; pulse, 96 ;
at 7 P.M.: temperature, 101.8°; pulse, 98 ; urine acid,
specific gravity 1028, no albumen ; face and eyelids con-
tinue swollen and eyes congested ; headache diminished ;
complete anorexia, but no nausea or gastric disturbance ;
gums spongy and bleeding.
April 15th. — Temperature at 8 A.M., 100°; pulse, 78 ;
at 7 P.M. : temperature, 101.2®; pulse, 78 ; urine free
from albumen ; swelling of face and eyelids subsiding ;
headache giving way to soreness of scalp.
April 1 6th. — Temperature at 8 a.m., 99.4°; pulse, 74 ;
at 7 P.M. : temperature, 100.4®; pulse, 78 ; urine free
from albumen ; facial aspect improving ; head better.
April 17th. — Temperature at 8 a.m., 98.8°; pulse, 74 ;
at 7 P.M.': temperature, 99.8°; pulse, 80 ; no albumen in
urine ; eyes much clearer ; swelling of lids subsided.
April 1 8th. — Temperature, normal ; pulse, 72; urine
albuminous^ straw-colored, acid ; reports himself as feel-
ing better.
April 19th. — Temperature, normal ; pulse, 72 ; albumen
in urine increasing in quantity ; no pain or sense of dis-
comfort in epigastrium or back ; free alvine dejections of
dark green matter — conjunctivae jaundiced.
April 2oth. — Temperature normal, urine albuminous,
eyes jaundiced,
April 2 1 St. — Temperature normal, urine continues
albuminous ; progressing favorably.
April 2 2d. — ^Temperature normal, albumen decreasing
in quantity ; skin and conjunctivae clearing up.
April 23d. — Temperature normal ; albumen disap-
peared from urine. From this time is dated the com-
mencement of convalescence. There is no pain, and
patient complains of nothing but unsatisfied hunger.
Case III. — George D. F , third cabin boy,
native of England, eighteen years and four months of
age, reported on forenoon of April 13th, with following
symptoms, viz. : intense frontal headache, giddiness, and
mental confusion ; eyes bright and conjunctivae deeply
congested ; face flushed ; racking pain in shoulder and
knee joints ; anorexia, but no nausea or epigastric pain
or tenderness, and no lumbar pain ; temperature, 99.2®;
pulse, 100 ; states that he has suffered from headache and
articular pains for two days, hence the accession of the
disease is fixed at the nth inst. Patient was ashore in
St. Thomas from i to 8.30 p.m. on March 29th, the last
two hours of which he spent sitting on the wharf, where,
it is to be presumed, miasmatic emanations are the most
virulent.
April 14th. — ^Temperature at 8 a.m., 100.2**; pulse,
96 ; at 7 P.M. : temperature, 102.8°; pulse, 100 ; tongue
(dry and bare last night), moist ; urine acid, specific
gravity T026, non-albuminous ; articular pains better,
otherwise much the same as yesterday.
April isth. — Temperature at 8 a.m., 99°; pulse, 78 ;
at 7 P.M. : temperature, 100.4° ; head symptoms, as well
as articular trouble, much better ; no appearance of
albumen.
April 1 6th. — ^Temperature, 99°; pulse, 76 ; head symp-
toms and articular pains entirely disappeared ; anorexia
persistent ; eyes still congested ; no albumen.
April 17th. — Temperature at 8 a.m., 99.8°; pulse, 80 ;
at 7 P.M.: temperature, 98.5°; pulse, 78; conjunctivae
congested; urine acid, straw-colored, transparent, and
non-albuminous ; no pain or tenderness of epigastrium. |
April i8th. — ^Temperature at 8 a.m., 99°; pulse, 78 ;
at 7 P.M. : temperature, 100.2°; pulse, 78 ; character of
urine unchanged ; eyes remain congested ; slight frontal
headache ; gums spongy and bleeding ; lips dry and en-
crusted.
April 19th. — Temperature at 8 a.m., 98.6°; pulse, 76 ;
at 7 P.M.: temperature, 98.4°; pulse, 60; no indication of
albumen in urine; sponginess and bleeding of gums
slightly improved.
April 2oth. — ^Temperature at 8 a.m., 97.8°; pulse, 60;
at 7 P.M. : temperature, 99°; pulse, 72 ; no albumen ; in-
jection of vessels of conjunctivae fading ; opened yester-
day a large abscess over left parotid region.
April 2 1 St. — ^Temperature at 8 a.m., 98°; pulse, 56 ; at
7 P.M. : temperature, 97.6° ; pulse, 60 ; conjunctivae less
congested ; trace of albumen in urine.
April 22d. — ^Temperature at 8 a.m., 97.2°; pulse, 54;
at 7 P.M. : temperature, 98°; pulse, 48 ; urine more
markedly albuminous ; conjunctivae jaundiced.
April 23d. — ^Temperature at 8 a. m., 97.4°; pulse, 48;
at 7 P.M.: temperature, 98.2°; pulse, 60; albumen disap-
pearing from urine, which is increasing in quantity;
opened a small abscess in outer edge of nasal septum —
left side. Doing well
April 24th. — ^I'emperature normal; urine abundant
and albumen disappeared ; patient is pronounced con-
valescent— the chief symptom being hunger.
The principles involved in the treatment of these cases
consisted in rest of the stomach, and of measures adapted
to relieve renal congestion and to increase the excretion
and elimination of urine. In the case of Captain W ,
July 5, 1884.]
THE MEDICAL RECORD.
the type o( the disease was different from that of Q
and F . In the former, gastric symptoms pre-
dominated and were quite serious for the first three or
foar days, while in the two latter the head symptoms
were the most important and -the cases approached
more nearly the sthenic type. It will be observed that
in these last cases the stomach was not at any time
noticeably involved in the train of morbid symptoms^ and
it was only at a very late date that albumen made its ap-
pearance in the urine. In the case of Q , the first
indication of its presence was on the eighth day of the
disease, and it had ceased to appear on the thirteenth ;
with F it was observed first on the tenth, and
had entirely disappeared on the thirteenth day ; while
in Captain W *s case it was found on the third day, and
it was not until the eleventh that reagents failed to re-
vttil its presence. Again, Captain W was profoundly
jaundiced, while the other two were not at all markedly
so.* Hence, while the principles of treatment were the
same in aU, these dififerences in type and symptoms made
it necessaiy to vary the details. For example, the
tincture of digitalis, which was used early with Q and
F as a cuuretic, could not be tolerated by Captain
W until about the fifth day of the disease, on account
of excessive gastric irritability. In all, revulsives were
applied over the epigastrium and renal region, from the
inception of the disease till the disappearance oi albumen
from the u/ine. The agents used for this purpose, and
found effective, were sinapisms and tincture of iodine.
Nothing whatever in the way of diet was permitted until
the fifth day of the disease, when the blandest articles, as
wine jelly, arrow-root, etc., were allowed, and the dietary
cautiously varied and increased from that time. From
about the eighth day, milk punch was, with appreciably
good results, added to the other allowance. After albu-
men ceased te appear in urine, a tonic of quinia, iron, and
acid, sulph. was substituted for the digitalis.' Captain
W was, of course, treated in the cabin, access to which
was prohibited to all except the surgeon and nurse (a
man who had had the disease, detailedfor that purpose).
The other cases were isolated in the sick-bay, no one
being allowed to enter there besides the surgeon, apothe-
cary, and bay-man. This place was selected for the pur-
pose because, first, there was no better; second, their
isolation could be accomplished here with the least
danger of attracting attention and arousing suspicion, a
thi]^ which it was obviously desirable to avoid. The
atmos[^ere oi the sick-bay was disinfected daily by
difilusion of a saturated solution of carbolic acid by means
of the steam atomizer.
The first case. Captain W , occurred in latitude
25.o8*'N., with a temperature of 73<> F. ; the last, F ,
Id latitude 27. io° N., with a temperature of 76** F.
The fiavorable progress of these cases is largely due to
the fact of their not appearing until the ship was well on
the way to the north, and to getting soon into cooler
weather. To the same cause the ship's company are
undoubtedly indebted for their immunity from further at-
tacL At noon of the 13th the ship had reached a tem-
perature of 65® F., and from that time there was a steady
decline till a temperature of about 42 "^ was attained,
about April 23d.
For the first few days after the first case announced it-
self, the situation, with two hundred and sixty-five human
bein^ mostly bovs, enclosed in the narrow confines of
a ship, in a tropical climate, and dependent upon the
light and capricious winds of the ** horse latitudes," was
anything but reassuring. It was thought best by the
sorgeon and executive officer to conceal from every one
the existence of the disease in the ship. But with these
tvo the anxiety, while the ship lingered in the region of
bi^ temperature, was intense, lest each day might wit-
<Ia«nthe - . , .
jfauiit odor of die breftdi, poisibiy due to carbonate of ammonium, from decom*
I^Mioa of retained nrea.
' b ^ hfgjnning iIk contents of the boweb were removed by an
■■pen; lu^h., 50.00 grm., and water. |
tiiere was notioad for tbe first few days a musty and peculiarly
of ai
Rofioap^
ness the accession of other cases to the sick list, and
with the dire consequences of an epidemic on the morale
of a crew of this kind staring them in the face. Then,
as suspicion began to be aroused, with its resulting de-
pression, the task of wearing a cheerful mien, with an
apprehensive mind, was, indeed, a difficult one to suc-
cessfully assume.* ^
gr00t:css 0f Medical ^cietice.
■ ■■ ■ ■ ■ f
Laryngitis Hemorrhagica. — Dr. Stepanoff regards
this affection as a distinct form of laryngeal inflammation,
arising from the same causes as the catarrhal form, yet
affecting females only. The primary symptoms are those
of ordinary laryngitis, but after from three to fourteen
days, hemorrhage occurs. It is sometimes excited by
coughing, but may also come on without any noticeable
cough. The amount of blood may vary from half an
ounce to four ounces. There may be one or several at-
tacks of hemorrhage, and after they have ceased, the
symptoms of catjirrhal laryngitis remain for a longer time
than in the common form. Suffocative attacks occur but
seldom. The laryngoscopic picture differs firom that of
the ordinary variety only in the presence of blood-clots.
The intensity of the catarrhal inflammation stands in no
relation to the amount of hemorrhage. Blood comes
only from the tjne vocal cords and seems to occur by
diapedesis, since it is readily controlled by a small in-
jection of nitrate of silver. — St. Petersburger Medicinische
Wochenschrijt^ April 26, 1884.
An Artificial Sponge. — Dr. Sampson Gamgee de-
scribes in The Lancet of May 3, 1884, a sponge devised
by him, which combines absorbing power with elasticity,
and is cheap enough to be burnt after use, thus render-
ing sponge infection impossible. It consists of an inner
bidl of absorbent cotton, surrounded with a wad of cocoa^
nut fibres, around which again is' a layer of absorbent
cotton, the whole being enclosed in a gauze envelope.
He found that a ball so made takes up readily from six-
teen to eighteen times its own weight of blood or water,
which when squeezed out still leaves the ball elastic and
absorbent. The sponge may be rendered antiseptic by
means of a very brittle ball or capsule, containing any
antiseptic desired, and enclosed within the inner nucleus
of cotton. By giving the sponge a preliminary sijueeze,
the capsule is broken and the antiseptic fluid set free.
A New Remedy for Phthisis. — Aluminium and its
compounds are affirmed by Dr. Pick to constitute a most
effective remedy against pulmonary tuberculosis, this
opinion being based on experiments upon rabbits as well
as on clinical observations. In one case, where infiltra-
tion of the apices of the lungs had occurred, removal of
the lesion and all the morbid symptoms is said to have
followed the administration of aluminium in the following
form : Metallic aluminium, eight grammes ; aluminium
hydrate, five grammes ; calcium carbonate, five grammes ;
gum tragacanth, in sufficient quantity ; divided into sixty
pills, one pill being taken three times a day. — The Lan^
cet^ May 3, 1884.
Diabetic Coma. — A case is related in The Lancet of
d young woman who, except from an occasional head-
ache, seemed to be in good health. She was found sit-
ting in a chair, apparently in a profound sleep, from
which, however, she could not be roused, except that
she would raise her hand to her head when spoken to
loudly. All attempts at resuscitation were in vain, the
coma gradually deepened, and the girl died. There was
no vomiting. At the autopsy no organic disease of any
of the organs could be discovered, but the tissues gave
forth a strong diabetic odor, and examination of the urine
showed the presence of sugar in considerable quantity.
_^ .
} The period of latency in the case of Captain W api>ean to have been about
five days, though, as he was ashore two or three times prior to the 4th, it i» un-
certain. With Q and F it was eleven or twelve, and tfauteen diay%
respectively.
lO
THE MEDICAL RECORD.
[July 5, 1884
Carbolic Acid in Muscular Rheumatism. — Dr.
Hurz recommends the employment of carbolic acid in
intra-muscular injections for the relief ot pain in muscu-
lar rheumatism. He uses a solution of i-ioo or 1-50.
The injections are not painful, causing at the most but
a slight burning sensation. The analgesic effect is mani-
fested within fifteen or tWenty minutes. — L Union Medi-
cale du Cancula^ May, 1884.
Mammary AxROPftv. — Dr. J. W. Reynolds writes to
The Lancet concerning a patient of his who is now in her
fiftieth year. She ceased to menstruate about three or
four years ago, and has borne six children. After wean-
ing her first child, which she nursed for a few weeks only,
she being twenty-one, her mammae completely disap-
peared ; not a vestige of gland could be felt, and there
was no loose skin, but the chest and abdomen were as
smooth as those of a child ; but when she became preg-
nant the mammary glands enlarged to a very fair size,
and there was an abundant supply of milk — too profiise,
in fact, for it ran away continuously ; and as it weakened
her and did not nourish the child, she had to discontinue
nursing. Then the glands would gradually disappear,
the skin contract, and everything become smooth again.
So with every pregnancy. Now, at fifty, her chest and
abdomen are as smooth as any young girl's — ^no loose
folds of skin or rugae.
Cider as a Prophylactic of Stone in the Bladder.
— Dr. Denis Dumont has examined the statistics of the
Caen Hospital, and found that in fifty-nine years only
four cases of stone in the bladder were admitted. In
one the nucleus was a foreign body ; and in two the pa-
tients drank wine, and not cider, which is the ordinary
beverage in Normandy. An inquiry made in the neigh-
boring departments of the Manche and Ome, showed
that stone in the bladder was extremely rare where the
use of cider was the rule. Meat being cheap and
abundant in Normandy, the rarity of stone cannot be
ascribed to the use of a food containing less nitrogenous
substances than in other countries. The remarkable
diuretic properties of cider, which the author has found
usefiil in gravel, obesity, and some forms of gastritis, are
considered to afford an explanation of this remarkable
freedom from calculus. — Birmingham Medical Review^
May, 1884.
The Prevention of Blindness in Infancy. — ^The
following instructions, based upon the directions of the
Society for the Prevention of Blindness, have been issued
by the Manchester and Salford Sanitary Association, for
the information of mothers and nurses {Practitioner^
May, 1884) : " One of the most frequent causes of
blindness is the inflammation of the eyes of new-bom
babies. Yet this is a disease which can be entirely pre*
vented by cleanliness, and always cured if taken in time.
The essential precautions against the disease are :
I. Immediately after the birth of the baby, and before
anything else is done, wipe the eyelids and all parts sur-
rounding the eyes with a soft dry linen rag ; soon after-
ward wash these parts with tepid water before any other
part is touched. 2. Avoid exposing the baby to cold
air ; do not take it into the open au* in cold weather ;
dress the infant warmly, and cover its head, because cold
is also one of the causes of this eye disease. When the
disease appears it is easily and at once recognized by the
redness, swelling, and heat of the eyelids, and by the
discharge of yellowish white matter from the eye. /m-
mediately on the appearance of these signs seek the advice
of a medical man; but in the meantime proceed at once
to keep the eyes as clean as possible by very frequently
cleansing away the discharge. It is the discharge which
does the mischief. The cleansing of the eye is best done
in this way : i. Separate the eyelids with the finger and
thumb, and wash out the matter by allowing a gentle
stream of lukewarm water to run between them from a
piece of rag or cotton-wool held two or three inches
above the eyes. 2. Then move the eyelids up and down
and from side to side in a gentle, rubbing way, to bring
out the matter from below them ; then wipe it or wash it
off in the saaie manner. This cleansing will take three
or four minutes, and it is to be repeated regularly every
half hour at first, and later, if there is less discharge^
every hour. 3. The saving of the sight depends entirely
on the greatest care and attention to cleanliness. Small
pieces of clean rag are better than a sponge, as each rag
is to be used once only and then burnt immediately ;
sponges should never be used, except they are burnt
after each washing. 4. A little washed lard should be
smeared along the edges of ^the eyelids occasionally to
prevent them from sticking. Special warning: Of all
the mistaken practices which ignorance is apt to resort
to, none is more ruinous than the use of poultices. Let
them be dreaded and shunned as the destroyers of a new-
born baby's sight. Tea-leaves and sugar of lead lotion
are equally conducive to terrible mischief, stopping the
way as they do to the only right and proper course to be
taken."
Brittle Bones. — A case was recently reported to the
Suffolk Medical Society, by Dr. Douglas Graham, of a
patient who had sustained eighteen fractures during the
first eighteen years of his life. They were distributed as
follows : The right arm, broken nine times ; left arm,
twice ; left leg, three times ; right leg, twice ; right and
left clavicle, once each. The patient's father J^roke his
bones fourteen times, and the father's cousin twenty-one
times. The father's uncle was also a bone-breaker. —
Boston Medical and Surgical Journal^ May 15, 1884.
Increase in the Length of the Leg following
Rheumatism. — Dr. Vinals reported to the Medico-Chi-
rurgical Academy of Spain, the case of a young man in
whom an increase of two inches in the length of the leg
was observed to follow upon an attack of rheumatism in
the knee. The reporter thoujght it due to increased ac-
tivity excited in the still growing epiphyses by the articu-
lar inflammation, ^he inequality was not permanent, as
the affected limb was in time overtaken in growth by its
fellow. — Revista de Medicina y Cirugia Prdcticas^ April
22, 1884.
SpiRiCA Ulmaria in Enlarged Prostate. — Accord
ing to Bauch, the queen of the meadows {spiraa ulmaria)
is destined to occupy an important place in the thera-
peutics of diseases of ,the genito-urinary apparatus. He
has administered an infusion of this plant to patients
with enlarged prostate in whom urination or the passing
of a catheter was very difficult, and within half an hour
they urinated abundantly and freely. The queen of the
meadows is diuretic, astringent, and antispasmodic, and
exerts a special action on the sphincter of the bladder,
spasm in which it relaxes. — Revista de Medicina y Ciru-
gia Prdcticas^ April 22, 1884.
Treatment of Scrofulous Adenopathies. — Dr.
Garcia Andradas claims to have obtained excellent results
in the treatment of sloughing scrofulous glands with the
solution of the perchloride of iron {El Dictamen^ April
30, 1884). He paints the surface of the caseous mass
with the solution, and states that the slough is soon cast
off, leaving a healthy granulating surface. This readily
heals under an ointment of turpentine and vaseline, one
part to fifteen. Of course the constitutional treatment
is not to be neglected.
Physiological Albuminuria. — At a recent meeting of
the Soci^t^ de M6decine of Paris, M. Coignard reviewed
and criticised the theories concerning albuminuria, and
also the thesis on this subject written under the direction
of Professor Bouchard. According to his personal ob-
servations, and those of a number of cases collected by
Keller, physiological albuminuria does not exist M*
Coignard admitted the existence of transitory albumi-
nuria, as also of transitory glycosuria, but denied that
albumen is ever found in the urine of perfecdy healthy
individuals. — British Medical Journal^ May 24, 1884.
July 5, 1884.]
THE MEDICAL RECORD.
II
The Cause of Cholera. — Mr. Vincent Richards has
been conducting some experiments on pigs in regard to
the cause of cholera, which have led him to very different
conclusions from those of Koch {Indian Medical Ga-
leife). He states that the choleraic discharges contain a
virulent poison, which, however, disappears within a few
hoursy when decomposition has begun. He supposes
the poison to be a chemical compound, and not a micro-
organism, since he has found that it is destroyed by
potassium permanganate. If the evacuations are rapidly
desiccated without decomposition, the poison may retain
its virulence for a considerable length of time and in this
way b^ transported by fomites. He believes that the
poison acts by paralyzing respiration.
The Significance of the Patellar Tendon Reflex
IN General Paresis of the Insane. — The following
are the conclusions of a paper on this subject by Pro-
fessor L. Bianchi in 11 Mavimento of May 15, 1884 : i.
Exaggeration of the patellar tendon reflex may be a
valuable diagnostic sign in the beginning of the disease,
especially in those cases in which the dUire de grandesse
is not accompanied by disturbances of speech. 2. Al-
though at the commencement of the disease it is as a rule
exaggerated, it may in the further progress of the malady
undergo certain changes. More often it diminishes or
disappears, rarely becomes more exaggerated than be-
fore. 3. By itself, whether exaggerated or abolished, it
does not indicate a determinate anatomical lesion of any
special region of the cord occurring as a complication of
general paresis. Therefore, instead of being considered
as the expression of certain recent morbid processes, it
should be studied in connection with the other symptoms
of the disease, and not by itself or at any special period
in the course of the malady.
Morphinism and Pregnancy. — Dr. Fer6 relates the
case of a young womaq addicted to the use of morphine
in rather moderate quantity (about 3^ grains a day), who,
when in the sixth month of pregnancy, endeavored to
break off the habit. But any sudden diminution in the
daily amount taken caused such severe uterine colic that
the progress toward recovery was very slow. At the
time of delivery she was taking about two grains per
diem, and no attempt to reduce this quantity was made
for a week. It was then sought to lengthen the intervals
between the hypodermic injections, but the uterine
pains returned and the lochia! discharge ceased and did
not reappear until the injections were resumed. At the
end of a month the daily quantity of morphine had been
reduced to a little more than one grain, and it was then
widiheld entirely. The patient suffered severely from
uterine and intestinal colic and was unable to sleep the
first night, but the following day all these unpleasant
symptoms ceased, and she was definitely cured. The
dSect of the sudden abstinence upon the child, when
bixth removed him from the influence of the drug, was
evident. He was a well-developed boy, though emaci-
ated. He suffered from convulsive twitchings with con-
tinuous agitation and crying for sixty hours, during which
time he did not sleep a minute. After that he recovered,
slept well, and acted naturally. This fact would seem
to indicate that, whatever may be said to the contrary,
the foetus is influenced by morphine even in relatively
small doses, and that it may suffer from the sudden
abstinence enforced by birth. This last consideration
indicates the necessity of a gradual withdrawal of the
drug in the case of opium-eaters who become pregnant.
— 11 Mamtnento^ May 15, 1884.
Diagnosis of Pleuritic Exudations by the Tun-
ing-fork.— The following are Dr. Federico's conclusions
relative to the utility of the tuning-fork in the diagnosis
of pleuritic effusions and exudations {Gazzeita Medica di
Romdy May i, 1884) : i. If the vibrating tuning-fork be
applied to any part of a normal thorax, a full, distinct,
and augmented sound results. 2. When made to vibrate
while in contact with thoracic parietes within which there
exists an effusion, and particularly if placed over that
portion of the chest where the dulness on percussion is
most marked, the tuning-fork emits a short, obscure, and
muffled tone. 3. The sound is shorter and more muffled
in proportion as the fluid is more abundant. 4. Although
the author has, thus far, only experimented with serous
effusions, he inclines to the belief that the sonorous
vibrations of the instrument would be still more weak-
ened and obscured if the effusion werp rich in corpuscular
elements. This theory derives support from the fact,
experimentally demonstrated by the author, that the
vibrations of a tuning-fork immersed in a watery fluid
contained in a thin vessel are communicated to the
receptacle, while the vibrations cease to be perceptible
when the serous fluid is replaced by a purulent one. The
author recommends the adoption of the following pre-
cautions in the application of the tuning-fork to its pro-
posed diagnostic use: i. The instrument should be
placed in contact with corresponding parts of both the nor-
mal and diseased half of the thorax, for purposes of com-
parison. 2. An instrument with long branches facilitates
the perception of slight variations in pitch and quality.
3. The vibrations imparted to the tuning-fork should be
of moderate intensity lest they be transmitted to the
stomach and colon and be thereby unduly augmented.
4. A certain amount of force should be employed in
holding the instrument in contact with the chest-wall, as
the vibrations are not well transmitted if this precaution
be omitted.
Origin of Musical Diastolic Aortic Murmurs. —
Dr. Groedel, of Nanheim, reaches the following conclu-
sions regarding diastolic aortic murmurs (^Berliner Klin-
ische Wochenschrift^ April 21, 1884) : The murmurs in
question, often perceptible at considerable distance from
tlie seat of their production, are caused by insufficiency
of the aortic semilunar valves, if the valves are in such a
condition that tliey may be put in regular and equal
vibration, during the entire diastole, by the regurgitant
blood current. The above condition obtains, first, when
the first portion of the aortic arch is dilated and relative
insufficiency of the valves is thus produced ; and, second-
ly, in cases of genuine insufficiency, provided the valves
be still capable of vibrating regularly and evenly.
A Substitute for the Cold Bath in Fevers. —
Professor Preyer, of Jena, publishes in the Berliner
Klinische Wochenschrift^ May 5, 1884, an extract from
a paper read by himself, at a meeting of the Jena Medical
and Natural History Society, on a novel method of re-
ducing animal temperature. The experiments upon
which Professor Preyer* s suggestions relative to the pro-
duction of antipyresis are based were performed upon
Guinea-pigs, but seem to show that the new method
may be equally applicable to man. The means of re-
frigeration employed was the water spray. When the
temperature of the water used was between 40° and 45°
F., the rectal temperature of the animals, was reduced
about 2° within from five to ten minutes. If, after the
discontinuance of the spray, the minute particles of
water entangled in the hair be allowed to slowly evapo-
rate, the temperature continues gradually to diminish
for several hours. If water at the temperature of 70** F.
be employed the refrigeration is manifested within twenty
minutes, but is not so pronounced. The rapidity and
the degree of the antipyretic effect may thus be easily
regulated by modifications in the temperature of the
water used, and of the interval during which the spray
is applied. The author states that the object of this
communication is to incite to farther experimentation on
animals as well as on the human subject.
Antiseptic Properties of Bichromate of Potas-
sium.—Some experiments recently conducted in France
show that urine, blood, milk, and other substances can
be preserved from putrefaction during several months by
the addition of one per cent of their weight of this salt.
— Cincinnati Lancet and Clinic^ May 10, 1884.
12
THE MEDICAL RECORD.
[July 5, 1884.
Phlebitis Complicating Rheumatism. — M. Schmitt
establishes two varieties of phlebitis accompanying acute
articular rheumatism. One form of the disease manifests
itself at the height of the rheumatic attack and augments
the local pains and the temperature, while the joints
become less tense and swollen. The phlebitis usually
develops at the point of junction of the deep and super-
ficial veins. Sometimes the veins remain permeable,
the symptoms being confined to slight oedema, slight
redness along the course of the vessels, and moderate
pain. More frequently, however, this form of phlebitis
produces obliteration of the veins, with more pronounced
oedema, a cord- like induration, and, possibly, with pete-
chias, ulcerations, and even pulmonary embolism. The
second variety of phlebitis appears at the termination of
the rheumatic attack, rapidly producing occlusion of the
vessel, with more oedema, and with pain of considerable
intensity. The phlebitis persists for several weeks, oc-
casioning difficulty in walking and in moving the limbs.
The femoral, popliteal, and saphenous veins are most
frequently affected, but the radical and brachial are
sometimes involved. — Archives Midicales Beiges, April,
1884.
Concealment of the Cicatrix after Removal of
Mammary Tumors. — M. D. MoUi^re describes an opera-
tion, devised by himself, for the purpose of hiding the
cicatrix resulting from the ablation of an adenoma of the
breast, located in the lower part of the gland. The
tumor was about the size of an egg, and became regularly
tumefied during the week preceding menstruation, re-
suming its former dimensions after the cessation of the
monthly flow. The operation was performed as follows :
A transverse incision having been made in the course of
the submammary fold, the cellular tissue behind the
mamma was separated from the glandular tissue, the
encapsulated adenoma easily enucleated, and a drainage
tube inserted. Union occurred by first intention, and
the small linear cicatrix, being situated at the bottom
of the submammary cutaneous fold, was completely hid-
den by the gland in its natural dependent position. —
Archives Medicates Beiges^ April, 1884.
Nervous Diarrhceas. — Professor H. Nothnagel for-
mulates the following conclusions regarding diarrhoeas of
purely neuropathic origin : Nervous diarrhoeas, first so
designated by Trousseau, are those which occur as the
result of anxiety, fright, or various other intense physical
impressions, and occasionally in hysteria, but which are
unattended by intestinal inflammation. The diarrhoeas
in question may be chronic as well as acute. In certain
individuals the above-mentioned etiological agencies
merely occasion abnormal frequency of the alvine dejec-
tions. In other cases depressing mental impressions may
cause a purely nervous diarrhoea to be engrafted upon a
chronic enteritis, and to notably prolong the duration of
the latter. The author cites cases illustrative of this dis-
ease, which, in his opinion, justify the establishment of
two varieties of nervous diarrhoeas. In one category be-
long cases in which the evacuations are of fluid consist-
ency, in the other those attended by formed or hardened
dejections. In the latter form the author believes that
the nervous influence resulting in increased frequency of
defecation is exerted upon the lowest portion of the large
intestine in which fecal matter is already accumulated.
In this case the only abnormal feature of the process is
the occurrence of evacuations at unusually frequent in-
tervals. A different nervous mechanism must be invoked
to explain the occurrence of the fluid evacuations. The
author assumes, in these cases, that either the entire
bowel is affected by violent peristaltic movements, which
mingle the fluid constituents of the discharges emanating
from the small intestine with the solid fecal matter of the
colon, or that an abundant transudation of serum, occur-
ring in the large intestine itself, liquefles the solid matter
previously accumulated therein. Professor Nothnagel
inclines m favor of the latter theory, although unable to
furnish convincing proofs of its accuracy. The exciting
influences resulting in these two forms of diarrhoea must
produce their effect through different nervous channels.
In one case those nerves which, under stimulation, oc-
casion increased peristalsis are incited to functional
activity, in the other the vaso-motor and secretory nerves
are chiefly instrumental in producing the diarrhoea. —
Allgemeine Medicinische Central-Zeiiung, yi^y 14, 1884.
The Differential Diagnosis of Syphilitic Neu-
ralgia.— Dr. Diffre {Gazzetta Medica di Roma, May i,
1884) expresses the belief that the symptomatology of
syphilitic neuralgia furnishes the most useful data for its
differentiation from other forms of the disease. The clin-
ical history and the results of treatment may also furnish
considerable assistance. The author asserts that the pain
of syphilitic neuralgia is intermittent, and that it manifests
spontaneous exacerbations. If excited by mechanical
means its intensity is diminished. The intensity of the
spontaneous variety may var^ from the lowest grades to
such degrees of pain as might be produced by strong
electric currents or the actual cautery. The pain ex-
tends along the course of the nerves, and is frequently
limited to small areas. The neuralgic attacks are less
frequent during the day, and even when observed at that
time areof much less intensity than when occurring at night.
Reflex Paralysis. — A woman, thirty-four years of
age, multipara, was admitted to hospital in the service
of Dr. Gomez Torres, suffering from paralysis and atro-
phy of the upper extremities. Some months previous to
her admission she had noticed that her hands were becom-
ing thin and that she was gradually losing all power in
them. The paralysis and atrophy increased in spite of
persistent electrical and other treatment, until at this
time she was unable to extend the hands at all, and the
thenar eminences had entirely disappeared. Examina-
tion showed that she was suffering also from chronic
parenchymatous metritis and extelisive ulceration of the
cervix. The diagnosis of reflex paralysis was made and
was conflrmed by the results of treatment, for the paraly-
sis and atrophy rapidly disappeared as the local affection
was relieved by appropriate measures. — El Dictamen,
May 20, 1884.
Some Peculiar Forms of Aphasia. — Dr. Brown-
S6quard, at a recent meeting of the Soci6t6 de Biologie
of Paris (Gazette des Hopitaux, No. 48, 1884), re-
counted some curious facts concerning aphasia. The
first case was that of an individual who had lost entirely
the faculty of speech. He possessed but one word in
his vocabulary with which he sought to express all his
ideas. Yet he was able to sing in a loud voice, enuncia-
ting the words and rendering the music with artistic feel-
ing. The second case was that of a physician of Cincin-
nati, who had become aphasic in consequence of softening
of the brain. This patient had lost completely the use
of language during his waking moments, but talked well
in his dreams. The third instance was observed in an
individual who was likewise suffering from complete
aphasia in consequence of a cerebral lesion. His powers
of speech were restored during times in which he was
delirious. Dr. Richet related a fact somewhat resem-
bling those just cited concerning an old woman who had
been the servant of a priest. Just before she died she
repeated very distinctly a number of Hebrew words
which she had heard her master pronounce thirty-five
years before.
NiTRFFE OF Amyl IN Ammoniacal Urink. — ProfessoT
Von Dittel observed at the Vienna Medical Society that
he had for a long time past, in obstinate cases of am-
moniacal urine, found this substance very usefuL A
solution is made of three drops in one hundred, and fifty
of water, and a tablespoonful of this is added to about a
quart of water, with which the bladder is washed out
The unpleasant smell of the urine diminishes immediately,
and is replaced by a pleasant ether odor. — Dublin
Journal of Medical Science^^Mn^y 1884.
July 5, 1884.]
THE MEDICAL RECORD.
13
Thk Bubbling Carbonic Water Baths of Nauheim.
— Drs. Augustus and Theodore Schott publish an article
under the above title in the Berliner Klinische Wochen-
sckrift^ No. 19, 1884. The object of the paper is to
give an unbiased statement regarding the chemical com-
position of the Nauheim carbonic acid waters, together
with their nature, their modus operandi^ and the indica-
tions for their use. Preceding the paper proper are cer-
tain general remarks on the history of carbonic acid
water baths. The analysis of the waters, conducted un-
der the supervision of Prof. Fresenius, shows that they
contain an amount of carbonic acid gas fully equal to that
of any other springs. The chief indication for the car-
bonic acid baths is found in the emaciation and anaemia
attendant upon chronic diseases, and in moderate degrees
of cardiac insufficiency resulting from constitutional dis-
eases. High grades of anaemia and of cardiac weakness,
however, contra-indicate the use of these baths, and are
aggravated by them.
Iodide of Potassium in Pneumonia. — Regarding
pneumonia as a general disease with local manifestations,
Dr. Schwarz recommended the use of iodide of potassium
in sii-grain doses every two hours, at the same time apply-
ing an ice-bag to the chest over the seat of the pulmo«
nary lesion. All his cases thus treated recovered, some
of them within two days. Dr. Gualdi {Gazzeiia Medica
iiRoma^ May 15, 1884) has similarly treated a number
of cases, and reports most excellent results. He formu-
lates the following conclusions based upon his experience
with this mode of treatment: i. Schwarz' s method of
treating pneumonia gives good results. 2. These results
are even better in the case of children than in that of
addts. 3. The treatment should be instituted at the
beginnmg of the disease, for when commenced at a later
stage the cure is less rapid and satisfactory. 4. The ac-
tion of the iodide is exerted upon the fever and the gen-
eral disease, and not upon the local lesion. 5. The
iodine and the potassium become separated within the
organism and each of them exerts a special effect. 6.
The action of the ice is upon the local condition. It is
Qsdiil in the period of pulmonary congestion, but in-
jnrious in the stage of hepatization.
NiTRFTE OF Amyl IN Opium-poisoning. — Dr. W. L,
Johnson reports in the Texas Courier-Record for May,
1884, a case of opium-poisoning treated by inhalations
of nitrite of amyl. The patient when first seen, three
hoors after having taken two ounces of laudanum, was
deeply narcotized, pulseless at the wrist, making six res-
pizaddons to the minute, perspiring freelv, with cold ex-
tremities, and cyanotic. Belladonna and other remedies
baving failed, twenty to thirty drops of nitrite of amyl
we poured upon a handkerchief and applied to the
pwent's nostrils. After two inhalations of the drug the
BttD looked up and asked what was the matter. From
tint time he continued to improve and made a good
ftcoTciy.
Chill as an Etiological Factor in Pneumonia. —
loan address delivered before the Birmingham Branch
of the British Medical Association {Birmingham Medical
Review, June, 1884) ^- J- Bumey Yeo expressed the
belief that chiU has a causal relation of some sort to
many cases of pneumonia, but thought that its influence
was often overrated. It is notorious, he says, that
pneuinonia often occurs during the prevalence of winds,
especially the winds of spring ; and not with winds from
Mf particular quarter, for it is found to prevail with
nnthwest winds as frequently as with east or northeast
winds. Now, in this connection we have rather over-
looked the fact that winds are carriers of dust as well as
conveyers of cold (or rather, abstracters of heat) ; and
ftat while, on the one hand, they carry away heat from
^ sarface of the body, on the other hand they gather
vp di^t of all kinds, and blow all manner of micro*
oiganisins bto our air-passages. It has been noticed
H^n and again that all depressing agencies may predis-
pose to pneumonia, such as exhaustion from physical
fatigue and depressing emotions, and it may be that
exposure to a cold wind acts both as a predisposing
cause, by the depression of the normal resisting power it
produces by rapid abstraction of heat, and also as an ex-
citing cause, by means of the micro-organisms it blows
into our air-passages.
A Rare Tumor of the Orbit. — ^At a recent meet-
ing of the Academy of Medicine in Ireland (Dublin
Journal of Medical Science^ June, 1884) Mr. Story ex-
hibited a tumor about the size of a small pea which he
had removed from the orbit of a girl aged twenty. It
had existed from earliest childhood, and had lately in-
creased in size. The tumor lay beneath the lower lid
toward the inner canthus, was freely movable in all
directions, strong and hard to the touch, and was covered
by slightly discolored skin. When the patient stooped,
laughed, cried, or took violent exercise, this patch of
bluish skin swelled. When the superjacent soft parts
were divided the little tumor came out without further
interference. On section it was found solid, and formed
of a series of irregularly concentric layers, which micro-
scopical examination showed to consist of fibrous tissue
and calcified matter of an unknown origin, together with
cellular conglomerations of an indefinite character.
Nothing resembling either bone or cartilage existed in
the tumor, its hardness being due to new calcification.
Mr. Story considered the tumor to be a phlebolith, the
history of the case and the pathological appearances
agreeing with that view as to its nature.
Treatment op Coryza. — Surgeon-Major G. E. Dob-
son writes in The Lancet of May 31, 1884, describing a
plan of treatment for coryza, which is certainly simple
enough, and which he claims is very e£fective. About a
drachm of camphor, coarsely powdered, or shredded with
a knife, is placed in a small pitcher, which is then half
filled with boiling water. The patient, having made a
paper cone large enough to surround his face by its wide
extremity and the mouth of the jug by its narrow end,
proceeds to respire freely, at each inhalation drawing the
steam into his nostrils, and at each exhalation forcing it
up against the outer surfaces of his nose and adjoining
parts of the face. A twofold action is produced : the
camphorated steam acts internally in a specific manner
upon the whole extent of the mucous surfaces, and ex-
ternally produces profuse diaphoresis of the skin cover-
ing the nose and face, there acting as a derivative from
the inflamed Schneiderian membrane. The pitcher
should be wrapped in a woollen cloth to retain the heat
in the water, or, better still, a tin vessel, under which a
spirit-lamp is burning, may be used. The respirations
should be continued for from ten to twenty minutes, and
should be repeated three or four times in as many hours.
The writer asserts that great relief is alwajrs felt even
after the first application, and that three or four usually
effect a cure.
A New Form of Cuirass for Pott's Disease in
Young Children. — As a substitute for the plaster-of-
Paris jacket. Professor H. C. Wyman {Medical Age) has
devised a method of treatment which is briefly as fol-
lows : The child being placed in such position that the
spine is extended to nearly the normal limit, a piece of
Canton flannel, large enough to cover one-third of the
circumference of the trunk, is laid on the back. A sheet
of absorbent cotton having been placed over this, a
cheese-cloth bandage six inches wide and several yards
long, with the meshes carefully filled with plaster-of-Paris,
is dipped in water and folded lengthwise over the whole.
When rubbed sniooth with the hand, so that it is per-
fectly adapted to the contour of the parts, a bandage is
applied around the trunk, with figure-of-8 turns about
the shoulders and pelvis, and the plaster allowed to set.
The jacket thus constructed is in the form of a splint,
and can be removed every night.
H
THE MEDICAL RECORD.
[July 5, 1884*
The Medical Record
A Weekly Journal of Medicine and Surgery,
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD & Co., Nos. 56 and 58 Lafayette Place.
New York, July 5, 1884.
IMPROVEMENT IN INFANT DIET.
Any step toward even the partial solution of the diffi-
cult problem of artificial feeding during infancy will
be hailed with satisfaction by all physicians. The heavy
mortality during the first year of life in those deprived
of breast milk is, especially in cities, an important factor
in the compilation of death-lists. Social science can
roll up statistics, but is unable to suggest a remedy. In->
creasing importance is given to this question when we
consider the large number, especially of American
women, who cannot or will not nurse their children. In
the majority of cases a wet-nurse cannot be procured,
either from their scarcity or the attendant expense, and
an artificial diet becomes imperative. A host of infant
foods are offered as a perfect substitute for the mother's
milk« All of these preparations, however, differ widely
from the milk for which they are to be substituted. As
a result, while some infant foods may produce a plump-
ness, they are all more or less colicky in their action.
They are particularly not adapted to early infancy, when
artificial food should not only be conformed to the baby's
digestion, but should anticipate any future disturbances
that are so apt to accompany the early months of life.
Some of the preparations contain large quantities of un-
changed starch that a young baby is unable to digest.
Even the Liebig foods only claim to have transformed
starch into glucose and thus removed one source of
trouble ; but the greatest cause of indigestion in cow's
milk, the caseine, is not directly affected by them at all.
It is true they are valuable by physically acting as at-
tenuants of the caseine, as the arrowroot and cracker
water formerly used, but they exert no chemical or
physiological action upon this substance that is the source
of so much of the indigestion during infancy.
In 188 1 a council was held at Salzburg for the purpose
of considering the subject of infant diet. Gerhardt,
Henoch, Biedert, Soltmann, and other leading authori-
ties were present. All agreed that advances in physio-
logy only prove that mother's milk is quantitatively and
qualitatively best suited to the development of the
child. They likewise agreed that animal milk is the
best substitute for breast milk. In discussing the sub-
ject of infant foods the chairman stated that it was
unanimously agreed that these preparations can in no
way be substituted for mother's milk, and, as exclusive
food during the first year, are to be entirely rejected.
The important question then to be considered is, how
cow's milk can be best modified to resemble human
milk.
Before discussing this question we will briefly notice
the well-known points of difference between these two
varieties of milk. Woman's milk is thin and watery,
with a peculiar animal taste and a persistent alkaline
reaction. Cow's milk, although containing more water
and less solid ingredients, is more opaque, and very fre-
quently has a shghtly acid reaction. Human milk con-
tains more milk sugar and fat, but a smaller percentage
of albuminoids than cow's milk. A point of great im-
portance is that the fraction of the total albuminoids
coagulable by acids in cow's milk is much greater than
that in human milk. The caseine of cow's milk does
not coagulate in soft flakes as in human milk, but in
harder and more indigestible masses. The usual method
of preparing cow's milk is to add sufficient water to re-
duce the percentage of caseine to its relative amount in
human milk. But in so doing the sugar of milk and fat,
both already in smaller quantities in cow's milk than in
woman's milk, have their amount still further reduced*
A little loaf sugar is generally added to bring up the
saccharine ingredients to their normal ratio. Hence to
dilute the caseine properly the fat is diluted far too
much. Now, if fat is removed from the milk, in addition
to the loss of nutrition involved in its absence, the
caseine coagulates in still harder masses. £ven after
the proper quantity of water has been added to cow's
milk, with perhaps an attenuant, as a little starch or gum,
the clot is only partially and incompletely diminished in
size and density. The problem, then, is how to reduce
the caseine and increase its digestibility, while at the
same time the other important ingredients of the milk
are maintained up to the standard of human milk.
Professor Pfeififer, of Wiesbaden, in considering this
subject brought out the valuable idea of peptonizing the
milk. By this process the hard and objectionable caseine
is physiologically changed into readily soluble peptone.
The principal source of irritation in artificial feeding is
thus removed. Cow's milk thus treated becomes thinner
and bears a closer resemblance to human milk, while
even if all the caseine is not digested, that which remains
coagulates in loose flakes. Hence a digested, or easily
digestible, caseine results from this process. As milk pep-
tone has a bitter taste, it is as well not to completely
transform the caseine. This artificial digestion of milk
is effected by means of an extract of pancreas. Dr. WiU
liam Roberts has tabulated four ferments as b^tng pre-
sent in the pancreatic juice — trypsin, curdling ferment,
pancreatic diastase, and emulsive ferment. The trypsin
changes proteids into peptones in neutral or alkaline
media, and thus for practical purposes of artificial diges-
tion, especially in reference to milk, has a great ad-
vantage over pepsine, which is only ix)tent through the
interaction of an acid. The caseine in the cow's milk is
altered and partially or completely digested by the
trypsin ; hence any preparation of pancreas that does not
contain this ferment in an active condition will be useless
for peptonizing milk. Now that a reliable extract of
pancreas can be obtained, this element of uncertainty
is obviated. It may be asked whether the practical re-
sults of peptonizing the caseine of cow's milk are as
beneficial in early infancy as the theory would indicate
July 5, 1884.]
THE MEDICAL RECORD.
15
As far as tried this question can be answered in the af-
firmative.
Professor J. Lewis Smith has the credit of instituting
a series of trials at the Foundling Asylum which have
thus far given satisfactory results, and he considers that
peptonizing milk- promises to mark an advance in infant
diet. We have thus seen that cow's milk itf the best
substitute for human milk ; . that the former is apt to dis-
agree with the infant on account of definite chemical,
physical, and physiological differences that have been
accurately ascertained, and that we now have the means
largely to overcome. Let ordinary pure cow's milk be
diluted with water, that has previously been boiled to
destroy all germs, until its percentage of albuminoids has
been reduced to the proper amount. Next add to it
enough cream to make up the fat, and some sugar of
milk. Then peptonize it with reliable extract of pan-
creas for the alteration of the caseine, and there is pro-
I duced the best physiological imitation of mother's milk.
The peculiar vital or maternal properties of human milk
must always elude analysis, but to this limit we have
well-nigh reached. Science, as always, stops before the
mystery of vitality.
AN ENGLISH VIEW OF THE MORAL TENDENCY OF THE
AMERICAN DOCTOR.
The Lancety in discussing the subject of the American
Medical Association, takes the trouble to inform its read-
ers that *^ there is a natural tendency in a y^ty demo*
cratic country Hke America to demand that one man
shall be considered as good as another, • . . and to
obliterate the traditional morality which enjoins modesty
of professional pretension and forbids the use of unworthy
means for acquiring reputation and practice." Without
stopping to demonstrate more clearly this relation between
democracy and immoral pretensions, information is then
pren as to who a homoeopath is, why he should not be
met in consultation, and finally the American profession
is told that they '* will have a rough time of it if they do
not stoutly maintain the principles " that are editorially
indicated.
Thanks, awfidly. But our esteemed contemporary, if
correct in discovering our moral tendency, at least mis-
apprehends the real issue before us, and leads its readers
to infer that our moral degeneracy will be checked if we
Rfose to consult with irregulars. Now those who are
referred to as << persons that ought to know better,*' ap-
preciated long ago that there was some kind of a tendency
in the profession not entirely praiseworthy, and saw that
somethmg was needed to check it, since existing codes
did not For one thing, a code was drawn up which
forbade advertisements, and which tried to substitute in-
diridoal liberty and responsibility for a restriction that
bad been long violated and dead. But, besides this, on
an sides there has been an attempt to reform medical ed-
ucation, an attempt deprecated as 'Wulgar ^ in certain
Sections, but now warmly seconded by the mass of the
profesaon.
The true issue to-day in America, as we would inform
oar didactic contemporary, is the educational, and coin-
cidentally moral, elevation of the profession. For this
we are striving, and we shall indeed '^ have a rough time
of it" if this is neglected. A profession carefully edu-
cated, and composed of men who have had some moral
training, will be certain to spurn quackery and fraud ;
and the question whether a man shall be at liberty to
consult with whom he pleases becomes a pitiful side-
issue.
A CRITICISM OF THE DEATH-RATE IN NEW YORK
CITY.
A CERTAIN writer of the British [medical press seems
anxious to do the people of this city a great statistical
injustice. He has taken the pains to prove to the satis-
faction of his unbiassed and cosmopolitan mind that the
population of New York is now only a million instead of
a million three hundred and fifty-five thousand, as our
Board of Health fondly believes, and that consequently
we are dying one per cent, faster than has been sup-
posed, and is weekly reported. The true mortality rate,
says this correspondent, is 34.01, or more, per 1,000, in-
stead of 25.19, as officially given. If this charge be
true. New York is one of the unhealthiest cities in the
world, and our city Board of Health is shamelessly de-
ceiving the people.
The reasons given by the critic referred to are as fol-
lows. He writes, speaking of the alleged great increase
in the city's population :
" It is fair to assume that the residents in New York
h^ve increased since 1880, but not in the ratio indi-
cated. That, however, I will pass by. The fict that
the census return is inaccurate, and in excess of the
truth, is more important. In the United States the cen-
sus is not taken as it is in England No day is fixed.
On the last occasion it required foturteen months to get
the returns in. Many of the persons whose names go
on the census from their places of business in the city
are non-residents, and they are put on record again in
Brooklyn, or New Jersey, or Stalen Island, or wherever
they happen to live. I and my family were among the
large number who were taken twice at the last census.
Twenty-four per cent, of the members of the Stock Ex-
change are non-resident. In the Cotton Exchange the
numbers are about the same. In the Produce Exchange
sixty per cent, of the members live out of town. The
resident population of New York does not exceed
x,ooo,ooo. I doubt if it is so much.''
He then proceeds to make another estimate based
upon the registration of voters. The total number regis-
tered in 1883 was, he states, 182,531 ; multiplying this by
five, we get only 912,655 as the total population, which
is nearly half a million less than the last estimate
(1,355,000), upon which our sanitary authorities base
their returns.
We do not propose to attempt to prove that New
York is a remarkably healthy city, and has over a million
of inhabitants. We leave this to our sanitary authorities.
But we would call attention to certain sources of error in
onr critic's mode of calculating. The census is taken in
June, when the swarms of tramps and vagabonds which
infest the city and swell its mortality, as well as thous-
ands of respectable families have left town for the sum-
mer. Any estimate of population based upon the
number of registered voters is utterly unti^stworthy,
for reasons which American citizens very well know,
and which need not be entered upon here.
I6
THE MEDICAL RECORD.
[July 5, 1884.
New York City receives a vast influx of transients, in-
cluding immigrants, of whom the sick remain while the
well pass on. Consequently the death-rate in its in-
stitutions is very large, amounting generally to one-fifth
of the whole.
The causes of the high and hypothetical death-rate
estimated as above are asserted to be bad air, bad water,
bad food, bad drainage, imperfect sanitary measures, and
crowded tenement-houses, which we are told exceed in
filth even the London slums. All of which is news that
ought to be gratefully received by our sanitary authori-
ties, whose eyes have heretofore been blinded by a mis-
taken patriotism and a desire to make a good showing to
the people.
Finally, says The Lancet correspondent, the great mor-
tality is due "last, but not least, to the inefficiency of
medical help. I say it advisedly, but emphatically, after
several years of close observation in the United States,
that the rate of mortality generally, as well as in the
city, would be very materially lowered if the standard of
medical education were adequately raised."
To this we would simply say that he is probably in a
measure right ; yet the late President of the American
Medical Association has asserted it to be in bad taste,
if not absolutely vulgar, to refer to the fact that Ameri-
can medical education is not just what it ought to be.
NOTES ON SUMMER VACATIONS.
We had declined several excellent articles upon the
timely subject of doctors and summer vacations. We
have, however, recently received from various sources
several such pertinent letters regarding the relations of
summering physicians to patients and public that it was
deemed wise to present them at once to our readers.
The first is from the father of a family who is boarding
at the seaside :
Mr. Editor, Dear Sir : I have sent my family, con-
sisting of my wife and six children, to spend the summer
at . I am paying ten dollars a week apiece, a
rate which is likely to consume most of the money I have
laid aside for the summer. When I am at home my
physician charges me $2 a visit, but last year at the
sea-shore 1 was charged $5, which included social
calls and several bouquets for my wife. Will you kindly
use your influence to persuade the summer-seaside phy-
sician to be more reasonable in his charges and leave me
a little money with which to move back to town in the
fall ? Very truly yours. Paterfamilias.
Another is from a lady in the city :
Dear Mr. £Dnx>R: I expect to be confined about
the middle of August. My family physician is obliged
to go to Europe this summer to study, and all his acquaint-
ances will be in the Adirondacks at that time for their
health. I know of no physicians who will be in town
then, except a few homoeopaths and the members of the
Assistant Sanitary Corps. What am I to do ?
Sincerely yours, — : .
A third is from a local physician at a fashionable health
resort in the interior :
Dear Doctor : I have a very fair practice in this
town during the year, but I have until lately looked for-
ward to the summer months as being especially useful
and lucrative. For several years past, however. Dr.
A , of New York, has been up here and taken all the
gynecology. Dr. B has absorbed the ear, eye, and
throat cases, and this year I learn that Dr. C is ex-
pecting to be here to attend to obstetrical cases and
nervous exhaustion. It seems to me that this is hardly
fair, as I believe that I have been quite successful with
visiting invalids before and only charged one-third as
much. But I am not, unfortunately, a New York or a
Philadelphia professor. Can you not secure a little jus-
tice to us rural doctors ?
Yours very truly, , M.D.
Finally we have received the following curious letter
from the proprietor of a large seaside hotel :
Dear Sir : I wish to secure a physician to reside at
my hotel during the summer, and I beg for your advice
in getting one who will be a little more satisfactory
to my guests in certain respects than those who have
heretofore been established with me. The medical gentle-
men previously here have all been of excellent manners
and fine professional attainments, but their charges have
been enormous, even compared with my own. Dr.
X ^ who was here last year, charged Mrs. L
$5 for brushing by her* on the piazza, and $10 for
putting her baby in the omnibus. As he danced several
times with her daughter she could not refuse to pay.
But such things are making my hotel unpopular with
invalids.
Can you suggest some competent man who charges
moderately?
Very respectfully yours, ,
The Cholera in Europe. — The progress of cholera
at Toulon may be best seen by the following table, show-
ing the number of deaths since the disease was first
noticed, June 14th : June 14th, death i ; June 19th,
death i; June 20th, deaths 2; June 21st, deaths 3;
June 22d, deaths 13 ; June 23d, deaths 5 \ June 24th,
deaths 12 ; June 25th, deaths 9; June 26th, deaths 10;
number of cases, 62; June 27th, deaths 4; June 28th,
deaths 6. On June 29th, two cases of apparent cholera
were reported at Marseilles ; on the next day five deaths
from the disease were reported. A case was also reported
at Saluzzo, Italy, on the 30th. The opinion so far con-
tinues to be that the disease is undoubtedly Asiatic cholera.
The form of the disease was at first reported to be mild.
A great deal of alarm has been excited throughout Europe.
Extraordinary, and in some cases foolish, precautions are
being taken to prevent the spread of the disease. The
roads and passes in France leading from Toulon have,
it is said, been narrowly guarded. Spain has established
a military cordon along its frontier. Quarantine against
vessels from French Mediterranean ports has been estab-
lished at Madrid, Trieste, Gibraltar, and other ports. A
medical inspection of railway passengers from Southern
France has been established in Italy, Austro-Hungary,
and other places. Professor Virchow takes the oppor-
tunity to blame the French Government for careless
sanitary measures. Toulon appears certainly to have
been a very dirty place, but Marseilles was reported clean
I and healthful at the time the cholera appeared.
ju]y5,i884.]
THE MEDICAL RECORD.
17
Itvos of tlbe WSizzk.
St. John's Guild. — ^This excellent organization, that
has been in existence since 1866, hopes to continue its
excttrsions this summer for the benefit of sick children,
yst summer the floating hospital made 32 regular ex-
oirsionsand 12 extra excursions, carrying 29,189 chil-
dren and mothers or guardians. The sea-side nursery
also did good work in keeping children for several days
m a i^eek in the country. Many children with diarrhoeal
(gseases had their lives saved in this manner. Money is
needed to cany on this work, that commends itself to all
charitable persons.
The State Board of Health has discharged its corps
of experts engaged to examine into adulterations in food
and drugs, owing to lack of funds*
Nbw Asylum for the Chronic Pauper Insane. —
The Commissioners of Charities and Correction have
bought a tract of land of 1,067 acres on Long Island, be-
tween West Deer Park and Farmingdale. They intend
to erect upcm it buildings for the chronic incurable pau-
per insane.
The Sundry Civil Appropriation Bill, as reported
to and passed by the House, provides for a repeal of the
Jar creatmg the National Board of Health.
The Medical Register of New York, New Jersey,
AND Connecticut for 1884-85^ which has just been pub-
lished, contains the names of 6,247 physicians. Of these
the New York State list contains 2,686 against 2,684 ^^^
year, and the New York City list 1,789 names against
1,661 in the previous year. The number registered in
the State at large, therefore, has decreased; that in
the dty increased.
The Worthy and Suffering Poor of this city have
only twenty-five dispensaries out of which to select their
medical and surgical attendants. We chronicle with
pleasure, therefore, the organization of the Good Samari-
tan Dispensar3r, which is ^ to give medical aid to the in-
digent," thereby supplying a long-felt want.
The Summer Sanitary Corps of physicians has been
appointed, and report for duty July 6th.
The Garfield Memorial Hospital, Washington,
D. C.y opened on June i8th for the reception of pa*
tiats.
The Cattle Disease in Kansas and Illinois. —
Rrofessor James Law has made an elaborate report upon
the disease which appeared last winter and spring among
the cattle in Kansas and Illinois. He concludes that the
animals suffered from dry gangrene, the result of eating
eigoted hay and corn. Professor Law's report contains
a Taluable review of the subject of ergotism in cattle.
The Vote to Admit Women into the Massachu-
srrrs State Medical Society has led the Boston Medi-
id and Surgical Journal vaxx> the expression of certain
atiabilioas Anglicisms. It refers to the practice of medi-
cine by women as a '^ foolish fad." Many will believe this
to hit the case exactly ; but they must admit also that
something has to be conceded to abstract justice, the
vomarried legion, and social peace.
Other Discoverers of the Cholera Bacillus. —
It is reported that Dr. Carter, Acting Principal of the
Grant Medical College at Bombay, has found the cholera
bacilli in the perfectly fresh dejecta of cholera patients.
Dr. Weir, of Bombay, has found the same bacilli in the
well-water drank by cholera patients.
Professor William Pepper has succeeded Professor
Still6 at the UniveVsity of Pennsylvania, instead of at
the Jefferson Medical College as stated.
Dr. Yeng Tis Hing. — On the recommendation of
Dr. Woolsey Johnson, Yeng Tis Hing, a Chinaman, was
recently registered as a practising physician at the
Board of Health. It remains to be seen whether he is
Old Code or New Code.
Bequests to Medical Charities and to Harvard
Medical College. — The late Samuel W. Swett left in his
will a bequest of $50,000 for the Massachusetts General
Hospital, to establish a convalescent department; $10,-
000 to the Children's Hospital of Boston ; $10,000 to
the New England Hospital for Women and Children ;
$20,000 for the Medical Department of Harvard College.
Deaths jn a Foundling Asylum. — Somewhat sensa-
tional accounts are given in the daily papers of a found-
ling home which was opened last January, at Hammon-
ton, N. J., under the charge of a Miss Niverson. Twenty-
three infants from Philadelphia, New York, and elsewhere
were brought to the institution. It is stated that all but
two of these have died, not having received meanwhile
pioper medical attendance. The New Jersey Health
Board will investigate the matter. The deaths occurred
chiefly from measles.
Medical Instruction in Japan. — A meeting under
the auspices of a committee of gentlemen consisting of
Bishop Stevens, Drs. D. Hayes Agnew, William Pepper,
and others, was held in Philadelphia, June 12 th, for the
purpose of inaugurating a movement looking to the estab-
lishment in Japan of a medical college, hospital, and
training school for nurses. The plan is largely the out-
come of the efforts of Dr. John C. Berry, formerly of
Maine, but for the past twelve years a medical missionary
in Japan. Dr. Berry explained the project at length.
He estimated that to establish a permanent endowment
of one professorship $45,000 would be required. Reso-
lutions were adopted indorsing the project, and in
furtherance of the plan as contemplated a committee
was appointed to confer with similar committees in other
cities of this country.
The International Medical Congress. — We have
received the programme of the eighth session of the In-
ternational Medical Congress to be held in Copenhagen,
August 8 to i6y 1884. All medical men legally qualified
to practise in their respective countries are entitiled to
membership on paying the subscription fee of twenty
crowns (Danish), equivalent to $5.50 in our money.
Each member will receive a copy of the " Transactions "
when published. The work of the Congress is divided
into fourteen sections, meetings of which will be held
daily from 10 to 12 and i to 3. The general meetings
will be held each day from 4 to 5.30, and in addition
some address of a more popular character will be deliv-
ered in the evening from 8 to 9.30. The official Ian-
i8
THE MEDICAL RECORD.
[July 5. 1884.
guages of the Congress are English, French, and Ger-
man, but communications which cannot be made in all
three languages will be given in French. The number
of papers and communications prepared or announced
for delivery in the general and sectional meetings is over
two hundred and fifty. Members of the Congress,
through the courtesy of the Danish Government and the
United Steam Navigation Co., of Copenhagen, will be
furnished with return tickets gratis from Copenhagen to
the frontiers of Denmark (Fredericia or Kiel). A bu-
reau of information for the benefit of the members will
be establishe;d at the station of the Korsdr-Copenhagen
Railway. All letters of inquiry in regard to lodgings,
etc., shoul4 be sent before the end of July to Professor
C. Lange, Secretary-General, 22 Kronprinsessegade,
Copenhagen, K., Denmark.
The late Dr. J. G. Adams. — ^At a stated meeting of
the Council of the New York Academy of Medicine, held
June 24, 1884, the following preamble and resolutions
were unanimously adopted :
Whereas, The Council of the New York Academy of
Medicine has heard with profound regret of the recent
death of their associate, Dr. John G. Adams,' an original
Fellow, and, at the time of his decease, Corresponding
Secretary of the Academy ; •
Resolved, That the Council desire to put on record
their warm appreciation of his fidelity to his convictions,
his genial friendship, his ripe culture, his courtesy, his
liberal, earnest, and persistent interest in the Academy,
and of his gentlemanly and Christian character.
Resolved^ That a copy of the above preamble and
resolution be entered on the minutes, be published in the
medical journals of the city, and sent to his relatives.
G. M. Smith,'M.D.,
H. T. Hanks, M.D.,
Committee.
The Late Dr. William Hustace Hubbard. —
Whereas, Dr. William Hustace Hubbard, a late member
of the house-staff of Bellevue Hospital, has been removed
by death, in the beginning of his professional career ;
therefore,
Resolved, That this board now expresses its apprecia-
tion of his manifest sterling qualities as a man, and of his
faithfulness and earnestness in his professional work ; also,
Resolved, That in the death of Dr. Hubbard we have
lost a worthy assistant, and the profession at large a most
promising, able, and upright member.
Resolved, That we tender our heartfelt sympathies to
his respected father Dr. Samuel T. Hubbard.
W. Gill Wylie, M.D.,
A. Brayton Ball, M.D.,
George L. Peabody, M.D.
Committee,
Another Microbe is Born. — It was discovered and
cultivated by M. Duclaux. It is that of the disease known
as the bouton de Biskra. A patient from Tunis suf-
fering from this affection was admitted to the Hospital St.
Louis, where the pathology of his condition was investi-
gated.
Bergh and Pasteur.— Mr. Henry Bergh, of this city,
has sent some of his ravings, in the form of a letter, to
the President of the Paris Society for the Prevention of
Cruelty to Animals* We publish some of the gems from
this letter. Mr, Bergh writes: "But, revolting as are
these canine massacres, they fall far short of the barbarities
of M. Pasteur, both in their atrocity and in the fatal conse-
quences to the physical as well as moral well-being of the
French nation. In the outraged name of science this mer-
ciless empiric is poisoning the flocks and herds of France,
after the fashion of his predecessor, the notorious Jenncr,
of England, who nearly a century ago commenced inoc-
ulating his countrymen with a noxious mucus taken
from diseased animals, under the pretence of preventing
and curing small-pox. That the human race, through the
unfortunate, existence of Jenner, has been hopelessly de-
teriorated ; that scrofula, cancer, and consumption, along
with their hideous long trains of chronic diseases, is the
fearful legacy of that 'man's presence on earth, some of
the most learned and conscientious scientists have de-
clared to be their belief, A French Jenfter now crawls
to the earth's surface and begins the fiend-like and dis-
gusting work of polluting the bodies and flesh of the lower
animals I Moreover, it is proposed in the Chamber of
Deputies to reward this man's detestable crime by voting
him a pension also."
Death from Chloroform given in Child-birth.
— ^A death under chloroform occurred recently at St,
Bartholomew's Hospital, attended by circumstances ot
an unusual character. The patient was a woman seven
and a half months pregnant, who had been admitted into
hospital on account of placenta praevia. On the day
preceding the fatality, chloroform had been taken by the
woman without any symptoms indicative of danger ; but
soon after the second administration was commenced,
respiration and pulse became suspended, and death was
unmistakable.
©Mtuat^B-
JOEL FOSTER, M.D.,
NEW YOUC*
Dr. Joel Foster, one of the oldest practising physicians
in this city, died on June 29th. He had been ill for
about a month and a half, but was not confined to his
bed until a week prior to his death. Then he sank
gradually, and expired at an early hour on the above-
mentioned date. He was born in Barnard, Vt., March
10, 1802. His ancestors were among the original settlers
of Vermont and figured in the French war, and he was
also a distant relative of General Stark, of Revolutionary
fame. He first studied medicine in Woodstock, Vt.,
under Dr. Gallop, and afterward removed to Philadel-
phia, where he resumed his studies in Jefferson College.
Here he graduated with the highest honors.
After securing his diploma he married and began his
work as a physician in Schoharie, N. Y. In 1855 he
came to this city, and since that time has been busily
engaged in his practice. When the President called for
volunteer physicians, after the second battle of Bull Run,
Dr. Foster secured thirty-seven doctors from the Acad-
emy of Medicine in this city and started for the field.
He did good service in administering to the wants of the
wounded, and gained honorable mention for his work in
this respect. Dr. Foster was the oldest life member of
the State Medical Society, and was one of the founders
of the Academy of Medicine in this city. He was also
prominently identified with the Infant Asylum. He was
a prominent and active abolitionist and was a friend of
William H. Seward.
July 5, 1884.]
THE MEDICAL RECORD.
19
"^jmievoa aud ^ottcjes.
DUGNOSIS AND TREATMENT OF DISEASES OF THE
Heart. By Constantine Paul, Member of the
Academy of Medicine, Physician to the Lariboisiere
Hospital. New York : William Wood & Co. 1884.
Dr. Paul's^ treatise on cardiac affections, which is the
March number of Wood's Library, is a systematic and
practical exposition of this interesting and important
dass of affections. In all that relates to etiology,
symptomatology, and diagnosis, we know of no better
work. In the chapter on treatment we miss that detailed
account of what is at present known with regard to the
therapeutics of the various stages of cardiac diseases that
one might expect in a special work of this kind. In spite
of this drawback, however, the work well repays a care-
ful perusal.
Post-Nasal Catarrh and Diseases of the Nose
causing Deafness. By Edward Woakes. IUus-
trated with Wood Engravings. Pp. 224. Philadel-
phia : P. Blakiston, Son & Co. 1884.
This interesting volume is intended to show the relations
that exist between that portion of the upper air tract em-
braced in the nasal region and the organ of hearing. It
would seem from the point of view taken by the author
that the otologist must seek for the cause of many aural
Symptoms in the nervous relationship known to exist be-
tween the different regions about the head, especially
those between the naso-pharynx and the ear. The ex-
tension of catarrhal inflammation from the pharyngeal
Tault to the ear, via the Eustachian, thus seems no^ to be
the principal cause of ear disease, as some have sup-
posed.
While the author's style is often unnecessarily in-
volved, and simple facts are frequently made to appear
more obscure to the general medical reader than needs
be, yet, on the whole, the subject is presented in an enter-
taining and instructive manner. He has brought into
the field of otology the methods of the study of disease
which have been already so successfully employed in
other departments of medicine, namely, the physiologi-
cal. The book may be taken, as far as it goes, as a safe
guide in the study of aural neuroses.
The present volume is to some extent an elaboration
of a former work, in which the nervous mechanism con-
cerning disturbances about the head, and especially about
the ears, was discussed. In the introductory chapter
there are observations on the correlating and reflex func-
tuHis of the sympathetic system, which will be found to
be broadly instructive, and which go to show that in any
successful plan of treatment of aural diseases the load
medication must often occupy a subordinate position.
The second chapter treats of the etiology of catarrh,
acate and chronic, and what the author designates as the
pre-catarrhal state; Chapter III. discusses the mechan-
^mof taking cold; Chapter IV., chronic or post-nasal
catarrh, and its sequences; the hygienic management
of the catarrhally predisposed is considered in Chapter
V, ; the diagnosis of chronic catarrh, examination of
patients, etc., is taken up in Chapter VI. Other chap-
ters are devoted to acute catarrh, chronic pharyngitis,
and the pharyngeal tonsil — their pathology and treat-
ment. Chapters XI. aud XII. treat of nasal stenosis.
The chapter on " taking cold " is an admirable expo-
sition of the subjectp and should be studied by every one
who has to treat nasal catarrhs.
Although the author has made considerable additions
to the physiological aspect of the subject, pathological
conditions are dwelt on more briefly than seems com-
mensurate with the detailed consideration of the former.
Attention is given to the treatment of nasal affections,
a:id some useful suggestions may be found under this
h-^d, although the emplojrment of sprays, the nasal
douche, and syringe seem to be recommended rather
more freely than would be done by most otologists on
this side of the water. The treatment of aural affections
receives a share of attention, and here Dr. Woakes fol-
lows the beaten track* He seems so be a warm advo-
cate of the early incision of the drum-head in acute pro-
cesses affecting the middle ear, although recommending
the procedure with some appearance of caution ; this, to-
gether with the subsequent free use of the Politzer air-
douche and running hot water into the ear seems, to
some of us at least, rather heroic. The work on the
whole is a valuable contribution to the subject of which
it treats, and it should be in the hands of every specialist
in this department of medicine, as well as every general
practitioner.
Medical Diagnosis, with Special Reference to
Practical Medicine. By J. M. Da Costa, M.D.,
LL.D., Professor of Practice of Medicine and of Clini-
cal Medicine at the Jeflerson Medical College, Phila-
delphia, etc. Sixth edition. Philadelphia: J. B.
Lippincott & Co. 1884.
It is pleasant to have to record the appearance of a
new edition of Da Costa's well-known medical diagnosis.
The work is thoroughly appreciated here, and its trans-
lation into foreign tongues shows the estimation in which
it is held abroad. The present edition is fully up to
date, several not unimportant additions having been
made. It is not a work of reference, but rather one that
should be studied from beginning to end.
Vorlesungen tJBER Pharmakologie. Von Professor
C. BiNZ, Ord. Professor, Direktor des Pharmakolo-
gischen Instituts der Universitat Bonn. I. Abtheilung.
Berlin: Aug. Hirschwald. 1884. Lectures on Phar-
macology. By Dr. C. Binz.
Professor Binz, of Bonn, hardly requires an introduc-
tion to the American reader, his original contributions
relating to pharmacological subjects having been fre-
quently noticed by the medical press both of England
and our own country. The volume before us comprises
Part I. of the subject-matter of the lectures delivered
annually at the University of Bonn. Two succeeding
parts will complete the work. The author has a happy
faculty of infusing a new interest into an habitually dry
and tedious subject. In this way the book contrasts
very favorably with the average Materia Medica and its
tiresome enumeration of superfluous details. The phar-
macology of Binz, judging from this the flrst volume, is
practiced and yet strictly scientific, clear and concise, and
yet complete enough to satisfy the demands both of stu-
dent and practitioner. It goes without saying that the
work is fully up to date. We believe that an English
translation would find a ready welcome in our country.^ <
The Diseases of Children. A Handbook for Prac-
titioners and Students. ByJ Armand Semple, B. A.,
M.B. Cantab., M.R.C.P. Lond. Pp. 352. New York :
G. P. Putnam's Sons. 1884.
This is a small volume, and presents the subject j of
paediatrics in a more condensed form than is the case
with the usual treatises. The volume does not strike us
as having any great merit aside from its compactness.
There is no evidence of originality in thought or method,
and we should doubt if Mr. Semple had had a long ex-
perience with children's diseases.
In this respect it is in striking contrast with Henoch's
work. The author also is not entirely free from mis-
leading statements, as when he describes croupous pneu-
monia, leaving one to infer that it may attack children at
any age, and independently of broncho-pneumonia.
For all this, however, the book is a very fair presenta-
tion of its subject, and is in the main trustworthy. It is
clearly written and systematically arranged. The pub-
lishers have printed it in excellent style.
20
THE MEDICAL RECORD.
[July 5, 1884.
Medical Annals of Baltimore. From 1608 to 1880,
to which is added a Subject Index and Record of
Public Services, By John R. Quinan, M.D. Balti-
more. 1884.
This volume represents a great deal of painstaking labor,
and will be of much local interest and value.
Transactions of the New York Pathological So-
ciety. Vol. IV. Based on the Proceedings of the
Year 188 1, and Supplemented from the Records from
1844. John C. Peters, M.D., Editor. New York:
Printed for the Society. 1882.
The New York Pathological Society is one of the best
medical societies in this city. Founded forty years ago
for " the improvement of its members in pathology, and
in the diagnosis and treatment of disease as founded on
pathology," it has ever held this object prominently in
view, and that it has lost none of its original fervor in
the advancement of medical science this present volume
of the Transactions bears abundant testimony. The
book is neatly printly and strongly bound, and contains
more matter of solid worth in its 380 pages than many a
more pretentious tome.
The Medical Directory of Philadelphia for 1884.
Edited by Samuel B, Hoppin, M,D. Philadelphia :
P. Blakiston, Son & Co. 1884.
This little volume contains, besides the list of the regu-
lar physicians of Philadelphia, the names of all the
homoeopathic and eclectic practitioners, and of persons
practising medicine without diplomas, but registered
under the laws of the State. There are also lists of
druggists, dentists, and graduates of recognized veterinary
colleges, as well as non>graduate veterinary surgeons
and dentists.
The General Practitioner's Guide to Diseases and
Injuries of the Eye and Eyelids. By Louis H.
TosswiLL, B.A., M.R Cantab., M.R.C.S., Surgeon to
the West of England Eye Infirmary at Exeter. Lon»
don : J. & A. Churchill. 1884.
The author's aim in writing this little book was to give
to the general practitioner a manual to which he might
refer for guidance in the diagnosis or management of the
more common diseases and injuries of the eye. And he
has succeeded admirably in his attempt. The book is a
model of brevity and clearness of description, and is en-
tirely free from the technical terms and mathematical
problems which are usually so confusing to the ordinary
reader of works on ophthalmology.
Diseases of the Bladder, Prostate Gland, and
Urethra. Including a Practical View of Urinary
Diseases, Deposits, and Calculi. Illustrated by Nu-
merous Wood Engravings. Fifth Edition, Revised and
much Enlarged throughout. By Frederick James
Gant, F.R.C.S., Late President of the Medical So-
ciety of London ; Senior Surgeon to the Royal Free
Hospital; Author of "The Science and Practice of
Surgery." New York : Bermingham & Co. 1884.
This, the fifth, edition of Mr. Gant's well-known treatise
on diseases of the bladder and neighboring organs comes
to us greatly enlarged and revised. Every chapter, in-
deed almost every page, shows marks of improvement,
and of such changes as were necessary to be made in
order to maintain the character of the work as a thor-
oughly reliable guide for the surgeon in dealing with
these affections. The author treats not only of the or-
dinary and more common diseases of these organs, but
enters also somewhat at length into the exceptional cir-
cumstances in which the surgeon may be placed, and
sets down rules, as far as rules can be thus set down, for
his guidance in all the straits in which he may find him-
self. Somewhat over one hundred out of the six hun-
dred pages of the book are devoted to the consideration
of urinary diseases and of the nature of the deposits in
this fluid. While the author presents in his work but
little that is, strictly speaking, new, or which may notjbe
found in one or another of the treatises upon the sub-
jects which it embraces, there are, nevertheless, few books
in which one may find so complete an exposition of all
diseases relating to the urinary organs as in this. It is,
furthermore, by no means a mere compilation, but pos-
sesses that peculiar freshness which is a sure evidence that
the author writes from personal knowledge, and has not
simply clothed the ideas of others in language of his own.
A Study of the Bladder during Parturition. By
J. Halliday Croom, M.D., F.R.C.P.E., Physician to
the Royal Maternity Hospital ; Assistant Physician for
Diseases of Women, Royal Infirmary ; Examiner in
Midwifery in the University, and Lecturer on Mid-
wifery and Diseases of Women, School of Medicine,
Edinburgh. Edinburgh : David Douglas. 1884.
The object of this book, containing the substance of
several papers communicated to the Edinburgh Obstet-
rical Society, is to show the extent and manner in which
the bladder and its contents are influenced by parturient
efforts. The author states that the sources of pressure
upon the bladder are three : a. Change of shape in the
uterine ovoid ; by stretching of the cervix ; ^, pressure
by the abdominal and other respiratory muscles, ^.^.,
diaphragm, levator ani, etc. The quantity of urine in
the bladder does not influence pressure, provided always
the point of over-distention is not reached. The mini-
mum pressure is found during the first stage, and amounts
to . I lb., while the maximum occurs during the second
stage, and is about 3.2 lbs. on the square incli. The
work evidences a large amount of painstaking investiga-
tion on the part of the author, but the subject is one in
which the ordinary practitioner would take but a languid
interest.
Beginnings with the Microscope. A Working Hand-
book, containing Simple Instructions in the Art and
Method of Using the Microscope, and preparing Ob-
jects for Examination. By Walter P. Manton, M.D.
Illustrated. Pp.73. Boston : Lee & Shepard. 1884.
This little book will be found y^ry useful for beginners
in microscopical study, who are often appalled by the
size of the standard treatises on this subject. The author
has here given directions for the preparing, staining, and
mounting of the objects to be examined, such as are
needed by those who have had little or no experience in
microscopical work. For advanced students it is of
course too elementary, but for beginners it is eminently
practical, and may serve as an introduction to the larger
works.
The London Pathological Society.
The thirty-fourth volume of the Transactions of this
Society is before us. Perhaps our own Society may get
some hints from it. It was founded in 1846, and ours in
1844. Its presidents always serve two years, ours gen-
erally only one. Its first president, in 1846, was Charles
J. B. Williams, ours was Willard Parker, in 1845, although
Dr. John A. Swett served as chairman for six months in
1845. ^^ other presidents have been Charles Aston Key,
Peter Mere Latham, Caesar N. Hawkins, Benjamin Guy
Babbington, James M. Amott, Sir Thomas Watson, Sir
William Ferguson, James Copland, Sir Prescott G.
Hewitt, Thomas B. Peacock, John Simon, Richard
Quain, John Hilton, Sir William Jenner, George D.
Pollock, Charles Murchison, Jonathan Hutchinson,
Samuel Wilks, John W. Hulk. It always has eight vice-
presidents, nine surgical councillors and nine medical,
none of whom are vice-presidents ; two honorary secre-
taries, one medical the other surgical ; two trustees,
and one treasurer. The whole number of members in
1883 was 650, and 27 new members were added during
the year.
Dr. Peacock, just deceased, generously bore the whole
cost of publishing and issuing a general index to the
volumes from 1864- 18 74, viz., vols, 16-25.
July S, 1884.]
THE MEDICAL RECORD.
21
Dr. Edwards Crisp, just deceased, during a long course
of years insisted upon the advantage of studying the
morbid anatomy of animals, and since 1864 was continu-
ally exhibiting specimens, which he had procured from
the Zoological Gardens and elsewhere. Dr. Crisp was
the pioneer of the .London Pathological Society in the
study of comparative pathology, and it must have gratified
him to witness the establishment by the council, at the
suggestion of Dr. J. Hutchinson, of a comparative fpa-
thology committee. Another committee has been formed
to obtain information respecting the uncompleted cases
in the Transactions, which has already reported.
Owing to the large number of specimens offered, a great
many could not be received on account of the limit of
time at the disposal of the Society, and extra meetings
are under consideration.
In 1882 there was ;^i39 balance in the treasury ; four
hundred annual subscriptions produced ;^42o ; twenty-
three admission fees, ^£24 ; two life fees, ;£^i ; two mem-
hers in arrears, ^£2. The sale of the Transactions to non-
members produced ^£62, sale of illustrations, j^iS-
Total income, ;^7o3.
The Society paid to the Royal Medical and Chirur-
gical Society for use of rooms, gas, etc., j£6;^ ; refresh-
ments, waiters, etc., ^^36 ; for janitor, microscopes, and
lamps, ;^i I ; for printing, binding, etc., of Transactions,
;fi94; for supplementary report, 750 copies, ;^i8 ; for
hthography, woodcuts, etc., j/^126 ; for stationery, ^£1$;
for postage, 3 pence ; for secretaries and treasurer, not
including stenography, j£^6 ; total expenses, ;^5o2 ;
balance in treasury, ^201,
Opera Minora ; a Collection of Essays, Articles, Lec-
tures, and Addresses from 1866 to 1882 inclusive. By
Edward C. Seguin, M.D. New York: G. P. Put-
nam's Sons. 1884.
The articles here collected make a large quarto volume
of near seven hundred pages. The author modestly says
that " the redeeming feature in the collection will per-
haps be the series of observed facts faithfully recorded."
The volume has more value than is measured by such an
estimate. Thejirticles touch upon nearly the whole field
of neurology, and nearly every one contains something of
interest or practical value. Expositions of nervous
phjsiology, contributions to neurological therapeutics, and
original researches in pathology— especially of the spinal
cord— form the leading features of a collection which
does great credit both to the author and to American
science.
New York anb Brooklvn Formulary of Unofficinal
Preparations. Published by a Joint Committee of
Delegates from the College of Pharmacy of the City
of New York, the New York German Apothecaries'
Society, and the Kings County Pharmaceutical So-
ciety. New York : Publication Office, College of
Tbaurmacy Building.
The great and increasing number of preparations of so*
called elegant pharmacy is as annoying and perplexing
to the physician as to the pharmacist, and any measures
looking toward a reduction of the number are to be wel-
comed. A committee of delegates from three pharma-
ceutical societies of this city and Brooklyn have prepared
a niunber of formulae for the compounding of the more
commonly used elixirs, emulsions, and syrups, and it is
hoped that the physicians of the two cities will order
these preparations only, and not designate on their pre-
scriptions those of any particular house. Such a result
is certainly to be desired, and perhaps may be obtained
through the wide distribution of this formulary. But the
drnggists will have to rise betimes in the morning to score
a point against the representatives of the manufacturing
finns with their smooth tongues and seductive ways. If
Acy succeed in driving these gentlemen from the field
they will have earned the gratitude of the entire profes-
sion, and will no doubt receive their reward.
Reports at SacietUs.
MICHIGAN STATE MEDICAL SOCIETY.
Nineteenth Annual Session held at Grand Rapids^ June
II and 12, 1884.
(Continued from No. 34, p. 671.)
In report of the first day's proceedings, by telegraph, of
this meeting, abstracts of papers were omitted.
Dr. Donald Maclean, Chairman of the Committee
on Surgery, read an interesting reportof four cases which
had come under his care at the University Hospital clinic.
The first case was a lady who presented symptoms of
SYPHILITIC PERIOSTITIS,
but who gave none of the early symptoms or any history
of any syphilis either in her own person or that of her
husband. The diagnosis seemed to rest between a malig-
nant affection and syphilitic affection. The doctor gave
her the benefit of the doubt, put her on large doses
of iodide of potassium, and she made a rapid and full
recovery.
Some time after she came to the clinic again and pre-
sented her little son, about four years of age. The little
fellow was bow-legged, and had exostosis of the upper
end of the tibia. This patient was put on iodide of
potassium and is now reported as quite recovered. The
third case was one of
NECROSIS OF THE LOWER END OF THE FEMUR.
In attempting to remove a large piece of necrosed bone
with the bone forceps
THE POPLITEAL ARTERY WAS TORN ACROSS.
The hemorrhage was arrested by pressure with the
fingers; the necrosed bone was removed and the pop-
liteal artery cut down upon and ligated above and below
the site of the injury. The patient did well and made
an excellent recovery.
The fourth case was a man of twenty-eight, who in
jumping from a train of cars in motion received an in-
jury on the elbow. The arm was firmly anchylosed at
the elbow and it was thought best to resect the elbow-
joint. A straight incision was made along the back of
the arm and when the parts were brought to view it was
found that the
RADIUS AND ULNA WERE DISLOCATED BACKWARD AND
SOLIDLY ANCHYLOSED
to each other and to the humerus. About one inch was
taken off firom the humerus, and about an inch from the
ulna and radius. The patient made an excellent recovery
and has regained motion at the elbow to a large degree —
that of supination and pronation. This case is typical of
about twenty others which the professor has operated
upon at the hospital clinic.
Dr. Charles J. Lundy's paper elicited considerable
interest. Dr. Lundy said that within a few years the re-
sources of the aural surgeon had been greatly increased,
both by the introduction of new therapeutic agents and
by the use of old ones in a new way. In appropriate
cases the
SO-CALLED DRY TREATMENT OF CHRONIC SUPPURATIVE
OTITIS MEDIA
had proven highly beneficial. All knew that the disease
was attended with danger, and many bad seen exam-
ples of cases, and necrosis of the temporal bone, mas-
toid abscess, meningitis, cerebral abscess, or death, which
occurred as the result of neglected suppurative otitis me-
dia. Therefore any system of aural therapeutics which
the better enabled us to control and cure this affection
was a great boon. Before beginning the use of pow-
ders, all remediable complications must be removed.
If aural polypus or granulations be present they must be
removed or destroyed, and so it was also with remova-
ble pieces of necrosed bone, in the mastoid or else-
22
THE MEDICAL RECORD-
[July 5, 1884.
where. The advantages which the dry treatment of
chronic suppurative otitis media seemed to offer were :
I, the constant medication of the parts; 2, the thor-
ough and continuous disinfection of the ear as well
as the destruction of micro-organisms; 3, the absorp-
tion of the discharges and protection from their irri-
tating properties ; 4, protection from atmospheric influ-
ences. Some space was devoted to illustration of these
points, and while it was not fully settled as to which
of these was the most important advantage arising
from the use of dry powders, a majority conceded
that the destruction of the micro-organisms and the pro-
tection from atmospheric influences were the strong argu-
ments in favor of the dry treatment. It could not be
claimed that powders should be used to the exclusion of
remedies in other forms, and they were counter-indicated
at times. In certain cases they proved a failure, and
sometimes did harm instead of good. While no definite
plan could be laid down for the management of individual
cases, yet some rules could be formulated for our guid-
ance in a general way.
The so-called dry treatment would seem to be contra-
indicated under the following circumstances : First, when
the discharge is so profuse that the powder becomes
supersaturated before it has had time to exert any bene-
flcial influence ; second, when granulations or polypi
exist the dry treatment should not be employed until
these bodies have been destroyed or removed, although
powdered boracic acid would cause absorption or de-
struction of these in a few cases ; third, when the disease
is complicated by caries or necrosis of the*temporal bone ;
fourth, when mastoid abscess is present or suspected ;
fifth, when there is good reason to suspect the presence
of meningeal or cerebral complications. The remedies
which might be used were numerous but the author had
confined himself to few. Wyeth's pure boracic acid was
free from irritating properties and a favorable remedy
with him. Boracic acid, one part with seven parts of
resorcin, formed a valuable combination. Bismuth and
perchloride of mercury he sometimes used, especially if
eczema of the auditory canal existed. Astringents could
be combined with the boracic acid if desired. It was of
great importance to cleanse the ear thoroughly before
using the powders. After the lapse of one, two, or
three days, when the powder becomes moist, it should be
removed, and the ear filled with fresh powder. Cases
were reported showing some very remarkable cures from
the use of remedies in dry form, especially from boracic
acid. A paper on
EXPERT TESTIMONY AND COMPENSATION,
from the pen of Dr. Samuel F. Duffield was a well-
digested, carefully written essay.
Starting with the German motto from Lessing, IVer
viel weiss hat viel zu sorgin (" He who knows much has
much to care for "), he claimed that Lord Bacon uttered a
truth when he said, '' The greatest trust between man and
man was the trust of giving counsel," and if, said the
essayist, he were in our profession and called to the wit-
ness-stand, in Wayne County especially, he would have
probably added, "and no counsellors are so poorly
paid." This province of giving counsel cannot be re-
served by the legal fraternity alone, they are not the only
Gamaliels at whose feet the young Sauls of Tarsus must
learn wisdom. A lawyer can craniy but he cannot counsel
on our specialties. Physicians as counsellors in their
departments of knowledge are denominated "experts."
So far they seem to have been expert in telling all they
know and not expert at getting paid for it.
He described the ancient law, which was intended to
prevent the perfidy of advocates, and showed how during
the time of Claudius it was so modified that advocates,
were permitted to receive any sum up to 10,000 sesterces,
or about $400, and thus was paved the way for that
amendment under Claudius which recognized the fact
that professional services have created something more
than imperfect obligation on the part of the recipient, and
entitled the practitioner to his '* quiddara honorarium,"
even through the intervention of the magistrate. Such
was the high standard affixed to the exercise of a liberal
profession among the most polished people of antiquity.
The author of the paper gave two' sets of cases, viz. :
I, cases favoring extra compensation ; 2, cases denying
the right to extra compensation — reference being had to
Buchman vs. State of Indiana, 59 Ind., i ; U. S. vs,
Howe, 12 Central Law Journal, 193; and for American
cases denying the right of compensation reference was
had to 53 Alabama, 389, before the Supreme Court of
Alabama, ex parte Dement
Dr. D. also reviewed the article by Rasselle John-
son which appears in the June number of the North
American Review^ showing his fallacious definition of
the word witness in that article, is not consistent, "for
the expert is not testifying of facts,** but is acring as an
interpreter by making legible that which was written in
blood, or paint, or other stain upon the clothing. He
stands as Daniel at Belshazzar's feast, interpreting the
mysterious, and to the mass the unknown characters which
shine out in the testimony, but which cannot be inter-
preted by the jury. Called by opposing counsel rather
than by the judge, answering alternately yes or no to con-
tradictory hypothetical questions ingeniously based on
selected facts in testimony, and so with show of science,
falsely so called, leaving the jury more befogged than
ever. True science asks a different definition from this,
and indignantly appeals from such data.
It can never be reached without distinct and honest
co-operation between legal and medical experts. The
bar must reach forth an honest hand to the physician and
he must conscientiously respond ; both must be willing
searchers for that gem which is the crystallization of
years of medical experience and science realizing the
truth of Goethe's words, Die weisheit ist nur in der war-
heit (** Wisdom is only in truth").
President Dr. A. F. Whelan, of Hillsdale, called
Vice-President H. Tupper to the chair, and read his
ANNUAL ADDRESS.
He reviewed the history and progress 8f medicine, and
said it had done more to break up dark faiths by build-
ing up the minds of the people, and despite the opposi-
tion and hindrances that have always been in the way it
will be triumphant. He closed with an appropriate
tribute to the memory of Drs. Jas. H. Jerome and Wm.
Brownell, deceased.
Dr. T. a. McGraw, of Detroit, read a paper of great
practical value on
DIAGNOSIS OF TUMORS.
He thought that all abnormal growths were the result of
irritation or a slow inflammatory process. Hypertrophy
was the result of increased nutritive action and is not a
neoplasm. He discussed quite extensively the nature
and pathology of tumors. He had made a thorough
study of cystic tumors of the breast, and thought that
they should be removed entirely as soon as discovered,
and if they showed a tendency to return the entire breast
should be removed. He thought that all tumors had
better be taken out promptly and thoroughly. He had
often known apparently innocent growths to take on a
malignant action from local irritation. He believed that
warts and moles were often irritated until they became
malignant. He thought that the better way to remove a
tumor was to use the knife.
Dr. a. B. Palmer, of the State University, read a
paper on
PROSTATIC HYPERTROPHY AND URINARY OBSTRUCTION,
ITS TREATMENT WITHOUT CATHETERISM,
which, from the simplicity and to many the novelty of
the method, attracted particular attention.
After referring to the frequency of prostatic enlarge-
ment in advanced life and to the occurrence of what
THE MEDICAL RECORD.
23
Spiemlart calls the ** catheter period," which means a
period of such obstruction to the passage of the urine in
which the bladder is not completely emptied, an irrita-
tion of the urinary organs of a somewhat decided char-
acter occurs, and which also implies that from that time
DDtrard the catheter must be a constant companion
and one likely to be brought into frequent use ; and after
fbrther referring to the great unpleasantness and not in-
frequent dangers of its introduction — the "catheter
fever" and the still more frequent shock — the method
of procedure in the management of cases was described
as follows : " The urethra is to be filled with urine as in
an effort at micturition. The penis is then grasped by
the hand of the patient and the urethra is pressed upon
near the glands or in some part of its course sufficient to
introduce the flow ; and then by straining, as in an at-
tempt to forcibly empty the bladder, the distention of the
urethra is produced. This distending pressure is gentle,
steady, diffused, and painless, and may be applied and sus-
tained at will, and in a majority of cases, if daily repeated
for a time and afterward occasionally, and if it is done
thoroughly, and especially if commenced at an early
period o( the obstruction, it will overcome this form of
stricture eflfectually and without irritation or danger."
A case as a specimen of many others was given in
detail as illustrating the efficacy of the measure.
The paper concluded with the statement that from
sufficient experience the efficacy and value of this method
had been demonstrated and it was strongly commended
to the attention of the profession.
In compliance with a resolution previously made by
Dr. Pratt and adopted by the Society,* the President ap-
pointed a committee to nominate officers for the ensuing
year, except President. The committee was composed
of Drs. William Brodie, H. McColl, S. H. Clizbee, G.
L Johnson, and £. P. Christian.
Dr. G. K. Johnson's paper was on motion, made the
special order for 9 a.m. next day.
Dr. K L. Shurly as one of a committee appointed
by the U. S. Climatological Association to collect data of
KATURAL CAUSES PREDISPOSING TO PHTHISIS PUL-
MONALIS,
appealed to the members present and the profession
throoghout the State to assist him by reporting to him
ofi blank cards which he distributed to those present.
As adjournment would take place before all the papers
offered could be read, on motion of Dr. Ward, authors
of papers were allowed to read them by title, and when
so read they were referred to the Publication Committee.
STERIUTY IN WOMEN.
Dk. J. H. Carstens, of Detroit, read a paper on
^Sterility in Women," calling attention to the frequency of
ds&ease and the great importance of this condition to
the State, and especially to the individual so afflicted.
Tbatin order to understand the cause and cure of ster-
ility it was best to consider the essentials of pregnancy.
Then we come to the conclusion, that sterility can be
cored by absence of disease of ovaries, Fallopian tubes,
^placements of uterus, strictures and occlusions of
Bterine canal or of the vagina. These were the causes
in women, but the husband was sometimes to blame and
sboald never be neglected. Especially should we be
parded in our prognosis and not promise a cure, as we
aever could be positive that pregnancy would occur, even
iftcr the cure of the diseases which often cause sterility.
Second Day — Morning Session.
Meeting called to order by the President Calling of
the roll and reading of the minutes was dispensed with.
Dr. Brearey, as chairman of the Committee on Ne-
crology, rendered a verbal report, and asked further time
to complete his written report and refer the same to the
Committee on Publication. Granted.
Report' of a case of
PERINEPHRITIC ABSCESS,
with remarks, by Dr. George K. Johnson, of Grand
Rapids, was next called for and read This was a case
occurring in a man twenty-two years of age, whose ill-
ness was marked by symptoms seen in typhoid fever,
which symptoms partially abated. Soon, however, an
indefinite ailment, characterized by weakness, want of
appetite, loss of flesh, feeble pulse, cachectic fever, and
pain in left iliac and lumbar region, led him to again
consult the doctor. In a word there was present the
group of phenomena which signalized hectic or pyoge-
nesis. Pain in the left costo-iliac space had come on
and was increased by pressure. A feeling of weight in
left flank and left upper abdomen was complained of, but
no pain in genital tract or groin. Urine voided fre-
quently, loaded with pus, but without blood, mucus, or
casts. Left half of abdomen distended with fluctuating
tumor, easily traced. Hypodermic needle passed into
the tumor withdrew a drachm of pus and confirmed the
diagnosis. The body forces fast waning and danger that
the cyst would rupture and pour its contents into the cavity
of the abdomen, the doctor decided to at once aspirate the
tumor. Passing the needle at the external margin of left
rectus, two inches below the level of the umbilicus, he
removed eighty-four ounces of pus. Within a few hours
rehef came, fever left, and pain vanished. On the second
day the temperature of the patient reached 100^ F. in
the morning and 104° F. in the evening, and on the
fourth day the temperature was 99^° F. in the morning,
and 104^° F. in the evening, when it reached its climax,
the patient having, though restless, suffered no pain or
swelling of the parts since aspiration. Six days after the
aspiration some fulness appeared over the site of the tu-
mor, and after a few days there was found to be consid-
erable reaccumulation of pus. But the discharge by the
urinary conduits was so free that no further accumulation
took place and all tumefaction slowly but steadily disap-
peared. Three months after aspiration the patient seemed
entirely well, appetite, strength, flesh, and spirits were fully
restored. The urine was normal, and all traces of the
tumor was gone.
The author closed his paper by a somewhat compre-
hensive and very instructive review of the somewhat
meagre literature of the class of cases to which the one
reported was typical, gave a careful history of the path-
ology and course of the disease, calling attention to
important points in its diagnosis, so essential to the prac-
titioner, who is often befogged for want of proper descrip-
tion by authors of the symptoms and signs of probable
and possible value in localizing ancl diagnosing peri-
nephritis and perinephritic abscess.
Dr. E. p. Christian read a paper on "Placenta
Previa,** which was referred to the Publication Committee.
officers for the ensuing year.
The Committee on Nominations rendered their report
recommending officers for the ensuing 'year as follows :
Vice-Presidents — J. Perkins, Owasso; J. M. Cook,
Muskegon ; Gordon Chittock, Jackson ; Case Brumme,
Detroit ; Secretary — Geo. E. Ranney, Lansing ; Treas^
urer — A. R. Smart, Hudson ; Judicial Council — F. K.
Owen, Ypsilanti j C. V. Tyler, Bay City ; H. M. Clou,
Lapeer ; Delegates to American Medical Association —
Wm. Brodie, Detroit; H. B. Baker, Lansing; J. H.
Bennett, Coldwater; J. B. Book, Detroit; W. F.
Breakey, Ann Arbor ; C. Brumme, Detroit ; J. H. Car-
sten, Detroit ; S. H. Clizbee, Coldwater ; L. Connor,
Detroit; E. S. Dunstan, Ann Arbor; S. P. Duffield,
Dearborn ; S. S. French, Battle Creek ; A. D. Hoga-
dorne, Lansing; H. O. Hitchcock, * Kalamazoo ; ,G.
K. Johnson, Grand Rapids ; D. Maclean, Deti'oit ; H.
M. Cole, Lapeer ; F. M. Oakley, Ypsilanti ; F. K.
Owen, Ypsilanti ; A. B. Palmer, Ann Arbor ; F. Pratt,
Kalamazoo ; G. E. Ranney, Lansing ; W. F. Sigler,
24
THE MEDICAL RECORD.
[July 5. 1884.
Pinkney ; H. A. Shank, Lansing ; E. Snow, Dearborn ;
C. F. Southworth, Monroe ; T. H. Tuppcr, Bay City ;
C. V. Tyler, Bay City ; D. C. Wade, Holly ; A. F.
Whelan, Hillsdale ; Chas. Shepard, Grand Rapids.
The report of the committee was adopted.
The Society next proceeded to ballot for President,
with the following result : Whole number of votes cast
196, of which Donald Maclean received 126; S. S.
French, 6^ ; scattering, 6.
Dr. Maclean was thereupon declared elected.
The usual votes of thanks for the many courtesies ex-
tended by the physicians and citizens of Grand Rapids
and to the retiring officers were then passed.
Dr. Miles, of Port Huron, extended an invitation
to the Society to hold its next annual meeting at Port
Huron. Carried.
Dr. a. W. Nichols, of Greenville, read an interesting,
practical, instructive paper on •* Nasal Catarrh," which
was referred to Committee on Publication.
GRANULATED LIDS.
Dr. Eugene Smith, of Detroit, read a paper on " Gran-
ulated Lids " and related a case in which he had used
jeqtiirity with good effect. He uses a three per cent
solution, and applies it two or three times a day for
three or four days, and then follows with boracic acid.
He thinks this remedy is well adapted to old chronic cases
where there is no purulent secretion.
MISCELLANEOUS BUSINESS.
A paper by Dr. R. J. Kirkland on " Chronic Catar-
rhal Otitis," one by Dr. A. R. Smart on " Therapeu-
tics of Dysmenorrhoea," one by Dr. D. W. C. Wade on
** Uterine Displacements," were all interesting, able pa-
pers, and were referred to the Committee on Publication.
Over two hundred physicians were in attendance, up-
ward of eighty of whom were elected members at this
meeting.
The Society transacted considerable miscellaneous
business pertaining to local and personal matters, and
adjourned till the second Wednesday of June, 1885.
G^oweepon&j^nct.
OUR LONDON LEITER
(From our Special Correspondent. }
CONFERENCES ON HEALTH — DOMESTIC SANITARY AR-
RANGEMENTS OF THE METROPOLITAN POOR — DOMES-
TIC SANITATION OF RURAL DISTRICTS — INDUSTRIAL
DISEASES — INFECTIOUS DISEASES — DISPOSAL OF THE
DEAD.
London, June Z4« 1884.
What may be termed the Health Congress began on
Monday last, June 9th. This consists of a series of con-
ferences organized by a joint-committee of the following
bodies : Society of Medical Officers of Health, Sanitary
Institute of Great Britain, Parkes Museum of Hy-
giene.
The meetings have been thrown open to all visitors to
the Health Exhibition. No one will be sanguine enough
to believe that a tithe of the sightseers who visit the Ex-
hibition will find their way into the conference room,
and patiently listen to the reading of the papers ; but the
chief end and aim of the meetings will be gained if,
through the publicity given to them, the public gets a
more intimate acquaintance with, and places a deeper
trust in, the science and practice of hygiene. Many of
the subjects discussed, and propositions brought forward,
have long been familiar to sanitarians, but to ordinary
medical practitioners, who are so largely occupied in the
treatment of disease, they are probably less well-known.
In any case the threshing out again of health topics can-
not fail to be beneficial.
The ball was opened on Monday by the reading of a
paper on " Domestic Sanitary Arrangements of thi
Metropolitan Poor," by Dr. Tripe. Dr. Tripe is a well-
known sanitarian, and as the medical officer of health
to a populous parish in the East end of London, is well
qualified to speak on the subject from actual observa-
tion. He remarked that the chief defects arose from
want of a proper water-supply. This, of course, led to
defective drainage and escape of sewer-gas from un-
flushed drains and dried-up traps. Unemptied dust-bins
were also great nuisances.
Mr. Ernest Turner, who is an architect, and conse-
quently approached the subject from an architectural
standpoint, followed with a paper on " The Improvement
of the Sanitary Arrangements of Metropolitan Houses."
It is satisfactory to find that a few architects are begin-
ning the study of hygiene. A whole number of The
Medical Record could easily be filled with accounts
of unsanitary arrangements perpetrated by architects in
the past. I could testify to a good many from personal
observation. It is not all the fault of the "jerry-build-
ers." A West end mansion I frequently pass had the
soil-pipe imbedded in the wall of the dining-room, and
constructed of such thin lead that it gave way and caused
a leakage of sewage through the wall, which continued
for some time. When the cause was at last discovered,
the owner determined to do, what in fact should have
been done at first, viz., place all the drain-pipes outside
the building.
On Tuesday the conference was continued by the
reading of a paper by Dr. George Wilson on " Domestic
Sanitation of Rural Districts." Dr. Wilson quoted the
report of the agricultural commission of 1867, which
showed that one-third of the rural homes of England were
unfit to be used as dwellings, and that therefore 700,000
hovels ought to be pulled down. In many villages he
knew himself half the cottages contained only two sleep-
ing-rooms, and about ten per cent only one, and his dis-
trict (Warwickshire) was considered by the commission
better than many. He said the poverty of the owners
and the low wages earned by the occupiers were obstacles
to improvement. Dr. Wilson advocated for rural dis-
tricts the adoption of the ** pail system " or else ash-pit
closets.
Mr. Boulnois, civil engineer, then read a paper on
"Sanitary Houses for the Working Classes in Urban
Districts." He condemned the erection of huge blocks,
also basement rooms. Flat roofs were good for gardens
or drying grounds, also for escape in case of fire. He
urged the advantages of a constant water-supply.
On Wednesday, a paper on " Industrial Diseases " wai
read by Dr. Bristowe, F.RS., Physician to St Thomas'
Hospital, and Medical Officer of Health for CamberwelU
The causation and prevention of industrial diseases is
subject to which sanitarians have devoted a good deal
attention of late years, and Dr. Bristowe made the moi
of his subject in the limited time allotted him, dwelling ii
succession on the chief diseases caused or aggravated b;
different trades, and the modes of prevention that may U
adopted.
On Thursday an interesting paper was read by Dr
Thursfield on " The Spread of Infectious Diseases ihroug
the agency of Milk." Dr. Thursfield remarked on iU
great increase in the consumption of cow's milk both bj
adults and infants — in the latter case, through the unfoi
tunate increase in the number of women physically i
competent for lactation. It was presumable that in mai
cases of disease from milk, the source had not beei
suspected, but making allowance for doubtful cases,
thought it might be accepted as a fact that enteric ani
scarlet fevers had been repeatedly disseminated by mill
and there was also very strong evidence as to the spre:
of diphtheria through the same agency. He consider
July 5, 1884.]
THE MEDICAL RECORD.
25
that the boiling of milk practically conferred immunity
from infection. Dr. Thursfield enumerated the restric-
tions it was desirable to place on the sale of milk, and
observed that an urban sanitary authority should have
the power to stop the sale of milk sent from any particular
fami, pending investigations, but that there should be
liability for compensation if the step proved unnecessary.
In the discussion which followed the reading of the paper,
Dr. De Chaumont, professor of hygiene at Netley, as-
sented to the views expressed as to the frequent convey-
iDce of infectious diseases by milk, but stated that the
views received here did not find acceptance abroad, and
that some of his French and German friends looked on
the whole thing as a gigantic joke. Dr. Corfield read a
paper on " The Spread of Infectious Diseases through
other Agencies than Milk.'*
On Friday the " Notification of Infectious Diseases "
was discussed in two papers by Drs. Alfred Hill and Al-
fred Carpenter, respectively. Dr. Hill urged its impor-
tance as the only means by which news of an epidemic
could be obtained, and was of opinion that it should be
compulsory on all medical men to notify. Dr. Carpen-
ter considered notification a moral duty to the State,
and that it was the duty of the State to enforce it. The
duurman, Earl Fortescue, spoke of the danger of in-
fcrfering with cither personal liberty or the rights of
property, and in summing up the discussion which fol-
lowed the reading of the papers, as on previous days,
said he thought a case had been made out for notifica-
tion, but it appeared to him that the duty should be laid
on the householder rather than on the doctor. With this
opinion the bulk of the profession will concur. It is
mainly the professed sanitarians who wish to compel the
doctor to notify. Ordinary practitioners are against it.
It would no doubt be a great lightening of the labors of
medical officers of health, but at the expense of an in-
crease of worry and responsibility to the actual practi-
tioners. It is significant that out of about 120 medical
men at Brighton, 100 have petitioned against notification
being made compulsory in that town.
The subject for to-day is the " Disposal of the Dead,*'
OQ which Mr. Wynter Blyth, medical officer of health
for Marylebone, will read a paper. Mr. Eassie will fol-
lov with one on *^ Cremation," of which he is an advo-
cate.
SUCCESSFUL LOCAL APPLICATION OF ETHER
TO MUCOUS MEMBRANE OF BLADDER FOR
NEURALGIA OF THAT ORGAN.
To THX EsiTOft OP The licotou. Rboobd.
Sol : Apropos of etherization by the rectum, permit me
to mention another channel through which I have in-
trodnced ether into the economy. In two cases of severe
and obstinate neuralgia of the bladder, which had re-
si^ed morphine, belladonna, hyoscyamus, fomentations,
ia hct, almost everything recommended in the treatment
[o^d!i^ distressing affection, I injected into the bladder
ctber, gtt. X., in water, 3 ij. Any detailed account of the
cases your valuable time and space will not permit and,
<bcrefore, I can only add that within one minute the ether
was perceptible in the breath in both instances, and with-
in five minutes' time there was perfect relief from pain
viuch had been previously most severe. The conclusions
were verified a number of times.
The mucous coat of the bladder being non-absorbing,
8 some authorities claim, how could the ether pass so
qeickly into the circulation ? Has ether ever been used
in this manner before and what have been the results.
I have been unable to find a precedent for its use in the
iterature upon the subject.
Very respectfully,
19B Sbobgia Stibbt, Bvftalo.
John Parmenter, M.D.
Official List €f Changes in the Stations and DtUiss ef Officers
serving in the Medical Department^ United States Army^
from June 22 to June 28, 1884.
Clements, Bennett A., Major and Surgeon. Ordered
to relieve Major Jos. P. Wright, Surgeon, of his duties
as Attending Surgeon at the Leavenworth Military Prison,
Fort Leavenworth, Kansas. Major Wright, on being
relieved, ordered to report to the Commanding General
Department of Texas, for assignment to duty. S. O.
144, par. 7, A. G. O., June 21, 1884.
Dickson, John M., Captain and Assistant Surgeon,
assigned to duty as Post Surgeon, Alcatraz Island, Cali-
fornia. S. O. 71, par. 3, Headquarters Department of
California, June 19, 1884.
GiRARD, A. C, Captain and Assistant Surgeon. Grant-
ed leave of absence for six months, with permission to go
beyond sea, S. O. 148, par. 11, A. G. O., June 26,
1884.
Official List of Changes in the Medical Corps of the U. S.
Navy, during the week ending June 28, 1884.
Knight, J. S., Surgeon. Placed on Retired List
Whiting, R., Passed Assistant Surgeon. Detached
from U. S. S. Vermont, and ordered to Marine Rendez-
vous, New York.
Babin, H. J., Surgeon. Detached from Marine Ren-
dezvous, New York, and ordered to U. S. S. Minnesota.
Wells, H. M., Surgeon. Ordered for examination
preliminary to promotion.
LuMSDEN, G. P., Passed Assistant Surgeon. De-
tached from U. S. S. Pensacola and placed on waiting
orders.'
ptMicaX Items*
Contagious Diseases — ^Weekly Statement. — Re-
port of cases and deaths from contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the week ending June 28, 18S4 :
Week Ending
June 21, 1884..
June 28, 1884. .
June 21, 1884..
June 28, 1884..
I
130
186
I
The Validity of a Life Insurance Policy. — An
important insurance decision has recently been rendered
in the United States Supreme Court, sustaining the
validity of a policy although statements were made by
the insured which were not absolutely true. He was
asked among other questions whether he ever had had
asthma, scrofula, or consumption, and he answered no.
After his death it was found that he had one of these dis-
eases in an incipient form at the time of making this
answer, but was unaware of it himself. This condition
of the case was held to avoid the policy by the trial court
and an appeal was taken from the decision to the Supreme
Court, where it has just now been reversed. The latter
court stated that if the insured had no reason to believe
that he was afflicted with the disease at the time of mak-
ing the apphcation, he should not be precluded from the
advantages of the policy.
26
THE MEDICAL RECORD.
[July 5, 1884.
AcxiNOMYCOSis, — At the last meeting of the London
Pathological Society, Mr. Frederick Treves gave a further
account of his supposed case of actinomycosis. The dis-
ease began two years ago after erysipelas. It commenced
with a swelling over the lower jaw, on the left side, which
increased and was excised. The wound would not heal
and an ulcer remained. The glands at the back of the neck
then enlarged, and nodules appeared over the chest, about
thirty in all. As each nodule appeared under the skin
it developed a pustule ; ulceration and fungation fol-
lowed. Mr. Treves said that although no fungi were
found, and no communication with animals traceable, he
was inclined to call it actinomycosis, as Ponfick's de-
scription was so accurately realized. Mr. Treves re-
moved several of the nodules and the patient seemed to
do well, but a second operation was succeeded by great
weakness and the patient died in a month. Secondary
deposits, in the form of round yellowish nodules, were
found in the lung, liver, spleen, and kidney. Mr. Watson
Cheyne had examined the organs, but had been unable to
discover any micro-organisms or cultivate any micro-
parasites. The structure resembled alveolar sarcoma.
Clusters of cells were arranged in a plexiform manner
with some connective tissue. Mr. Treves remarked that
the suppuration of each nodule, soon after its appearance,
was remarkable, and so was the protracted character of
the malady. He considered that the diagnosis at times
lay between scrofula, cancer, farcy, and actinomycosis.
Mr. Hulke, who had seen the patient during life,
thought the case resembled farcy.
Mr. Watson Cheyne remarked that as the farcy organ-
ism could be easily cultivated, and cultivation experi-
ments had produced negative results, farcy might be ex-
cluded. He thought the case was one of carcinoma.
Mr. Treves remarked that the case was slower than one
of farcy.
Contagious Diseases Acts. — The total repeal of
the Contagious Diseases Acts is likely to be soon ac-
complished. Since the adverse vote of the House of
Commons last year the action of the compulsory clauses
has been suspended, and the Secretary for War now
proposes to bring in a bill for the abolition of the re-
maining provisions of the acts. There is good evidence
that venereal affections have increased during the last
year, and should the new bill pass, a further increase
may be expected. Public opinion, though, will not sup-
port the acts, and the accounts of how the French system
works have done a great deal to disgust every one with
all systems of compulsion.
Report of a Case of Multiple Pi^egnancy ; CiSSAR-
EAN Section. — The following interesting case was read
before the Montgomery County, O., Medical Society by
Dr. C. H. Humphreys, of Dayton, O., and created quite a
sensation : "The rarity of Caesarean section always lends
interest to every new case. I was recently the accouch-
eur on an occasion requiring its performance, and beg
leave, therefore, briefly to report it. On a Sunday even-
ing, some three weeks ago, a gendeman entered my of-
flce, and with some hesitation requested my attendance
upon the subject of this sketch in confinement, who was
a rather^handsome young primipara, unmarried, a native
of Massachusetts, and since last summer a resident of
this city. Labor began the night previous, and about 9
A.M. a living fcetus was bom without assistance. The
pains continued unabated, however, and toward evening
it was decided medical aid should be called. Upon arri-
val I made a vaginal examination and diagnosed multiple
pregnancy. As well as I could determine, the dystocia
was caused by a transverse presentation. The patient
showedj much exhaustion and was constantly changing
her position in bed. Version by external manipulation
was fairly tried, but this procedure proved an entire fail-
ure. I did not think introduction of my hand within the
uterus to perform version possible, and did not attempt
it. Her condition contra-indicated such violence. At
about 6 P.M., the patient's condition being unpromising,
and it being evident that something must be done without
delay, I determined in my dilemma to make at once
Caesarean section. Accordingly preparation was hastily
made, and the patient placed on an operating table. She
at first declined an anaesthetic, but Anally consented to
the use of ether, which acted well. Commencing near
the umbilicus, I made an incision about three inches
long in the median line and opened the abdominal
cavity. The uterus presenting, it was incised to corres-
pond. A dead foetus with membranes ruptured lay
transversely and was removed, the placenta separating
with but little hemorrhage. Two others were removed
with envelops entire, and each had separate placentae.
The umbilical cords were duly tied and cut, and efforts
at resuscitation made, which Anally were successful.
The uterine wound was closed by the continued suture
of fine silk. Some delay was caused by hemorrhage
from the divided uterine vessels, which finally was ar-
rested by hot water. The peritoneum was sponged clean
and dry with carbolized warm water, and the incision
closed by deep interrupted sutures of strong silk. No
dressings were applied. Duration of operation, about
thirty-five minutes. Before the question may be raised
as to whether this was a justifiable operation, permit me
to * let the cat out,' and confess that this patient was
only a cat ! And I might also here venture that the re-
sult of my operation ought to vindicate our profession
from the charge occasionally made against some of its
members with derision by some evil-minded laymen, that
*he cannot doctor a cat ! ' I have only to add that pussy
was carefully nursed by watchful little friends and made
a speedy recovery. The abdominal sutures were re-
moved a week afterward, and union was found to be
complete. The kittens that were * untimely ripped from
their mother's womb ' died of inanition within the week.
The first-born yet survives, however."
The Dram-Shop Act not Applicable to Druggists
IN Illinois. — A section of what is called the Dram-Shop
Act, passed not long since by the Illinois I^egislature,
provides for the filing of a bond for $3,000 by any sellers
of intoxicating liquors, and it has been a question
whether this applied to druggists who had permits to sell
for medicinal, chemical, and sacramental purposes. A
case of this sort was tried in Vermilion County, and
it was held that druggists were bound by the pro-
visions of the law like all other persons. An appeal was
taken, however, from this decision, and the Supreme
Court of Illinois has just reversed this decision, holding
that druggists are exempt from the bond. It was also
decided in the same case that where a village ordinance
prohibits the sale or giving away of intoxicating liquors
within the village limits, but allows druggists to sell for
purely medicinal, chemical, and sacramental purposes,
if there is no provision made for a written permit, that
the ordinance itself is a permit to all the druggists in the
village, and they will be protected in selling.
The Druggists and the Drug Appraisers. —
Charges have been preferred against the Appraiser's De-
partment of the Custom House in this city by a number
of firms importing dye-stuffs, drugs, and chemicals, charg-
ing that they are hampered and injured in their business
by the unjust discriminations of the officials. A memorial
has been prepared and sent to Congress in which the
importers say that charges of undervaluation are contin-
ually made against their invoices, which charges have
been shown to be baseless, and that as a result they are
injured in business and reputation. The memorial states
" that while canying on their said business, and in all re-
spects, as they believe, complying with the laws, they are
continually obstructed,jhindered, delayed, and embarrassed
in their efforts to get possession of their goods after they
have passed into the hands of the customs authorities at
this port, and that such delays and hindrances amount to
a serious interference with business, causing much loss
July 5, 1884-]
THE MEDICAL RECORD.
27
and damage. . . . That it frequently happens that
goods needed for speedy delivery are held for one, two,
or diree months, so that in many cases the importer is
prcrented from delivering to purchasers according to
contract, and is often in this way subjected to heavy loss.
That the undersigned have not only been subjected to
the delays and annoyances aforesaid, but damaging re-
ports of fraudulent undervaluations have been invented
and circulated concerning persons in their trade and busi-
ness ; that such reports, though often indefinite and vague,
junount to an imputation of fraud, and wrongfully and
unjustly throw suspicion on the business and transactions
of the undersigned and others, and that such charges are
made by United States officers, and have appeared and
been published in their official reports." The memorial
concludes by requesting that an investigation be had into
the whole matter, under the direction of Congress. The
following firms are the signers of the document : W. M.
Pickardt & Kuttroff, 98 Liberty Street ; F. Bredt & Co.,
26 Mun^y Street ; Lutz & Morius, 15 Warren Street ; J.
C. Bloomfield & Co., 1 1 Dey Street ; Leisel & Halbach ;
W.J. Matheson & Co., 20 Cedar Street ; Geisenheimer &
Co., 22 Liberty Street; E. Selbach & Co., 48 Cedar
Street; Schulze, Berge & Koeck, and Baumig, Bissell &
Co., 22 Dey Street. It is thought probable that an in-
vestigation will be ordered.
"A Good Gen£Rall Rule of Physvke." — Some one
has hunted up from an old book called " Hundred Mery
Talys" the following interesting prescription: "A cer-
tijn artificer in LondA there was, whyche was sore seke
and coulde not well dysgest his meat. To whom a
phjsicion cam to give hym councell, and sayd that he
mustvse to ete metis that be lyght of digestyon and
small byrdys, as sparowes, swalowes, and specyally that
bjrd which is called a wagtayle, whose flessh is meruelouse
lyght of digestyon, bycause that byrd is euer mouying
and styryng. The seke man, herynge the phesicion say
so, answered bym and seyd : * sir, yf that be the cause
that those byrds be lyght of dygestyon, then I know a
mete moch lyghter of dygestyon than other sparow,
swallow, or wagtaile, and that is my wyues tong, for it is
oeaer in rest, but euer meuying and sterryng.' By this
tale ye may leme a good generall rule of physyke."
A French Compliment for Richmond. — A Dr.
Bougarel, who states that he was for four years in charge
of the pest-house in Richmond, Va., sends to Z^ Con-
C9itrs Medical a very pleasing account of the state of
mescal education in that city. There are, he says, one
medical college and two hospitals, one for the blacks
and (me for the whites, but the medical students never set
ibot in the hospitals, gaining their practical knowledge
in a college clinic. At the end of two years (the writer
might have added of five or six months each) these
3«mg gentlemen start out armed with the diploma of
doctor, written in Latin, with the Hippocratic oath printed
adie back. Two of these doctors are assigned to ser-
m in the hospitals, and there, under the eye of the
cftief surgeon, they undertake the most hstzardous opera-
tHBis. They do not appear to be very successful, how-
ever, for the veracious writer states that almost all the
patieDts die, adding by way of explanation that '' human
life counts for less than nothing in America." Those
iho survive the operation are by no means out of the
woods, for they are then turned over to the tender mer-
cies of the nurses, who apply the dressings in a most ele-
mentary way without observing the least precautions.
The doctors in the meanwhile are walking about town with
Aeir hands in their pockets. They do, however, as a
matter of form, visit the wards once a day, sometimes in
tut morning, sometimes in the evening, as suits their
ODnvenience. But in Philadelphia, Dr. Bougarel con-
tinues, medical education is even more simple. The
candidate begins by paying down twenty-five dollars, un-
dergoes a very superficial examination, and leaves the
college fortified with a diploma, in virtue of which
he may henceforth assassinate with impunity those whom
his attainments attract to him. The writer closes with
the assurance that his readers may rely absolutely upon
his statements, for he has cited only such facts as he has
himself observed. Notwithstanding the outrageous ex-
aggeration of Dr. Bougarel* s letter, it must be confessed
that his account rests upon some foundation of truth, at
least of what was truth at the time of which he writes.
A New Method in Adherent Placenta. — Dr. W.
W. Jaggard writes to the Chicago Medical Journal :
"The New York Medical Record, May 17, 1884, alludes
to a report in the Clinique, by Dr. J. Feld, of Kansas
City, on * A New Method in Adherent Placenta.' In
six cases of adherent placenta, the life of the woman was
saved by pumping cold water through the umbilical cord.
Although The Record is in error in its denomination of
the method as a new one, it deserves credit for calling
attention to a very old and very excellent procedure.
The injection of cold water into the umbilical vein in
post-partum hemorrhage and adherent placenta was ably
advocated and extensively practised by Mojon (1826),
Kilian, and others. The umbilical vein is divided trans-
versely, a tube or quill fastened securely in the proximal
extremity, and cold water injected, slowly and carefully,
into the placenta, by means of an ordinary syringe. The
cold water, forcing its way into the placenta, distends
that organ to twice its original volume, escaping through
the lacerated utero-placental vessels, bathes the endome-
trium, and stimulates the uterus to powerful contractions,
usually resulting in the total separation and spontaneous
expulsion of the after-birth. Stoltz and Rombach (1855)
have extolled most highly this measure, while Lin^ard
(1875) claimed that the injection of 150 grammes of pure
cold water into the umbilical vein was *the best, most
reliable, and least dangerous expedient in all cases of
postpartum hemorrhage or adherent placenta.' At
present this method is extensively practised in Germany,
more particularly in Bavaria. Scanzoni, in Wurzburg,
practises this method exclusively."
Medicine and Medical Men in Denmark. — The
coming meeting of the International Medical Con-
gress, to be held in Copenhagen, makes Denmark just
now a point of professional interest. The Lancet is
publishing a series of letters relative to this question,
from one of which we extract the following : " In propor-
tion to the population of Denmark, the number of Dan-
ish medical men is large, as is the case in almost every
country. In the city of Copenhagen, where the inhabit-
ants number some two hundred and fifty thousand, there
are more than three hundred and fifty doctors, of whom
about two hundred and fifty are general practitioners,
the remainder being mostly either young medical men in
the hospitals or elderly gentlemen who have retired from
practice. There is no difference made between surgeons
and physicians, inasmuch as all have to pass the same
examination at the University, and this gives the whole
profession a uniformity which does not exist in England.
With the exception of a few specialists and surgeons,
the majority of medical men are general practitioners,
and it is customary for each household to have its own
doctor, who, in return for his services, receives a fixed
annual fee varying in amount according to the means of
the family. This arrangement is attended with its ad-
vantages and disadvantages, but is generally thought
satisfactory to both parties concerned. It tends to
make the incomes of the medical men more fixed and
permanent, and it affords the patient the opportunity of
calling in his doctor for what may be either serious or
trifiing complaints. As an illustration of this latter,
there is a trustworthy story of an elderly lady sending
for her doctor late at night because she was troubled in
her mind as to whether it would be prudent for her to
eat a baked apple the first thing in the morning. In
Denmark medical men hardly ever attend normal deliv-
eries. These cases are left entirely to midwives, who
28
THE MEDICAL RECORD.
[July 5, 1884.
have to attend a midwifery school at the Lying-in Hos-
pital for the greater portion of a year, and then to pass
an examination previous to being allowed to practise.
Of late, however, there has been a movement in the
medical profession in favor of general practitioners un-
dertaking these cases, though as yet the movement has
not met with much success. A change which would
probably meet with most approval would be for educated
ladies, qualified as mid wives, to undertake these cases.
At present their number is small. The social position
of members of the Danish medical profession is almost
the same as in England, excepting that there are very
few who have large incomes from their practice. Fees,
as in England, are here considered only a pium disider-
aium, and are as a rule much smaller. Consequently a
man with an average income is only tolerably well off,
but as wealth is more equally divided in Denmark than
in England, a small income has not the same signifi-
cance. While one meets with few millionaires, but few
paupers are to^be seen. One observes in the streets of
Copenhagen nothing approaching the luxury in the out-
ward appearance of life which prevails in England, but
at the same time one does not encounter rags and
misery, and such a thing as death from absolute starva-
tion has hardly ever been heard of. The result of this
financial equality is that money has not the same im-
portance attached to it as in England, consequently that
perpetual struggle to keep up appearances (an expres-
sion which does not exist in the Danish language) is
unknown here, a man's education rather than his ac-
count at his banker's forming his passport into social
circles. There exists a good understanding between the
Danish medical profession and the general public. One
very seldom hears of a medical man being judicially
accused of faults in treatment, and a fine in such cases
is almost unknown. Such a thing would be ruin to any
practitioner, as his case would soon be public property
in a small country like Denmark. There is, too, a de-
cidedly good feeling among the members of the profes-
sion themselves, at least in Copenhagen. There are,
however, very few medical societies and clubs, partly
owing to the fact that clubs do not flourish in this
country, and partly because medical men, being chiefly
practitioners, have very little time to spend outside their
homes. This is also the reason why there are compara-
tively few Danish medical authors.*'
A Fine Opening. — The following instructive an-
nouncement appeared in the columns of the Wiener
Medicinische Zeitung. It may throw some light on the
Austrian social system : " To Physicians :- A young single
medical doctor, who by means of matrimony, and the as-
suming of an important and lucrative dental practice, is
inclined to found a very agreeable existence, is hereby
given an opportunity. A yearly income of 10,000 guldens
can be shown. The young lady concerned is the daugh
ter of very respectable parents, seventeen years of age,
beautiful, well-bred, and correspondingly educated. The
father wishes to retire from business, and will deliver to
the young doctor a dental practice, dwelling beautifully
furnished, together with material, dental tools, and in-
struments to the value of 8,000 or 10,000 guldens en-
tirely gratis. Dental knowledge is not necessary for the
beginning, since this can be acquired in the course of a
few months, under the instruction of the present possessor.
Applicants address *Zahnarzt,' care Editor Allgem.
Wiener Med, Zeitung^
Cremation and Burial in London. — Cremation is
regarded with but little favor by the London official
mind. Two furnaces have already been built under the
auspices of the Cremation Society, and as Mr. Justice
Stephen has declared from the bench that the practice is
not illegal, more are shortly to be constructed. But at
South Kensington the cremationists have been refused a
stall at the forthcoming Health Exhibition. The chair-
man of the Health Committee does not approve of it.
May we live to see him cremated ! (after death), says
the Pall Mall Gazette, The latest reverse sustained by
the votaries of "ashes" is the decisive negative given by
Parliament to the Cremation bill. This bill proposed to
regulate cremation and place it under proper restric-
tions, but the second reading was negatived by nearly
two to one. Our present method of burial is insanitary
in the manner usually adopted. Many of our metropol-
itan cemeteries are in the centre of crowded districts —
even those of modern creation. Brompton Cemetery,
for instance, is now surrounded by houses on all sides,
and is the centre of a densely populated" district. It
needs no very lively imagination to picture the possible
— nay, probable — effect upon the dwellers in the vicinity.
It has been shown, too, by some very loathsome practical
experiments, that under certain conditions the human
body is not completely disintegrated and resolved into
dust for a good many decades. About five or six years
ago a very ancient city burying-ground, Bunhill Fields,
the place where John Bunyan lies interred, was sold (!)
to a well-known firm of London carriers, who obtained
permission to build stables over it and remove such
bodies as they found necessary, they engaging to re-inter
them elsewhere. In sinking the piles whereon to erect
their buildings, they came across and removed a large
number of corpses. Decomposition had, of course, com-
menced, and the effluvia was overpowering, but some
bodies were scarcely disintegrated at all and presented
an almost fresh appearance. A Urge number of bodies
were carried away as dug up j'they were carried on
men's backs, who were plied with brandy ad libitum.
The details may be mentally realized without much de-
scription, and the danger to health is obvious. This affair
was hushed up as much as possible, and I believe no
notice of it appeared in the public press at the time. I
have known other instances of graveyards being dis-
turbed, to the danger of the living and the desecration of
the dead. It is not lon^ since it was proposed to as-
phalt over an East-end disused graveyard and then build
on it. Nearly all our large railway lines run through one
or more churchyards, and many public buildings in Lon-
don have been literally founded on the tombs of our an-
cestors. The National Gallery is one. Some of these
evils would doubtless be removed if "burning" became
common, but it is plain that even from a scientific point
of view it is not quite free from objection. It hides all
trace of poison and other modes of violent death, and
renders a subsequent '^ exhumation " impossible. It is
legal now, and it is thus a pity the bill restricting its prac-
tice did not pass»^^
Treatment of Angeiomatous Growths. — Dr. H.
O. Marcy writes in the Archives of Pediatrics for May,
1884, describing a method used by him for the removal
of naevi. He states that he has for a considerable time
employed in the treatment of a variety of vascular
growths a suture which he calls " the shoemaker's stitch."
The eye of the needle is placed near the point which is
without cutting edges. Armed with the ligature the
needle, which is set in a strong handle, is thrust deeply
under and quite away from the vascular growth ; emerged
from the distal side the ligature is detached and the
opposite end threaded, when it is withdrawn and again
inserted purposely only a short distance from the first
puncture, since it is important to include only a com-
paratively small portion of tissue. Thus the process is
repeated, stitch after stitch, until the entire mass is en-
closed and the fixation is completed by a single knot.
In this way uniform and steady pressure can be attained
and maintained as long as is desired. The purpose ol
the procedure is not to strangulate and cause necrosis
of the tissue, but to constrict so as to reduce to the
minimum the circulation and yet preserve its integjrity
The author claims by this method the avoidance of th<
unsightly cicatrices sometimes resulting from the cure o
angeiomatous growths.
The Medical Reci^j^^
-^ Weekly yournal of Medicine and Surgery
Vol. 26, No. a
New York, July 12, 1884
Whole No. 714
©rigitml %xXit\it^.
SOME REMARKS ON AFFECTIONS OF THE
HEART.
BT J. MILNER FOTHERGILL, M.D. Edin., Hon. M.D.
Rush Mkd. Coll., III.
Ajsocun PKLLow or the collsgb or fhysictans op fhiladklphia, physician
TO TKB OTY OT LONDON HOSPITAL POK CXSKASBS OP THB CHEST.
II.
VALVULITIS,
Thx ordinal^ impression about valvular disease of the
lieart is that it is a morbid action which, once set on foot,
marches steadily and resistlessly onward, the valve mis-
chief getting worse and worse and consequently making
fiirther and further demands for compensatory hypertro-
{diy until the S3rstem fails to meet the demand, and then
the patient dies ; and, what is more, that this is a com-
paratively speedy affair. Such possibly is correct from
the point of view of the dead-house, and is borne out by
mf remembrance of the Pathological Institute of Vienna,
bat is very far from what experience of practice in Eng-
land tells me. That such cases do occur from time to
time may not be denied, and a marked instance came
1 nnder my notice rather more than a year ago. The pa-
tient was an athletic man, about thirty, of good family
history, who was playing cricket in September, 1882, and
iho died with valvular disease, both aortic and mitral,
die latter the more pronounced, and effusion into every
yBXK& cavity, in the middle of January, 1883. Here the
pcopess was terribly swift. I can also remember a case
in isy father's practice, where rheumatic fever was fol-
ftwed by mitral disease, and the patient, an elderly man,
ded with dropsy in about eighteen months from his first
betDg taken ilL But I unhesiutingly deny that such
cases are the rule, or even common ; in fact, they are
rare— in my experience.
This, indeed, is valvulitis as seen in the dead-house,
lod spoken of by pathologists ; but it is not the valvu-
libs of those who live, crippled indeed, but still alive and
often at work. The prognosis of valvular disease is very
dfeent now from what it was held to be among earlier
observers. That cases running their course swiftly made
ie deepest impression on these pioneers is comprehen-
Ue enough. But there is, I rejoice to say, another side
Id the question, and that side will now be presented to
Ie reader.
There are two forms of valvulitis which must be clearly
iferentiated from each other in order to comprehend
Ie subject properly. There is (i) acute valvulitis; and
(1) chronic valvulitis.
(i) Acute valvulitis. — This may be the result of rheu-
irtic fever, to a lesser extent of scarlatina or other mal-
ilf of early life, or it^ may be set up by violent effort,
Hbe possibly rheumatic.
Here there is an inflammatory storm which passes
*er the serous lining of the interior of the heart. Be-
kath this inflamed serous membrane there is a develop-
lent of connective-tissue corpuscles into the structures
Bderoeath the endocardium. In the valve-curtains, in
ke chordae tendinae, in the musculi papillares, there is a
pnrth of soft young cells. The inflammatory storm
pees away, but the soft young cells remain ; and pos-
KKix^, as they do, an inherent tendency to contract in
no long time, they shrivel up, and then distortion and mu-
tilation of the parts in which they exist follows. The
valve-curtains are shrivelled, may be dragged down to
the stumps of the musculi papillares by contraction of
the tendinous cords ; or they are fused together, and the
mitral valve is converted into a fleshy cone with a
perforation down it, extending into the left ventricle.
Such is the ruin wrought in the mitral valve by this de-
forming process. In the aortic cusps there is drivelling
of the free edges, one or more being mutilated, and that
more or less severely as the case may be. But once the
mischief done, it remains, like the cicatrix of a bum,
static and non-progressive. A certain damage is done to
the valve-curtains which cannot be undone, and which,
as we saw in the preceding article, is compensated (so far
as the powers of the system will permit) by a proportion-
ate growth of the wall of the muscular chamber behind the
lesion.
This is valvular disease of the heart, as it has presented
itself clinically in my experience. As a malady of child-
hood it is infinitely commoner in little girls than little
boys. Some die of dropsy about puberty, others live on.
In one instance I have personally watched the case from
about the age of eight till the girl is now twenty-six years
old, a village schoolmistress, who gets through her duries
without discomfort, but is short of breath on effort, as
dancing, and who, when out of health, is apt to have
some oedema about her ankles. In another case a peas-
ant had rheumaric fever under my father, with mitral re-
gurgitation, about twenty-eight years ago. He suffered
at times from severe pulmonary congestion and spat
blood, and was once, indeed, gravely ill under my care
eighteen years ago. At that time he had to work for a
living, but, fortunately for .him, he got some money left
him, which enabled him to live without toil, and since
then he has never been seriously ill, only scant of breath.
He is a hale, cheerful old man. He writes me at the
present time : •* I don't think I suffer so much from my
heart as I did some years ago, but my breathing don't
improve with old age." In a third case, that of a well-
known authoress, she made severe efforts abotit fourteen
years ago which resulted in acute valvulitis, leaving behind
it a distinct mitral regurgitation, which makes itself felt
only on effort. While she is at her desk she is well. She is
married and has had children, but her literary work goes on.
So much for mitral cases. A distinguished artist
has had aortic regurgitation for ten years. The lesion
is a moderate one and the ventricular enlargement is not
immense ; he leads a quiet life, and is not measurably
worse during the last six years. Some time ago a patient
came to me for a malady in no way connected with his
heart, who had distinct aortic regurgitation. It was a
small lesion, the hypertrophy was not great, and he had
worked hard as a solicitor all the time since it was set on
foot, seventeen years previously. A doctor-patient of
mine had a considerable aortic regurgitation, dating back
to the time when he was a memcal student under the
famous Stokes, of Dublin, and who for over thirty years
had worked hard in practice — often, indeed, being at
death's door — ^but in whom the valve lesion was as static
as the Dead Sea. Such are some of the aortic cases
which have come under my notice. Of aortic obstruc-
tions it is unnecessary to speak ; they very commonly
run on for years, into the teens, indeed, in several cases
known to me. This is the other side of the question —
the clinical as compared to the dead-house aspect !
30
THE MEDICAL RECORD.
[July 12, 1884
(2) Chronic valvulitis, — ^This is a totally different mal-
ady. It is a slow progressive disease as a rule, sometimes
not very slow. It is otherwise known as sclerosing endo-
carditis. It consists of a parenchymatous inflammation,
or cell-growth into the valve-curtains, and earthy salts
may be deposited in the neoplasm when the condition
spoken of as ossification of the valves is found. At other
times atheromatous tubercles are found springing from
the surface of the affected valves. Here there is, speak-
ing broadly, usualljr an hypertrophied ventricle and hard
arteries, with firm, mcompressible pulse and a loud aortic
second sound. In other words there is " the gouty heart. "
There is a high blood-pressure in the arteries, the ven-
tricle overcomes this by hypertrophic growth, and by the
powerful contraction of the ventricle the mitral valves
are closed violently and so become chronically inflamed,
or the aortic cusps undergo strain from the powerful
aortic recoil, and a cell-growth is instituted in them.
This form of valvulitis is essentially progressive, though
the rate of progress is by no means the same in each
case. The muscular changes which have preceded the
valvulitis must be entertained in these cases, as well as
what may have followed. A number of such cases have
passed under my observation, from the pre-murmuric
stage of accentuation of the aortic second sound to the
gradual development of an unmistakable murmur, and
the other evidences of a valvular lesion. In one case
death followed within eighteen months of the time when
no murmur was to be heard, and was due to aortic valvu-
litis. The course is usually not so swift. For four or
five years a number of such cases have been under ob-
servation, but all are marching to the grave at a measur-
able rate. Mitral valvulitis in the gouty heart does not,
I am inclined to think, progress so quickly as is the case
with aortic valvulitis, at least usually. In one case, an
old medical man over ninety, there was mitral stenosis
which ran a course of about three years, so far as is
known, accompanied by severe angina pectoris.
There is, then, a totally different prognosis, as there is
a totally different pathological action at work, in cases of
progressive valvulitis to what there is with the static in-
jury left by an acute endocardial inflammation. And
it is therefore a matter of the greatest moment to dis-
criminate which affection it is before one in any given
case.
Then there is true gouty inflammation of the valves of
the heart, well described long ago by James Wardrop.
This is usually the progressive valvulitis just described,
but cases do crop up where the process is rather that of
the acute articular gout followed by a period of quies-
cence. Of this last I have not had sufficient experience
to speak very confidently.
Of ulcerative endocarditis my experience is limited
There is a persistent high temperature with the develop-
ment of a murmur ; and the case runs its course with
painfiil celerity.
These two last forms will be put aside in the following
remarks, which are confined to the usual forms of val-
vulitis commonly encountered in practice, viz.: the static
injury, and the progressive or sclerosing valvtditis.
Having determined from the murmur the seat of the
valvular lesion, according to the rules l«i^down in our
text-books, it is not well, in my opinion,'s^o assume
straight away that you have to deal with a pit^essing
valvulitis which will soon exhaust the power 0< the
organism to keep pace with it by compensatory hyp^cr-
trophy of the muscular tissue. That such is at times th;R
case is indisputable. Having decided that there is a real
lesion there are some other points to be ascertained.
The first is the character of the valvular mischief ;
whether the case is one of by-past injury without any
tendency to progress, or is of the progressive type. This
the history of the case will usually determine. If the pa-
tient has been scant of breath on exertion for years, then
probably the lesion is old. Perhaps the dyspnoea on
effort dates fi-om some comparatively recent illness, may
be rheumatic fever ; or if an elderly person with a mitral
lesion, from an attack of bronchitis. If, however, on
the other hand, the patient complains that recently the
breath has been found to be getting short, and the
murmur has got the wonted concomitants of the gouty
heart, probably the mischief is a progressive valvulitis.
Not only your prognosis, but your treatment will be
materially influenced by the character of the lesion.
The second is its extent. Have you a large or a small
lesion to deal with ? The amount of injury inflicted
varies with different cases. A mitral lesion may be so
small as only to make itself felt on considerable effort ;
or it may be such as to necessitate a light occupation ;
or it may be so great that the individu^ is reduced to
the condition of a human lizard, incapable of active
movement. Such a case I have in the hospital at present
in a girl of fourteen. Her injected cheeks, her blue lips,
her hurried respiration alike tell of a large mitral lesion.
The congestion of the pulmonic circulation, the diminu*
tion of the thoracic space, and consequently the neces-
sity for rapid inspiration, tell far more as to the extent
of a mitral lesion than does the character of the
murmur. Eloquent as to the presence of mischief^ the
murmur is voiceless as to its extent. That must be
measured by other evidence than that furnished by the
stethoscope. Then there is the associated condition of
the muscular wall A small lesion (no matter whether
its murmur be small or loud) only calls for moderate
hypertrophy; and if in aortic regurgitation you find
little (that is, comparatively little) ventricular enlargement
you may feel pretty certain you have only a small lesion
before you. That small lesion may become a large one ;
and, if so, the enlargement of the ventricle will tell you
very distinctly of the progress of the valvulitis, and the
amount of deformity it is producing. The aortic val-
vulitis due to strain progresses at a very different rate
in the university oarsman, who gives up his athletics
and settles down as a parish priest, married and sedate,
to that exhibited in the case of a boatman who must
work hard to live. Where strain is continuously thrown
upon the parts, the progress from bad to worse is rapid.
Where a quiet life is led, the valvulitis seems to come to
a standstill As a broad rule, then, it may be laid down
that in aortic disease the size of the left ventricle is the
best guide to the extent of the disease. And another
broad rule may be laid down alongside this, viz.: the
greater the enlargement the sooner the compensatisg
hypertrophy will be exhausted ; the smaller the hyper-
trophy the longer it can be maintained Consequently
the prospects in a small lesion, if static, are infinitely
better than in those cases where die lesion is a lai^e one.
Beyond these matters lies the question of the condition
of the muscular fibrillae, whether well-fed, ill-led, or the
subjects of fatty degeneration.
When a patient presents himself or herself before a
medical man, complaining of symptoms which point to a
valvular lesion, and such is actually found, it does not
necessarily follow that there is any marked change going
on in the valvular mischief. This may be the case, but
by no means necessarily so. The valve-injury may date
back for years, but it is only recently that the patient has
felt worse than usual. It is failure in the muscular wall I
There has been sustained over-demand upon the heart ;
or there is a history of defective nutrition, or a mixture
of both. Commonly it is found that the necessity for toil
has made the patient persevere with it, disregarding the
uncomfortable sensations until these last become supreme,
and he must hie to the doctor. Or times have been bad,
work slack, and wages small, and then the underfed con-
dition reveals itself in loss oif vigor in the restless, ever-
wocking heart Here it is enough to lessen the demand
upon the heart, to provide a sufficiency of nutritive food,
and brace up the heart-muscle by agents which increase
the vigor of its contractions, and the case does well. The
heart improves till its owner can once more work. Or
maybe the digestion is upset, and the assimilation of al«
July 12, 1884.]
THE MEDICAL RECORD.
31
buminoidd is defective, or their further elaboration by the
[iver is impaired by some disturbance of that viscus, and
then tbe heart and diaphragm are alike underfed, and then
the symptoms of fiatty degeneration are closely simulated.
And such is the explanation of many a sudden break-
down in a heart, the seat of an old-standing, non pro-
gressive valvular lesion. Here attention to the liver is
requisite for sufficient tissue-nutrition. In other cases
there are not merely the symptoms of fatty degeneration,
bat other evidences of tissue-decay are furnished (a mat-
ter which will be considered in the next article), and there
ensts no reasonable doubt that mural decay is on foot,
resistless and irremediable. When assured that such is
the case, no prognosis can be too dark.
In dealing with a valvular lesion there are to be con-
sidered (i) its site; (2) its pathological nature; (3) its
extent ; and (4) the associated condition of the muscular
walls; not only diagnostically but prognostically and
thenpeutically.
What lessons in practice does pathology teach us as to
the treatment of valvulitis P It tells us that while the
inflammatory storm is sweeping over the endocardium
tbe most perfect rest is desirable. Yes ; but its study
tells us more ! It tells us that so long as there is any
cell-^wth going on underneath that endocardium, per-
fect rest should be maintained. The less the develop-
ment of the connective-tissue corpuscles, the smaller the
ultimate deformity caused by their inevitable contraction.
To limit the cell-growth is to bound the resultant lesion.
So clear is this, that no roll of statistics is required to
prove it Perfect rest in the recumbent posture, the sys-
tem calmed, and the blood-pressure lowered by chloral if
necessary.
Such is the rational treatment of a case of acute val-
vulitis until there is a reasonable assurance that the day
of the development of connective-tissue corpuscles is
pt and over. Limit the lesion first 1 When the injury
is done, the process of mutilation over, then, and not till
then, please, comes the time to help the system to build
up the necessary compensatory hypertrophy. The first
line has to be inexorably maintained until the valvulitis
is or has been brought to a standstill. To get a patient
who has been the victim of endocardial inflammation to
make one unnecessary effort, is to drive a nail into his
coffin. In progressive valvulitis quiet is desirable so as
to avoid strain on the diseased valves. In both cases
d^italisy which increases the strain on the valves, is con-
ba^indicated in tbe true interests of the patient until
heart-fiulure sets in. When a gouty element is present in
chronic valvulitis, then a non-nitrogenous dietary and
Qii&acid solvents are distinctly indicated.
I
VaCHOW UPON THE ChOLKRA AND TUBERCLE Ba-
cnius.— At the time of the return to Berlin and public
recepdon of the Cholera Commission, Professor Virchow
nade a speech, in which he uttered some timely words
flfnming. He said : "It appears to me that the
Goremment is not entirely free from the opinion that
with &e discovery of the bacillus everything is accom-
plished which may be necessary to control the disease.
Id this connection I may speak a warning word. It is
norc than thirty years since we discovered the little
ngviism which causes the small-pox, but this fact has
not changed in the least the practical measures pre-
nously adopted for its prevention. The tubercle baciU
bs 18 a very important thing, but with the exception of a
new point of view of the disease, which is given, we are
no farther advanced in our practical relations to it." He
then goes on to say that the cholera has for some time
ban practically treated as though it were caused by a
J«cial organism. He also referred to the laxity of the
&giish in the matter of quarantine.
Hiccough. — A sure cure for hiccough is a pinch of snuflf,
warding to Dr. P. F. Ellis, in the Texas Courier-Record.
MANACA IN THE TREATMENT OF RHEU-
MATISM.
Report of Fourteen Cases.
By C. M. CAULDWELL, M.D.,
VISITING PHYSiaAN TO ST. JOSBPH^S HOSPITAL, NBW YORK.
During the past year I have used the fluid extract of
manaca in the treatment of thirty-five cases of rheuma-
tism, and have come to regard it as a valuable remedy
in certain forms of this disease. The drug was first
brought to my notice by Dr. John H. Ripley, who had
prescribed it, in private practice, with very satisfactory
results.
As the information to be gathered concerning the ac-
tion of the drug was rather indefinite, it was decided to
note its effect upon persons in health, before commenc-
ing its use in disease. Accordingly, two healthy men
were given twenty drops of the fluid extract, five times
daily for one week. The only appreciable effect was an
increase in appetite and a slight *' valerian-like " odor of
the urine ; otherwise this secretion remained unchanged.
The pulse and temperature were unaffected, and no ab-
normal sensations were produced.
The drug was now prescribed for patients suffering
with various forms of rheumatism. My cases differed
widely in occupation, habits, and social position — some
being private patients, some inmates of St. Joseph's
Hospital, while others were treated at the New York
Polyclinic The ages ranged between eleven and fifty-
eight years. The sexes were about equally represented.
The dose of the fluid extract — which was that prepared
by Parke, Davis & Co. — was from half a drachm to
three drachms a day. In no case did the drug disturb
the digestion, while in several instances the tongue
cleared and the appetite improved during its administra-
tion. In about one-eighth of the cases frontal headache
or a sense of fulness in the head developed after the
medicine had been pushed for several days.
Manaca was used in but two cases of acute articular
rheumatism with high temperature ; in both it absolutely
failed to relieve the pain or modify the fever.
In cases of chronic rheumatism it frequently gave re-
lief, and in a few instances all rheumatic symptoms
slowly disappeared. In this class of patients my results
would probably have been better had the dose been
larger, as Dr. W. S. Gottheil reports (in The Medical
Record of September 8, 1883) seven successes out of
twelve chronic cases, all having been treated with large
doses of the drug. The doctor usually gave six drachms
of the fluid extract per day, and occasionally as much as
an ounce and a half in twenty-four hours.
By far the most satisfactory results, in my experience,
were obtained in cases of subacute rheumatism, in which
there was little or no rise in temperature. Fourteef
patients suffering with this form of the disease were
treated. Twelve recovered and two received no benefit
whatever.
The following are histories of the cases of this class :
Case I. Rheumatism of six week^ duration ; recov--
ery in one week; two relapses. — R. J , twenty-one
years of age, plumber, applied for treatment February
13th, stating that for six weeks he had been unable to
work on account of rheumatism in all the larger joints.
This was his first attack of the disease. The knees were
the original joints involved, but the pain and swelling
had constantly shifted from one articulation to another,
at the same time increasing in severity, so that now it
was diflicult for him to walk even a short distance. Ex-
amination showed moderate redness, swelling and tender-
ness of the ankles, left knee, and right elbow. The pa-
tient's general condition was exceUent. Temperature,
loof^. No cardiac complication present. Manaca
given in twenty-drop doses four times a day.
February 14th. — Considerable improvement has taken
place. Both swelling and redness are rapidly diminish-
ing. Continue treatment.
32
THE MEDICAL RECORD.
[July 12, 1884.
February 19th.— ^The patient expresses himself as per-
fectly well, being entirely free from rheumatic symptoms.
Ordered to continue manaca in connection with tincture
of iron for ten days longer.
Febniary 28th. — Patient returns, complaining of the
same trouble, which came on yesterday while working in
a newly plastered room. His ankles and left knee are
red, hot, and swollen. He has taken no medicine since
last seen, as he considered it unnecessary ** to drug him-
self when hi was well.*' Manaca ordered as before.
March 5th. — All symptoms have again subsided, and
the patient is at work. He refuses to continue treat-
ment, as he holds that " medicine is for the sick, not
the well."
April 2d. — He has remained in perfect health up to
two days ago, when the old enemy again attacked the
ankles and knees. These joints are swollen and tender
to-day. Manaca as formerly.
April 4th. — Rheumatism has subsided, and the young
man is now willing to continue any medicine prescribed.
Manaca and iron tincture are to be kept up for two
weeks.
May I St. — There has been no further relapse.
Case II. /Rheumatism of thirty -six hours' duration;
recovery in one week, — R. E. C , aged thirty-three ;
actress. Patient was first seen February nth, and had
then been in bed for thirty-six hours, suffering with an
attack of rheumatism, which had involved in rapid suc-
cession the left shoulder, elbow, both wrists and ankles.
The joints of the upper extremities were swollen, hot,
and exceedingly tender. Temperature, 101°. The pa-
tient was thin, anaemic, and in very poor general condi-
tion. Considerable cardiac hypertrophy and a well-
marked mitral regurgitant murmur were noted. Thirteen
years before she had " rheumatic fever with rheumatism
of the heart," confining her to bed for about two months.
Since had often had mild attacks of the articular affec-
tion. Cardiac palpitation had at times been trouble^
some. A saline laxative, to be followed by twenty drops
of manaca, i\y^ times daily, was ordered, and the afifected
joints wrapped in cotton.
February 14th. — The patient has been very comforta-
ble for twenty-four hours, and rheumatic symptoms are
rapidly subsiding. The temperature is normal. Treat-
ment continued.
February 1 8 th. — Recovery is complete. Manaca and
iron tincture are to be continued for two weeks.
March 15th. — There has been no relapse.
Case III. Rheumatism of three week^ standing ;
recovery within a week; relapse, — M. W , aged
twenty -five ; porter. Patient came under observation
February 19th. He had then been unable to attend to
business for three weeks on account of rheumatic pains
and stiffness in knees, elbows, ankles, and wrists. For
two days the right knee had been red, swollen, and
somewhat tender ; a week previous the elbows were in
the same condition ; and before that the right ankle had
been the troublesome joint. His general condition was
fair. Temperature normal. He never had rheumatism
before, but both parents suffered from the disease. Or-
dered manaca, in fifleen-drop doses, five times daily.
February 25th. — All his symptoms have subsided and
he is at work. Is to continue treatment one week.
March 2d. — Patient returns with his former complaint
in both ankles and left wrist. He neglected taking his
medicine as directed, thinking the precaution unneces-
sary. Last evening, after exposure, the present attack
came on. Manaca as before.
March 5th. — Patient is in good condition once more.
Ordered to continue medicine for ten days, and then
gradually diminish the dose.
Case IV. Rheumatism of five weeks' duration; re-
covery in five days, — M. S , aged thirty-five ; domes-
tic. This servant was first seen on February 21st, hav-
ing then had rheumatism for five weeks. It had shifted
from one articulation to another, until nearly every
joint had, in turn, been stiff and painful, but never in-
flamed. In spite of the usual anti-rheumatic remedies
she had not improved. Four or five years before she
had a similar attack. Her general condition was excel-
lent.* Manaca in fifteen-drop doses, four times daily,
was ordered.
February 23d. — Considerable improvement has taken
place already. Continue treatment.
February 26 th. — Reports entirely free from rheuma-
tism and feeling very well. Ordered to continue medi-
cine one week longer.
Case V. Rheumatism of six weeks' duration ; re-
covery in ten days, — E. O'C , aged forty-nine, house-
keeper. The patient was first seen February 26th, having
then been suffering for six weeks with subacute rheu-
matism involving the knees, elbows, and wrists. For
about two months she had had more or less supraorbital
neuralgia and been greatly troubled with acid dyspepsia.
For three years she has been subject to subacute rheu-
matic attacks. Her general condition was fair, but ano-
rexia and insomnia were complained of. The knees and
elbows were stiff and tender, but no swelling was present.
A saline laxative, followed by twenty drops of manaca
four times daily, was ordered.
February 28th. — No improvement in the condition of
joints. Appetite and digestion are a little better. Con-
tinue treatment.
March 2d. — Joints are much better, but the patient
complains bitterly of lumbago, which came on as the
joints began to improve. Continue manaca, and apply
sinapisms over the lumbar region.
March 6th.— -Reports free from both lumbago and rheu-
matism to-day. Is put upon full doses of iron tincture,
to be continued for one month.
April 15th. — The patient was looked up to-day. She
has had no return of her former troubles, but keeps a
supply of manaca on hand for immediate use in case of
returning rheumatic twinges. She is also treating several
of her rheumatic friends with the remedy.
Case VI. Rheumatism of two day^ standing ; re-
covery in four days, — C. E. K , aged thirty-two, cut-
ter. The patient was being treated for phthisis when,
upon February 28th, he was attacked with pain, tender-
ness, and stiffness in both shoulders. Within twelve
hours these symptoms shifted from the right shoulder to
the elbow and wrist. As his lung trouble was progressing
favorably it was decided not to interrupt the antiphthisicsd
treatment, and a stimulating liniment only was ordered
for the affected joints.
March 2d. — The rheumatism is worse. I^ast night the
patient was very restless from joint-pain. Give manaca
in fifteen-drop doses every three hours. St6p all other
medicines.
March 6th. — Rheumatism has steadily improved, and
to-day is fairly gone. Stop manaca and return to former
treatment.
March 31st. — There has been no return of rheumatism.
Case VII. Rheumatism of two months duration;
recovery in one week, — ^J. C , aged twenty-three, en-
gineer. Patient applied for relief February 28th, com-
plaining of soreness and stiffness in the muscles of the
lumbar region, also of weli-marked lameness in both
feet and ankles. The ankles, insteps, and toes were
swollen and tender on pressure ; slight redness but no
heat was present. No other joints were involved. The
young man had several previous attacks of lumbago, but
never had articular rheumatism until two months before
coming under observation. During those months his
lameness gradually increased, although in fine weather
he was able to ^et about quite well. His general health
was good in spite of a free indulgence in tobacco and
alcohol.
Total abstinence and fifteen drops of manaca five times
daily were ordered.
March 3d. — Reported somewhat relieved of rheuma-
tism, but suffering with a severe frontal headache, which
July 12, 1884.]
THE MEDICAL RECORD.
33
joiy be due to the medicine or to beer. He has taken
{)odi faithfully. Ordered a saline laxative and manaca
as before^
March 7th. — Rheumatic and head symptoms have
subsided and the patient has returned to work. 'Is to
continue treatment for one week and report any re-
lapse.
Case VIII. Rheutnaiism of titree weeks* duration ;
wmca a total failure, — M. H , aged thirty-five, do-
Bcstic. For fifteen years this patient has had repeated
attacks of pain and stiffness in all the larger joints, but
always uDaccompanied by inflammatory symptoms. Dur-
ing these attacks an approaching storm renders her al-
most helpless, while in fine weather she can do ordinary
liousework fairly well. Her habits were very bad. In
fact she was intoxicated when first seen, and was suffer-
ing from gastro-intestinal catarrh, evidently due to a lib-
eral use of beer and whiskey. She was free from rheu-
floatism at the time. Treatment was directed against the
gastro-intestinal disorder. Upon March ist she began
to complain of general joint-pain and stiffness, but as
her stomach was still irritable it was not deemed best to
institute anything in the way of internal anti-rheumatic
treatment. The troublesome joints were rubbed with a
stimulating liniment and covered with flannel.
March 13th. — The gastric trouble is much better, but
DO improvement in the rheumatism has taken place. Ma-
naa in twenty-drop doses five times daily is ordered.
March 15th. — Pains are more troublesome. Rheuma-
tism increasing in spite of improved general condition.
Cbntinue treatiuent.
March 19th. — No improvement. Continue treatment
March 23d, — Rheumatic symptoms are decidedly
worse. Stop manaca ; try a mixture of potassium, io-
dide, and colchicum wine.
April loth. — ^Patient made a very satisfactory recovery
upon this treatment.
Case IX. Rheumatism of four weeks' standing ; re-
cmry within two weeks, — H. M. S , aged forty-five,
artist The patient was first attended for rheumatism
apon April 14th, and had then been troubled for about
one month with aching and stiffness in all the larger
joints. An approaching storm increased these symp-
toms so as to confine him to his room, while in fine
weather he was out of doors, free from pain but never
quite free from stiffness. In former years he had similar
attacks, but of shorter duration. His appetite and gen-
eral condition were poor. Pills of iron, quinine, and
stzTchnine, with twenty drops of manaca four times
^ly, were prescribed.
April 17th. — Patient thinks he is a little better, but
seems more stiff and feeble than at the last visit. Con-
tinne treatment.
April 21st. — Marked improvement has taken place
king the last two days. Only trifling stiffness now re-
ims. Same treatment
May ist — Rheumatism has given no trouble for a
Kvi Stop manaca and continue tonic pills.
May 15th. — No return of the disease up to date.
Cask X. Rheumatism of four day^ duration ; re-
tmrjin two days ; relapse, — T. McK , aged forty-
fioQT, merchant. Patient had been under treatment for
phthisical consolidation of the left apex for several
veeks. Upon May 6th he was exposed during a pro-
mise night-sweat, and the following day was confined to
bed with pain and stiffness in all the larger joints, espe-
cially the knees. He had a similar attack years before.
A mixture of potassium, iodide, and colchicum wine was
oidered, and the limbs wrapped in flannel
May loth. — ^The rheumatism is no better, and the pa-
tient is troubled with anorexia and insomnia, being un-
able to take his usual exercise in the open air. Treat-
BMnt changed to manaca, twenty drops six times daily.
May 1 2th. — Recovery fi-om rheumatism is complete.
Kscontinue manaca and return to antiphthisical treat-
May 1 6th. — A relapse occurred to-day, and patient is
confined to bed. Manaca as before.
May 2 1 St. — Recovery is again complete, and manaca
is to be continued with other drugs for a couple of
weeks.
June 20th. — No further relapse has occurred.
Case XI. Rheumatism of two days* standing; recov-
ery in six days, — M. R , fifty-two years of age, ma-
son. When first seen upon June 15th the patient l^ad
been confined to bed for two days with his first attack of
rheumatism. The knees, especially the right, were hot,
swollen, and exceedingly painful on motion and pressure.
The ankles, elbows, and wrists were also involved but
less severely. Temperature normal. Appetite and gen-
eral condition good. Wrap the joints in cotton and
take twenty drops of manaca five times daily.
June 17th. — ^There is no change in the case except
that the force of the inflammation is now felt in the
shoulders and elbows, the knees being much better. In-
crease dose to thirty drops five times daily.
June 20th. — During the last two days recovery has
been rapid, and the patient has spent most of his time
out of doors. He complains of considerable firontal
headache, which came on yesterday and is getting worse.
Reduce dose of manaca one-half.
June 2 2d.-^The patient has entirely recovered from
rheumatism and headache. Stop manaca and take iron
tincture for two weeks.
July 15 th. — Patient seen to-day ; has had no further
rheumatic trouble.
Case XII. Rheumatism of a day's duration ; entire
failure of manaca to relieve, — C, J. S , twenty years
of age, salesman. Upon July loth the patient, while
under treatment for phthisis, fell asleep in a draught,
and shortly afterward was seized with pain, heat, and
swelling in the left shoulder and elbow-joints. In a few
hours the inflammation shifted to the ankles, causing well-
marked lameness. There was no rise in temperature.
General condition was bad. Ordered manaca in twenty-
drop doses five times daily.
July 1 2th. — The joints are more painful, and the pa-
tient more irritable than when last seen. Continue treat-
ment.
July 15 th. — The young man is steadily getting worse
and is now confined to bed. Ordered the dose increased
from twenty to thirty drops, but the patient refuses to
continue the drug and intimates that he must have a
change either of treatment or physician. He has a
change of treatment, and a mixture containing potassium,
iodide, and colchicum is given.
July 25th. — ^The patient has slowly but steadily im-
proved since the last note was made, and is now almost
free from rheumatism.
Case XIII. Rheumatism of twenty four hours!" dura-
tion ; recovery in two days, — T. McG , aged fifty-
five, carpenter. For fifteen years this patient has
been a sufferer from chronic rheumatism to a greater or
less extent When he came under observation he had
had no rheumatic symptoms for six months, but had
been much troubled by cardiac palpitation, cough, and
dyspnoea. Examination showed extensive pulmonary
emphysema, chronic bronchitis, and a mitral regurgitant
murmur. His general condition was fair. Concen-
trated nourishment, rest, and a mixture containing con-
vallaria and quebracho were prescribed.
Upon September 15th he awoke with stiff, swollen,
and painful elbows, wrists, and ankles. During the day
the knees became affected, and muscular rheumatism
developed in the lumbar and cervical regions.
September i6th. — ^The condition remains as yester-
day. All former medicine suspended, and manaca in
twenty-drop doses five times daily is ordered.
September i8th. — The more acute symptoms have
subsided, leaving only stiffness — especially of the knees.
Iron tincture and convallaria are to be added to the
manaca and continued for two weeks.
34
THE MEDICAL RECORD.
[July 12, 1884.
October 15th. — The above treatment has been carried
out. No relapse has occurred.
Case XIV. Rheumatism of two weeks' standing ;
recovery in five days, — C. C , aged eleven, school-
girl. Was first seen, for rheumatism, upon September
2 2d. For several days she had complained of slight stiff-
ness and soreness m the knees, shoulders, and neck.
Her general condition was excellent. Ordered Dover's
powder, to be followed by small doses of Rochelle salt
three times daily.
October ist. — The joint-stiffness and soreness has not
entirely disappeared at any time since last note was
made, and to-day it is worse than ever before- Ordered
manaca in twenty-drop doses three times daily; also
clothe the child in flannel undergarments.
October 3d. — Considerable improvement has taken
place.
October 5th. — Recovery complete. Continue treat-
ment for one week.
VERATRUM VIRIDE AND GELSEMIUM IN
THE SUCCESSFUL TREATMENT OF TET-
ANUS.
By R. B. HARRIS, M.D.,
SAVANNAH, GA.
The pathology of this most formidable malady is, to say
the least of it, limited, and as yet wrapped in some ob-
scurity. It is certain, however, that the symptoms of
tetanus are to be referred to an unhealthy action in the
nerve-centres, spinal and ganglionic, -The disease has
been thought by many writers to be a purely reflex phe-
nomenon, and although the writer of this article is in-
clined to take this view of it, yet he is in considerable
doubt as to its truth. In support of this theory cases of
traumatic tetanus have been reported where, upon the
division of the nerve, the spasms have ceased and the pa-
tient recovered.
Macnamara reports a case in which he saw tetanic
spasms result from the ligation of a large bleeding
pile, his patient being attacked with spasms of the sphinc-
ter ani muscle within thirty-six hours after the operation,
and although the ligature was immediately removed, the
disease ran a rapidly fatal course. Many cases of a simi-
lar character might be noticed here, but it is not the in-
tention of the writer to discuss the pathology of tetanus
in this paper to any lengthy extent. There are many
cases of tetanic spasms coming under our observation
where it is impossible to refer the attacks to a wound,
abrasion, or apparent injury of any kind, and it is in
these cases that the difliculty arises of attributing the dis-
ease to reflex action. The morbid effects in this class of
cases may, however, be set up by some source of irrita-
tion in the mucous tissues or in the glandular system,
and therefore hidden from view. The pathological
changes in the spinal cord after death from tetanus are
said to consist of extensive congestion of the tissues,
with some exudations; but the question arises, and a
grave one too, as to whether these changes are the
causes or the effects of diseased nerve action ; could this
question be satisfactorily determined, much light would
be thrown upon our subject.
It is unnecessary for the writer to enter upon the
symptomatology of tetanus, except as to temperature ; a
bare mention of the fact, however, suffices, that all cases
of this disease which have come under his observation
have exhibited a temperature not exceeding loi** F.,
and this while the heart's action was as high as 130
and 140 beats to the minute. The main object of this
article is to report four cases of tetanus treated by the
writer, in which he believes recovery due to the adminis-
tration of veratrum viride and gelsemium.
Case I. — W. S , a young, vigorous, and plethoric
man, twenty-two years of age. Was called to him August
II, 1867 ; found him with little or no fever, very rest-
less and uneasy, tongue heavily coated, and speech a
little thick. Upon inquiry, learned that two weeks since
he had received a slight injury, from which he had suffered
but little. Yesterday, the loth, had a slight spasm
which repeated itself this morning with some violence,
and occasioned my being sent for in haste. After get-
ting this much of the history of the case, I gave one grain
of sulph. morphia and watched my patient closely. In
about one hour or so I discovered some retraction about
the scrobiculus which caused a slight difficulty of breath}
ing. I now began to suspect tetanus, and, fearing this
uneasiness about the epigastrium portended another
spasm, I gave him a teaspoonfiil of laudanum. (This
case came under my treatment before the hjrpodennic
s)rringe was generally used.) I examined the wound he
had received, and found nothing but the cicatrix of what
appeared to have been scarcely more than a scratch,
just above the patella of the right knee. His bowels had
not been moved for two or three days, I therefore had
administered two ounces castor oil and twenty grains
calomel in combination. I now noticed considerable
contraction of the extensors of the back, and some rigid-
ity of the entire muscular system ; gave two grains of
gum opii, and in a short time, seeing that a spasm was
inevitable, gave a teaspoonful of laudanum with the hope
of keeping it off ; but in half an hour after this last dose
he was attacked with a most severe spasm, his body
forming a complete arch, and lasting ten or fifteen min-
utes. As soon as this was over I gave him two more tea-
spoonfuls of laudanum, which I got down with some diffi-
culty; in a few minutes he again had a most terrible
spasm. The muscular system was now perfectly rigid,
the jaws firmly closed, and the hands tightly clenched,
and this after the administration of four teaspoonfuls oif
laudanum, two grains of opium, and one grain of mor-
phia in four hours. The pulse now ran up to iio,
and somewhat irregular. Had the spine and extremities
vigorously rubbed with turpentine and mustard, and
enemas of salt, soap, and warm water given, but without
the desired effect. Spasms continued at short intervals.
August 1 2 th. — This morning patient perfectly rigid,
pulse 140, and pupils very much contracted. The tem-
perature in this case was not taken for want of a ther-
mometer. Having given all the narcotics I thought was
prudent, I determmed to change my tactics, and accord-
ingly gave patient ten drops Norwood's tine veratrum
viride, and having had his head and shoulders pulled
over the edge of the bed with a large tub underneath, I
poured four large pitcherfuls of cold water over the
head, neck, and shoulders; when the last pitcherful
was being poured on the system gradually relaxed, and
my patient in a few minutes lay seemingly exhausted ;
pulse now 130 ; pupils contracted. Two hours and a
half after the first dose of veratrum I gave twelve drops
more. At three o'clock, now three hours since the last
dose of veratrum was given, I gave another of twelve
drops ; in one hour his pulse dropped to 104, and he fell
asleep.
At 6 P.M. another violent spasm came on, and I again
resorted to the cold douche with equally good results as
before, and as soon as the spasm ceased I gave another
dose of veratrum combined with fifteen drops tine, gel-
semii. (Tine, gelsemii was made of the green root, four
ounces to a pint of ninety-five per cent, alcohol, macer-
ated for fifteen days and filtered; the tincture made
from the dried root is almost worthless.) In two hours
after this dose was taken the pulse fell to 68. Patient
now perfectly quiet and seems much better, pupils almost
natural size.
Under this condition of things, I ordered four drops of
veratrum (Norwood's) and eight of gelsemium to be re-
peated every four hours, with instructions that, should a
spasm come on, the cold water was to be used as before.
August 13th. — This morning (latient seems much bet-
ter ; pulse 64, skin cool, pupils dilated, but tongue very
heavily coated ; ordered an enema of castor oil and warm
water, which brought about a very copious action of the
July 12, 1884.]
THE MEDICAL RECORD.
35
bowels. Discontinued the veratrum and gelsemium and
oniered quinia sulphate, three grains every three hours.
Was sent for this evening, and on arrival I found my pa-
tient in another violent spasm. I at once applied the
cold douche as above mentioned, and as soon as possi-
ble administered ten drops of veratrum and fifteen of gel-
semiuffl ; in a short time the muscular system became re-
laxed and patient more quiet After waiting two hours
I repeated the last-mentioned dose, and in a short time
after had the satisfaction of witnessing the gradual fall
of tbe pulse from 120 down to 6S beats. I now ordered
reratnim and gelsemium to be repeated and continued in
four and eight drop doses every four hours until my re-
loin.
August 14th. — Patient domg well, but a little TduU ;
coDtinued last prescription ; pulse 60 ; ordered a*llight
milk punch three times a day.
August 15th. — ^To-day patient is brighter and calls for
oourishment ; pulse 62, pupils natural, and tongue clean-
ing; takes his nourishment readily, but complains of great
stffi)ess of the jaws ; continue prescription as above.
August 2oth. — I have attempted to stop the veratrum
and gelsemium twice since the 15th, but each time my pa-
tient evinced sonie spasmodic symptoms, and I returned
to them in combination as before, with positive results.
August 23d — Patient improving slowly, is very much
prostrated, but has an increasing appetite. Veratrum
and gelsemium continued in three- and five-drop doses
every four hours with quinine.
August 26th. — ^Patient discharged to-day, with in-
stnictioDs to continue the medicine for five days longer,
gradually diminishing the dose.
Case II. — ^This case came under my observation June
18, 1879, ^T^^ ^^ a case of idiopathic tetanus in a girl
twenty years of age. When I first saw her she was in a
most violent spasm, no portion of her body touching the
bed on which she was lying, except her heels and the
back (^ her head. I immediately resorted to the cold
douche, but without the same happy result as in the pre-
ceding case ; the efifect was good, however, and I soon
had an opportunity of giving Mteen grains of calomel and
two ounces of castor oil in combination. Tongue very
much coated; pulse, 126; temperature, 99^; respira-
tion, 23. Ordered the following to be given at once r
9 . FL ext. veratrum vir 3 j.
Fl, ext. gelsemii 3 iij.
M. S. — Give fifteen drops in a little water every
two hours, and increase each dose two drops.
Saw her again in four hours from my first visit ; had
bad two spasms; pulse, 112; continue prescription.
Four hours from last visit, no more spasm, pulse down
to 40; gave a tablespoonful of brandy, shortly after
ibidi the pulse rose to 70. Continue prescription in,
tOHirop doses every four hours. This patient was up'
n seven days, but continued my prescription for one
vttk, gradually diminishing the dose.
Case III. — Negro boy, aged eleven years ; was called
to him December 14, 1881. Upon inquiring into the
bistoiy of the case, I learned that about two weeks prior
to this time he had received a severe blow upon the
back; on examination there was no external signs of
violence, except that there was an apparent tenderness
about the third and fourth dorsal vertebrae. The boy
was speechless ; pulse, as well as I could count it, be-
tveen 140 and 150 ; temperature (in axilla), 100° ; ja]¥»
io firmly closed that I could scarcely insert the point of
the blade of a thin case-knife between the teeth, and a
terrible rigidity of the entire muscular system. In this
case 1 saw no hope of recovery, but in a few minutes I
iad a course of treatment laid out for him, and lost no
time in putting it into execution. I had a large tub of
bot water brought in, and emptied a common size (quar-
ta-poand) box of mustard, and a half-pint of salt into
iti and pat my boy in up to his neck ; while he was in
^ bath I had another smaller tub of boiling water
brought in, and into this I put a laige blanket ; I now
gave my patient five drops of the fluid extract of gelsemii
and half a drop of the fluid extract of veratrum viride h)rpo-
dermically. After being in the balh twenty minutes I
had the blanket in the boiling water wrung out and spread
upon his bed, and the boy immediately rolled in it up
to his chin, and in an hour after repeated my hypoder-
mic dose. Some discretion should be exercised in roll-
ing a patient in this blanket taken immediately from a
tub of boiling water, as there is danger of too much heat.
Having to go to another patient I returned in two hours,
feeling that I would not be surprised to find him dead ;
but to my astonishment he was as limp as an old wet
rajg, and in a profuse perspiration ; pulse 98, but jaws
still firmly closed. I ordered castor oil and warm water
enemas to be ^ven every fifteen minutes, until an action
was had on his bowels. Saw him again about bedtime,
six hours from my last visit ; bowels well acted on ; pulse,
104 ; gave him another hypodermic dose of veratrum
and gelsemii and rolled him in another hot blanket as
before. I could now get the point of a teaspoon be-
tween his teeth. Ordered the following :
3 . Fl. ext. veratrum vir. 3 j.
Fl. ext. gelsemii 3 iij.
M. S. — Give ten drops in a little water every four
hours.
December 15th. — Patient improved in every respect ;
pulse, 84; temperature, 99®. When spoken to he an-
swers with a nod or shake of the head ; has taken some
nourishment Ordered last prescription continued, with
the addition of three grains of quinine every four
hours.
This case progressed to almost complete recovery, was
up and walking about the house, when suddenly, from
some unknown cause, he was attacked with convulsions
and died before medical aid could be obtained, on De-
cember 25 th.
Case IV. — ^J, M , aged fourteen years; about
three weeks since, this boy received an injury on the
side of the head, caused by a blow which had cut to the
skull. His father told me that about two weeks after
the reception of the injury, he had noticed that the pa-
tient got about very badly and would occasionally fall
down.
I was called to this case on February 26, 1884 ; found
him sitting up, but having regular tetanic spasms every
few minutes; pulse, 120; temperature very little above
normal ; jaws partially closed and rigid. I at once gave
him an ounce and a half of castor oil and twelve grains
of calomel in combination, and ordered him to bed, giv-
ing his mother instructions to keep warm poultices to
the wound on his head.
February 27th. — Patient in the same condition as when
I saw him yesterday, except that his bowels have been
copiously acted on by the calomel and oil. Ordered the
following :
5. Fl. ext. veratrum vir Z]-
Fl. ext. gelsemii 3 iij.
M. S. — Give fifteen drops in a little water every
three hours.
This evening (February 27th), pulse down to 48;
gave him a little brandy and ordered prescription to be
continued in eight drop doses tvety four hours, with
the addition of three grains quinine with each dose.
Whenever my patient was sleepless at night I occasion-
ally gave a few grains of chloral hydrate and bromide of
potassium, but with this exception, there was no other
treatment instituted in this case, which progressed to
complete recovery in fourteen days.
I am somewhat in doubt as to die therapeutical action
of the veratrum and gelsemii, but will have more to say
upon the subject in the near future. In the meantime I
earnestly ask the profession to give this matter their seri-
ous consideration and attention, and report the result?.
36
THE MEDICAL RECORD.
[July 12, 1884.
WHEN ARE WE AT GREATEST RISK FROM
CONSUMPTION ?
By EDGAR HOLDEN, M.D., Ph.D.,
MBDICAL DIRBCTORi MUTUAL BBNBFIT LIFB INSURANCE CO.,
NSWARK, N. J.
For many years, even among the best informed, the
impression has prevailed that consumption exhibits a
deductions from them secure, and the correspondence of
result from the diverse sources enumerated in the table
can leave no doubt of the correctness of the conclusion.
The experience of the population of New York City,
of England, and of the United States in general, give the
results for unselected lives and may be contrasted with
the experience of life insurance companies which deal
only with those carefully selected. ,
CONSUMPTION.
Showlf^lbfi difimmce benreea actual and spparoil martaO^
Ratio to •ub 10.000 Of Ingt FUtlo of ^••th to •$ch 100 deaths.
aL4f
Sl^O
41410
91*70
^U
JjSff^n^y
N. Y. Qiiyy
MMh,«U.f.y
IQlifiQus..
ScoUemt
iMMMlmM
JUiuLBm^^
^^TTT
II i9.f?m.iif,t.
N. B,— Ercpcr cotidmlon tan b«; tkiJKii only Jioai tht k&. hand lable^ and u as folkiwt, int. :
ConsDiDptiaa li prcvalenl aiall peilDds of Me, and iDCEcaiea laiher tbaa dkumKhsa wSih age. Ffguies iakf t TaMe art per tofxia: in tigtU, per wa.
preference as regards development, for certain ages.
Thus, it has been the conviction that those who escape
the marasmus and tubercular meningitis of infancy come
again into danger at puberty, and that again between
thirty-two and thirty-eight a climacteric is reached at
which the mortality acquires its maximum of intensity,
then diminishing to declare a wholesale sweep between
sixty and sixty-five.
These views have grown out of an experience ap-
parently well founded, since the mortality in every
physician's personal field of observation has seemed to be
greatest at those periods, but the conclusion is neverthe-
less a fallacy, and it has been made broader and deeper
by statistics of mortality in which the ratio of deaths from
consumption to the total number of deaths has been re-
lied upon.
A moment's reflection, however, will show that while
we may judge of mortality from any given disease with
reasonable accuracy by comparing the number of deaths
with the total number of deaths ; yet, for individual ages
or decades, we must obtain the ratio of deaths borne at
these ages to the total number living at those ages.
The reason for this will be obvious from the fact that
a far greater number are living between thirty and forty
than between fifty and sixty, and consequently there is a
far greater harvest for this most prevalent of diseases.
Rare facilities for prosecuting an investigation to ob-
tain a correct result have led me with considerable labor
to a conclusion as startling as I trust it will be found
conclusive, viz., that death from consumption, instead of
being, as is almost universally supposed, most prevalent
in early adult life in this country is in reality not so, but
grows relatively more frequent as life advances. This is
true in the community at large, and among selected lives
is actually less at the ages hitherto deemed most sus-
ceptible.
The figiures dealt with have been so large as to make
The advantages derived by these companies from
selection is manifest. The right hand table exhibits
the results of the fallacious figures heretofore deemed
trustworthy.
ON THE HEROIC USE OF CALOMEL IN DIPH-
THERIA AND CROUP.
By I. P. KLINGENSMITH, M.D.,
BLAIKSVILLB, FA.
After having given the ordinary or expectant plan of
treatment, including iron, quinine, chloride of potash,
lactic acid, stimulants, etc., a faithful trial for eight
years, and having had the usual high mortality rate, I be-
^an to look about for other remedies more definite and
specific in their action.
About this time Dr. J. W. Anawalt, of Greensburg, Pa.,
called my attention to the success of the calomel treat-
ment in his hands. Since then three cases have come
under my personal observation, to which I will briefly
call attention. In each of these cases the disease mani-
fested as great a degree of malignancy as in many others
treated in past years by the ordinary methods, which
terminated fatally.
Ca^e I. — On Sunday, April 10, 1883, I was called to
see Amos McD , aged twenty-eight months, of pre-
vious delicate health. Upon examination I found the
pulse rapid and irritable, skin hot and dry, and the voice
husky, with a croupy cough. The tonsils and a portion
of the fauces were covered with a thick, tough, whitish-
yellow exudation ; while the glands at the angle of the
jaws were somewhat enlarged and tender. I at once
ordered twenty grains of calomel, which was followed by
ten grains every hour, until the third day, when, the mem-
brane beginning to separate at the edges, the mercurial
was discontinued. During the first three days of the
treatment, a total of seven hundred and twenty grains ot
July 12, 1884.J
THE MEDICAL RECORD.
37
calomel were given, after which a solution of chlorate of
potash was administered every two or three hours for a
(ew days.
From the third day on there was a gradual improve-
ment in the case, and by the sixth day the membrane
bad separated entirely. The recovery was rapid, and
the exhaustion, so common in cases of such gravity, was
eniMy absent
Case II. — On the afternoon of February 22, 1884, I
vas called to see Hulda H , aged three and one-half
years, of hitherto good health, who had then been sufifer-
ing for forty-eight hours, during' which time she had slept
bat little.
Upon examination I found a temperature of 102° F.,
rapid pulse, hurried respiration, croupy cough, exten-
sive deposits, and congested face. I at once gave her
twenty grains of calomel, which was followed by ten
grains every hour for fifteen hours. A gradual improve-
ment of the symptoms ensued after the administration of
the first few doses, enabling the child to fall into a natural
refreshing sleep. After discontinuing the calomel, the
following mixture in drachm doses was given every two or
three hours for a few days :
3. Potass, chlor gr. xxx.
Ammon. mur gr. 1.
Syr. prun. virg | ij.
M.
By the fifth day convalescence was fully established,
and the child made a rapid recovery.
Case III. — I was .called to see Alice H y aged
four years on May 8, 1884. She had then been indis-
posed for upward of twenty-four hours. An examination
revealed a high temperature, painful croupy cough, la-
bored respiration, skin dry, face flushed with some diph-
theritic ^posits. I immediately administered twenty
grains of calomel and followed with ten grain doses every
hoar until twelve doses were given, making a total of
one hundred and thirty grains. In this case no other
remedies were used, and in three or four days the child
had fully recovered.
The mercurial used in these cases was the English cal-
omel, and was given by filling a teaspoon half full of cold
water, then dropping the medicine upon it, after which it
was placed well back in the mouth of the patient. The
calomel purges, but not to excess, causing simply free
and copious evacuations of a greenish appearance. I
have never known ptyalism to occur in a single case.
My experience with this plan of treatment is based upon
die three cases detailed above, besides a number occur-
ring in the practice of other physicians. I am not one
of &ose who claim to cure all my cases, but I do believe
that with a faithful and proper administration of the
remedy in question, disintegration and separation of the
nembranes will be facilitated, as well as relief afforded to
% the spasmodic character of the disease.
Differential Diagnosis of Simple and Tubercu-
UK Meningitis. — In an analysis of a number of cases of
DKoingitis occurring in the Children's Hospital at Stock-
holm, Dr. O. Medin endeavors to formulate the points
of diierence in the tubercular and simple forms of the
&ease. Tubercular meningitis attacks only those chil-
dren already suffering from tuberculosis of other parts,
while simple acute meningitis occurs usually in previously
healthy individuals. Th6 former manifests its onset
bj convulsions, frequently strabismus, and dilatation or
contraction of the pupils. Vomiting is frequent at the
commencement, diarrhoea is the usual condition, and
constipation is rare. The abdomen is iiever flat. The
sunple form begins with somnolence, twitchin^s, sudden
changes of color in the face, and hypersesthesia. More
frequently than in the tubercular form we meet with the
i^^kocephalic cry and paralysis limited to the arms or to
the hct. The tubercular variety is always fatal in its
temunation — J^evue MUicaUy May 24, 1884.
|^00tjeBfi 0f ^jedicaX JEicienuce*
Splenectomy. — Dr. Koeberl6 reported to the Soci^t6
de MIdecine de Strasbourg a case of extirpation of the
spleen performed by him in April last. The operarion
was performed on account of hypertrophy consecutive to
intermittent fever, the spleen measuring sixteen inches
in length. The liver was also greatly enlarged, and there
was an abundant serous exudation in the pleural, peri-
cardial, and peritoneal cavities, together with oedema of
the lower extremities. Despite difficulties occasioned
by diaphragmatic adhesions, the operation, lasting over
three hours, was successfully performed. The patient,
having come from under the influence of the anaesthetic,
was resting comfortably, when suddenly the eyes rolled
convulsively, a few long inspirations were taken, and life
became extinct. Death was supposed to have been
caused by an intercranial hemorrhage.— ^/^''^^^ dAc*
couchementSy May 30, 1884.
Ergot in the Treatment of Constipation. — Dr.
Granzio reports two cases of constipation, following the
abuse of purgatives, relieved by ergot. Three doses of
ten grains each were given at intervals of two hours, and
were followed by a copious evacuation. A second stool
occurred spontaneously the next day, and after the ad-
ministration of ergot in smaller doses for a few days a
definite cure was obtained. The constipation was due
to atony of the muscular wall of the intestines. — Allge-
meine Mcdicinische Ctntral-Zeiiung^ May 24, 1884.
Chlorotic Fever. — About two years ago Dr. Hum-
bert MoUi^re and F. Leclerc published the results of
some thermometric observations made by them in cases
of chlorosis, which seemed to indicate that this is a febrile
condition. Since that time others also have observed
the same thing. In the Lyon Midical of May 25, 1884,
Dr. Mollidre states that a further series of observations,
in some cases extended through a period of eight months,
has verified his previous conclusions, and established
definitely the fact that chlorosis is a febrile disease and
that the old name of febris alba virginum is strictly cor-
rect The temperatures were taken with scrupulous
regularity at the same times each day, and always by the
rectum. In most cases there was a slight evening ex-
acerbation, but in one instance the reverse obtained, the
mercury being higher in the morning than in the evening.
The average temperature was from 100® to 1 01. 8®. Care
was taken to exclude all cases in which there was even
a suspicion of tubercular trouble. In some young girls,
who were 'not chlorotic, but were simply anaemic from
overwork or poor food, no elevation of temperature ex-
isted. In all the cases of true chlorosis there^was a
cephalic souffle, audible over the eyes on a level with
the temples, and in some instances in the occipital region.
This souffle was synchronous with a systolic murmur
heard at the base of the heart and with bruits in the
vessels of the neck. The febrile action was always in
proportion to the intensity of the disease, subsiding
gradually as the chlorotic condition disappeared. The
urine in the cases examined was of normsd amount, very
light colored, sometimes containing a slight cloud of
mucus, and never presenting any excess of urea above
the normal quantity. Dr. Molli^re leaves undecided
the question as to the nature of this constant febrile re-
action, whether it be a true pyrexia or of nervous origin,
but inclines to the former opinion.
Antipyresis by Inunction. — Colbat favors a revival
of the old method of Schneemann of inunctions with fat
or vaseline in the febrile diseases of childhood. He uses
cerate or vaseline in scarlatina, variola, broncho-pneu-
monia, and other pyretic conditions, and states that it
reduces the temperature and induces a condition of rest-
lulness. He denies that there is any danger of blood-
poisoning in the employment of these inunctions. — Medu
cinisch'Chirurgisches Corresponden%-Bl(Ut^ May, 1884.
38
THE MEDICAL RECORD.
[July 12, 1884.
BoROPHENYLic AciD. — ^A new series of experiments has
recently been made to determine the antiseptic value
of this substance. Borophenylic or phenylboric acid ap-
pears in the form of bushy needles, slightly soluble in cold
water, but freely so in hot water, alcohol, and ether. It
has a faintly aromatic odor, recalling that of marjoram.
It has no caustic action upon the mucous membranes,
even when applied in the form of powder, but excites
merely a slight irritation. In fifteen-grain doses it causes
ringing in the ears, vertigo, moderate headache and
somnolence. Its antipyretic properties are said to be
undoubted, and it would appear to be of greater efficacy
than carbolic acid in arresting fermentation and putrefac-
\on.— Journal de Mddecine de Bruxelles^ May, 1584.
Production of Paralysis without ANiGSTHssiA by
Peripheral Irritation.— Brown-S6quard, in experiments
upon guinea-pigs, has found that when chloral is applied
to the external auditory canal complete muscular par-
alysis without loss of consciousness is induced. When
chloral is injected into the stomach the same efifect is
observed, though in a less marked degree. In every
case the loss of the power of voluntary' movements pre-
ceded anaesthesia and sleep. The experimenter supposed
that a special influence was exercised upon the nervous
centres, through irritation of the auditory, auricular, or
other peripheral nerves, whereby muscular movement
was abolished without loss of sensibility. — Gaceta Midica
Catalana^ May 31, 1884.
Repeated Attacks of Vomiting in Children. — This
affection is one of early childhood. Vomiting occurs
in attacks, coming on at varying intervals of time and
lasting from a few hours to several days. The little
patients are often greatly debilitated. There is fre-
quently pain, sometimes intense, in the epigastric or
umbilical region. The stools are irregular, sometimes
abundant, sometimes scanty, and may be whitish or clay-
colored. The causes are variable. The attacks may
be due to exhaustion, to a nervous condition, to im-
proper nourishment, or to the influence of cold. As
regards treatment, a low diet, with or without chicken
broth, is advised, and in addition calomel in small doses
should be exhibited — L Union Medicate du Canada^ No.
3, 1884.
Prophylaxis of Puerperal Fever. — In his report of
the Rotunda Hospital for 1883 {Dublin Journal of Medi-
cal Science^ June, 1884), Dr. A. V. Macan recites in
detail the method in vogue in that institution for the
prevention of puerperal hetero-infection. Vessels con-
taining a I to 40 solution of carbolic acid are placed
over every wash-hand basin, and every one, before mak-
ing a vaginal examination, is required to wash his hands
in the solution, using a nail-brush carefully, and after-
ward dips them for half a minute in a i to 1,000 solution
of corrosive sublimate. Every student or nurse who ex-
amines a woman per vaginam has to write his or her
name down on a card, so that if the patient should
afterward prove to be infected the origin of the infection
may be traced Only four students are allowed to ex-
amine any given case, and none who is dissecting is
allowed to enter the hospital. There is an absolute rule
against touching the woman's genitals with the fingers
after delivery, except in cases of post-partum hemor-
rhage, ruptured perineum, or retained placenta, and then
the assistant master only is allowed to make the examina-
tion. If any operation be necessary the vagina is irrigated
and the external genitals are carefully washed in a i to
2,000 corrosive sublimate solution, and afterward the
uterus is syringed out, and a suppository containing 3 jss.
of iodoform is passed to the fundus and left there. Dr.
Macan sees no necessity for prophylactic antiseptic in-
jections if the fingers and instruments are perfectly free
from septic poison, and consequently never uses them.
Out of 1,090 women confined during the year but six
died, and all these deaths followed more or less com-
plicated labors. Not a single woman died who had a
natural labor, nor was there a death among the 64 cases
of forceps delivery, many of which were difficult extrac-
tions, and some undertaken before the full dilatation of
the OS. In the same report. Dr. Macan states that the tem-
perature of every case was taken twice daily, and that he
was unable to recognize any constant rise of temperature,
even to the extent of one degree, accompanying the first
secretion of the milk. Indeed, the temperature curve
of the puerperal state, in a typical normal case, does not
appear to differ in the slightest degree from that in the
non-puerperal state. He is inclined to believe that any
temperature above 100** F., except immediately after
delivery, indicates that something abnormal is taking
place, though it may not always be possible to say what
the exact cause of the rise may be.
Hypodermic Injections of Calomel in Diseases of
the Eye. — Dr. Rampoldi injects calomel subcutaneously
over the temples in certain ocular troubles. He main-
tains that there is not only a specific action in the case
of syphilitic affections, but that it also acts most efiica-
ciously as a derivative in other cases. He has seen the
pupil respond . readily to atropine after these injections
had been used, when before they were unchanged. The
good eflfepts of this procedure are often observed in those
conditions in which leeches are indicated in which there
is no suspicion of a specific taint. — RecueU ^Ophtal-
mologie^ May, 1884.
A New Apparatus for the Relief of Deafness. —
Professor Politzer describes in the Wiener Medizinischt
Wochenschrift of May 31, 1884, a little instrument in-
vented by himself to aid those whose power of hearing
is impaired. The principle is to transmit the vibrations
from the pinna to the membrana tynapani. Politzer
opposes Voltolini's opinion that the cartilage of the ear
is a poor conductor of sound, and on the contrary
believes that the pinna, by means of its vibrations, is of
great importance in the mechanism of hearing. His ap-
paratus consists of a small elastic drainage-tube, one
end of which is beveled off so as to rest evenly against
the drum membrane, while the other end is curved slightly
and by its elasticity presses gently against the anti-helix.
Near its outer extremity the tube is attached to a small
concavo-convex rubber plate. This plate is fitted so that
its concave side lies in apposition with the concavity of
the concha. The idea of this attachment is to increase
the conducting power of the instrument and to transmit
with greater facility the vibrations of the pinna. In a
large number of experiments made to test the value of
this instrument, the inventor found that in most cases
the hearing distance for the voice was considerably in-
creased, in some instances fi-om two feet without to
fifteen or twenty feet with the apparatus. In many cases
the hearing distance for the watch was 'also increased,
though in no such striking degree as that for the voice.
In cases in which the drum membrane was partially or
entirely destroyed, it was found necessary to attach an
artificial drum to the inner extremity of the tube. In
deafness due to anchylosis of the ossicles or to disease
of the labyrinth, little or no improvement was obtained
by the employment of the tube.
Action of the Intercostal Muscles. — M. Laborde
has recently performed some experiments upon the
cadaver of an executed criminal which would seem to
have solved the problem concerning the action of the
intercostal muscles. The body was obtained a very
short time after death, while the electrical reaction of
the muscles was still present. M. Laborde ascertained
that contraction of the internal intercostal caused a
narrowing of the thoracic cavity, while that of the ex-
ternal muscles caused an elevation of the ribs and an
expansion of the chest. Hence the external intercostals
are muscles of inspiration, and the internal of expira-
tion.— Revue Midicale^ May 24, 1884.
July 12. 1884.J
THE MEDICAL RECORD.
39
A New Edition of thb Siamese Twins. — A case is
reported io the Hospitals- Tidende of May 21, 1884, of
twins bom in a parish in Finland Each child has its
oiro bead and the two upper extremities. From the
united body two normally shaped legs are given off, and
between them is the single genital organ (female). In
addition there is a third leg, the foot of which is provided
with eight toes. There are two anal openings. While
one child sleeps the other may be awake and cr3nng.
Paraldehyde in the Treatment of Delirium
Tremens. — Dr. Gugl reports some additional cases of
delirium tremens treated successfully with paraldehyde.
The dmg was given in the syrup and tincture of orange
peel, and was taken readily by the patients, the taste and
smell leading them to regard it as a particularly good
quality of schnapps. The author asserts that paralde-
hyde is absolutely without danger in the dose of i^ to 2
drachms per diem. — Allgetneine Medicinische Central--
Zeitung, May 28, 1884.
Variations in the Size of the Pupils in'Epileptics.
—As a result of a number of observations, Dr. Giuseppe
Mnsso concludes that : i, The pupils of epileptics do not
dilate to any greater extent than do those of healthy in-
dividuals ; 2y in a large proportion of cases there is an
habitual dilatation of the pupils of greater or less degree ;
5, in a certain number of cases the epileptic attacks are
preceded by an inequality in the size of the pupils, which
inequality disappears when the fit is over ; 4, although in
certain cases of epilepsy inspection shows a greater sen-
sitiveness of the pupils to the stimulus of light, yet this
phenomenon is not of sufficient frequency to be of any
special diagnostic value. — Recueil tP Ophtalmologie^ May,
1884.
The Dosimettric Method of Administering Chlo-
roform.— M. Peyraud takes a piece of fine cambric, and
doubling it once, lays it on the face of the patient to be
anaesthetized, covering only the mouth and nose. On the
litde bridge of cloth passing from the nose to the mouth
he poiirs a single drop of chloroform, waits until an in-
s(»ntioQ has been made and then pours another drop,
and so he proceeds, putting on just one drop immediately
after eadh expiration. At the end of some| minutes, if
anaesdiesia is dela]^ed, he increases the dose to two drops.
Complete insensibility is obtained ordinarily in from seven
to ten minutes. The writer claims that aniesthesia is
produced by this method without any preliminary stages
of agitation and hyperaesthesia, and without the occurrence
of any irregularity in the pulse or respiration. When
once anaesthesia has been obtained he withholds the chlo-
roform for a minute or two, and then resumes its admin-
istiation in the average dose of three drops per minute.
The patients, it is said, find the chloroform given in this
way not at all disagreeable to inhale, and so small is the
proportion of chloroform in the inspired air (the vapor
cf one drop to 30.5 cubic inches), that there cannot pos-
fll%be anything to disturb the functions of haematosis
or to irritate the respiratory mucous membranes. M.
Pejraud cites several instances in which anaesthesia was
produced and maintained during an operation with very
small amounts of chloroform. In one case of an hys-
terical woman on whom an operation, lasting an hour
and a half, was performed for cancer of the kidney, only
6^ drachms of chloroform were used. It is assumed that
Ae danger of arrest of the heart's action is, in this pro-
cedure, reduced to a minimum.— y^t^r/ia/ de Midecine de
hrieaux.
In abstracting this article, a writer in the Gazette
Mldicale de Strasbourg^ of June i, 1884, states that the
Wmetric method has been in vogue in that city for
nanj years. Esmarch's apparatus, consisting of a wire
mask covered with a piece of fine linen and fitting over
tiic mouth and nose, is used. The air passes freely
Arongh the wire gauze on each side, while the linen
JtfTes to hold the chloroform. A contrivance is also
enplojred by means of which the anaesthetic can be .de-
livered drop by drop, with perfect accuracy, as required.
The writer is in perfect accord with M. Peyraud as re-
gards the great advantage possessed by this method of
administering chloroform. He states that in a laparotomy
recently performed, anaesthesia was maintained for three
hours wirti the expenditure of one ounce of chloroform.
Tubercular Neuralgia. — In an article in La France
M^icale of May 29 and 31, 1884. Dr. Ferdinand Drey-
fous states that neuralgias are observed in tuberculous
subjects in three different stages of the disease, i. In
the terminal stage they are, in the majority of cases, to
be attributed to the cachexia which is a recognized cause
of neuralgia in other conditions. 2. During the course
of well-established phthisis we often observe intercostal
neuralgia, or even tuberculosis of the phrenic or pneu-
mogastric nerve. In these cases the painful nerves are
m more or less intimate connection with the organ chiefly
affected. 3. Finally, in the initial period we may meet
with peripheral neuralgias in various parts of the body,
but by far the most common is sciatica. It is not usually
very troublesome and is frequently overlooked by reason
of the attention being directed chiefly to the general
condition. It is, hQwever, not at all infrequent at this
period of commencing tuberculosis, and has even been
described as one of the early symptoms of the dis&se.
Sciatica, when occurring at this stage, is usually unilateral,
a point of some diagnostic value, since neuralgias of
diathetic or toxic origin, as in diabetes and plumbism,
are more commonly bilateral and symmetrical. The
sciatic nerve is more frequently affected, it is supposed,
partly because of its large size and partly by reason of
its relatively abundant vascularity, which exposes it to
greater danger of colonization by the micro-organisms.
Funnel-Shaped Thorax. — Dr. F. Percival relates an
instance of this curious deformity in the Rivista Clinica
for May, 1884. The subject was a man, forty years of
age, whose family history showed a predisposition to
phthisis, and one of whose sisters showed evidences of
marked rachitis. He had himself always been healthy,
and two children of whom he was the father were per-
fectly sound. The malformation of the chest had existed
since birth, but had never caused any inconvenience on
the part of either the heart or lungs. The excavation,
shaped like a truncated cone, began at the junction of
the manubrium with the sternum, and ended below at a
distance of about five inches above the umbilicus. One
could put his closed fist in the depression, and at first
sight it seemed as though the sternum must touch the
spinal column. The greatest depth was three inches,
and the distance from this point to . the spinal apophyses
was scarcely four and a half inches. The aperture of the
depression was of an oval shape, measuring six inches in
length and four and a half in width. It was situated a
little more to the right than to the left side of the thorax.
Posteriorly there was a slight degree of kyphosis of the
vertebral column, but no lateral deviation. Dr. Percival
thought that the cause of the deformity was probably an
arrest of development in the sternum, possibly due to a
disease of the bones allied in its nature to the rachitis
from which one of his sisters had been a sufferer.
Tubercles of the Breast. — The following are the
conclusions formulated by Dr. Ghislani Durant in an
article with the above title {Gaillards idedical Journal y
June, 1884) : i. The breasts may be the seat of tumors
similar to the pathological products, found in many other
organs, to which the name of tubercle is given. 2.
Tubercle in the mammary gland is much more common
than is generally supposed. 3. Mistakes as to the true
nature of these growths have often been made, and abla-
tion of the breast, from a belief in their cancerous nature,
has often resulted. 4. During life we may by clinical
observation distinguish these from other tumors. 5. As
no absolute necessity for the ablation of these tumors
exists, we should refirain firom operating, unless unequiv-
ocal signs of malignanqr develop.
40
THE MEDICAL RECORD.
[July 12, 1884.
The Medical Record
A Weekly yournal of Medicine and Surgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD & Co.. Nos. 56 and 58 Lafayette Place.
New York, July la, 1884.
CHOLERA AND ITS PREVENTION.
The report that cholera has appeared in a seaport town
of Europe sounds a note of warning which the health
authorities of the United States would do well to heed.
It Ts possible that the European States, with their expe-
rienced boards of health to guide them, and their well-
equipped sanitary police to execute their orders, may
prevent the spread of the pestilence on the continent.
But whatever precautionary measures foreign govern-
ments may take to protect themselves, it will be the part
of prudence to examine at once our own defences, and
take such measures as will secure us against an invasion
of the Oriental scourge. For we are, in truth, but little
less exposed to an invasion of cholera than the cities
contiguous to Toulon, owing to the constant emigration
of the lower classes of that and other seaport cities of
the Mediterranean to this country.
If we examine our methods of preventing the intro-
duction and spread of contagious and infectious diseases
of foreign origin in the light of modern science, knowl-
edge, and experience, we can but conclude that they are
cumbersome, expensive, and inefficient. Indeed, we do
not hesitate to state that for the most part our machin-
ery for protection against foreign epidemics was con-
structed, and is managed, in the spirit and enlightenment
of the middle ages. . Our quarantine system is still too
much governed by the old idea, that time is the most im-
portant element in the destruction of the contagious or
infectious germ, and that non-intercourse is the true
method of preventing the propagation of the germs of
epidemics.
Within the past two years the old cordon saniiaire,
which is but another name for the shot-gun quarantine,
has been the chief reliance of the highest functionary in
this country to prevent the spread of yellow fever.
Within the same period a vessel having on board hun-
dreds of emigrants suffering from small-pox, has been
detained in quarantine until the disease had completed
its work, not a person being allowed to leave the ship in
the meantime. This is only another method of enforcing
the old dogma of non-intercourse, and is closely allied
to the cordon sanitaire and the shot-gun quarantine.
The inadequacy of our present measures of prevention
will become apparent if we reflect for a moment upon
the present teachings of science as to our power to de-
stroy in their incipiency the very germs of the diseases
against which we create and maintain our costly and
well-nigh useless quarantines. If cholera be taken as an
example, we can readily determine how far in advance of
our practice are the requirements of sanitary science.
We now know that cholera can never invade this country,
except the germs are, first, in the digestive organs of a
human subject ; or, second, are in his clothing, goods,
or other effects where they have been lodged. With this
knowledge as our guide, how simple and effective be-
come all of our preventive measures ! We aim to ef-
fect two objects, viz., first, to destroy the germ ; and
second, to prevent its introduction into the human stom-
ach. The first is accomplished by the use of well-known
germicides, and the second by care that neither by water,
food, unclean hands, or other means, the germ enters
the mouth. With a proper appreciation of these simple
yet fundamental facts, we may apply preventive meas-
ures with precision. The cholera germ can be sought
out and destroyed as absolutely as the spark of fire that
would cause a conflagration.' This was repeatedly
proven during the outbreak of 1866 in this city, when
scarcely two cases occurred in the same family, so
promptly were remedies employed. An outbreak of
cholera among the institutions on Blackwell's Island was
in the same manner at once, and absolutely, suppressed
by attacking the germs, and guarding the inmates against
the ingestion of choleraic matters. It will be readily
understood that preventive measures based on these prin-
ciples wholly discard non-intercourse, whether enforced
by cordon sanitaire or shot-gun quarantine. On the
contrary, no other obstruction is offered to travel and
traffic than what may be necessary to find and destroy
the germs in transit.
Again we repeat that in the light of the above facts
our quarantine system, and our quarantines at their best,
will prove at present, as in the past, no effectual barrier
against the introduction of cholera into this country.
They are a delusion which serves a good purpose in
quieting the apprehensions and fears of the public mind,
but should no longer deceive the health authorities of
this country, and especially of the great seaboard cities.
Not a moment should be lost in the most thorough sani-
tation of these cities, and a vigilant supervision should
be given to all forms of diarrhoeal affections. We do not
assume the rdle of alarmists, but would in all seriousness
warn our health authorities that cholera in a seaport
town of Europe always did, and now does, indicate that
it is at our own doors.
The only system of preventive measures against epi-
demics of foreign origin which can ever adequately ac-
complish the purpose was partially organized by the
National Board of Health. Had its powers been equal
to the task we should now have a service which would
be an impregnable defence against the invasion ot
cholera. That Board inaugurated the following scheme,
viz.: I. The co-operation of commercial nations in
notification of the existence of pestilential diseases, in
uniform and well-matured measures of defence and pro-
tection. 2. Sanitary inspection of every vessel at the
port of departure, with power to detain and care for the
sick, to secure absolute cleanliness of the ship, and to
thoroughly supervise the cargo. 3. A sanitary service at
sea which should isolate every form of contagious dis-
ease, destroy the first evidence of contagion, and pre-
July 12, 1884.3
THE MEDICAL RECORD.
41
serve the vessel, passengers, and cargo, in the best
saaitaiy condition. 4. A series of insular refuge stations
to irhich every infected vessel must resort before at-
tempdog to enter a port ; this station was to be fully
equipped with every appliance which science and ex-
penence could suggest for the cure of the sick, the
cleansing of the ship, and purification of the cargo. 5.
Local quarantines with every provision for the most exact
expert examination of passengers, cargo, and vessel, as
to the presence of the germs of disease. Such a service
is practicable, and when fully perfected and put in opera-
tion will bring to a summary termination the roving
pestilences which now infest the great lines of travel and
commerce. But until this reform is accomplished local
sanitary authorities must rely upon works of cleansing
to remove every condition favorable for the reception
and propagation of the epidemic, and by vigilant in-
qiiiiy and inspection discover the first evidences of the
presence of the disease, and destroy every vestige of con-
tagion.
INFANTICIDE IN THIS CITY.
Murder has always been looked on as the most heinous
of Climes, and only to be expiated by the. life of the
mmderer. This view, of course, is the one taken from
the spirit and letter of the law. Although at times the
object of the law is defeated through a variety of causes,
die justice of capital punishment is seldom disputed. It
happens at intervals that a very carnival of murder seems
to pervade certain communities, and then the sense of
outraged justice asserts itself, and the people demand
the rigid enforcement of the provisions for its punish-
ment In New York City crimes have been committed,
oijsterious and horrible, like the Nathan murder, that
have been for weeks and months the wonder of sensation
lovers and the fear of the timid. The newspapers devote
cohimn after column depicting every minute detail of
such tragedies as the one mentioned, and yet of another
fonn of murder, more revolting if possible, there is seldom
any mention made, or if there is it takes the shape of a
three or four line item.
Suppose in the space of four months and a half the
police had picked up, in various parts of Manhattan
Ishnd,the bodies of forty^five unknown men and women
ifao had met death by violence, starvation, or exposure
at te hands of parties unknown ? Would not the public
heart almost congeal with horror to think of the awful
satonialJa of homicide being carried on in the city?
li^odd not the citizens of New York demand, in tones
aotto be misunderstood, that every e£fort should be used
to bring the murderers to justice? There has not been
m the time mentioned that number of adult bodies found,
bat there has been of children ranging in age from a few
luuis up to two months. In February there were three
imnd, in March seven — three on one day, the 28 th ; in
April dght ; in May twenijhone^ and in June up to the
20th of the month, six. To give some idea of the extent
of tenitory covered by these figures, it is enough to say
that eighteen police precincts. Central and Riverside
Parks, are represented. These statistics are from the
Coroners' records and are presumed to be correct, and
do not indode any cases of foeticide ; neither are any
Bidnded of which there is the least knowledge in regard
to either parent or of the child previous to the finding of
the body. These forty-five are absolutely unknown, and
almost certainly the victims of infanticide. The Coroners
have held inquests in all the cases and found that death
has resulted from many causes, but beyond drawing the
fees accruing it cannot be said that they have done any-
thing in the premises. Indeed, it is hard to believe that
they do not consider the frequency of this fearful crime
in the nature of a special dispensation rather than a sad
commentary on the decaying morals of a civilized peo-
ple.
The police, too, apparently regard infanticide as a
necessary evil, and make no attempts to discover the
perpetrators ; or if they do make such efforts, they are
only perfunctory and are given up almost as soon as
started. They have a most peculiar method of reasoning
in explaining their luke-warmness in ferreting out thb
species of murder. Their argument is, in effect, that the
ones who commit the crime are so cautious and circum-
spect in disposing of the evidence in another part of the •
city from that in which the crime was committed, that it
would be useless to attempt to discover the author.
Strong logic, truly ! The crime of murder can be en-
gaged in with impunity if the murderer will only act with
discretion I The reasoning is too diaphanous, however.
There is in most of these cases a strong thread of evi-
dence to begin with, which, in the hands of one who
cared to use it, could be turned into a mighty cable, or at
least into a hempen rope strong enough to sustain in
mid-air the fiend or devil cruel enough to destroy a de-
fenceless child. The claim that evidence is hard to ob«
tain might be listened to, were the facts different and the
finding of a ghild's body a rarity ; but it seems supremely
silly to set up such an excuse when the instances are so
widely scattered throughout the city and of such alarm-
ing and amazing recurrence. Some parts of the city
seem to be favorite and selected repositories for mur-
dered children ; one of these delightful spots is -that part
of the Eighteenth Precinct situate between Twenty-third
and Twenty-fifth Streets and First and Second Avenues.
This vicinity has been selected, no doubt, on account of
its propinquity to the Morgue, and such little incidents
s^rve to show the tender consideration of these pleasant
people to whom abortion is a recreation and child-murder
a pastime.
On the night of May ist a party of boys found the
body of a child in a marble-yard on Twenty-third Street,
near First Avenue. An officer of the Eighteenth Precinct
brought the body to the Morgue. It was about five
weeks old, and about its neck and face showed signs of
death from either suffocation or strangulation. It was
well clothed and had been placed in a coarse bag with a
paving-stone weighing ten or twelve pounds. Manifestly
the intention of the party leaving the body in the marble-
yard was to await an opportunity to drop it in the East
River. In answer to an inquiry made by a reporter the
sergeant at the desk in the police-station said that the
case did not amount to anything, and even if it was in-
fanticide, it would be impossible to obtain any clue. The
following night another body was found a block distant
from where the first was. Two nights after a third dead
child turned up within a stone's throw of the police sta-
tion. Three cases in four days! and yet there was
42
THE MEDICAL RECORD.
[July 12, 1884.
nothing to work on ! It is safe to say that any reporter
who had taken a case with as good points as these would
never hold up his head again had he not worked them to
a successful conclusion. Further than this, leaving out
of the question the evidence furnished by the circum-
stances attending the finding of each body, there is the
undeniable fact that no child is born without some one
knowing of the birth beside the mother, and it is rank
foolishness to assert that the child can disappear and only
one person be acquainted with the circumstance.
But the police do injustice to their detective abilities.
The real reason they make no effort to unearth the mur-
derers of children is not the lack of evidence but the lack
of inducement. These poor murdered children never had
the right to exist, and if they are made away with no one
grieves or pines. The unhappy mother is rid of a burden,
the father of a stumbling-block, and the world of a bas-
tard. The child itself is better off too, is the argument
of the practical. All of which may be true — but shame
* on a social system which makes infanticide possible by
teaching that it is a crime for a child to be born !
It is undoubtedly correct to say that nine-tenths of the
people who ever give a thought to the subject feel a
throb of pity for the so-called unfortunate mother who
destroys her child. These mistaken soft-hearted persons
seldom stop to consider that in many cases the mother
does not do the job herself, but contracts for it through
the agency of a baby-farm. Probably many of these
dead children are the offspring of women living a dis-
reputable life, who through negligence or ignorance have
allowed themselves to become mothers. Pity is wasted
here at least. Even if the mother is a young girl who
has listened to the seducer, no excuse can be invented
to cover up her fault when she becomes a murderess.
Leaving speculations and arguments aside, one truth
stands out in bold and horrid relief, and that is that foeti-
cide and infanticide are looked upon to-day with a feel-
ing nearly akin to indifference. When a Christian people
have reached that point where they are not susceptible
to such insidious attacks on the very basis of all morality,
it is time to sound an alarm and insist on the enforce-
ment of the statute law relating to murder, whether the
victim be the offspring of a person of mark or only the
unfortunate illegitimate child of a common woman.
TEMPERANCE PHYSIOLOGY IN THE PUBLIC SCHOOLS.
Publishers, in this and other cities, of text-books for
schools are brought to face a curious result of the
present energetic work of the temperance agitators.
Writers or editors of school-books on anatomy, physiol-
ogy, and hygiene are compelled to pay especial atten-
tion to the poisonous and demoralizing effects of alcohol
and tobacco. In order to get a physiology accepted, the
essential requisite is not that it be a good text-book, but
that a disproportionate space be given to these subjects,
and that statements be made which are hardly borne out
by facts or in accordance with the conclusions of science.
It may be seriously questioned whether it is wise, after
all, thus to inject temperance tracts into the body of a
science text-book. In the long run it pays best to tell
and teach the exact truth. And we are quite sure the
exact truths regarding alcohol and tobacco are sufH-
ciently terrible to impress duly the child. To say, as some
text-books seem to do, that alcohol is a poison and a
deadly poison, that it causes catarrhs, sclerosis, dropsy,
crime, insanity, and shortened lives, and that moderate
indulgence is an impossibility, is to present only one side
of the picture. When the young student grows up and
finds whole nations indulging in alcohol habitually, with
no excess of drunkenness, and when he learns other feat-
ures of the reverse of the picture, the results of his one-
sided instruction may easily prove to be bad. Medical
men are agreed that alcohol is a poison to youth and to
those of hereditary taint, that it is dangerous in manhood,
but is helpful in declining age. They also see that mod-
erate drinking with the meals is a possible and often use-
ful practice.
Is not this enough to teach, without making our school
text-books the organs for an intemperate and dangerous
fanaticism ?
ANiESTHETICS IN ST. PETERSBURG.
It is always interesting to learn of the practical methods
employed by physicians and surgeons who live in dis-
tant countries and under different conditions from our
own. At a: meeting of the society of St. Petersburg
physicians in January last, a large number of members
contributed their experience in the use of anaesthetics,
and we believe that an account of the opinions expressed
will be instructive. It will be seen at once that the St.
Petersburg profession is still in the chloroform era of
anaesthesia. This is generally the case in those parts of
Europe in which the life of the lower classes is esteemed
of rather small moment
Dr. Schmitz began the discussion by saying that in the
Children's Hospital of the Princess Oldenburg a doubly
rectified chloroform was used, and that even in operations
lasting an hour and a half no bad effects had been ob-
served.
Dr. Wulff said that at the Obuchow Hospital com-
mercial chloroform was employed. In the case of alco-
holic patients it was customary to give a preliminary
hypodermic injection of morphine to facilitate the anaes-
thesia. Severe collapse in the use of chloroform was not
often observed. A few cases of death had occurred, but
it was doubtful if the chloroform was the cause.
Drs. Hirsch and Petersen related cases of obstinate
resistance to anaesthesia. Dr. Hirsch' s case, a very
feeble man, failed to be affected by an ounce and a half
of chloroform.
Drs. Moritz and Schmitz related histories of cases of
pronounced hea:^ disease in which chloroform was given
without harm.
Dr. Hirsch thought that] in cases of heart disease the
chloroform might kill when given a second time if it did
not the first, and instanced an illustrative case in his
own practice.
Drs. Moritz, Petersen, and Hintze all thought that
some of the cases of sudden death after admimstration of
chloroform were the results of psychical influence. Sev-
eral cases were referred to in which death suddenly oc-
curred on the application of the knife, although no
antiseptic had been given.
Dr. Hoist thought that preliminary morphine injec-
tions did not act well. They caused an unquiet narcosis.
July 12, 1884-]
THE MEDICAL RECORD.
43
Dr. Monastyrski thought that these injections made
the stage of excitement shorter^ but that in the stage of
narcosis there was more danger of asphyxia. He had
bad much better results with the doubly purified chloro-
form than with the commercial article. He had given
cbloroform to patients with heart disease several times
with no bad results.
In reply to a question as to the age at which it is safe
to give chloroform to a child, Dr. Wulflf said that he had
given it twelve times in one day to a child under two
weeks of age. Dr. Schmitz had administered chloroform
to a baby twelve days old, and performed an amputation
under its influence.
Dr. Magawly had used chloroform in hospital and
private practice for many years. He had only met with
tiro deaths, both occurring in weak and emaciated pa-
tients. Autopsy in one case revealed a fatty heart.
NEW MET!HODS OF TREATING EPILEPSY.
A WRITER in the JBer liner Klinischer Wochenschrift has
nsed perosmic acid in the treatment of epilepsy, giving it
in M form in doses of .002 milligr. He has had but
little success, a few cases only having notably improved.
He, however, thinks the remedy worthy of further trial.
Boumeville and £ricon have recently reported the re-
sults of their experience in treating epilepsy with sclero-
tinic acid. They gave it in daily doses of 10 ctgr.
gradually increased to 25. Among twelve patients thus
treated, amelioration was obtained in only five. The
drug is a failure as an anti-epileptic.
Professor William Pepper has delivered several clini-
cal lectures upon the treatment of epilepsy in children.
He calls special attention to the value of careful regula-
tion of diet, of removing all ^soturces of irritation, and
of securing rest, including plenty of sleep.
In a series of experiments on chronic epileptics. Pro-
fessor Henry C. Wood found that bromide of hydrogen
(hydrobromic acid) decreased the number of fits more
dian the other bromides. He gave it in doses of § > to
\ iij. daily.
Dr. S. Hughes Bennett, while offering no new remedy
for epilepsy, has recently published statistics which show,
as he thinks, that under bromides attacks are stopped in
12.1 per cent, of cases, are lessened in 83.3 per cent,
ffldare increased in 2.3 per cent. He also believes his
operience to show that the continued use of the bromides
exercises no deleterious mental or physical effect except
in a small proportion of cases. He thinks that epileptics
can take bromides better than other persons, and that
in course of time the eruptions and the depression dis-
appear.
The experience of Kunze, who claims to have cured
nine epileptics out of thirty-five with curare, has not been
repeated by others. Curare has almost uniformly failed
to effect any real benefit in epilepsy.
Ball, in addition to the use of bromides, belladonna,
and zinc, advises the use of leeches to the mastoid pro-
cess, and cathartics, in order to correct cerebral conges-
tion.
Little has ever been done for epileptics by the use of
dectridty. The recent very favorable expression as
to its value by Erb may, however, lead to further and
more careful trials.
f The experiments of Boumeville with^the bromides of
gold, camphor, arsenic, etc, show that not so good re-
sults can be obtained by these preparations as by the
ordinary bromide compounds.
Continued contributions to the therapeutics of epilepsy
only show that almost any new remedy can produce some
temporary amelioration of the disease. But nothing at
all approaching in value the bromide compounds as anti-
epileptics has yet been discovered.
HIGH FEES IN DENTISTRY.
The astonishing statement appeared a few days ago in
the daily press that a dentist of this city had charged a
fee of seven thousand dollars for four days' work in den-
tistry. It appears that the patients were three wealthy
ladies of one family, and that the operators were father
and three sons. Time consumed four days, with some
extra work after hours. Value of time-work $50 per
hour for each gentleman. So much can be learned
from the reports referred to. The gentleman, a foreigner,
to whom the bill has been sent, thinks there must be
some mistake, and asks for explanations. Being assured
tojthe contrary by the operators, he is more astonished
than ever, and refuses to pay the amount.
On general principles skilled labor deserves to bejwell
rewarded, but even that has a standard withinfeasy
range of ordinary,imagination. When applied to][den-
tistryjit is [^hard^ to associatej teeth-pulling, teeth-filling,
and plate-making with such extraordinary or special
skill as would place the value of services so dispropor-
tionately high as compared with similar work in any
other mechanical grade. It is safe to say that no diffi-
cult capital operation in surgery, upon the skilful per-
formance of which would depend the actual life of a pa-
tient, could command such a fee ; nor, indeed, would
any approach to such a sum be charged by any consci-
entious or reputable surgeon. And yet the dentist,
whose responsibilities are nothing, and whose skill at
best in his ordinary vocation of teeth>^lugging is equal
to that of a first-class mechanic, can cNarge a fee which
would put to blush the most ambiticvs professional
money-getter, and astonish the capabilities of a million-
aire.
THE HURST PERFORMANCE.
The Georgia Wonder, Miss Lulu Hurst, has been ex-
hibiting her alleged wonderful powers in this city during
the past week. We may say at once that she failed to
satisfy the intelh'gent and critical among her audiences
that she possessed any occult force whatever. The re-
marks which we made concerning her in a previous edi-
torial were perfectly justified by a careful personal exam-
ination of her exhibitions. The " new force" acts only
through the muscles of Miss Hurst and those experi-
mented upon. It is, in fine, muscular force, and that is
all. Miss Hurst is a strong, large-framed girl, and has
the power of very rapidly contracting her muscles. A
man takes hold of a cane with two hands and is told to
hold it still if he can. He immediately throws his
muscles into a state of extreme tension; Miss Hurst
44
THE MEDICAL RECORD.
[July 12, 1884-
tlien lays her big hands on the cane, with the thumbs
underneath, we are told. By very slight but rapid mus-
cular movements the cane is twitched around. The
more the man resists, the more tense his muscles, and
the more easily the cane is pushed about. Soon the man
becomes excited ; he thinks he is wrestling with a force,
and performs various ludicrous gyrations. Miss Hurst
ingeniously makes him labor and perspire over nothing.
This is the sura and substance of all the experiments.
No test upon an inanimate object shows anything at all.
In keeping a chair from the floor, she holds 'it in a pe-
culiar way, and apparently exerts her own not inconsid-
erable strength.
If Miss Hurst, as is possible, is not consciously de-
ceiving, then it would seem as if the contact of her
hands with umbrellas, chairs, and billiard cues produced
a kind of artificial chorea. The phenomena she exhibits
and calls out, are, at any rate, interesting perversions of
the ps3xho-motor sphere.
They are still more interesting as illustrating the cre-
dulity and the utter incapacity for scientific examination
of such performances which have existed among most
of her audiences. We understand, however, that the
true nature of her *' force" has been exposed since her
arrival in this city.
g^ettra of tlue WSicf^h.
Death of a Doctor from Chloroform. — Dr. Mac-
Rae, of Scotland, wa.s suffering from a tumor at the nape
of the neck, for the removal of which he went to Edin-
burgh, and placed himself under the care of Professor
Annandale. While the chloroform was being adminis-
tered prior to the necessary operation. Dr. MacRae, who
was in the prime of life, suddenly died.
Memorandum for the Prevention of Cholera. —
The State Board of Health has issued a memorandum
regarding the measures to be taken to prevent the intro-
duction and spread of cholera in this coimtry. The
Board consider it probable from past experience that
cholera will reach this country, and they recommend the
most careful disinfection and cleansing of our cities and
towns.
Progress of the Cholera. — The deaths from chol-
era at Toulon and Marseilles have been slowly increas-
ing in number daily from July ist to 8th, as follows :
July ist, Toulon, 6 ; Marseilles, 3. July 2d, Toulon, 5 ;
Marseilles, 4. July 3d, Toulon, 13'; Marseilles, 5. July
4th, Toulon, 4. July 5th, Toulon, 7; Marseilles, 12.
July 6th, Toulon, 4; Marseilles, 15. July 7th, Toulon,
9 ; Marseilles, 16. July 8th, Toulon, 10 ; Marseilles, 14 ;
Nice, I (?). The total number of deaths from cholera at
Toulon since the beginning of the epidemic is 154, The
number of cases in the hospitals at Toulon has been be-
tween 115 and 150. Despite the number of cases at
Marseilles the death-rate of the city is low, and it is be-
lieved that a great deal of needless alarm exists. Dr.
Koch has arrived at Toulon, and has found the bacillus
of cholera in the intestines of those who have died from
the disease. He pronounces it Asiatic cholera, there-
fore. He is reported to have stated that it would spread
to Germany ; also that the germs of the disease were
taken into the system in food and drink, not by inhala-
tion. While the Spanish, Italian, and Austrian Govern-
ments have instituted quarantine against vessels from
French ports, England refuses to adopt anything but her
inspection system. A vessel from Marseilles with two
cases of cholera on board is said to have been intercepted
in the Channel. All passengers and baggage arriving at
Paris from infected districts have now to be disinfected.
The Colorado State Medical Society met at
Denver on June 19th, 20th and 21st. Dr. Whitehead,
President, in the Chair. The following officers were
elected for the ensuing year : President — Dr. Hawse, of
Greeley ; Vice-Presidents — Drs. Soly, Rogers, and Ear-
hart ; Recording Secretary — Dr. S. A. Fisk.
The Investigation of Lulu Hurst. — ^We have
received a number of letters from Southern medical men
protesting against our judgment of Miss Hurst's per-
formances. We venture to answer them all here by
publishing a letter written in answer to one of them by
a gentleman who investigated the matter at our request :
" Dear Doctor : Having been asked to investigate the
Hurst phenomenon, I went and saw her last night In
common with the medical gentlemen with me, I thought
she utterly failed to demonstrate the possession of an/
peculiar powers; the phenomena could all be ex-
plained, and easily, by assuming the existence of uncon-
scious convulsive movements and by the peculiar mus-
cular rigidity and expectant state into which those
experimented upon got themselves. While perfectly
willing to be convinced, we saw nothing to justify us in
assuming a new force, but only a curious disturbance of
the voluntary motor system, and an interesting illustra«
tion of what may be done with persons in a state of ex«
pectancy and great muscular tension. Some of her
experiments were subsequently repeated among our-
selves. Miss Hurst does indeed cause dead matter to
move, but no more than any large and muscular girl
could make it."
Disinfection of Rags from Egypt. — The following
are -methods of disinfecting rags which are considered
satisfactory by the Treasury Department : i. Boiling in
water for two hours under a pressure of fifty pounds per
square inch. 2. Boiling in water for four hours without
pressure. 3. Subjection to the action of confined sul-
phurous-acid gas for six hours, burning one and a half to
two pounds of roll brimstone in each 1,000 cubic feet of
space, with the rags well scattered upon racks.
Local Health Officers and Inspectors of Cus-
toms.— The Treasury Department has decided that State
Health authorities cannot prevent United States Inspec-
tors of Customs from landing at quarantine stations and
pursuing their duties there, if necessary. The question
came up at Charleston, S. C.
Experiments with a Decapitated Human Head. —
M. I^abarde has been making some truly ghastly experi-
ments with the head of Campi, the murderer, who was
recently executed in Paris, and in the Revue Scientifique
he publishes an account of them. By means of a tube
he connected the carotid artery of the head with the
corresponding artery of a living dog, and the head being
placed upright on a table, the stop placed on the dog
July 12, i884*]
THE MEDICAL RECORD.
45
iras removed. As the blood was carried into the head
the livid hue of the face disappeared and color returned,
the forehead and cheeks being suffused and the eyelids
moving. Some time had elapsed since Campi's death,
and M. Labarde regrets that such experiments cannot
tske place immediately after execution, as the physiolo-
gist might thus be able to witness a ** grand and terrible
spectacle."
Dr. Martin McGovern has been appointed Police
Surgeon, vue Dr. M. H. Henry, resigned.
New Method of Supporting the U. S. Marine
Hospital Service. — The last Congress passed the fol-
lowing law : " That sections forty-five hundred and
eighty-five, forty-five hundred and eighty-six, and forty-
five hundred and eighty-seven of the Revised Statutes,
and all other acts and parts of acts providing for the as-
sessment and collection of a hospital tax for seam^, are
hereby repealed, and the expense of maintaining the
Marine Hospital Service shall hereafter be borne by the
United States out of the receipts for duties on tonnage
provided for by this act ; and so much thereof as may be
necessary is hereby appropriated for that purpose."
The sailor is, therefore, no longer taxed forty cents a
month, and the marine hospital service is supported by
the owners of vessels, instead of by their employees.
The question may now be raised, whether employers can
constitutionally be taxed for the support of their employ-
ees when sick.
Gifts to Hospitals. — ^The sum of two million francs
was bequeathed by the late Baroness Alquier for the
erection of a new hospital in Paris. The London Hos-
pital has just received $50,000 from Baroness Rothschild.
Membership in the American Medical Associa-
tion.— ^At the meeting of the American Medical Asso-
ciation, held at Washington in May last, an amendment
to Emulation II. was adopted, which provides that
*'Membeiship in the Association shall be obtainable by
any noember of a State or County Medical Society recog-
nized by the Association, upon application, endorsed by
the President and Secretary of said Society ; and shall be
retained so long as he shall remain in good standing in
his local Society, and shall pay his annual dues to the
Association."
A Religious Quack Advertisement. — As a speci-
men of the means by which the simple are induced to
part with their money, the following, says the Studenfs
]wmaly cut from the advertisement columns of The
Ckrisfian Million^ is worthy of perusal: ''The Bitter
Cry for Help. — Thousands of God's creatures are lifting
up their plaintive voices for help. Poverty presses hard
upon them, and renders their lives a sad monotony,
living in narrow dwellings, and constantly breathing im-
pure air, they are physically weak and altogether unfit
ibr the duties of life. Sickness and suffering, hunger
and ignorance, are, as it were, written on the very door-
posts of their dwellings. In higher circles we find a
Merent state of things — no poverty, no badly- ventilated
homes ; but many afflictions, nevertheless, weigh upon
them, symptoms of ill-health which their physicians ap-
pear to be unable to remove — failing sight, deafness,
noises in the ears, indigestion, coughs, and a variety of
other complaints, make these well-to-do people very,
very sad. From all classes comes up the cry for help.
The man who has the power to help his brother and is
unmindful of his trust is surely unfaithful to the better
promptings of his nature. The noble army of faithful
workers, ministers, doctors, and sick visitors, deserve our
prayers and sympathy. The Rev. E. J. Silverton, has
for many years been engaged in alleviating the sufferings
of mankind, curing deafness and removing noises from
the ears by means of his * Aural Remedy,' curing in-
digestion and all its tortures by his ' Patent Pills,' and
building up broken-down constitutions by his ' Medical
Energiser and Magic Cough Mixture/ and his 'Nutrient
Food of Food.' All these wonderful medicines may be
ordered of any Chemists, who will procure them for any
sufiferer. The prices are arranged to meet all classes, viz.,
'Patent Pills,' is. ijd., and 2s. 9d. per box," etc. Were
any ordinary quack to use the name of the Supreme Being
for trade purposes it would be considered rank blas-
phemy, but, in the case of a '* Reverend " it is doubtless
accepted by Christian Million readers as a guarantee of
good faith.
An Epidemic of Typhoid Fever in Switzerland. —
Typhoid fever has been very prevalent in Zurich, a city
of 83,000 inhabitants. The disease has been character-
ized 'by severe complications. One of the causes is
thought to have been the low water in the lake.
Journalistic Changes and Evolution. — The prog-
ress of evolution is said to proceed from the homogene-
ous, the simple, and the undifferentiated, to the hetero-
geneous and complex. Exactly the reverse occurred,
nosologically speaking, when the Kansas and Missouri
Valley Medical Index and the New Medical Era and
Sanitarian consolidated under the plain and undifferen-
tiated title of the Medical Index.
Religion and the American Doctor. — Nothing
for a long time has so stirred up the religious sentiments
of the American physician as a resolution introduced
into the American Medical Association last May, pro-
posing to dispense with the opening prayer. Most of our
contemporaries have made vigorous comments express-
ing approval of the action of the Association in promptly
tabling the matter. No one has put it quite so vigor-
ously, however, as the energetic editor of the Texas
Courier-Record^ who concludes his criticisms of the in-
judicious introducer as follows :
** Oh, shame, where is thy blush ? Oh, cheek, where
is the limit to thy flintiness? Oh, immaculate gall,
assurance, impudence, thy name is him who in-
sulted that grand body of grave, thoughtful, earnest
workers, whose very lives and presence testify the exist-
ence and providence of the living God, and belie and be-
little your puny doctrine."
It is no discredit to the heart of our esteemed con
temporary that he subsequently confesses to having re-
ceived the consolations of refreshment.
Third Congress or the Italian Surgical So-
ciety.— The third Congress of th^ Italian Surgical
Society will be held in Turin on the 15th to the 20th of
September, 1884. The secretaries are Drs. G. Novaro
and G. Berruti, of Turin.
46
THE MEDICAL RECORD.
[July 12, 1884-
The French Association for the Advancement
OF Science meets at filois on September 4 to 11, 1884.
Vivisection Work in England. — A return which has
just been published showing the number of experiments
performed upon living animals during the year 1883 under
the Vivisection act, is a somewhat remarkable document.
It appears that in England and Scotland 44 persons have
held licenses under the act during some part of that
year, of whom 32 performed experiments and 12 per-
formed none. In Ireland 8 persons held licenses, of
whom only 4 performed experiments. The total number
of experiments of all kinds was 535 in England and Scot-
land, and 34 in Ireland. Of these 290 were carried out
under the restrictions of the license alone, 55 under
special certificates dispensing with the use of anaesthet-
ics, and 122 under certificates dispensing with the obli-
gation to kill the animal before recovering from anaes-
thesia. Under certificates permitting experiments on
cats, dogs, horses, mules, and asses there were 102 opera-
tions, but it appears that only four or five were upon
cats or dogs, and none at all upon the other animals
named. As regards the 290 cases first mentioned, to-
gether with a number carried out under certificates pre-
scribing anaesthetics, the animals were rendered insensi-
ble during the whole of the operations, and were not
allowed to regain sensibility. Their sufferings were accord-
ingly quite inappreciable by the most acute sympathizer.
The 55 experiments without anaesthetics consisted in
simple inoculation or hypodermic injection with morbid
matter whose operation it was desired to discover, and
the pain inflicted was at the most that of ordinary vacci-
nation and its results. Of the 122 experiments in which
the animals were allowed to regain sensibility, 114 also
consisted principally in inoculation, and were for the
most part connected with an important inquiry into the na-
ture of tubercular affections. No pain was inflicted save in
some 14 or 15 instances, and even in these it was trifling.
In the remaining eight cases anaesthetics were used, and
though the surgical operations amounted to more than a
mere puncture, the pain would be only that usually at-
tending the healing of a surgical wound. The experi-
ments upon cats and dogs are classified under the heads
already mentioned The conclusion of the Inspector's
report is that " the amount of direct or indirect suffering
from the performance of physiological experiments dur-
ing the past year was wholly insignificant, and limited to
about 14 or 15 animals."
Water and Constipation. — Dr. Squibb, in his last
Ephemeris^ has a suggestive article upon constipation.
He thinks that most constipations are due to insufficient
water in the fecal mass. The individual does not ingest
enough water to supply the blood with its seventy-nine
per cent., therefore the blood absorbs it from the intes-
tinal contents. " Drink water," is Dr. Squibb*s motto. It
is a good one ; but water, as every one knows, will not cure
habitual constipation in a very large percentage of cases.
Dr. Axel Iversen. — ^The name of the surgeon as-
sociated with rectal etherization should be written Iver-
sen, not Yversen. It was incorrectly spelled in the Lyon
M^dicaly in which Dr. Molli^re's notice appeared, prob-
ably through the writer's attempt to represent the Dan-
ish pronunciation by the French spelling.
%mizms atid ^flriticea.
The Physician's Combined Day-Book and Ledger.
By H. T. Hanks, M.D. New York : J. H. Vail &
Co. 1883.
To the average physician, who knows as little of book-
keeping as he does of navigation, one of the greatest
trials of his life is the keeping his accounts straight, and
anyone who helps to simplify and lighten his labors in
this direction may justly be regarded as a benefactor to
the profession. And after a practical trial of the system
here presented we are disposed to grant this title to the
author. In this book provision is made for the date and
character of the visit, the member of the family attended,
special charges, etc., all within the smallest possible
space. The charges can be continued from month to
month or year to year without re-entering, and the entire
account of each patient may be comprehended at a glance.
The necessity of a ledger is done away with, thus saving
the gfiysician much time and avoiding all possibility of
error in making the transfer. The author *' claims to
have arranged in this book the most exact and labor-
saving system of book-keeping ever devised for the use
of a physician," and as far as our experience will permit
us to judge we think his claim is well founded.
Elements of Pharmacy, Materia Medica, and Ther-
apeutics. By William Whitla, M.D. (Q. V. I.),
Physician to the Belfast Royal Hospital ; Consulting
Physician to the Ulster Hospital for Diseases of Wo*
men and Children ; Vice-President of the Ulster Medi-
cal Society, etc. With Lithographs and Woodcuts.
Second Edition. London : Henry Renshaw. 1884.
This manual, intended primarily for students, contains a
vast amount of practical information arranged in very
convenient form for ready reference. It is divided into
six parts, treating of pharmacy, materia medica, thera-
peutics, non-official remedies, prescription writing, and
chemical reaction, with some of the more important tests.
The arrangement of the drugs is in alphabetical order.
There is an index of poisons and their antidotes, and a
very copious general index adds to the value of the work
as a ready-reference manual The fact that a large edi-
tion was exhausted within two years is a sufficient evi-
dence that the book has supplied a want.
Hand-Book of Eclampsia, or Notes and Cases of
Puerperal Convulsions. Comprising all the Cases
which have occurred during the Present Century within
a Radius of Several Miles around Avondale, Chester
Co., Pa., so far as can be ascertained. By E. Mich-
ENER, M.D., J. H. Stubbs, M.D., B. Thompson, M.D.,
R. B. EwiNG, M.D., and S. Stebbins, M.D. Phila-
delphia : F. A. Davis. 1883.
The authors of this little brochure have collected and
studied forty-fpur cases of puerperal convulsions occur-
ring during the present century in the vicinity of Avon-
dale, and have here presented their conclusions derived
from this study. Briefly stated, their belief is that the
proximate cause of puerperal eclampsia is hyperaemia of
the brain, and the treatment based upon this belief con-
sists in prompt and plentiful bleeding. The essay will
repay a careful perusal, even though the conclusions of
its authors may not be accepted in their entirety.
Female Hygiene and Female Diseases. By J. K.
Shirk, M.D., Member of the Lancaster City and
County Medical Society. Lancaster, Pa.: The Lan-
caster Publishing Co. 1884.
This is a book intended for the laity, and treats in intel-
ligible language of the hygiene and diseases of the female
reproductive organs. It contains much useful informa-
tion on a subject of which women are often too ignorant,
but we think it would have been productive of more un*
mixed good and would have served an equally useful pur-
pose had the directions concerning the medicinal treat-
ment of disease been omitted.
July 12, 1884.]
THE MEDICAL RECORD.
47
Reports 0t ^ocUtuB.
NEW YORK PATHOLOGICAL SOCIETY.
Stated Meetings June 11, 1884.
H. E. Van Gieson, M.D., Vice-Preside^, in the
Chair.
Djl Wackerhagen presented specimens as follows ; The
first was one of
carcinoma of the breast
removed from a German woman seventy-two years of
age. Twenty-five years ago she noticed a small lump in
the breast, which gradually enlarged but caused no in-
convenience until two years ago, when it became painful.
In December last a small abscess formed below the
nipple, which continued discharging until the operation
on May iSth. During a few weeks before the oper-
ation the pain was at times very severe, and she was
anxious to have the tumor removed. It weighed nine
ounces, and consisted of normal gland structure and adi-
pose tissue, in the midst of which was a mass of fibrous
tissue arranged in trabeculae, which radiated in all di-
rections, and in the meshes of which were free fat and
probably some cell elements. To one side of the cen-
tre of this mass was a cavity whose walls were composed
of the same fibrous material of a darker color, and from
which could be expressed a thick greenish juice. This is
probably a post-mortem change. To the touch the speci-
men was fairly firm, and presented nodular areas of small
size throughout the mass. The smaller mass came
from the axilla. It weighed about two ounces, and was
composed of adipose tissue, lymphatic glands, and nod-
ales the size of large chestnuts and composed of fibrous
tissue arranged in trabeculae which radiated in all direc-
tions, and in the meshes of which were cellular elements
and some fat To the touch the ncTdules were firm and
fairly well defined. There were also blood-vessels dis-
seminated throughout the mass, but apparently not in the
nodules, at least of appreciable size. The dressings were
bichloride and iodoform, and were not removed until the
eleventh day, when complete union had taken place
throughout.
epithelioma of the penis.
The second specimen was a portion of a penis re-
moved from a gentleman aged sixty-four. He had suf-
fered from irritation of the glans for several years, the
result of phimosis. During the past year pain and itch-
ing had been very severe, and at times there had been
conaderable hemorrhage. The glands in both groins
were enlarged, but had decreased greatly in size since
the operation. The tendency of the growth seemed to
be outward, rather than down into the deeper portions of
the tissue. The urethra was apparently intact, excepting
at the meatus. Upon the glans was seen a growth which
atended from the meatus nearly to the corona glandis, or
the point of junction of the glans with the cervix of the
penis. This growth was soft, of a papillary or fungiform
appearance, and seemed to involve, to a moderate extent,
the normal tissue of the glans. A portion of the glans
bad been removed for microscopic examination. A simi-
lar growth was seen upon the prepuce, extending from
the line of junction of the outer and inner surfaces down-
vard on the inner surface for a distance vary ing from a
scant half inch to an inch in length. It was nearly an-
nular, forming almost a complete circle upon the inner
«irface of the prepuce. Upon the right side the neo-
plasm was gradually gaining the outer surface of the
prepuce, over which it extended for a short distance.
The specimen was referred to the Committee on Mi-
croscopy.
lipoma of the neck.
The third specimen was a lipomatous tumor removed
from the neck of a young married woman, aged twenty-
three. It was located posteriorly and to the right of the
median line, and at a point nearly midway between
the occipital protuberance and the vertebra prominens.
It weighed sixteen drachms. The mass consisted of a
fibrous capsule which gave off branches of fibrous tissue
that filled the capsule in such a manner as to make it
somewhat cavernous. Within the meshes of fibrous tis-
sue was collected a large amount of fat, which gave to the
mass a degree of compressibility. The capsule was quite
thick, very tough, and vascular, as could be readily seen
by the numerous ligatures on different portions of the sur-
face. Sections of the mass float in water, giving evidence
of its lipomatous nature. One or two small secondary
nodules were observed around the periphery of the mass.
These were similar in structure to the large growth.
The fourth specimen was an
encysted tumor of the thigh
situated just below the greater trochanter, removed from
a gentleman, aged twenty-six. The tumor was enclosed
in a firm fibrous capsule which was partially covered with
adipose tissue. On section a white caseous mass was
seen, which was readily expressed with slight pressure.
The cheesy mass was soft and mushy, disintegrating
readily on pressure.
tubercular PERITONFTIS — GENERAL TUBERCULOSIS.
Dr. W. p. Northrup presented a specimen with the
following history : The patient was a female, inmate of
the New York Founding Asylum, aged three years and
ten months. She was brought in from the out-nurse in
February, 1884. She was somewhat emaciated ; had
well-marked ascites ; bowels inclined to be constipated ;
moderate bronchitis. Beyond these there were no noted
symptoms. The ascites gave ready fluctuation, but on
changing the position of the child the fluid did not move
about readily — seemed to be encysted. Later, though the
fluctuation continued it was less prompt and somewhat
different in character.
Autopsy f ]\ine lOf 1884. — Body: Extremely emaciated,
abdomen distended. Brain : Examination not allowed.
Lungs : Bronchial and tracheal glands enlarged through-
out, though none to a large size. Left lung is adherent
over nearly its whole surface. In middle third posteriorly
are two cheesy masses about the size of an ordinary hick-
ory-nut. Aside from this the same description will serve
for both lungs. Large, opaque, and glassy miliary tuber-
cles are uniformly distributed throughout both. Between
the .tubercles is a moderate amount of diffuse pneumonia
and well-marked oedema. Heart: Normal. Peritoneum:
On opening the abdomen the muscular wall and the con-
tents of the serous membrane are found glued together.
The peritoneum is thickened and thickly sprinkled with
cream-colored, rounded tubercles about half as large as
a pea. The coils of intestine, large and small, liver and
spleen and stomach, are tightly glued together into a
fluctuating mass. Fluid, gruelly faeces escape before any
artificial opening can be found. In dissecting open the
intestines a coil can be followed for a few inches and^
then it dips down into the mass and is lost. The whole
mass is then cut across and the half coils are found
held in place by the gelatinous mass of tubercle and
thickened peritoneum, so that the cut ends remain half
patulous. Mesenteric glands have broken down into
large cheesy masses. Numerous ulcers, large and small,
are found. Many have perforated the wall of the intes-
tine. Others are deeply sunk with overhanging edges.
Liver : Peritoneal covering much thickened, and contains
large tubercles. On section, a few ordinary miliary
tubercles are found. Spleen : Same description applies to
its covering, and the tubercles seen on section. Kidneys :
One ureter dilated to nearly one-half more than normal
size ; three to five opaque white miliary tubercles found
on cut surfaces.
Dr. Northrup said he had seen this condition of peri-
toneum in young adults, but never before in a child under
four years.2
48
THE MEDICAL RECORD.
[July 12, 1884-
Dr. Peabody thought the condition was not common
in children, although sufficiently frequent in adults. Al-
though large tubercles of the peritoneum were not com-
. nion, large masses of tubercular tissue were likely to be
found wherever tubercles had existed for a considerable
length of time.
Dr. J. C. Peters said that some time ago he saw two
cases, one in a child two or three years old, and the
other in a child four or dve years of age. The clinical
history was peculiar in the fact that the only symptom
present for some time was extreme irritability of the
bladder. Afterward cerebral symptoms developed, and
the existence of tubercular meningitis was evident and
was supposed to be the principal disease. Both children
died, after a sickness lasting about three weeks, and in
each there were tubercles as large as those in Dr. North-
rup*s specimen, on the peritoneum, and tubercles in
every organ seen ; the brain was not examined.
Dr. Ferguson referred to a case of perforation of the
intestine without definite symptoms, which he encoun-
tered at an autopsy not long ago, and in which the diag-
nosis of ovarian tumor had been made by several gyne-
cologists. There was no ovarian tumor at all, but
simply a dilated portion of intestine, which had ruptured
and emptied the contents of a large sac into the perito-
neal cavity without giving rise to any marked symptoms.
Dr. C. H. Knight presented a specimen with the fol-
lowing history :
TUBERCULAR MENINGITIS — HEREDITARY SYPHILIS ? — BASI-
LAR GUMMOUS MENINGITIS?
Jenny M , aged one year^ was first seen on March
24, 1884. Had been fretful and restless for a day or two,
and had vomited once -, slight febrile reaction ; symptoms
were thought to be due to irritation from an upper lateral
incisor tooth which was beginning to come through.
Five days later I was called to see the child, whom I
found lying with wide-open staring eyes, and apparently
unconscious ; head constantly rolling from side to side ;
gives a feeble cry or whine from time to time ; takes no
nourishment without rejecting most of it in a few mo-
ments ; occasional twitchings of extremities ; temperature
normal, pulse slow and regular. Merc, inunc. and K.
I., gr. j., every hour.
March 30th. — Pulse, 68, regular ; temperature, 99^° F.
in axilla ; refuses to nurse ; has taken little beef-tea and
milk from spoon ; lies most of the time apparently
asleep, but the left arm is in constant motion between
the side and the nose, as though tr3ring to brush some-
thing from the face ; left leg is occasionally drawn up ;
right side motionless and flaccid ; rolling of head ceased ;
face pale ; pupils contracted, left more than right — re-
spond slowly to light ; typical Cheyne-Stokes respiration ;
no vomiting ; bowels moved naturally yesterday p.m.
March 31st. — Pulse irregular, 95 ; temperature, 100 J°
F. ; respiration same as yesterday ; pulse slows during in-
tervals of non-respiration and accelerates with return of
breathing ; sleeps most of the time without moving ; when
* roused moves only the left arm and leg ; left cheek
flushed, right pale ; signs of iodism, hypersecretion nasal
mucous membrane ; occasional sneezing ; congestion of
conjunctivae, especially right; no eruption.
April ist. — Pulse, 130 ; respiration, 20 ; temperature,
101° F. Breathing is quieter and has lost the Cheyne-
Stokes character ; no movement of bowels for three days ;
urine passed naturally ; pupils normal ; no strabismus.
April 2d. — Pulse, 1 20 ; temperature, 99^° F. ; respira-
tion, 22 and more regular ; intervals of rest occur only
once in a minute or so ; child seems brighter and is more
easily roused ; takes very little nourishment, but retains
what is swallowed ; when roused is fretful and makes a
peculiar chewing movement of the jaw ; movements of
left arm and leg continued ; has a vacant, staring ex-
pression, but the lids are closed when the eyes are ap-
proached by the finger.
April 3d. — Ophthalmoscopic examination attempted by
Dr. Amidon ; unsatisfactory view of fundus on account
of incessant motion of eyeballs ; apparent hyperaemia on
left side ; right eye wider open than left ; occasional
twitching of eyelids ; eyeballs constantly moving up and
down rather than from side to side ; every few seconds
left eye is drawn violently toward the nose by clonic
spasm of the internal rectus ; left pupil contracted, right
normal or dilated and feebly responsive ; child is entirely
unconscious, but there is evident attempt to protect the
eyes by closure of the lids when the finger or a bright
light is brought near ; right arm and leg motionless and
flaccid, left arm inclined to be rigid ; left thigh inces-
santly flexed and extended ; extremities cold ; head bathed
in perspiration. Temperature, 99** F, ; respiration shallow
and irregular ; period of rest for twenty to thirty seconds
followed by a deep inspiration and an equal period of
rapid breathing, at the rate of sixty or seventy to the
mmute ; pulse, 140, irregular and compressible ; bowels
moved this morning after two grains of calomel; no
nourishment nor medicine has been retained to-day;
remained in above condition from 8 p.m. until 5 a.m.
April 4th, when the patient gave a feeble cry and had
clonic spasms on the rig/t/ side lasting several minutes ;
then relapsed into previous condition and died quietly-
at 8 A.M.
For the report of post-mortem and for microscopic
sections, I am indebted to Dr. Amidon.
Autopsy^ nine hours after death, — Head of average size
and good shape ; calvarium very thin ; anterior fonta^
nelle open and depressed, about three centimetres square ;
scalp and dura fused at fontanelle. On cutting the op-
tic nerves at the base, a quantity of fluid (120 (?^ cc.)
escaped from the arachnoid behind the optic commissure,
between the optic tracts and the crura and the under
surface of pons and medulla. On removing the brain
by section, just above the pons more fluid came from
the iter and third ventricle. A diffuse gelatinous de-
posit covered the base about the optic commissure and
tracts and about the points of emergence of the crura,
also the under surface of the pons, and to a slight extent
the medulla, also the peduncles of the cerebellum and
the region of the cerebellum contiguous to the pons.
This deposit was in places three millimetres thick, translu-
cent, non-vascular, tenacious within the meshes of the pia
mater, and with that membrane readily stripped from
subjacent tissues — in many places its surface imparted to
the finger a sensation of ** smooth sand." The pons
was compressed into a polygonal shape by the serous ex-
udation, and its tissue was very hard ; on section the
lK)ns and medulla appeared to be normal, with the ex-
ception of a dilated iter. The pia mater, on the con-
volutions at the base of the frontal, temporal, and occipi-
tal lobes, in the neighborhood of the gummy deposit, and
especially about the optic commissure and between the
olfactory tracts, was studded with miliary deposits of
grayish-white color, not connected with the vessels, ap-
parently beneath the pia yet stripping off* with it. Con-
vexity and substance of cerebrum normal. Lateral
ventricles dilated. Ependyma of all the ventricles nor-
mal. No other viscera were examined.
Remarks, — It appears that the father contracted
S)'philis in 1877 (six and a half years ago, five and a half
years before birth of this child). He was treated early
and continuously for several years, and his symptoms
have been mild, comprising induration of inguinal glands,
erythematous and later small papular syphiloderm, and
sore throat, all slight and transient and within the first
eighteen months. About one year later infection of the
mother occurred, and she was admitted to Roosevelt
Hospital in July, 1878 (four and a half years before the
birth of this child). She was treated for chancroidal (?)
ulceration of the genitals and a syphilitic ulcer of the right
forearm near the elbow, nine weeks in duration ; about
six weeks later she had an eruption and lost most of the
soft palate by ulceration. Two and a half years ago she
again had sore throat, ulcers on her legs, and at the same
July 12, 1884.]
THE MEDICAL RECORD.
49
tiffle she lost the nasal septum and cartilage by ulcera-
tion. Since then she has had no symptoms and she now
seems entirely well. Her treatment has been very im-
pexfect and irregular. She has never had a miscarriage.
Daring the first year of the mother's infection a child was
born who is now living. He was quite healthy at birth,
but nine or ten months later he had ulcers on his body
and onychia. He is now strong and well-nourished but
perhaps a little under size. The child from whom these
specimens were taken was born during the fifth year of
the mother's infection, more than a year subsequent to
her final syphilitic manifestations. There were no lesions
at birth, and when first seen by me the child appeared
tborooghly well nourished. The teeth were normal in
evolation, shape, and size, and the mother insisted that
the child had never had any skin eruption or other sick-
ness.
Microscopical examination made by Dr. Amidon. The
tubercles consisted of collections of lymphoid cells, the
central portion of the collections being dense and opaque.
There is a general infiltration of the pia mater (at the
base) with large polyhedral cells, larger than white blood-
corpuscles. The translucent material at the base of the
brain consisted of loose connective tissue holding the
same cells in its meshes.
Dr. Ajiidon said that the case was interesting to him
especially on account of the family history. It was sup-
posed that the cerebral trouble was undoubtedly syphilitic
in character, and, at the autopsy, the gross appearances
resembled those given by syphilitic rather than tubercular
lesions; but the microscope revealed that the lesions
were tubercular. The existence of miliary collections of
small cells over the base of the brain should have con-
yinced them that the case was one of tubercular menin-
gitis, but the clinical history differed so much from that
ordinarily met with in tubercular meningitis, that it, to-
gether with the peculiar gross appearances, misled him.
Djl Northrup remarked that nystagmus and the
peculiar motion of the limbs noted were not uncommon
in general tuberculosis ; so also the gelatinous exuda-
tion at the base of the brain. He regarded the case as
Qonsuaily interesting in connection with the syphilitic
histoiy.
Dr. Peabody said that the case was interesting to him
beause he saw a similar one last winter, occurring in an
adolt, in whom there was a distinct syphilitic history. As
he recalled it there was no peculiarity in the symptoms.
At the autopsy he found a gelatinous exudation cover-
ing the base of the brain, and extending down upon the
anterior portion of the cord, from an eighth to a six-
teenth of an inch thick, but with it no pus whatever.
Microscopical examination failed to reveal any tubercles,
Int in the neighborhood of the thick exudation he found
OMisiderable perivasculitis and evidence of arteritis ob-
literans, and the combination led him to believe it to be
Tphilitic in character. He thought it perfectly possible
thiU in Dr. Knighf s case syphilis and tubercular menin-
gitis co-existed.
Dr. Northrup remarked that in well-developed tuber-
cular meningitis a gelatinous layer at the base of the
bain was found usually, and it was very apt to be tinged
vith a green color. He had always regarded this con-
dition as one of oedema of the pia with a small quantity
of pas.
Dr. Van Gi£SON thought that the case ran a short
ttNose for one of tubercular meningitis. A gelatiniform
cndation is not infrequently seen m such cases, and he
vas of the opinion that the quantity depended upon the
ot«nsity of the inflammation excited by the tubercular
<^posit Chemically it was nothing more nor less than
coagidated liquor sanguinis. He had not noticed the
pecnish tinge spoken of, but where there was marked
congestion there had been, more frequently, the gelatini-
fcnn exudation.
With regard to the question whether or not syphiUs
■ay have been an etiological factor in the case. Dr.
Van Gieson thought that in children it could be assumed
with a peat degree of certainty of being true, that syphi-
litic lesions of the skin will manifest themselves before
cerebral symptoms develop, and as the skin in Dr.
Knight's case showed no lesions, he should be inclined
to eliminate the syphilitic element from the history ; that
view was also favored by the age of the patient.
Dr. Amidon asked if the temperature was not low for
tubercular meningitis.
Dr. Van Gieson said he had seen quite a large num-
ber of cases of tubercular meningitis, and he had had one
in which the disease ran its course, and terminated fatally,
and the temperature at no time was above 100® F., taken
in the rectum with corrected thermometers ; the general
manifestations of the disease were extremely characteris-
tic. Whenever he was called to see a young child, com-
plaining of headache, lassitude, loss of appetite, with
grating of the teeth at night, etc., and a temperature of
99° F., he at once suspected, from the very fact that the
temperature was low, that the life of the child was in
danger, and that if there was to be a rise of temperature
it was apt to be preagonistic.
Dr. Amidon regarded the temperature in Dr. Knight's
case as belonging to syphilis rather than to meningitis,
and fully believed that in all cases of meningitis, rise of
temperature occurred before death.
Dr. Van Gieson believed that cases of tubercular men-
ingitis occurred, not uncommonly, in which there were
only slight exacerbations of temperature. In deciding
the question of temperature, he regarded it as important
that the thermometer should be introduced into the rec-
tum, and allowed to remain for at least five minutes.
TUBERCULAR MENINGITIS.
Dr. R. W. Amidon presented microscopic slides with
the following history : Female child, aged seventeen
months. Maternal grandmother died of chronic pul-
monary trouble, after the age of fifty years. Some of the
grandmother's brothers died of phthisis when younger.
Maternal aunt died recently of combined cardiac and
pulmonary disease. Child's parents subject to colds.
The child had never been sick before. Was nursed
by mother until over a year old. Was rather apt to take
colds. Had a good deal of trouble with first few teeth.
Had be^un to walk alone, also talked some. Was a nor-
mally bright child.
About March 15, 1884, began to cut some back teeth,
which seemed to cause much irritation. A week later
became irritable, disinclined to play, and resumed creep-
ing. Wouldn't walk, wanted to be let alone, and liked
to lie down. All the time constipated. Ate well. About
March 24th bored pillow a good deal. Four days ago
was some irritation about right ear, which child rubbed
a good deal March 26th the left ear was likewise irri-
tated. The child was treated for "teething," and had
been given an unknowfi amount of hyoscyamine.
I was called to see the case at half past nine on the
morning of April 5 th. I then elicited the preceding
history. I learned that after a good nighf s rest the child
woke conscious, and immediately (7 a.m.) was seized
with general convulsions, commencing with twitching
of the face. Spells of clonic spasms of the face and
extremities occurred at intervals from this time on.
There was loss of consciousness, eyes open, fixed and to
the right, was feverish before the convulsions. When
first seen there was conjugate deviation to the right, eyes
open and fixed, pupils dilated (hyoscyamia) and equal,
slight occasional twitching about the left angle of the
mouth and almost continuous slight twitchings in mus-
cles of legs and fore-arms. Respiration, 60 ; pulse not
perceptible at the wrist, because of tendinous twitchings ;
very hot and bathed in warm perspiration. 10.12 A.M.:
temperature in left axilla, 41.5° C. (106° F.). 10.32:
pulse, 120. 10.40: respiration, 34; temperature, 40.75°
C. ; began to give chloral hydrate hypodermically in .10
(two grains) doses, at intervals of ten minutes. This
50
THE MEDICAL RECORD.
[July 12, 1884.
seemed to check the convulsions. 10.55 : pulse, 108 ;
respiration, croupy and $6, 1 1.40 : pulse, 80 ; respira-
tion, 76 ; temperature, 40. 75** C. Died about noon.
An autopsy revealed the pia of the base of the brain
studded with miliary tubercnles. Rest of the body not
examined.
Dr. J. C. Peters had found the primary S3rmptonis of
tubercular meningitis more variable than of almost any
other disease he had been called upon to treat. Some
cases at the outset resembled remittent fever ; in others
there was merely a slight stiffening of the neck in the
morning, which passed off in the afternoon ; in some,
projectile vomiting occurred without other symptoms,
and as almost any of the nerves given off at the base of
the brain were liable to be involved, a very great va-
riety of symptoms could be established. He knew of no
disease which presented difficulty in diagnosis for the
first four or five days equal with that offered by tubercu-
lar meningits.
Dr. J. Lewis Smith thought the temperature depended
upon the existence of meningitis. Tubercles might exist
without meningitis, and without elevation of temperature,
except, perhaps, a rise in the afternoon. If the menin-
gitis was moderate, the febrile movement would be mild.
He could coincide with Dr. Peters' remarks, and knew
of no disease of childhood which was more difficult to di-
agnosticate at the beginning than tubercular meningitis.
aortic aneurism — ULCERATIVE ENDARTERITIS — AORTIC
INSUFFICIENCY — CONGENITAL ANOMALIES OF THE LIVER.
Dr. Frank Ferguson presented specimens illustrating
the above lesions removed from a made, fourteen years of
age, and born in the United States. Only a few facts of
the patient's history could be obtained. He did not give
any rheumatic history. He had slight cough for some
months. Two months previous to his admission into the
New York Hospital on May 6, 1884, he complained of
shortness of breath, weakness, loss of appetite, and he
became pale and listless. On admission he was fairly
nourished ; there was no oedema of ankles and legs ; face
looked puffy ; he was anaemic and cachectic. He was
very dyspnoic and his respiration was largely diaphrag-
matic. His cardiac action was rapid and very irregular.
The precordial area was increased ; the apex-beat m the
fifth space and nipple line. There was a harsh murmur,
with the maximum of intensity at the apex of the heart,
and heard with and after the first sound. In the third
space, just to the left of the sternum, a soft bruit was
heard with the first sound. The second sound was redu-
plicated. He quietly died two days after admission.
The heart is larger than normally found in subjects of
this age ; its cavities are dilated, and endocardium is
thickened. There are vegetations on the segments of
the aortic valve, some of them calcareous. One of the
segments is almost entirely destroyed. Just above the
attachment of the destroyed cusp there is a small round
smooth opening in the wall of the aorta, communicating
with a sac half an inch in diameter, with smooth walls
situated in the upper and anterior part of the inter-ven-
tricular septum.
Above this aneurismal sac there are several small ir-
regular ulcers in the wall of the aorta, and one large ulcer,
half an inch in diameter, with smooth bottom, and edges
covered with vegetation.
The liver is ovoidal in shape, left lobe is rudimentary ;
there are three nodules of liver tissue on the under sur-
face of the right lobe. The location of the gall-bladder
is normal, but the fundus of the bladder is partially di-
vided by a septum ; the organ instead of being ovoidal or
pyiiform, is triangular in shape. The microscopic ex-
amination of the liver shows diose changes which occur
with cardiac valvular lesions.
The spleen was large, firm, and pigmented. The kid-
neys were larger than normal, firm and congested. The
lungs were congested and pigmented — the condition of
brown induration. The stomach was congested; also
the mucous membrane of the intestines.
CHRONIC FIBROUS MYOCARDmS,
Dr. George L. Peabodv presented a heart removed
from the body of a German woman, fifty-six years of age,
who died in the New York Hospital, having been under
observation about two weeks. The clinical history was
meagre. The patient had borne several children, and
had been in comparatively good health up to four months
before her admission, except that without known cause
she began to suffer from palpitation of the heart twelve
years ago, and had suffered from it, at intervals, since
that date. Four months ago she had an attack of pneu-
monia which ran a rather protracted course, but from
which she recovered completely. She entered the hos-
pital with dyspnoea, oedema of the lower extremities and
lower half of the abdominal walls, and also with marked
ascites. The chief subjective symptom was dyspuoea.
When she entered, she was passing about the normal
quantity of urine, but the quantity then diminished, and
it contained albumen and hyaline and granular casts in
abundance, and had a low specific gravity throughout
At the autopsy the kidneys presented the combined
lesions of parenchymatous and interstitial nephritis, and
the liver was found dislocated entirely below the firee
border of the ribs.
The chief interest centred in the condition of the
heart, which contained a large amount of fibrous tissue,
especially in the muscle about the apex, where the walls
were very thin. Microscopic examination showed that,
in the immediate neighborhood of the patches of distincdy
fibrillated white fibrous tissue, there was distinct fatty
degeneration of the muscular tissue, but beyond that the
muscular wall was substantially normal. The endocar-
dium was everywhere thickened, the attached borders of
the aortic cusps were thickened, and there was atheroma
in the aorta surrounding the opening of the coronary
arteries, and also about the mitral valve.
Dr. Peabody remarked that he had not found fibrous
myocarditis without atheroma in the coronary arteries.
There was a slight degree of cirrhosis and 2,500 cubic
centimetres of flmd in the peritoneal cavity. Clinically,
Dr. Peabody thought that this form of hypertrophy with-
out valvular lesion gave the patient greater distress than
any other.
Dr. Van Gieson asked Dr. Peabody if in such or
similar cases he had observed symptoms of angina pec-
toris, as with calcification of the coronary arteries.
Dr. Peabody replied that he had seen two cases.
Dr. J. C. Peters had seen two specimens in" which
there was almost complete obstruction of the coronary
arteries from atheroma, the patients having suffered horn
angina pectoris. Both patients died suddenly. In one ^
there was rupture of the left ventricle.
Dr. Ferguson had had a case, within the last month,
of large aneurism of the heart involving a part of Ac
septum, and in which there was extensive interstitial
myocarditis with some granulo-fatty change in the mus-
cular fibre, but not distinct, and both coronary arteries
had been almost completely pbliterated by the lesion of
endarteritis obliterans ; there was no atheroma. The his-
tory of the case extended over eighteen months and the
patient was seventy-six years of age.
Dr. Levi remarked that he had been taught that calci-
fication and atheroma were two distinct conditions.
Dr. Peabody remarked that they did not necessarily
pass into each other, but he thought that atheroma some-*
times preceded calcification.
The Society then went into executive session.
A Munificent Gift. — St. George's Hospital, Lon^
don, has recently received a bequest of $500,000 firom
the late Mr. William King.
July 12, 1884.]
THE MEDICAL RECORD.
51
THE PARIS ACADEMY OF MEDICINE.
Stated Meeting^ June 10, 1884,
M. Alphonse GuiRiN, President, in the Chair.
(Special Report for Thb Medical Record.)
The Academy was called to order by the President, who
announced the death of Mme. Richet, and expressed the
sjrmpathy of the members for M. Richet in his affliction.
M. A. FouRNiER presented a communication in behalf
of M. Duclaux upon
THE MICROBE OF THE BISKRA BUTTON.
The coccus in question was obtained from the blood
of a patient suffering from the Aleppo evil. It was found
equally in the blood flowing from a puncture made in the
iflunediate neighborhood of the boil, and in the general
circulation. When introduced into the circulation of a
rabbit there ensued a chronic disease, characterized by
successive crops of boils, gangrenous at their apices, either
scattered irregularly over the entire surface of the body,
or grouped together, or sometimes even confluent. In
general appearance they bore a close resemblance to the
Biskra button. The rabbits, during this period of erup-
tion, became thin and their fur was rough, though they
continued to eat. After a while the boils disappeared
and the animals recovered their usual health. In one
case the eruption began ten days after the inoculation
and continued a mondi.
Some further experiments were made with a view to
deterauine the results of the
CULTIVATION OF THE COCCUS
in concentrated veal bouillon. The effects of the injec-
tion of the culture-fluid were found to vary according to
the age of the cultivation and the mode of injection.
When injected under the skin in the dose of twenty
drops, during the first days of the culture, extensive
gangrene was caused Later, when the fluid was about
ten days old, the gangrene was of limited extent. I^ater
still, localized phlegmons only were observed. And
finally, two months or more after the commencement of
die cultivation, the results obtained were negative.
When the fluid was injected directly into a vein death
ensued at a period after the inoculation varying in length
according to the age of the culture-fluid After two
months or more had elapsed, injection into the veins gave
00 results. But if a drop of this weakened culture-fluid
were added to fresh bouillon, the evidence reappeared,
becoming gradually less and less as in the first series of
eipeinnents.
M« Lkgouest remarked that the disease produced in
die rabbit by these inoculations resembled in no way the
Bidoa button as seen in man. In the former case the
onpcion was said to have lasted a month, but in man
^coarse of the Aleppo evil is of much longer duration.
¥a this and other reasons he doubted whether it was
tiKsune disease in the two cases.
if. Blot inquired as to the number of times these ex-
POBnents were repeated by M. Duclaux.
M. FouRNiER was unable to state positively, but did
BOt doubt that they had been repeated a sufficient num-
ber of times. He was certain that the disease produced
VIS really the Aleppo evil, and thought it not at all to be
vondered at that its manifestations in the rabbit should
^Skl from those in man.
M. Colin thought that the experiments, having been
andc on rabbits only, were by no means conclusive. If
twenty drops of any kind of freshly prepared bouillon
ue injected into a rabbit, extensive gangrene and death
bf septicaemia may result. Later, when the animal mat-
ters rf the fluid are destroyed by putrefaction, it may be
^iijccted with impunity. If now fresh bouillon is again
^ whether a drop of the old fluid be added or not, we
«c the former series of results repeated In order to be
^^^^^dnsive, the injections should be practised on larger
^Dunab^ such as the horse or the ass.
M. Larrev agreed with M. Legouest that the disease
described as having been produced in rabbits by inocula-
tion with this coccus did not resemble at all the Aleppo
evil as it occurs in man.
M. BouLEY defended the author of the paper from the
charge of having confounded the effects of septicaemia
with those of the micrococcus of the Biskra button.
Each animal reacts after its own fashion in the presence
of a microbe, and it could not be expected that the
symptoms of the disease in the rabbit should be the same
as those met with in the human being. He thought the
experiments of M. Duclaux were particularly interesting
as showing how the microbe, having exhausted the nutri-
tive elements in one solution, is able to regain new vigor
when transplanted to a freshly prepared bouillon.
A memoir was then read by M. Du Mesnil, candidate
for the title of Corresponding Member, on
concussion of THE SPINAL CORD, SCLEROSIS OF THE
LATERAL COLUMNS, AND DEGENERATION OF THE CELLS
OF THE GRAY SUBSTANCE.
His conclusions were that : i, Concussion of the spinal
cord is a condition the existence of which, in the present
state of science, ought to be maintained ; 2, it may be the
starting-point for secondary inflammatory lesions ; 3,
these inflammatory lesions may assume the form of cir-
cumscribed myelosclerosis.
M. L^ON Labb£ then read a paper entitled
INTRA-ARTICULAR IRRIGATION WITH CARBOLIZED WATER
IN THE TREATMENT OF CHRONIC HYDRARTHROSIS.
After reviewing briefly the various attempts made to cure
chronic hydrarthrosis by intra-articular injections of dif-
ferent substances, the author described the procedure
known as Schdde's operation. This consists in punctur^
ing the articulation with a trocar of wide calibre, forc-
ing out the fluid, and then injecting a three to five per
cent, solution of phenic acid. A large quantity of the
solution is used, and the injections are repeated until the
water flows away perfectly clear. The wound made by
the trocar is then sealed with gold-beaters* skin and
collodion, the joint is enveloped in a thick layer of wad-
ding, and the limb is immobilized in a guttered splint.
Strict antiseptic precautions are observed, and the great'
est care is taken to prevent the entrance of air into the
articulation during the operation. The author had seen
Sch^de perform this operation, and had himself operated
upon two patients with success.
M. Jules GufiRiN regretted that M. Labb^, in his
review of other modes of treatment, had not mentioned
the one iijrhich had given in general the best results of
any. This method, which he had employed for a period
of thirty-five years, was divided into three parts, corre-
sponding to the three stages of the disease. At the com-
mencement of the disease, the treatment from which the
best results are obtained is by vesication. Later, when
the affection has lost iii a measure its acute character,
cold water is indicated Finally, in the third and chronic
stage, the treatment by means of
punctate cauterizations
is the one which is the most effectual in overcoming the
disease. These cauterizations are a matter of every-day
occurrence now, but it was far otherwise thirty or more
years ago.
M. Colin claimed that the veterinary surgeons were
the first to make use of the cautery in the treatment of
joint diseases, and that the surgeons of to-day were
merely imitators of the veterinarians in this respect.
M. GufiRiN said that punctate cauterization was a
very different procedure from burning by hot irons as
practised by veterinary surgeons. In the former case
the burn was very superficial and never caused suppura-
tion. Punctate cauterization, therefore, both in its mode
of employment and in its effects, was essentially a new
method
The Academy then adjourned.
52
THE MEDICAL RECORD.
Duly 12, 1884.
THE ROYAL IMPERIAL MEDICAL SOCIETY
OF VIENNA.
Stated Meetings May 30, 1884.
Professor Leidesdorf, President, in the Chair.
(Special Report for Thk Mbdical Rrcosd.)
The Society having been called to order by the Presi-
dent, Dr. Hofmokl exhibited some patients upon whom
he had recently operated. The first case was one show-
ing the results of
OSTEOTOMY OF THE FEMUR
for knock-knee. The operation was performed after
Massini's method, and resulted in a perfect correction of
the deformity.
The second patient had suffered for twelve years from
symptoms of
vesical calculus.
The median operation was performed, and an enor-
mous stone was removed after crushing. It had nearly
filled the bladder. It was composed chiefly of lime salts
with a nucleus of uric acid. The patient was now well,
except that he was unable to retain his water for any
great length of time because of the paresis of the bladder,
which still existed.
A third patient was shown, who suffered from
REPEATED BREAKING DOWN OF A CICATRIX.
A stone had been removed from his bladder by the
high operation three years before. Since that time the
cicatrix had yielded seven different times. There was
no stricture of the urethra discoverable, though there
was always considerable straining in passing water. When
the cicatrix was about to break, it would be seen to
swell out like a toy balloon, would then burst, and the
urine would flow out through the anterior abdominal
wall. These repeated occurrences had become almost
unbearable, and the patient had already made one at-
tempt to taJce his own life.
Professor V. Dittel exhibited to the Society an
apparatus, devised by Dr. Silbermann, of Breslau, for the
temporary closure of one ureter.
It is a matter of great importance to the surgeon con-
templating the removal of a kidney to determine whether
the other is healthy and capable of secreting urine. It
has hitherto been nearly impossible to determine this
with any certainty owing to the difficulty of obtaining
the urine of one kidney unmixed with the secretion of
the other. The attempt has been made to catheterize
the ureter, and has been successfiil in the case of women
after dilatation of the urethra, but in man this is impos-
sible. Dr. Silbermann' s instrument consists of a cath-
eter (No. 18 French) provided with a large opening if
inches long, upon the side, and several small holes at its
extremity. The instrument having been introduced, the
eye being covered so as not to injure the walls of the
urethra, a smaller canula is passed through. This small
tube is provided with a rubber ball at its extremity, which,
when in position, lies directly in the eye of the catheter.
The instrument being so turned that this part lies against
the mouth of the ureter, mercury is forced through the
inner tube, dilating the rubber ball and effectually clos-
ing the orifice. Thus the urine that passes into the
bladder can come from one ureter only, and a few
minutes will suffice to show whether the corresponding
kidney is performing its functions normally. The instru-
ment has been tried several times in healthy individuals
and has been found to answer the purpose intended.
Professor Mauthner then exhibited a patient with
OPHTHALMOPLEGIA INTERIOR,
or paralysis of the muscle of accommodation and sphincter
iridis, with preservation of function of the external mus-
cles of the eye. After the reading of a paper on
CEPHALOMETRY AND CRANIOMETRY
by Professor Benedikt, the Society adjourned.
THE BERLIN SOCIETY OF INTERNAL
MEDICINE.
Stated Meetings May 26, 1884.
Herr Leyden, President, in the Chair.
(Special Report for Thb Msdicax. Rbcokd.)
The first paper of the evening was read by Herr G.
Bshrend upon the
nature of prurigo.
The author took exception to the teaching of the Vi-
enna school that skin diseases are essentially local affec-
tions, and maintained that they may arise from changes
in the blood, or may be symptoms of some general dis-
ease. In proof of this position he cited the eruptions
that are often seen to follow the long-continued use of
certain drugs, and those occurring in nephritis, or in the
'exanthematous diseases. These eruptions, he stated, are
independent of the nature and specific action of the mat-
ters under whose influence they arise. Hence they may
be called, and were so called by the author himself, in his
work on dermatology,
HiCMATOGENETIC ERUPTIONS OF THE SKIN.
No direct evidences of the haematogenetic origin of
prurigo have hitherto been forthcoming, but the speaker
had recently observed two cases which seemed to supply
the omission.
The first was that of a child, seven and a half years of
age, who had had scarlatina some two years and a half ago.
It had previously been a healthy child with a complexion
free from any appearance of eruption. Just as the des-
quamatory stage was at an end there was a thick eruption
of pustules, most noticeable on the lower extremities, but
present also on the body and arms. As these pustules
dried a new crop appeared, and then another, and another
for some eight or ten weeks. When this pustular erup-
tion ceased a prurigo appeared, and still existed at the
time of the report. The eruption occupied the extensor
surfaces of the articulations chiefly, and was entirely ab-
sent from the flexor surfaces. There was also some pig-
mentation of the skin, and swelling of the inguinal glands.
The second case was a seven-year-old boy, who had
had scarlet fever and secondary nephritis three years pre-
viously. When first seen some months after the subsi-
dence of the original disease, he was suffering from well-
marked and typical prurigo. The mother stated that a
pustular eruption was first seen, which gradually disap-
peared and gave place to the prurigo.
The speaker maintained ttiat the scarlatinal poison
had first given occasion to the development of the pru-
rigo, though the latter had remained after the cause had
been removed from the system. A similar occurrence
is seen in the persistence of an eczema, following vac-
cination, long after the influence of the vaccine virus
upon the organism has ceased.
Herr Lewinski thought the prurigo was due to the
inflammation of the skin accompanying scarlatina rather
than to the scarlatinal poison.
Herr Behrend rejected this view and maintained
that the localization of the eruption upon the extensor
surfaces of the joints, as well as the pigmentation of the
skin, were sufficient to establish the correctness of his
diagnosis. He regarded the pustular eruption as the
transition stage between scarlatina and prurigo.
Herr Kronecker presented an account of some ex-
periments made by himself and Herr Schmey, in the
course of which they had accidentally discovered the
centre of co-ordination for the ventricular
pulsations.
The experiments were being conducted with a view of
establishing the mode of contraction of the ventricles.
A dog was put under the influence of curare, artificial
respiration being maintained while the heart was exposed
and raised up to the opening in the thorax. The reg-
July 12, 1884.]
THE MEDICAL RECORD.
53
istering apparatus being ready, Herr Kronecker thrust a
needle into the heart in order to record its movements.
At that instant the ventricles ceased pulsating, dilated,
ind presented only irregular fibrillary twitchings. The
needle was removed at once and the heart was kneaded,
but without avail. The auricles continued to pulsate, but
the animal died without a single beat of the ventricles
occnrring. This accident led to further investigations,
in which the experimenters found that an injury to the
cardiac wall at a certain point invariably caused paralysis
of the ventricles. This point, the limits of which were
not yet exactly mapped out, was over the lower bound-
ary of the upper third of the ventricular septum near the
descending branch of the left coronary artery. Here,
then, must be the distributing point for the nerve-supply,
the part where the messages to the different muscular
fibres are arranged and co-ordinated, so that each por-
tion of the ventricular wall shall contract in harmony
with every other portion. When this centre is destroyed
the separate muscular bundles do not contract with less
force but irregularly.
Experiments were also made to determine the effects
of irritation upon this newly-discovered co-ordinating
centre. It was found that a very weak induced current
passed through this point was sufficient to arrest the
rhythmic pulsations of the ventricle. But if the elec-
trodes were placed at a distance from this centre it
required a current of much greater strength to produce
the same effect. Herr Kronecker thought that the cases
of sudden death from
PARALYSIS OF THE HEART
were to be explained through this excessive vulnerability
of the co-ordinating centre In sclerosis of the coronary
arteries, fatty degeneration, and sometimes during con-
valescence from acute diseases, sudden death from par-
alysis of the heart has been observed. In such cases
the individual may breathe several times after the car-
diac pulsations are no longer perceptible. It is fortu-
oate that this centre is situated in a part of the ventricu-
lar wall so well protected from external injuries.
In concluding, the speaker reminded bis hearers that
these experiments were made upon dogs only, and it was
very probable that tlie centre of co-ordmation in the ani-
mals of a lower order was not so strictly defined. This
should be borne in mind if similar experiments were
made on rabbits or frogs, otherwise the results obtained
might appear to conflict with his own.
The Society then adjourned.
A Criticism from India on the Cholera Bacillus.
-The Indian Medical Gazette^ in the course of an
daborate review of Koch's work and discovery, says :
"A review of the whole evidence brought forward by the
Genoan Cholera Commission shows that they have only
sncoeded in establishing the fact that a peculiar form of
badllus is normal to the intestines of cholera patients ;
bat the exact part which this organism plays in the mor-
bid process is left wholly undetermined. Only a very
moderate degree of probability has been made out in
bor of this bacillus being the cause of cholera ; but the
Mity of trusting to probabilities and conjecture in an
etiological inquiry into cholera is generally well recog-
aittd. The problem, therefore, of the causation of
diolcra still remaining unsolved, it awaits and ought to
receive that careful attention which its great importance
iiemands." It is not fair to depreciate the value of Koch's
<fiscovery ; but, on the other hand, it will do no good to
give to it any greater weight than the evidence strictly
Th£ Number of the Blind in Russia is unusually
peat, amounting in some districts to .2 per cent of the
population.
THE THERAPEUTICAL SOCIETY OF PARIS.
Stated Meeting, May 28, 1884.
M. Delpech, President, in the Chair.
(Special Report for Thx Mkdical Rbcord.)
After the Society had been called to order, M. Petit
exhibited some specimens of
euphorbia pilulifera.
This plant, which resembles the ordinary wartwort {r^eille-
matin), grows in stony places in the neighborhood of
Brisbane, Australia. It is used in that country and in
England in asthma and all chronic spasmodic bronchial
affections. An infusion is made of one ounce of the
fresh plant in three and a half pints of water, of which the
dose is a glassful morning and evening. M. Petit offered
to furnish samples of the dried plant to any of the mem-
bers who might desire to experiment with it.
M. E. Labb£ continued some remarks which he had
made at the previous meeting upon the properties of
ozonifacient water.
This product, which may be extracted from the pinus
maritinuiy was discovered by M. Boursier, and is really a
terebinthinb hydrate.
Its ozonifacient properties give to it a special value as
a disinfectant. It may be used in the form of spray,
vapor, or as a liquid. If the spray be directed over any
putrefying and foul-smelling material the fetid odor is at
once destroyed. The vapor possesses a terebinthinate
odor, and would seem to be indicated in the case of fetid
expectoration. The vapor is certainly absorbed by the
respiratory mucous membrane, for when inhaled for any
length of time symptoms of intoxication are produced.
In the
treatment of diphtheria
a wash of ozonifacient water has appeared to give good
results, but the trials of the remedy in this disease have
been too few to allow of any definite conclusions. Com-
presses wet with the substance and applied to any sur-
face giving off a fetid secretion are productive of good
results. The speaker thought that this product, owing
to its cheapness and the small quantities which it is
necessary to employ, was destined to assume the first
rank among the disinfectants.
M. Blondeau remarked upon the strong terebinthinate
odor of the substance, and suggested that it owed its dis-
infectant properties to the turpentine which it contained.
M. Labb:^ maintained that turpentine had no such
ozone-producing properties as the product in question
was shown to possess.
M. Dujardin-Beaumetz exhibited some fresh and
dried specimens of the
kola nut,
the fruit of the sterculia acuminata, a tree growing in
Central Africa. The natives look upon it as a universal
cure-all, and attribute to it tonic, nutritive, excitant, and
aphrodisiac properties. Analysis shows that kola con-
tains caffeine and tannin in large proportions and a rel-
atively less amount of theobromine. It has been used
with success in the diarrhoeas of hot climates, in cardiac
diseases, and as a tonic.
M. Petit asked whether the beneficial effects of the
kola nut were not due to the caffeine contained in it, and
thought, if this were so, it would be much better to use
the latter drug by itself than to give it mixed with other
inert substances in the form of kola preparations.
M. Dujardin-Beaumetz then made a few remarks
upon
HAMAMELIS VIRGINIANA.
He said that, while not agreeing with those who thought
no substance could possess valuable therapeutic prop-
erties which was not poisonous in large doses, he must
54
THE MEDICAL RECORD.
[July 12, 1884.
nevertheless say that he had never been able to observe
even any physiological effects from witch-hazel.
M. Campardon related two instances in which he had
observed a gradual
DECOLORATION OF PIGMENTED SPOTS,
due to varicose veins, following the internal administra-
tion of an infusion of hamamelis. In neither case was
the remedy applied locally.
After some further remarks by the members regarding
the parts of the plant in which the active principle was
contained, the Society adjourned.
OUR LONDON LEITER.
(From oae Special Correspondent.)
SIR JAMES facet's ADDRESS AT THE HEALTH EXHIBI-
TION — THE CONSERVATORSHIP OF THE COLLEGE OF
SURGEONS — BURIAL ALIVE — OVERPRESSURE IN SCHOOLS
— STATE OF THE THAMES — SMALL-POX IN LONDON —
CONFERENCE ON SANITARY LEGISLATION.
London, June ar, 1884.
On Tuesday last, June 1 7th, the Prince of Wales paid
his first visit to the International Health £xhibition, and
on this occasion an address was delivered by Sir James
Paget in his usual felicitous manner. Sir James depre-
cated mere comfortable idle health. The pattern healthy
man was, he said, one who lived long and vigorously ;
who in every part of his life did the largest amount he
could of the best work, and when he died, left healthy
offspring.
Referring to published statistics, Sir James Paget
pointed out some striking facts. He estimated that
in this country the whole population between fifteen and
sixty-five years of age do, in each year, twenty million
weeks' less work owing to sickness. He remarked that
typhoid fever alone destroyed 4,000 working people a
year in England and Wales. From this one preventable
disease we had an annual loss of 230,000 weeks' work
from illness. Referring to infantile mortality Sir James
remarked that in 1882 the mortality of children under
fifteen was nearly a quarter of a million. If you reck-
oned that each child cost only ^^8, more than two
million pounds sterling were thus lost every year. But
they had cost much more, and much more still was Ipst
by the loss of the work they might have lived to do.
The numerous diseases that might be prevented by suit-
able precautions were then referred to, and Sir James
Paget concluded by urging that we wanted more am-
bition for renown in health. He would like to see a
personal ambition for renown in health as keen as that
for bravery, or for beauty, or for success in our athletic
games and field sports ; as for national renown in war,
or in arts or commerce.
Mr. Stewart, of St. Thomas' Hospital, has been
elected to the Conservatorship of the College of Sur-
geons, vacant through the resignation of Professor
Flower, who was appointed to the Natural History Mu-
seum some months since.
A controversy has been going on lately in the columns
of Tkg Lancet as to the possibility of persons being
buried alive. Some of the correspondents deny the pos-
sibility of this occurrence altogether. Some of the facts
narrated by others seem to show that it has occurred
even in the present century. It is very pertinently
pointed out that burial should not be permitted till some
signs of decomposition have appeared. A good deal of
discussion took place some years ago as to various *' signs
of death," but no more reliable sign, and one of such
easy application, has as yet been pointed out.
Overpressure in education is again denounced by
sanitary authorities. The system of payment by results
seems partly to blame in Board Schools. This makes it
the direct interest of the teachers to force as many pu-
pils as possible up to a given standard, and tends to
press hardly on the weaker or duller members of a dass.
But overwork is not confined to Board Schools, nor to
students of tender age. Every now and then we hear of
suicides among university and other students attributed
to overwork for competitive and other examinations.
The condition of the Thames during the last week is
presumably due to the unusual dryness of the season.
Between Twickenham and Kew the bed of the river has
been exposed at low water, and children have actually
crossed on foot from one side to the other. The river is
said to be getting shallower day by day. Should this
prove to be the case, the intra-metropolitan portion of
the stream can scarcely fail to be afifected. The stagna-
tion of sewage at Barking and Crossness will probably
become more offensive, and other dangers to health are
likely to ensue.
Small-pox is still on the increase in London. Last
week (ending June 14th) the number of patients under
treatment in the hospitals, hospital-ships, and convales-
cent camp of the Metropolitan Asylums Board rose to
1,238, being an increase of 142 on the preceding week.
The number of new cases admitted during the week was
332. Owing to the further increase in the number of
patients under treatment, it has been found necessary to
lease a hospital belonging to the Poplar Board of Works.
It is cheering to note that the deaths from small-pox in
London during the same week were only 30 in number.
A Conference on sanitary legislation will be held next
week at the Health Exhibition. It will last two days,
and be under the auspices of the Social Science Asso-
ciation.
OUR PARIS LETTER.
(From our Special ConreqxmdcaL)
REMOVAL OF CONTAGIOUS DISEASES TO HOSPITAI.S — HOW
IT IS DONE IN PARIS — THE NEW METHOD FOR THE
TRANSFUSION OF BLOOD — A CURIOUS CASE OF MALIN-
GERING— HOW A THERMOMETER WAS TAMPERED WITH.
Paxis, June 30, 1884.
A VERY useful measure has been taken by the Pre-
fect of police with reference to the removal of persons
suffering from contagious diseases to the hospitals from
their own homes. Special carriages have been con-
structed for the purpose which are kept at the H6tel
Dieu, and he has informed the commissaries of police of
each district that all that will be required is a medical
certificate as to the nature of the malady of the appli-
cant, giving his name and address. These carriages are
placed at the disposal of the public daily from 8 a.m. to
6 P.M., and in order to get one application must be made
to the commissary of police of the quarter in which the
patient resides, or to the central police office of the dis-
trict No charge will be made for the use of these car-
riages, and the commissaries of police are further in-
structed thoroughly to disinfect the carriages after each
journey, and also to disinfect the room from which the
patient has been removed. Hitherto these carriages
were reserved for small-pox patients only, but they are
now to be available for all contagious or epidemic mala-
dies, such as small-pox, scarlet fever, measles, diphtheria^
etc. This, as I have said, is certainly a very useful
measure, but unless the public are made acquainted witli
such an arrangement in a more efficient manner these
carriages will scarcely ever be called into requisition, as
has happened with the ambulance-carriage reserved for
small-pox patients, as the public being ignorant of its
existence for the last two years, it is reported that it was
taken advantage of only ten times during that period.
At a recent meeting of the Academy of Sciences Pro-
fessor Vulpian read a paper for M. Afanassiew, a Rus-
sian physiologist, on a new method for the transfusion of
blood, which consists of peptonizing the latter, by which
means its coagulability is suppressed for a certain time.
July 12, 1884.]
THE MEDICAL RECORD.
55
M. Afanassiew acquired the knowledge of this fact by
experiments he had performed on dogs, from which he
itmoved two-thirds of their blood, which reduced them
to death's door. In injecting into their veins blood
Qiixed with peptones, he was enabled to restore them to
life. Accoiding to the author these peptones do not in
any way affect the globular elements of the blood ; the
peptones simply prevent coagulation, and thus render
aseless the process of defibrination before injecting the
blood M. Afanassiew promises to continue his experi-
ments on animals before venturing to apply his new
method to man.
A very curious case of malingering was recently brought
to the notice of the Soci^te M^icale des Hdpitaux
by Dr. Du Castel, which was detected in a young woman
in a hospital under the following circumstances : She
iras admitted for a herpetic disease of the throat, and in
going into her previous history she stated that she had
had an attack of pneumonia, which, however, was con-
sidered doubtful, as she had recently had an attack of
hemoptysis. She had never had convulsions. At the
end of five or six days, the sore throat was almost com-
pletely cured, and the temperature of her body, which
bad risen to 39.5^ C, fell to nearly normal ; but she was
seized with an attack of delirium followed by great ex-
citement which lasted several hours. A few days later,
the patient declared that she had spit up a good deal of
'^ thick matter" during the night, which nobody saw, as
she had emptied her spittoon before the doctor's visit.
Soon after this, she presented symptoms of coma, ac-
companied with a slight increase of the temperature.
This was followed by complete paraplegia accompanied
with generalized hyperaesthesia. Finally followed a series
of hysteriform attacks, distinctly marked aphasia, mutism,
etc, the thermometer ranging at this time from 39° C.
to 39-5° ^- '^^^ physician hesitated in his diagnosis of
hysteria, and he felt inclined to ask himself whether,
owing to the deafness which existed during the attack of
sore throat followed by spitting up of matter (?), there
was not some lesion of the internal ear complicated
with cerebral abscess. This state of uncertainty lasted
some time, when one morning the interne charged to
take the temperature of the patient observed to his sur-
prise that the thermometer marked 43.4° C. It was
imagined that there might have been some error, and the
temperature was again taken, when the thermometer
marked 39°. Eight days later the thermometer marked
43° and a few tenths, then the temperature remained for
1 few days after about 39^. One morning the ther-
mometer marked 44^. Thi$ naturally puzzled the interne
jfid the physician, when it was resolved to examine all
the thermometers of the ward, but nothing wrong was
detected; nevertheless the temperature as taken each
day was sometimes 38°, sometimes 43°, and sometimes
}ff C, but the rise or fall was the same whether the
kraiometer was applied to the axilla or in the vagina,
ttddie thermometer had even risen to 48°. Suspecting
50oe trickery on the part of the patient, she was closely
vaidied, and as it appeared to the physician that as the
patient got the mercury to rise so high he saw no rea-
son why she should not succeed in getting it to rise
eren higher, and as the ordinary clinical thermometer
was not long enough, he used a stove thermometer
oaddng as high as 160^ Centigrade, and to his great
confosiDn, and that of his assistants, this thermometer,
«lnch was placed in the axilla, one morning marked 76°,
vhidi a few days later was even surpassed. The trickery
vas, however, at last found out. When the patient
tiiooght she was not observed, she was seen approaching
Ikerleft hand to the lower extremity of the thermometer
^^uch was placed in the right axilla, and finally the
n»ystery was discovered. The interne, who was on the
vatch, demonstrated that by gently and repeatedly strik-
ing the lower extremity of the thermometer, the mercury
coold be made to rise to any height in the instrument.
Dr. Du Castel, who communicated this case to the
Medical Society, said he merely wished to observe of
how little use it was to take the temperature in hysteri-
cal patients unless they were closely watched.
Dr. Hanriot Agr^gd has been appointed Professor of
Chemistry at the Paris Faculty of Medicine, in the room
of Professor Wurtz, lately deceased.
^vtm atifi W^vv^ ^jeujs.
Official Listof Changes in the Staiians a$id Duties of Officers
serving in the Medical Department^ United States Army,
from June 29 to July 5, 1884.
GiRARD, J. B., Captain and Assistant Surgeon. Or-
dered to relieve Surgeon W. E. Waters from duty as
Post Surgeon, Plattsburg Barracks, Plattsburg, N. Y.
Surgeon Waters, upon being relieved, directed to return
to his proper station (Madison Barracks, N. Y.). S. O.
131, par. 3, Headquarters Department of the East, June
30, 1884.
Hartsuff, Albert, Major and Surgeon (Fort Riley,
Kan.). Granted leave of absence for one month, with
permission to apply for one month's extension. To take
effect when his service can be spared S. O. 130, par. 6,
Headquarters Department of Missouri, June 25, 1884.
MiDDLETON, J. V. D., Major and Surgeon. Ordered
to relieve Surgeon B. E. Fryer from duty as Post Sur-
geon, Fort Leavenworth, Kan., on or before July ist.
S. O. 133, par. 5, Headquarters Department of Mis-
souri, June 28, 1884.
Benham, R. B., First Lieutenant and Assistant Sur-
geon. From Department of Dakota to Department of
Texas. S. O. 150, par. 8, A. G. O., June 28, 1884.
GoRGAS, William C, First Lieutenant and Assistant
Surgeon. From Department of Texas to Department
of Dakota. S. O. 150, par. 8, A, G. O., June 28, 1884.
Wales, Philip G., First Lieutenant and Assistant
Surgeon. From Old Fort Colville, Washington Terri-
tory to Fort Coeur d'Alene, Idaho. S. O. 89, par. 3,
Headquarters Department of Columbia, June 23, 1884.
Official List of Changes in the Medical Corps of the U. S.
Navy, during the week ending July 5, 1884.
Wells, H. M., Surgeon. Detached from Naval Hos-
pital, Brooklyn, ordered to U. S. S. Lancaster.
Sayrs, J. S., appointed Assistant Surgeon. Commis-
sion dated June 27, 1884.
Cordeiro, F. J. B., appointed Assistant Surgeon.
Commission dated June 27, 1884.
Prevention of Cholera.
[1884. Department No. 98. Marine Hospital Service.]
Treasury Department,
Office of the Secretary,
Washington, D. C, July 2, 1884.
To Collectors of Customs:
It has been brought to the attention of the Depart-
ment that persons from the infected districts of France
are leaving in considerable numbers by other than
French lines. You will, therefore, require evidence that
none of the baggage of immigrants or returning travellers
has been shipped from the infected districts since June
20, 1884. A certificate of the local quarantine officer
to the effect that no danger to the public health need be
apprehended from allowing the landing of any passen-
ger's baggage, may be accepted as entitling such traveller
or immigrant to land his effects.
ChAS. J. FOLGER,
Secretary.
56
THE MEDICAL RECORD.
[July 12, 1884-
ptedical Stems.
Contagious Diseases — Weekly Statement. — ^Re-
port of cases and deaths from contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the week ending July 5, 1884 :
Week Ending
Casts.
June 28, 1884..
Julys, 1884...
Diaths^
June 28, 1884..
Julys, 1884...
186
156
The Significance of Scars and Copper-Colored
Spots on the Forehead. — T. Pershing, of Wilmington,
Del., criticises a statement made by Dr. A. L. Ranney in
the first of his articles on " Methods of Examination in
the Diagnosis of Nervous Diseases,'* published in The
Record. It is there affirmed that ulcerations upon the
forehead not traumatic are syphilitic ; scars and copper-
colored spots are equally significant. Dr. Pershing says
that "herpes zoster occurring on the forehead may be
severe enough to cause ulcerations.* *
The Treatment of Asphyxia. — A lecture was re-
cently delivered by Dr. Benjamin Howard, in the course
of Professor Charcot, at the Salp6tri^re, upon the
mechanism and treatment of asphyxia. The plan usually
followed, of making traction upon the tongue, is, the
lecturer stated, useless, for the anatomical conditions will
not admit of elevation of the epiglottis by this means.
The only way by which this elevation can be accom-
plished is to place the head and neck in a position ot
forced extension. When this is done, the tongue is sepa-
rated from the pharynx and a wide and free passage
without any obstruction is established leading directly
from the posterior nares to the lungs. The lecture was
supplemented by demonstrations upon the cadaver in
which the facts were proven to be as stated.
Dermatology at Vienna. — A correspondent of the
Northwestern Lancet writes : " One very noticeable feat-
ure is the almost exclusively local treatment of all skin
diseases, except those due to syphilis, and the scrofulous
or tuberculous diathesis. Though Kaposi mentions iron
and arsenic in his book, I never saw it given or men-
tioned in the hospital. Scrofulous and chlorotic patients
were given cod-liver oil, which was almost the only in-
ternal medication which I observed. He says the inter-
nal treatment of skin diseases was proven useless years
ago in this hospital. He is accustomed also to occasion-
ally express himself very strongly upon the doctrine that
tubercle, lupus, and syphilis are related diseases. He, as
well as Neumann, repudiates this idea in toto. On every
reference to the subject he says : * Gentlemen, lupus is
lupus, tubercle is tubercle, and syphilis is syphilis. Any
shading of the one into the other does not exist. Syphi-
litic lupus is nonsense.' Lately he read that Koch
claims to have discovered the tubercle bacillus in lupus
nodules. He said on coming to the class : * Gentlemen,
if this be so, all I have to say is that it is bad for the
bacillus, for it would be proof positive that he is not the
cause of specific tuberculosis.' The favorite treatment of
lupus is removal of the nodules with the caustic potash
stick or a curette, and application of mercurial plaster.
During the winter he used the treatment of the sublimate
solution. It bleached the ugly-looking surfaces, remov-
ing the coloring matter from the scars very nicely, but
caused so much eczema, and the apparent benefit was so
transient that it was soon thrown aside. Psoriasis, when
not covering too great an area of skin, is treated by re-
moving the scales with a curette, or, after maceration
with soft soap, removal in the bath with a scrubbing
brushy after which the affected partsof the skin are painted
with chrysarobin salve — chrysarobin 5 or 10 to vaseline
40 — twice a day for several days. Every one of the
large number of cases which I observed improved rapidly.
Owing to the discoloration of the skin caused by chrysaro-
bin, the face, head, and hands are never treated wifli this
remedy. On these parts tar is still the favorite. A pyro-
gallic acid salve of the same strength is sometimes used,
spread upon linen, and after removing the scales as be-
fore. It does not cure so rapidly as the chrysarobin, but
in skins which would be too severely inflamed by the lat-
ter drug it proves very useful."
The Treatment of Tape-Worm — Tape-Worms
AND Pregnancy. — Dr. Frank H. Rowe, of Cummins-
ville, O., referring to a request for opinions regarding
the treatment of tape-worm, sends the following. The
ingredients must be reliable and the compounding care-
fully done : " 5 . Pulv. cort. radix ^ranat., \ ss. ; pulv.
secale cornut, 3 ss. ; pulv. gum acacia, 3 ij- ; ol. felicis,
3j., ol. crotonis, one drop, mixed well; mix well in
rotation, pulv. peponis, |j. M. Ft. emulsio with aq.
dest., S vij., add sodje salicylate, grs,.xv. S. Take the
above emulsion at once in the morning. One hour be-
fore taking it, take a small cup of good coffee alone ; the
emulsion should be taken while lying down, a sinapism
of pure mustard having been previously applied over the
epigastrium. After the free use of saline cathartics, sol-
magnes. cit., 5 ^ij., magnes. sulph., f j. M. S. at once
— to be taken the previous day. And the evening be-
fore taking the emulsion, the supper should consist of a
very liberal repast, consisting exclusively of onions and
herring (or mackerel) salad. While referring to the sub-
ject of tape-worm, I would notice a recent article in the
London Record in relation to the reflex disturbances pro-
duced by taenia, ascribing a series of miscarriages in one
or two individuals to their presence, pregnancy going on
to full time after the removal of the worm. Such has
not been my experience in a recent case of a similar
character. A patient having had at least four miscar-
riages between the fifth and seventh month, accidentally
discovered evidences of the presence of a tape-worm. I
successfully treated her for it in the meantime. She be-
came pregnant, and flattered herself that the cause of
her miscarriages was removed, and that she would go on
to full time. Such, however, was not the case, as at the
usual time she miscarried. Habit possibly had some in-
fluence in determining this. The reflex disturbances
produced by taenia seem to be over-estimated. And,
judging from the physical condition of cases seen, one
must conclude that their effect upon the health of the
individual containing them must oftentimes be almost
nur
Antipyrin is the name of a chinolin-derivative'^ first
used by Filehne and recently experimented with by P.
Guttmann. In doses of two grammes it reduces the tem-
perature powerfully, this reduction lasting five to sLx
hours. It has no bad after-effects, and only very rarely
disturbs the stomach.
A Novel Method of Cultivating Bacilli. — Prof.
Baumgarten takes a bit of tuberculous tissue and intro-
duces it with antiseptic precautions into the anterior
chamber of a rabbit's eye. After six or eight days he re-
moves a small portion of the tuberculous nodule and
introduces it into a second rabbit's eye, and in six to
eight days repeats the process with a third rabbit. He
thus gets a mass of tubercle bacilli almost entirely free
from extraneous tissue. He recommends this method a^
the most convenient and certain way of securing pure
cultivations.
The Medical Record
A Weekly Journal of Medicine and Surgery
Vol. a6. No. 3
New York, July 19, 1884
Whole No. 7x5
<3^ri0itial ^rticljea
SOME REMARKS ON AFFECTIONS OF THE
HEART.
By J. MILNER FOTH£RGILL, M.D. Edin., Hon. M.D.
Rush Mkd. Coll., III.
isnokrft FBLLovr op thr collbgb or physicians op philadblfhia, physician
TO THE CITY OP IjOKDON HOSPITAL POR XMSBASBS OP THE CHBST.
III.
STRUCTURAL CHANGES.
Probably there is no disease to which humanity is liable
more dreaded than fatty degeneration of the heart. All
stndents are liable to have this weird malady, wrapt in
ffl/stexy, when first studying disease of the heart ; it is
the k^ noir oi many persons who curiously dip into
medical literature, especially if their thoughts are directed
bf their family history to cardiac maladies ; perhaps
medical men themselves fear it more than any occult
malady with the exception of aneurism. Why is all this?
fiecsuise it is a general belief that fatty degeneration of
die heart is a disease which is shrouded from our ken ;
k stalks in darkness, unseen, beyond detection. Mys-
teiy ^ves it its terrors ; it belongs to the unknown !
N'odimg of the kind ! It is a malady, which reveals itself,
albeit not one which forces itself upon the attention like
nlrular disease, or a paralyzed limb. Fatty degenera-
tion of the heart has its known history, its pathological
idations, like other diseases. That it is the cause of
sodden death may at once be laid down as an axiom. So
long as its structure is unimpaired, its muscular fibrillar
sound, the heart will struggle on, often though the cause
of death, yet itself the last to die.
Fatty decay of the heart-wall may go on masked by
odier troubles, and, consequently, not be recofpized, as
occnnred in a padent of mine at the hospital while writing
tbese papers. She was a woman in the fifties, with some
sdema in her legs, and a mitral lesion ; not, apparently, a
foj serious case. She stood a full dose of compound jadap
powder without any suspicious indications, and seemed to
be improving, when suddenly she died without a struggle,
^fben the post-mortem came the explanation was not &r
loseeL She had a nutmeg liver, granular kidneys, and
Stature of the heart- wall was considerably impaired.
Sbebdbeen, in all probability, a drunkard. But of this
itBapossible to be certain. A faint arcus senilis and a
cMf cornea was the only outward visible sign of the
mid pathological changes. Here fatty degeneration
■^ have been suspected, but it was certainly not
liable. There was no clot in the heart : death had
coBie about by fatal syncope. And it is this last to
vbdi imy degeneration renders its victim liable ; no
■ttter whether the appearance of general health is main*
liBed, or, as in the case just given, there is also other
fdpabie disease present.
At other times an elderly man dies suddenly after an
Ad, as rushing to catch a train ; or after emotion, like the
fat anatomist John Hunter : or at some gathering ; or
tttlie nii^t-stool, as died a well-known temperance lec-
^■cr under my own care not long ago. In the last case a
hie, veO-nounshed, florid, elderly man, who had quite re-
^ndf been lecturing with his wonted vigor, was seized with
jftattack of severe dyspnoea, which left him shaken, but not
*lltt«ise the worse of it His medical attendant called
^ in in consultation, and the circumstances roused my
suspicions that the right ventricle was not to be trusted.
Strict orders were given about quiet being maintained,
all effort avoided, especially straining at stool (which
brought on the attack), and no lectures to be announced
for some time. All went well for a time, and he began
to think the doctors took too grave a view of his case.
So he went down to the city to see to some business,
came home, after that went into the water-closet, and died
there. There is no moral doubt that there was fatty
decay of the right ventricle present in that case.
What are the indications of a fatty decay in the heart-
walls ? The heart has a dead-leaf here instead of the
normal dark flesh color, i,e,, when the condition is pro-
nounced ; it is friable, readily torn, and if a piece be
pressed between 'blotting-paper the stain of grease is
found. Under the microscope, first, the transverse striae
are clouded and then lost ; second, granules of fat are to
be seen near the germinal matter, afterward spreading
throughout the fibril ; third, the fibril has given way to a
string of oil globules within the sarcolemma. The disease
may be general ; it may be connected with the area sup-
plied by one coronary artery ; or it may belong only to
the area fed by one branch of one of die coronary arte-
ries, where that branch is occluded by some growth in
the wall of the vessel
What is the cause of decay in the fibrillar of the heart*
wall? An insufficient supply of blood. How is that
brought about ? By an atheromatous condition of the
tunica intima of the nutrient artery usually. Degenera*
tive change in the coronary vessels is the cause, par ex*
celUnce^ of fatty necrosis of the muscular fibrillse of the
heart. There may be an atheromatous tubercle blocking
the orifice of a coronary artery, as was found in an
elderly gentleman who died in the sexual act with a
venal Venus, in one of our London parks, some time ago.
Or it may be that an adherent pericardium along the
coronary vessels cuts down the blood-supply until the
heart-fibre is no longer properly nourished, as was said
to be the case with the late renowned Sir James Young
Simpson. But, speaking broadly, when fatty degenera-
tion of the heart-wall is found, the coronary arteries are
the seat of atheromatous change. Atheroma is the de-
velopment of connective corpuscles in or under the
tunica intima of the arterial wall. It may be in patches
or it may be diflused. Usually there is the hard artery,
liable to be also tortuous. The change can often be
seen in the temporal arteries, which to the eye elon|;ate
on each pulse-beat. The artery loses its elasticity
while its lumen is diminished.
The general associations of the fatty heart are these :
First, the «* gouty heart," or chronic Bright's disease, a large
left ventricle, a tight artery, and an accentuated second
sound at the aortic root The physiological evidence of
high arterial tension is a large bulk of urine. But after a
time the bulk of urine drops ; and as Sir William Jenner has
pointed out, this is a clinicsd fiict of the grimmest signifi-
cance. Why is the bulk of urine falling ? Because the
hypertrophied heart-wall is being undermined by a decay
in the muscular fibrillar. There are other evidences of a
waning energy in the left ventricle, and the case either
ends suddenly, or presents the well-known features of
heart-failure. Sometimes there is little hypertrophy, and
diese are, apparently, the cases where death takes place
suddenly, on or after some effort, as a rule. Old people
are intensely reticent when they have done something
foolish, and if all the circumstances could be known, my
58
THE MEDICAL RECORD.
[July 19. 1884-
own utdividual opinion is that a history of some effort
would be found to precede the fatal syncope in almost
ail cases where the heart ceases suddenly in diastole in
persons apparently well. In some cases the fatal event
occurs in a person apparently in fair health, as in the
case given of the temperance lecturer. At other times
evidences have been furnished of failure of the heart un-
mistakably pointing to the morbid change. At other
times men are seen with a tranquil gait, very careful of
themselves, apt to have attacks of vertigo, are seen at
times to clutch at some object to help them to keep up,
who are said to be the subjects of fatty degeneration of
the heart — and doubtless in some cases this is correct.
At other times such is not the case. I remember when
in general practice being called in to see an old gentle^
man, who from his evidences of failing strength, plus the
feebleness of his heart-sounds and the condition of his
arteries, was to all appearance the subject of a fatty
heart. Yet by rest and tonics in time he improved
greatly, and as the heart regained its tone an aortic
systohc murmur could be heard while there were evi-
dences of hypertrophy of the left ventricle. When I left
the neighborhood he was a hale, fairly active old man,
and died of something unconnected with his heart. It is
quite clear that this case was not one' of fatty degenera-
tion of the hearty but rather one of temporary malnatxi-
tion.
How is it that very often the morbid condition of
atheromatous change is more pronounced in the coronary
arteries than in any other part or portion of the arteriid
system ? Such is undoubtedly the fact, and the thick-
ened, tortuous, white coronary arteries stand out prom-
inently by contrast with the blue veins when the heart is
laid bare. They are thickened, and what is more^ their
calibre,is diminished, and with that the blood-current which
flows through them. The heart-muscle is underfed, and
then, in time, fatty degeneration of the fibrilke follows.
Why is the coronary circulation so much more than any
other part of the arterial system the seat of this morbid
process ? To my mind, the answer is, that this is due
to the fact that the coronary arteries spring from the
aortic root and so are filled by the full force of the aortic
recoil. Other arteries of like size have the shock broken
by intervening moderate-sized vessels, or are not so
forcibly dilated by the aortic recoil. The full force of
the aortic recoil falls upon the aortic valves, and the
blood-current eddies furiously in the sinuses of Valsalva,
acutely distending the coronary arteries. Especially
is this the case with the hypertrophied ventricle and
high arterial tension of the gouty heart. Atheroma is
the result of over-distention {ueberspannung) plus some
tissue-tendencies of the gouty diathesis, or the syphilitic
cachexia. Consequently, while the aorta and the rest of
the arterial system are but in an early stage of the athero-
matous change, and still possess considerable elasticity,
the coronary arteries are in an advanced condition, are
tortuous, inelastic, with their calibre gravely diminished
by thickening of the tunica intima encroaching on the bore
of the blood-vessel. The lessened blood-current is
broken in its course by the curves of the artery and an
insufficient blood-supply to the heart-muscle leads to its
decay. Such is, to my mind, the sequence of the events.
Consequently fatty degeneration is the sequel to the
gouty heart Such at least are its clinical phenomena
as presented to me in my experience. Of course a man
must be guided by what he himself has seen and en-
countered ; he cannot be so familiar with the experience
of others, but what I read of their observations tallies
with my own. As an apple waxes, ripens, and ultimately
rots, so the gouty heart passes through these varying
phases of muscular growth, high arterial tension, harden-
ing arteries, and diminution of calibre by the atheromat-
ous change, the blood-supply to the cardiac muscle
being cut down until the muscle is unequal to its work,
and stops in diastole. Having run the risks of the heart
bursting the arteries, the big heart gradually rots and
'8top3. Haying passed the rocks of the earlier risks the
patient drifts on to the deadlier shallow beyond. The
history of many families, certainly my own on all. sides,
is arterial rupture (which in no case has been fatal, and
that only in advanced life), followed in time by sudden
cessation of the heart in diastole from softening of its
fibres ; and this last morbid change has always given dis-
tinct evidence of its approach and not come like a thief
in the night
Such, then, is my view of the natural history of the
fatt^ heart : it is the last development of a long patho-
logical process, the longest and most striking wiSi which
we are yet familiar
Of course it is not asserted that fatty degeneration of
the heart never has any other antecedents ; but this is
its history as ordinarily encountered in practice. Occlu-
sion of the coronary arteries, or rather partial occlusion,
is the cause of the decay of the heart-walL In one case
death may take place suddenly, unexpectedly. In an^
other, and far more commonly, when the wall is weakened
dilatation commences, or rather recommences, and as
hypertrophy's arresting hand is lifted so the symptoms
of a failing heart are developed, and all the skill and
pains in the world can never strengthen that failing
heart, or even do much to stave off the inevitable end.
When a patient with an hypertrophied heart and hard
arteries begins to And the bulk of urine falling, and then
heart symptoms showing themselves, with or without any
coexistent valvular disease, the transient eye can read
the beginning of the end. And this end is far, far more
common than sudden death in the midst of apparent
health, where the heart has undergone little or no pre*
ceding enlargement.
Fatty degeneration of the heart is common with ill-fed
drunkards. But it has nothing to do with obesity, and
is as comnon in lean persons as with stout persons. It
has no relation to the growth of adipose tissue. It is
a decay of the muscular flbrillae, which undergo in life
the same molecular changes as are found in the produc-
tion of adipocere after death. Fat takes the place of
muscular tissue within the scarcolemma, and the heart
stops contracting because it is the seat of mural decay,
in other words is " rotten."
A species of acute fatty degeneration of the heart goes
on whenever a high temperature is maintained for some
time, as in the specific fevers. Indeed, in relapsing fever,
where the temperature runs very high, the heart becomes
so weakened that death from syncope is not rare in the
stage of convalescence.
The rebuilding of the cardiac fibrillar ai^er a sharp
pyrexia is sometimes very slow, and months may elapse
before the patient is equal to much exertion. The most
pronounced cases, in my experience, of cardiac adynamia
due to acute fatty degeneration have been those of young
adults who have had typhoid fever, several of them medi-
cal men.
Then there is fatty infiltration, a growth of true adipose
tissue outside the heart and to some extent within its
structure. Here fat is deposited betwixt the fibrillse,
which are pressed upon by these fet-cells. A certain
amount of adynamia in the heart is the result Such
fatty growth is usually found in obese persons of lax fibre.
It is by comparison with fatty degeneration a somewhat
uninteresting pathological condition.
Then there is a condition of adynamia in the heart, and
also in the diaphragm, which, in its features, simulates
fatty degeneration m conditions where the assimilation
of albuminoids is impaired. It is commonly seen where
the liver is disturbed, and instead of elaborating the pro-
teids brought to it by the portal vein ^or perhaps peptones
not converted once more into proteids) into the serum-
albumin of the liquor sanguinis, the liver turns them
into lithates and bile acids, in consequence of which the
heart and diaphragm are ill-nourished. Being ill-nour-
ished they are deprived of much of their energy, with the
result that the pulse is feeble, the heart-sounds weak,
July i9> 1884.J
THE MEDICAL RECORD.
59
there is cerebral ansemia, there is breathlessness in effort
(partly from feebleness in the diaphragm), and the gen-
^ condition which is associated with fatty degeneration
is closely simulated. Indeed it is the "double " of fatty
degeneration. To this state I have given the name of
** Heart Starvation," for which a critic in the London
Medical Record accused me of " the attempt to dress up
well-known clinical facts in strange and startling phrase-
ology;*' continuing: "Apart from the language in which
they are disguised, there is not a fact mentioned in this
essay which is not also a commonplace to every expe^
rienced practitioner " (August, 1881). Despite this hare-
brained frivol of self-satisfied ignorance, many men
of sound judgment regard the essay as a useful contri-
bution to medicine on a subject on which little is
known. If this occurs in a comparatively young person
it would hardly be likely to be mistaken for a truly senile
change. But when it occurs in a person who is of that
age when senile changes may be looked for, it is not
always possible to distinguish betwixt it and fatty degene-
ration of the heart, as in the case given above as occur-
ring in my early days. It is really this condition of mal-
nutrition grafted upon an old-standing valvular lesion
which brin^ the patient to the doctor very often. For-
tunately it is a remediable condition, which fatty degene-
ration (as described above) certainly is not:
The condition of the heart-muscle is a matter on which
more general information is desirable. It is not fiatter-
mg to our profession to hear patients say that years
before they had been told they had fatty degeneration of
the heart and must soon die suddenly, and yet then were
well The condition which had been diagnosed as " fatty
degeneration " was really that of its double, " heart star-
ration."
A CONTRIBUTION TO THE STUDY OF CO-
RYZA VASOMOTORIA PERIODICA, OR SO-
CALLED « HAY FEVER.'* *
By JOHN N. MACKENZIE, M.D.,
BKVRi TO TM« BAI.TIMOKB BYK, BAR, AND THSOAT .CMARTTY HOSMTAL,
BALTIMOKB, MD.
^^Nunqu€im ita fuisquam bene subducta raiione ad vitam fuity
QuiH res, atas, usus semper aliquid opportet novi^
AUqmd moneat, ut ilia qua te scire credos, nescias^
Ety qua tibi putaris prima^ in experiundo ut repudies?'*
—Terence, in " Adelphis," Act V.
When the phenomena of a given disease or unnatural
condition are inexplicable by known pathological laws, or
do not come within the range of that specidation which
onpirical fact and scientific experiment allow, it is cus-
tOBoary to seek in the term " idiosyncrasy " a convenient
icfage for acknowledged ignorance. This applies with
especial force to the affection in question, the peculiar
fetoes of whose clinical history have been submitted to
til lazy explanation. The well-recognized, but imper-
fady andeistood personal susceptibility to certain forms
of local irritation, which is the sad prerogative of the
afeers from this disease, has always been the stumbling-
Nock in its investigation and the rock upon which the
niioQs speculations as to its nature have been wrecked.
Hasty generalizations based on the study of conditions
«tternal to the organism, to the exclusion of pathological
Vncies within, together with deductions drawn from iso-
«ed cases, and the uncertain testimony of the laity, have
t^ rise to a variety of names indicative of its supposed
rt^)gy, such as "hay fever" or "asthma," "pollen
TO" or "poisoning," "rose" or "peach cold," etc,
appellations which should be discarded and forgotten, as
]key not only tend to perpetuate erroneous views and to
J^uce elements of confusion into the investigation,
wt also, by a diversion of the mind from mere essential
Woditions, have in no small measure contributed to retajrd
^ogress in the therapeutic management of the disease.
jjJlaaarB ddivcred at the Baltunore Eye, Ear, and Throat Hospital. June 14,
While the term coryza vasomotoria periodica^ suggested
in the title of this communication, does not meet all the
requirements of a logical definition, it may nevertheless
be used provisionally until more exact knowledge of the
affection furnishes data for the construction of a better.
For, as will be shown below, the disease is essentially a
coryza, showing, in most cases, a decided tendency to
periodic recurrence, and dependent upon some functional
derangement of the nerve-centres as its predisposing
cause.
Until within the past few years clinical and experi-
mental inquiry has been directed to the investigation of
the most prominent exciting external influences provoc-
ative of the attack, and other and more important agen-
cies have been entirely overlooked, or set aside as the
general or special expressions of an idiosyncrasy, an ex-
planation which is practically meaningless and conveys
no definite or intelligent idea concerning the essential
nature of the disease. While it is undoubtedly true that
the inhalation of certain forms of matter, and pollen is
only one of them, exercises an unquestionable irritative
influence in the production of the paroxysm, it is, at the
same time, equally certain that in a large proportion, if
not all, careful inquiry will discover this influence to be
purely secondary or accidental — to be dependent upon
some local or constitutional condition. Although a
number of investigators had previously labored with
praisewortliy zeal to establish a definite pathology of the
disease, the first to open the way to the rational solution
of the problem was the late Dr. George M. Beard, of
New York, who, by carefully selected statistics, pointed
out the importance of the neurotic element as a factor in
its production.* According to Beard, hay fever is a
neurosis, a functional disease of the nervous system, an
affection of modern life and of the nineteenth centur3r.
While he does not explain exactly in what such a neurosis
consists, while his researches are open to fair criticism,
and while his conclusions cannot be unreservedly ac-
cepted, they served, at least, the important purpose of
lifting medical thought from the grooves to which it had
been confined by the supporters of the pollen and bacteria
speculations, and diverting it into newer and more fruitful
channels.
Beard, and those who preceded him, not only depre-
cated the possible etiological importance of catarrhal
affections of the upper air-passages, but went so far as to
say that the very opposite state of affairs existed, and
that the subjects of " hay fever," so called, were exempt
from nasal and other forms of catarrh. The first, perhaps,
to correct this erroneous impression and to point out the
important rdle which disease of the naso-pharyngeal,
cavities plays in the production of hay fever was Dr. Daley
of Pittsburg, who, in 1881,' showed that, in a proportion at
least of cases, there is local disease of the nose or
naso-pharynx, without which the exciting cause is in-
nocuous ; and futhermore proved by clinical evidence
that the cure of the affection may be effected through the
removal of the local intrinsic condition.
The following year. Dr. Roe, of Rochester, published
the favorable results of his treatment of the disease by
operative procedures directed to the hypertrophied mem-
brane in the nasal 'chambers.' According to Roe, hay
fever is caused by the contact of the pollen of grasses or
flowers and other irritating particles in the atmosphere
with the nasal mucous membrane, which in certain indi-
viduals is rendered peculiarly susceptible by virtue of
disease, either active or latent, of the naso-pharynx,
associated with hypertrophic catarrh of the nasal passages.
In the course of some experiments made by me on
the healthy and diseased mucous membrane, with refer-
» Hay Fever, etc, N. V.. 1876.
* Vide Archives of Laryngology, April s, 1883. Dr. Edaon had previously
(letter to New York Mboical Record, 1878, vol. u., p. 3x7) called attention to the
Uct that all canes of the disease presented one or more of certain symptoms
referable to the nose, as great sensitiveness of the nasal membrane, coryxa, per-
sistent sternutation, naso-pharyngeal catarrh, etc
* N. V. Medical Journal, May 13, 19, 1883.
6o
THE MEDICAL RECORD.
[July 19, 1884.
ence to nasal cough and the determination of an area in
the nostril for the production of the various reflex phe*
nomena associated with nasal disease/ the following
facts were ascertained, whose application to the disease
in question will, I venture to think, throw some addi-
tional light upon its pathology: i. That in the nose
there exists a well-defined sensitive area, whose stimula-
tion through a local pathological process, or through ab
extra irritation, is capable of producing an excitation
which finds its expression in a reflex act or in a series of
reflected phenomena. 2. That this sensitive area corre-
sponds, in all probability, with that portion of the nasal
mucous membrane covering the turbinated corpora
cavernosa. 3. That nasal cough is produced only by
stimulation of this area, and is only exceptionally evoked
upon irritation of other portions of the mucous mem-
brane. 4. That all parts of this area are not equally
capable of generating the reflex, the most sensitive spots
being probably represented by that portion of the mem-
brane covering the posterior end of the inferior turbi-
nated body and the septum immediately opposite. 5.
That the tendency to evolution of reflex phenomena
varies in diflerent individuals, and is probably dependent
upon the varying degree of excitability of the erectile
tissue. In some the slightest touch is sufficient to excite
the reflex act, while in others chronic hyperemia or hy-
pertrophy of the cavernous bodies seems to evoke it by
constant irritation of the reflex centres, as occurs in
similar conditions of other erectile organs, as, for exam-
ple, the clitoris.
Apart from experimental proof of such localization —
viz., to the posterior and inferior portion of the nostril — "
I showed, from my clinical observation, (i) that in oases
where reflex cough is present, these are the portions
chiefly, if not solely, involved ; (2) that the act may be
produced here at will by artificial stimulation of the dis-
eased area, and (3) dissipated by local , applications to,
or removal of the same ; (4) that foreign bodies only
excite cough when they are imparted in the sensitive
area ; and (5) that polypi give rise to reflex phenomena only
when they arise from or impinge upon the sensitive por-
tions of the area ; and lastly, a point of importance
as bearing on the treatment, (6) that where complete
atrophy of the turbinated structures exists, as, for exam-
ple, in certain cases of ozoena, reflex cough is not pres-
ent, nor can it be induced by artificial stimulation.
These facts are not alone true of cough and asthma ;
my experience furnishes me with a series of cases where
they could be demonstrated as true of various other
reflex phenomena originating in diseased conditions of
this area, and I have already called attention to the
reflexes ■ which I have met with (cough, pain in the ear
and larynx, redness of drum membrane, etc.) in the
course of operative procedures in this region.*
Since I first directed attention to the posterior end of
the inferior turbinated body and septum as the most sen-
sitive spots to reflex-producing impressions, I have re-
ceived several communications confirmatory of the views
expressed in my paper, which have also derived support
from the publications of other writers. Thus, the obser-
vation that reflex asthma arises from nasal disease only
when the posterior portions of the sensitive area are in
some way involved, either directly from a pathological
condition of the parts or from the irritation of a poly-
pus,* has been confirmed by Dr. Roe,* who explains the
> On Nasal Cough, and the Extatence of a Sensitive Reflex Area in the Nose,
American Journal of Medical Sciences, July, 1883. The results of these experi-
ments were first brought before the Baltimore Medical Association in the early
Kt of .S883, and subsequently before the Medico-Chirurgical Faculty of Mary
, d (April, X883, viiU Iransacttons), and the American Laryngological Assoda-
tiOQ (May, 1883, vide Transactions).
» Trans. Med. Chir. Fac of Maryland, 1884. American J. Med. Sc, loc. cit..
Trans. Vurgmia State Society, 1883.
* There is one point pertinent to the subject of this paper which should not be
lost sight of, and that is that certain reflex phenomena may be awakened by stim-
ulation of the apparently normal membrane.
« Vidt a paper by the author on Reflex Cough due to Nasal Polypi, etc. (read
April as, 1884). Trans. Med. Chir. Fac of Maryland, and N. V. Medical Rbc-
ORD, May 4, 1884.
* Journal of the American Medical Association, September 15, 1883.
more frequent occurrence of the paroxysms ; at night
by the gravitation of blood to the sensitive area. The
same author, moreover, in his recent paper on '*hay
fever/' * points out the fact that, in the majority of cases,
the seat of irritation during the attack is the inferior tur-
binated bone and posterior portion of the septum, thus
furnishing additional confirmatory clinical evidence in
favor of localization of the reflex area in the lower and
posterior portions of the nostril.* While these observa-
tions go to show that the most sensitive spots are repre-
sented by the area indicated above, it is but fair to state
that a different opinion is entertained by a German con-
frere, well known from his labors in this special field.
In August, 1883, ^^^1*^ appeared in Germany an inter-
esting brochure from the pen of Dr. Haek, of Freiburg,*
in which this writer maintains, as the result of indepen.
dent experiment, that the anterior extremity of the inferior
turbinated bone is the point from which all reflexes take
their origin, and that those arising from stimulation of
other portions of the nostril only occur, secondarily,
through congestion of the cavernous tissue of this cir-
cumscribed locality.
Like Daly and Roe, Haek holds that morbid con-
ditions of the nasal membrane play the most important
part in the etiology of the disease. He also believes
that there are two factors in the production of the par-
oxysm, viz., a hyperaesthetic condition of the terminal
filaments of the fifth and olfactory nerves, and an in-
creased irritability of the cavernous tissue, caused, as a
rule, by local nasal disease, and inclines to the belief
(also held by Roe) that the neurasthenic symptoms are
secondary to the nasal affection, calling attention, at the
same time, to the fact that the latter may coexist with a
general neurosis without having any connection with it*
Finally, Dr. Harrison Allen advances the view* that
"hay fever" depends solely upon obstruction of the
nostrils (from deflection of the septum, hypertrophy of soft
parts and bone, turgescence of nasal mucous membrane),
and that the cure consists simply in removing the ob-
struction (or tendency thereto) in the nasal chambers.
According to his experience, sufferers from hay fever and
allied disorders have one feature in common — the in-
ferior turbinated bones lie well above the floor of the
nostril, an anatomical peculiarity which subjects their
bulging mucous membrane to additional irritation from
extraneous substances.*
It would appear, then, that the truth is irresistibly
emerging into recognition that certain abnormal con-
ditions of the nasal passages are necessary to the pro-
duction of the ensemble of phenomena which form the
classical picture of so-called hay asthma. Although the
results arrived at by different observers, working inde-
pendently of each other, and starting out in some in-
stances from different standpoints, are not altogether
harmonious, they present nevertheless a singular unanimity
in their convergence to a common point — in thieir recog-
nition of the importance of remedial measures addressed
to the nasal chambers as a prime factor in the therapeutic
management of the disease. While, then, it is probably
true that certain states of the nasal passages are neces-
sary to the production of a paroxysm, it is, at the same
time, equally demonstrable that these are not always de-
pendent upon well-defined local nasal disease, but that,
in a number of cases, such conditions are originally
brought about by abnormal excitability of the vasomotor
centres from inherited or acquired disease. The prob-
lem, then, presents for consideration two important con-
^ N. V. Medical Journal, May 3 and 10^ 1884.
* In a recent number of L* Union M^dicale (January aa, 1884, La toux nasale)
M. Longuet believes, with me, in the existence of a tussigenicarea {aone tustighu\
in the posterior end of the inferior turbinated bone and septum, whidi he com-
pares \o the hystero and epileptogenic zones of Krown-S^uard.
* Ueber eine operative Radicalbehandlung bestimmter Formen von MigrXne,
Asthma, Heufieber, etc Wiesbaden, 1884.
* Sec also, Wiener Med. Wochenschrift, No. 14, 1883.
* American Journal Med. Sctenoes, January, 1884.
* Allen reports several cases successfully treated by lemoving the obstruction to
respiration. Cases have also been treated with the cautery by Dr. Sajousot
Philadelphia (reported at last meeting of the American Laryngological Associa-
tion}, whose conclusions on the subject do not differ from those of Dr. Roe.
July 19, 1884.]
THE MEDICAL RECORD.
6i
ditioos; on the one hand the local nasal phenomena,
and on the other the etiological relations of the central
nervous system. In allotting to each its respective
aasative significance, care should be taken, in avoiding
theScyliaof the neurologist, not to be too closely attracted
to the Charybdis of another form of specialism.
Approaching the question from this standpoint, and
guided by my personal experience, I believe that our
definite knowledge of the etiology of the disease may be
briefly expressed as follows :
I. The essential, distinguishing feature of the paroxysm
of so-called " hay asthma " resides in an exalted con-
dition (erethism) of the nasal erectile tissue, and especi-
ally that portion occupying the posterior end of the
inferior turbinated bone and the septum immediately
opposite. This latter area corresponds to the distribu-
tion of the spheno-palatine branches of the superior
maxillary nerve, as distinguished from the nasal branch
of the ophthalmic, which latter supplies the more anterior
portions of the nasal fossas. The former nerves, derived
through the ganglion of Meckel, probably therefore con-
tain the vaso-motor nerves which govern the erection of
the turbinated tissue, and hence the localization of the
sensitive area becomes the key to the mechanism of the
paroxysm and brings us nearer the solution of the path-
ological process that sets it id motion.
So far as my observation goes, every attack is attended
with more or less swelling of the erectile tissue, which is
more pronounced in the lower and posterior parts of the
nostril. This swelling, occasionally inconsiderable, is
often sufficient to produce absolute and complete closure
of the nasal fossae. I have moreover, so far, never seen,
nor have I been able to find the record of a single case
where paroxysms of hay fever occurred where the tissue
was completely atrophied or destroyed by disease. In
two cases under my observation, the nasal chambers were
markedly capacious, but, at the same time, the erectile
tissue was well developed. Finally, the cure of the
affection by the artificial destruction of the erectile bodies
amounts to a demonstration.
2, This exaggerated iiritability of the cavernous tissue
may be directly due to the constant presence of con-
gestk)n or other pathological conditions of that structure,
the result of direct or indirect (reflex) irritation from
ci extra influences, plus a hypersensitive condition of
the vasomotor centres begotten of their prolonged ex-
diation by the irritating influence in the nostril ; or it
nay be brought about, in the first instance, by an exalted
state of the central nervous system, leading eventually
CD disordered functional activity of the vasomotor nerve-
centres; or, finally, a hypersensitive condition of the
latter may be conditioned by other pathological states
of the system as a whole, or as the result of reflected
initation frona its individual parts.
I am inclined, therefore, to transfer the point of
potest excitability from the peripheral ends of the
aw filaments to the nerve-centres themselves. While
1 do not deny the possibility of a hyperaesthetic condi-
^ or even organic changes in the terminal filaments
of the sensitive nerves, as an occasional factor, and
•tnlc fully aware of the want of experimental proof in
^ of the view advanced, still it seems to me a more
*^uate, a more comprehensive explanation of the
'sicd phases of the disease. Upon this theory can be
**«t explained, moreover, the occurrence of paroxysms
b*J irritation reflected from various parts of the "body
*ttaotc from the nasal passages. The weight of clinical
•"ycnce, too, is in favor of disordered functional activity
of the nerve-centres, as against organic alteration of the
peripheral sensitive nerves. Finally, it is probably not
tf dK terminal ends of these filaments, but in the centres
themselves, that the perception is awakened which dif-
fcrentiatcs one form of irritant from another ; that the
iKnres themselves are but the passive channels through
^htt the impression is transmitted, and that the pro-
^Ktion of a paroxysm by a given irritant will depend,
other things being equal, upon the, so to speak, dis-
criminating power or peculiar susceptibility of the centres
themselves.
3. There is practically an infinitude of causes, ex-
ternal and internal, which may precipitate the nasal
orgasm, such as various forms of matter suspended in
the atmosphere (pollen, different forms of animal life,
etc.), or the erection of the tissue may be conditioned
by those influences that are commonly productive of
erection of the nasal corpora cavernosa, such as varying
meteorological relations, various forms of reflected irrita-
tion, or, finally, it may be occasioned through psychical
causes. It follows, therefore, as a corollary to the above,
that any one irritant is insufficient of itself to provoke
the attack, the latter being only possible either from
disordered functional activity of the nerve-centres, ^or
local structural disease.
4. The power of a given local irritant to produce
such impression, and the violence of the resulting attack,
in all probability depends upon its physical properties
and the length of its sojourn in the nasal cavities. Thus,
the peculiar glutinous nature of some substances, as for
example pollen, the irregular surfaces of others, as the
golden-rod * and similar substances, will give rise to more
prolonged irritation than substances of smooth contour,
which are readily swept out of the nostrils.
5. Apart from its accidental occurrence with the flow-
ering of certain plants, etc., the marked periodicity of
the paroxysm in some cases, its regular appearance at
a certain hour and on a certain day, so far from over-
throwing its neurotic nature, points to some functional
derangement as its possible cause. This tendency to
periodical return of a given state is characteristic of cer-
tain morbid states of the nervous system, of which the
so-called functional aphonia is a prominent example.
It is not, therefore, stepping beyond the bounds of legiti-
mate speculation to suggest this as the explanation of a
certain number of cases.
6. Whatever be the original cause of such special
tendency to erection and consequent evolution of reflex
phenomena, the essential part of the mechanism of the
paroxysm is the orgasm of the erectile area. This is the
main-spring of the machinery by which it is set in mo-
tion, and without which the onset of the attack is im-
possible.
From what has been said above, it naturally follows
that the rational treatment will consist (i) in diminishing
the reflex excitability of the turbinated tissue ; or, fail-
ing in that, (2) the partial, or, if necessary, complete
destruction of the tissue itself.
The first indication must be met (r) by tonic renjedies
addressed to the nervous system, and by the exhibition
of such drugs and methods as experience has shown
control reflex excitability (the bromides, belladonna,
chloral, counter- irritation to nape of the neck, etc.) ; (2)
by the careful search for, and intelligent treatment of
any pathological condition which may be regarded as a
source of reflected irritation ; and (3) by simple topical
treatment of any existing nasal disease or irritation. In
carrying out the second indication care should be taken
to sacrifice as little of the erectile tissue as possible. It
would accordingly be better to commence by removing
or destroying that portion which covers the posterior
end of the inferior turbinated bone, and, if necessary,
that covering the septum immediately opposite ; or, in
other words, that area which contains the greatest
number of filaments of the sphenopalatine nerve. Should
this not accomplish the desired result, any additional
sensitive spots should be located by means of the probe,
as has been done by Roe, and appropriate treatment
adopted.
The destructive agent used in any given case will vary
according to circumstances. It may be said, in general,
1 The golden-rod has also been regarded as the cause of hay iever. See editorial
article on the Pathology of Hay Fever, by Dr. .Frank Woodbury, in the Phila.
Med. Times, December x, 1883. p. 175.
62
THE MEDICAL RECORD.
[July 19, 1884.
that hypertrophic enlargements of the turbinated bodies
are best removed, if practicable, with the cold wire
snare ; swelling of the cavernous tissue over the septum
is best treated with the galvano-cautery, while for com-
plete destruction of erectile tissue, the latter agent or
electrolysis is the best agent we possess.
Reference has been made several times above to re-
flected irritation of a distant organ as a factor in the
production of the paroxysm. In order to illustrate this
point, and at the same time make good the assertion of
the fact, I will insert the following case :
Mrs. , aged thirty-seven years, married twenty
years, the mother of one child, now eighteen years of
age, came in the early part of April of this year to con-
sult me on account of severe " hay fever." She has re-
sided all her lifetime in a small manufacturing town on
the banks of one of our Maryland rivers, and in proximity
to a malarial district. Family history unimportant. Sev-
eral of the neighbors suffer from paroxysms similar to her
own. She is herself a woman of average intelligence, of
spare habit, dark hair and eyes, good disposition, not in-
clined to be hysterical, nor easily frightened ; is " dys-
peptic," and siiffers greatly from inability to digest her
food. Without possessing a decidedly nervous tempera-
ment, in the common acceptation of the term, a more
or less pronounced neurotic tendency expresses itself in
a certain unnatural acuteness of the senses, and suscepti-
bility to psychical impressions. Has never suffered from
any nervous disease, with the exception of occasional
neuralgic pains in the course of the fifth nerve, which
have, however, of late, ceased to give her much trouble
or concern. Has had malarial fever, and for the past
four years has suffered from constant ovarian trouble.
The left ovary is probably the only one involved, the
condition being some chronic inflammatory disease.
Has suffered for two years from "hay fever." Prior
to her ovarian trouble, enjoyed excellent health and
exhibited no tendency to catarrhal disease of the nose
or throat.
The paroxysms are ushered in, as a rule, by chilly
sensations, followed by violent and uncontrollable sneez-
ing, intense redness of the conjunctivae, increased lachry-
mation and spasm of the lids. During the attack she
cannot see to read or write, any attempt to use the eyes
being accompanied by great pain, photophobia, etc.
The voice soon becomes husky and nasal, considerable
mucus b expectorated from the throat, and a profuse
watery and slightly mucous secretion is discharged in
abundance from the nostrils. There is generally super-
added to these symptoms a short barking cough, which
often continues for several days after the subsidence of
the attack. During the latter, the nostrils are always
completely closed, so that nasal respiration is impos-
sible. Pain is felt across the bridge of the nose and in
the frontal and occipital regions, pain in the ears and
tinnitus are nearly always experienced, and the meatuses
feel as if stopped up by a foreign body. The amount of
asthma accompanying the attack varies greatly, being at
times more pronounced than at others. During the
paroxysm pain is always felt in the left ovary, and any
existing pain of that organ aggravated. The ovarian pain
comes on after sneezing, and occasionally continues after
the paroxysm has subsided. The attacks come on at all
seasons of the year, and bear no definite relation to the
conditon of the atmosphere as regards moisture or dry-
ness ; but are worse in spring and fall, i>., in the
seasons of greatest temperature changes. They come
on at all hours of the day, and she is often awakened
from her sleep by the sudden accession of a paroxysm.
The sh'ghtest exposure to draughts of any kind suffice to
bring on the attack ; the accidental unfastening of her
night-dress at the neck during sleep, stepping from the
bed to the floor, going about in her stocking feet, or
changing her shoes for her slippers, and other equally
trivial causes have frequently precipitated it. It is also
brought on by physical or mental over-exertion, or by
emotional excitement.* The attacks are not modified by
diet, dust has little or no effect, while gas and smoke of
various kinds produce a disagreeable, smothering sensa-
tion with some dyspnoea, but are insufficient to provoke
the characteristic phenomena of the paroxysm. There
are some plants that cause slight sneezing ; but although
frequently exposed to a pollen-laden atmosphere, ex-
posure has .never produced a paroxysm. The attacks
invariably appear and are moire severe at the menstrual
period, appearing sometimes at its commencement,
sometimes at its close. This latter condition of affairs
has lasted for one year. They last generally for two days
and one night, after which all the discomfort she suffers
from them passes gradually away. She averages about
two attacks a week, during which she is confined to her
room, and often to bed. They sometimes leave her in
a state of nervous prostration, from which she slowly
recovers.
By the protection of the nasal passages from the con-
tact of air during the attack, the paroxysms are somewhat
mitigated in severity, except at the monthly period,
when this has no effect. Residence at the sea-shore in-
variably gives relief ; except during menstruation, when
the attack is as severe as when at home.
During the intervals between the attacks, she does
not suffer from nasal or throat trouble, beyond the ac-
cumulation of a slight amount of mucus in the nasal
passages upon arising in the morning, with occasional
dryness of the throat and huskiness of the voice. These
phenomena are, moreover, of quite recent development.
Physical examination, — Nothing to indicate visceral
disease, apart from the morbid condition of the ovary.
No disease of auditory apparatus, larynx, trachea, or
lungs. Anterior nasal passages apparently perfectly
healthy. The posterior extremities of the inferior turbi-
nated bodies, as seen in the rhinoscopic mirror, without
being notably enlarged, present an ashy gray color often
seen in hypertrophy of these bodies. The nasal fossae
are perfectly free and symmetrical The lower border of
the inferior turbinated bones cannot be seen in the mir-
ror, and are not elevated above the nasal floor in front.
There is no malformation or irregularity in the skeleton
of the nose or other part of the face. The mucous mem-
brane of the nasal pharynx is congested, and covered
here and there with a faint film of transparent secretion.
The mouths of the Eustachian tubes are normal, in ap-
pearance. The lower pharynx is congested and studded
here and there with small granules (commencing granu-
lar pharyngitis). No irregularity in the conformation of
the pharyngeal cavities.
The treatment adopted in this case was in accordance
with the indications laid down above, with special at-
tention to the diminution of excitability of the erectile
area. The nasal passages were kept thoroughly cleansed
and protected against local irritation. Anodyne and al-
terative applications and acetic acid were made to the
congested surfaces with the understanding that, should
they fail to relieve, the galvano-cautery was to be re-
sorted to.
At the end of one week little improvement was no*
ticed ; but at the close of the second marked change for
the better had occurred, both as regards the number and
severity of the paroxysms. At the expiration of six
weeks the attacks had lost their distinguishing characters,
the only annoyance from which the patient suffered bein^
an occasional brief access of sneezing. At the two men-
strual periods which intervened during this time, how-
ever, she had attacks resembling the original paroxysna,
but greatly modified in severity. At the present writing,
the sneezing has so markedly diminished, that it no long—
er gives her much concern, and her last monthly period
was passed without the slightest nasal discomfort, although,
she was convinced that it was inevitable, and had pre—
> The patient attributes a great deal of her trouble to the excitement and aiental.
anxiety which she underwent while in constant care of the wounded in her hua —
band's factory, where accidents to the hauids were constantly occurring.
July 19. 1884.]
THE MEDICAL RECORD.
63
pared herself for the attack. What the final result of this
case will be I am, of course, unable to say, but from the
present outlook, operative procedures will doubtless be
unnecessary.
Remarks. — ^The above case shows, among other things,
that the paroxysms of the disease commonly called '^ hay
fever," may be brought on in the same individual by a va-
riety of agencies differing entirely in origin, character,
and mode of operation. At times they are produced by
causes which are ordinarily provocative of common coryza,
at others from the increased irritative stimulus given to a
morbid process in a distant organ, or finally, they are
occasioned by impressions of a purely psychical nature.
The attacks at the menstrual epoch are readily explicable
bythe physiological erection of the nasal corpora cavernosa
iriuch occurs at that period ; for, as I have pointed out
elsewhere,' in a certain proportion of women these bod-
ies become enlarged and engorged during menstruation,
the swelling of the membrane subsiding with the cessa-
doa of the catamenial flow. This turgescence may be bi-
lateral, or confined to one side» may be inconsiderable and
give rise to no inconvenience, or, on the other hand, the
svollen bodies may include the nostrils and give rise to
various reflex phenomena. In the '' hay fever " sufferer,
anything that tends to produce swelling of this tissue
excites at the same time the tendency to the production
of the reflex phenomena characteristic of the disease.
In thb particular case the chief, and, under certain cir-
cumstances, the sole excitant of the paroxysm was^the
utero-ovarian excitant of the menstrual epoch.
The history would point to a hypersensitive condition
of the vasomotor nerve-centres, the result, perhaps, of con-
stant irritation reflected from the diseased ovary, as the
chief predisposing cause, or so-called ^^idiosyncradc" influ-
ence in this particular case. It is fair, too, to look upon
the increased excitability of the erectile bodies, and the
consequent repeated attacks of cough, as responsible for
the amount of existing nasal disease.
The practical outcome of the above conception of the
disease is simply this : Those who recognize in it the
imndation of a rational therapeutic, and direct their treat-
ment accordingly, will relieve all, and cure a large pro«
portion c^ their patients ; while those who blindly ac-
cept the traditional fallacies of the theory of external
canses must continue to divert themselves with perpet-
ual palliative experiment, and cling to the gloomy belief
of die Englishman, that the only cure for the disease is
patience, if removal from the British Isles is impossible,
tfaanking God, at the same time, that there are only thirty
days in June ! *
Apocymum Cannabinum. — Canada or American Indian
hemp bark has a very persistent bitter taste, contains
taanin and gallic acid. Is sometimes emetic, and causes
diaphoresis ; also cathartic, like jalap. It promotes ex*
peroration, also drowsiness, increases the urinary secre*
tioQ and diminishes the force and fervency of the pulse,
like aconite or digitalis. It is most used in dropsy, and
IS a tonic and alterative in dyspepsia. Dose of pow-
dered root, five grains, as an anti-periodic, twenty grains
as an emetic. Decoction of | j. to Ojss. of water, and
boiled down to a pint ; a wineglassful three times a day,
as a diuretic, or 3 j. of the bark of the root in | viij.
of water, % ss. every six or eight hours. This is one of
those remedies which should always be thought of in ob-
i&Date cases of cardiac or hepatic dropsy. Its diuretic
actioD is frequently prompt and even extraordinary. It
isthe basis of Hunt's remedy for renal diseases. Although
apocynom is us^ by some as gin and bitters, yet it is very
<isa^able to others, and some persons far advanced in
dropsjr will almost rather die than swallow the simple in-
^m. A large addition of chimaphila or wintergreen
vill aid its diuretic powers and improve its taste.
^\auam of the Scmal Appaiatus as an Etiological Factor in the Production
" Xml Disease. American Journal Med. Sciences, April, 1884.
1 Yi4g\etia to British Med. Journal, 1883, p. 1315.
WARBURG'S TINCTURE.
Hints for Simplifying and Cheapening It.
By JOHN C PETERS, M.D.,
NEW Yont '
Some time ago I was so impressed with tbe shrewd hints
of The Record about Warburg's tincture that I have
made a careful study of that complex preparation/ which
1 hope will be instructive to its readers.
In the tincture 42 ounces of various ingredients are to be
dissolved in 500 parts of proof spirit, which is about half
alcohol and half water, by placing them in a water-bath
for twelve hours, then expressing them and adding 10
ounces of disulphate of quinine, the whole mixture being
replaced in the water-bath until all the quinine is dis-
solved.
The process seems simple, but it may safely be assumed
that a great residuum of resinous, bitter, and aromatic
substances will be left behind.
Next to quinine the most important ingredient is aloes,
of which I lb. British, or 16 ounces avordupois, or 7,000
grains are to be dissolved in the 500 ounces of proof
spirit. There arc next 4 ounces, or 1,750 grains of
rhubarb. Third, 4 ounces, or 1,750 grains of angelica
seeds, which is a simple aromatic tonic, spice, or stim-
ulant, like aniseed, calamus, and the like. Fourth, 4
ounces, or 1,750 grains of the so-called confectio datno-
craiis, which is a mild confection of opium, which once
contained sixty-two ingredients, with about 5 grains to
the ounce of opium. Nearly a century ago the London
physicians substituted the confectio Londonense^ made
of opium, 6 drachms; long pepper, i ounce; ginger,
2 ounces; caraway seeds, 3 ounces; syrup, i pmt.
There is i grain of opium in every 36 grains, and the
dose is 10 to 30 grains. Hooper says : '* To the credit
of modern pharmacy this is almost the only confection of
opium that now remains of all those complicated and
confused preparations called Damocratis» Mithridate,
Theraic, etc. It more nearly approximates the virtues
of all of them than any other, and may be considered an
effectual substitute for them in practice. It is a very
warm and stimulating confection and admirably calcu-
lated to soothe pain and restlessness, and sustain strength
in low fevers." Fifth, 2 ounces, or 875 grains of elecam-
pane^ or less than 2 grains to the ounce : all its virtue
a redue to a slightly peculiar camphor, which giyes it its
odor. Sixth, 2 ounces of saflfron. Seventh, 2 ounces oL
fennel seeds. Eighth, i ounce, or less than i grain to the
ounce, of gentian. Ninth, i ounce of zedoary, which is
almost identical with ginger. Tenth, i ounce of cubebs.
Eleventh, i ounce of myrrh. Twelfth, i ounce of cam-
phor. Thirteenth, i ounce of boletus laricis, which is a
purgative comparable to jalap and senna.
To sum up, in each ounce of Warburg's tincture we
have about ten grains of quinine ; fourteen of aloes; four
of rhubarb ; one of opium ; two of elecampane ; two of
saffron ; one of gentian ; one of ginger ; two of fennel
seeds ; one of cubebs ; one of myrrh ; one of camphor ;
and one of boletus or jalap or senna.
In building up his tincture Warburg probably took a
hint from the German and French so-called Paracelsian
elixir of life, which is composed of aloes, nine parts ;
gentian, rhubarb, zedoary, saffron, and boletus laricis, or
larch, or purging agaric, each one part ; digested in proof
spirit two hundred parts, and of wliich the tonic and
alterative dose is one or two drachms.
The European tincture of rhubarb is made with carda-
mom and coriander seeds, and safiron. The angelica
seeds, fennel seeds, elecampane, saffron, zedoary, cubebs,
and the little mjrrhand camphor are pleasant aromatic ad-
ditions to the tincture ; and the one grain of gentian, and
one grain of boletus or jalap do not deserve a great deal
of attention.
The question arises whether a few aloes and rhubarb
pQls with quinine and spices will not accomplish almost all
that Warburg's tincture will.
64
THE MEDICAL RECORD.
[July 19, 1884.
Or if a liquid preparation is preferred any physician
can build a formula for himself with simple tincture of
aloes and liquorice, U. S. P. ; tincture of rhubarb and car-
damoms, U. S. P. ; or tinct. rhei et sennae, U. S. P.,
made with rhubarb, senna, coriander and fennel seeds
aided by a little paregoric and compound tincture of gentian
— the latter made with gentian, bitter orange peel and
coriander seeds — which will complete the whole, unless
one prefers to add a few drops of tincture of myrrh and
fluid extract of cubebs.
DELIRIUM CLOSELY RESEMBLING MANIA A
POTU, FOLLOWING THE FREE USE OF
MORPHINE.
By S. W. DANA, M.D.,
NBW YORK.
The patient, a youth of seventeen, of good constitution
and temperate habits, during an attack of acute perito-
nitis lasting seven days took morphine from two to nearly
six grains daily — about twenty-eight grains in all. Dur-
ing the first four days his mind remained clear and active,
though the morphine given was sufficient to reduce his
respirations to twelve per minute. There were brief
periods of sleep, not amounting to more than three or
four hours in twenty-four. During the last three days
there was much less sleep and occasional light delirium.
After the morphine was discontinued the delirium grad-
ually assumed most of the characteristic features of de^
lirium tremens and continued three days. During this
time insomnia was absolute. The patient had delusions
of hearing and sight ; heard imaginary persons calling
out to him ; described their appearance and repealed
their words; often fixed his eyes upon and clutched at
imaginary objects in the air ; was in constant movement
and made frequent attempts to get out of bed ; had im-
portant matters to attend to, and felt injured in being
restrained. The pupils of his eyes were rather wildly
dilated.
Meanwhile the general condition of the patient was
otherwise good. His pulse and temperature were nor-
mal. He took a half pint of milk every three hours, and
had a perfectly natural action of the bowels every day.
Abdominal tension and tympanitis were rapidly disap-
pearing, and convalescence from the peritonitis was pro-
gressing favorably. Under these circumstances I re-
frained from medication, confidently expecting that
natural sleep would soon supervene. When, however,
the delirium had continued three days with no indication
of abatement, I prescribed, with the view of procuring
sleep, the following potion :
J 9. Potass, bromid 3 ss.
Chloral hydrat. grs. xv.
Morph. sulphat gr. |
Aqua q. 8. M.
Twenty minutes after taking this dose the patient fell
into a quiet sleep, which continued sixteen hours, save
momentary interruptions every three hours, when nour-
ishment was given. At the end of his sixteen-hour nap
the patient awoke cheerful and sane. His subsequent
convalescence was rapid, and there was no further de-
lirium.
Two symptoms usually met with in delirium tremens
were not present in this case, namely, anorexia and
muscular tremor.
Tetanus following Heaton's Method for the
Cure of Hernia.— The editor of the Peoria Medical
Monthly states that two patients who were recently
operated upon by the Heatonian method died a few days
afterward from tetanus. A third patient suffered severely
from an extensive phlegmonous inflammation of the whole
lower limb.
THE INHALATION OF SULPHURIC ETHER
WITH A DESCRIPTION OF AN AUTOMATIC-
SUPPLYING INHALER.
By FRANZ HEUEL, Jr., M.D.,
SURGBON TO THB OTY HOSPITALS ON RANDALL'S ISLAND, PROSKCTOR TO THR
CHAIR OP SURGKRY AND INSTRUCTOR IN OPBRATIVR SUKGRRY IN THS MXDICAL
DBPARTMRNT OP THR UNIVERSITY OP THB CITY OP NSW YORK.
The administration of anaesthetic vapors in graduated
quantities and controllable by the operator has, for years,
been a matter of investigation and study by the medical
profession. Many forms of apparatus have been devised
to accomplish this end, but the majority, while promis-
ing much in theory, fail, in practice, to answer all of the
requirements which an instrument of this class should
possess. Among the principal objections to these differ-
ent forms of apparatus may be enumerated that of the
unsatisfactory distribution of the anaesthetic fluid, giving
rise to disagreeable and, sometimes, disastrous accidents ;
and the imperfect working of valves, obstructing free res-
piration and thereby rather asphyxiating than anaesthe-
tizing the patient. Another objection is the difficulty
which attends their thorough cleansing, a matter of some
weight in these days of asepsis. Aside from which, if
there is anything that will disgust a patient at the com-
mencement of the administration of ether, it is an appa-
ratus impregnated with the odor of vomited or expecto-
rated matters. Finally, the intricacy of their construction
often renders their management difficult, increases their
expense, and, in a great many instances, adds to their
bulk and difficulty of transportation.
For ordinary use nothing to date has been found bet-
ter than the simple napkin or towel folded in the form of
a cylinder or cone and having incorporated between its
folds a piece of paper to give it the requisite amount of
stiffifiess, thereby preventing the inhaler, when saturated
with ether, from collapsing upon the face of the patient
and excluding all air. Gross ignorance or criminal care-
lessness on the part of the administrator during inhala-
tion may produce death by asphyxia, owing to the use of
an ill-adjusted apparatus or the crowding upon the face
of towels saturated with ether so that the patient is de-
prived of all air. Such accidents, however, must be
exceedingly rare. As a fresh napkin or towel should
always be used for each case, the cone will always be
in a cleanly condition. This is more than can be said
of a good many face-pieces where inhalers are employed.
The too frequent removal from the face of the cone, for
the purpose of replenishing the anaesthetic, may be
avoided by placing a sponge, handkerchief^ or piece of
lint in the top of the cone to be saturated with ether.
When additional ether is necessary it should be poured
into the inverted cone as quickly as possible, since a few
inhalations of pure air will neutralize, to a considerable
extent, the anaesthetic effect already obtained. As has
been aptly remarked by Dr. J. B. Roberts,^ ether, in
order to be properly administered, should be given in
large quantities and with little air, while chloroform
should be given in small quantities and with much air,
otherwise the stage of excitement will not be overcome
without considerable trouble and loss of valuable time ;
in fact, might lead the administrator to think the patient
could not be fully etherized. A widely prevalent idea is
that ether should be given with much air. In speaking of
this as the ''Ether Folly ;' Dr. J. B. Roberts says it "is
almost universal. Often have I heard physicians say of
a patient, ' He couldn't be etherized ; I had to give him
chloroform.' Now, the fault was not with the patient,
but with the doctor. I doubt there being an individual
or an animal in the world that cannot be anaesthetized
with ether properly administered. ... I do not
advocate giving ether carelessly, but I assert that it is
usually given inefficiently. More danger is to be found
in this long-continued inefficient etherization than in the
prompt method I describe."
> Philadelphia Polyclinic, February 15, 1884.
July 19. ig^4-3
THE MEDICAL RECORD.
65
1%e amount of vapor inhaled can be easily regulated
]« removing the cone a short distance from the patient's
^e and allowing him an admixture of atmospheric air
fphea necessary, looking to its physiological effects rather
t^ga any arbitrary rules relative to. an admixture with
atiBOspheric air. Too great concentration of vapor need
inrdij be guarded against, as experience has taught us
the comparative safety of inhalation of sulphuric ether.
A simple napkin or towel, therefore, will answer the pur-
pose, and either is as safe as any inhaler can be, although
I)Oth have their objections, diief among which is the
^e waste of ether consequent upon their use, especially
in a warm room, as only a small quantity of the vapor
^en off can ever be inhaled ; the larger part escapes
^ the side of the cone, enters the apartment, and inter-
ieres with the oomfort of the surgeon and his assistants.
Hence, in constructing an apparatus for ether inhala-
tion, the objects to be attained are, first, that it be more
cofivenient, durable, and economical, though just as
ample, easily managed, safe, and cleanly as the towel
cone; second, that it present no possible difficulty to
(ree respiration either by the inadequate diameter of its
res|niatory passages, or by inhaling or exhaling valves,
rhich are apt to get out of order ; third, that it be self-
sappljiBg, with tihe anaesthetic under perfect control,
thereby avoiding the. necessity of removing the instru-
ment from the face to replenish with ether ; fourth, that
it present the air as nearly as possible saturated with
ether, at die same time preventing its general diffusion
outside of the body without impeding the patient's res-
jiratioD; and, lastly, that it be inexpensive, and not
bulky or cumbersome.
To attain these desiderata I have devised an inhaler,
coostmcted for me by Messrs. Tiemann & Co., of this
etf, which overcomes in a satisfactory manner all of
&e difficulties enumerated above. I have used it in
lospita] and private practice for the last nine months,
ad have found that it practically fulfils the theoretical
nqmrements of a perfect inhaler.
It is constructed of thin nickel-plated brass, with a
tliber £u:e-piece, ^d is, when closed for transportation,
i cylinder six inches long by three inches in diameter,
io^ of convenient size to carry in the pocket, andcon-
Ms» as shown in the accompanying woodcut, Fi^. i, of
iiee parts, viz. : An ether reservoir, a ; a. respiratory
Aunber, ^ / and a face-piece, ^, one placed below the
Ifcei.
Ihe ether reservoir is cylindrical in shape, holding
Asftt twelve fluid ounces.. It has at the top, near the
aide, an opening, </, closed by a screw-cap and rubber
washer for filling the reservoir. The screw-cap has
drilled through its side, below the washer, a small open-
ing, so that when unscrewed, before using the apparatus,
by a few turns it will permit air to enter the ether reser-
voir to supply the vacuum left by the exit of ether
through the stop-cock at the bottom.
At the bottom of the ether reservoir, near the side, is
an opening closed by a metal stop cock, e, continuous
with which, and in a plane parallel to and one half-inch
below the bottom, is a spiral coil, /, of small copper tubing,
having perforations about one inch apart on the top or
side nearest the reservoir. This pipe runs from the
stop-cock on the side straight to the centre, and then
spirally toward the periphery. To steady it, it is soldered
at its outer margins to a ring, ^, projecting from the bot-
tom of the reservoir. The stop-cock has attached to it
an index hand and chequered button, ^, which moves
on the outside of the reservoir, and indicates when par-
allel to the long axis of the reservoir that it is closed, J /
when moved away from this axis toward ^, that it is
being opened. The ring ^, projecting from the bottom
of the reservoir, fits, by an accurate bayonet joint, into
the top of the next cylinder, d, which is the respiratory
chamber. Both the ring g^ and the top of the respira-
tory chamber are pierced with corresponding holes five-
sixteenths of an inch in diameter and about three-eighths
of an inch apart. These I will designate as the respira-
tory openings. The bottom of the respiratory chamber
is slightly turned in, forming a shoulder upon which is
fitted a disk of wire ^auze, li, to retain the evaporating
medium and protect it from expectorated and vomited
matter. Around the outside of the respiratory chamber,
and one-half inch from the bottom, is soldered a piece of
brass wire, /, to act as a shoulder to the top of the rub-
ber face-piece, r, which fits over the bottom of the res-
piratory cylinder. Within the respiratory chamber and
upon the wire gauze is packed washed sheep's wool,
" which I have found the best medium of evaporation for
the ether, which drops upon it from the spiral coil above.
Now it will be seen why the perforations in the copper
coil are placed in the upper side, as the ether, when the
inhaler is placed in the vertical position for use, must
first fill the entire coil before it can escape from the
openings, thereby ensuring an equal distribution of the
anaesthetic fluid For the same reason the coil is first
run straight from the stop-cock to the centre of the ether
reservoir, and then spirally to its periphery, as the in-
haler, when in use, cannot always be kept in a strictly
vertical position.
The face-piece, ^, is made of soft vulcanized rubber,
shaped like a truncated cone, with notches for the chin,
»i, and nose, n, to more accurately fit it to the face.
Being made of soft rubber, it adapts itself equally well to
a round, thin, large, or small face, a prominent or a flat
nose. It will answer as well for a child as for an adult.
In the former the chin must be placed within the face-
piece, the rubber then covering the nostrils, mouth, and
entire chin. In the latter a notch, m, in the rubber fits
on the \:hin. At the top, and within the face-piece, a
metal ring, /, is baked on, which firmly fits over the
bottom, ^, of the respiratory chamber.
In the use of the inhaler, as with any other appliance
for the administration of anesthetics, the following points
should be observed :
The patient is first prepared by loosening the clothing
about the neck and waist, so that there shall be no ob-
struction to respiration or circulation. The part to be
operated upon is then made freely accessible. Should
the patient have any artificial teeth they must be removed,
in order to guard against their entering the respiratory
passages or being swallowed. The assistant having
charge of the etherization should place the patient supme
upon the operating table or bed, with the head slightly
raised upon a pillow, and should stand at the head o
the bed. He should have within easy reach his inhalei
^ \
66
THE MEDICAL BLECORD.
[J% I9i 18844
and a dressing forceps, with which to draw out the tongue
should it fall back and cause closure of the glottis ; or, if
necessary, to remove pieces of egested matter. He
should also be provided with a hypodermic syringe charged
with brandy, whiskey, or diluted aqua ammonia, to use in
case the pulse becomes feeble. A basin and towels will
be necessary, in case the patient should vomit or expec-
torate. The assistant administering the ether should pay
strict attention to the duties incumbent upon him, to the
exclusion of even momentarily transferring his thoughts
to the operation, or what may be going on in or about
the room.
Everything being in readiness the inhaler, with the
stop-cock still closed, is placed vertically over the pa-
tient's mouth and nose. It should be supported in this
position by placing one hand on either side of the pa-
tient's face so that in case of necessity the movements
of the head may be restrained Occupying this position
the administrator can easily determine the condition of
the pulse from an examination of the carotid, facial, or
temporal arteries. In a few encouraging words the pa^
tient is directed to "blow out" (exhale) forcibly, regu-
larly, and to continue to do so as long as he can
remember. The rubber fitting the face very closely the
patient will necessarily be compelled to breathe through
the sheep's wool and openings in the respiratory cham-
ber, but neither of these impede in the least free and
natural respiration. Hence the feeling of apprehension
and sense of suffocation which usually disturbs him at this
time when any of the ordinary inhalers are used is, to a
large extent, avoided. I direct the patient to **blow
out " because I have found this a much better plan with
the average person than to request him to inspire deeply,
as it is more easily comprehended and he will be obliged
to take a deep inspiration as a necessary result of a long
exhalation, thereby getting more of the anaesthetic and
sooner coming under its elects.
After the patient has made a few respirations in this
manner the stop-cock of the ether reservoir is turned on
by the thumb of either hand supporting the inhaler on
the face, permitting only a few drops of ether to flow in
to the absorbent material in the respiratory chamber, so
as to gradually accustom the larynx to it. In this man-
ner, and at short intervals, more ether should be added
until the full anaesthetic effect is obtained. Having
reached this point it will be found that a much smaller
quantity will answer to maintain its effect than usual.
After being applied, the apparatus should not again be
removed from the face, unless an urgent necessity de-
mands it ; otherwise the patient, by breathing pure air,
would neutralize to a certain extent the effect of the
ether already given, and thereby necessarily prolong its
administration.
Care should be taken not to oversaturate the material
in the respiratory chamber, lest the ether might flow over
the patient's face. By the exercise of a little caution
this can easily be avoided.
Sometimes, during semi-consciousness, when a patient
forgets or refuses to exhale regularly, the respirations
may be stimulated by asking him questions, asking him
to count from one to fifty, or to say his ABC. Again,
if the administrator will endeavor to guide the person's
thoughts into agreeable channels, from the commence-
ment of the etherization, by conversing with him on
pleasant and familiar subjects, it will often have the effect
of inducing pleasant dreams for the patient throughout
the employment of the anaesthetic. By these means the
patient often passes under the effects without a struggle
or beine in the least alarmed.
Should it become necessary, after anaesthesia is induced,
to turn the patient on his side, the ether reservoir may
be taken off and the respiratory chamber with attached
face-piece only used, in which case small quantities of
ether are dropped as needed from the supply opening, d,
of the ether reservoir upon the absorbent material in the
respiratory chamber. To prevent a too free diffusion of
the vapor about the room the supporting hand may be
placed over the respiratory chamber.
After using the inhaler, the face-piece should be re-
moved and thoroughly cleaned by placing it in water; the
sheep's wool, if desired, can be washed to free it from
the products of respiration and then dried to be used
again ; but it is better to throw it away, as it is very cheap,
and use new, fresh wool for each case.<||
The apparatus can now be put together for trans-
portation, by reversing the face-piece (see Fig. 2) over
the respiratory chamber and placing over the bottom the
metal cap, r, which accompanies the apparatus.
From time to time it is well to put a drop of oil on the
stop-cock of the reservoir, as the ether dissolves out the
oil and makes the stop-cock turn with difficulty.
"^vagvess of ptjedical Siciencz.
Simulation of Unilateral Amaurosis. — ^To discover
simulation of one-sided blindness. Dr. Bravais recom-
mends the method of Snellen. This latter rests on the
fact that if one writes with a red pencil on paper, the
letters written cannot be recognized if seen through red
glass. If one holds before the apparently healthy eye a
red glass, and before the pretended blind eye any kind of
glass, or none at all, and requests the simulator to read
the red letters on the paper (which have not been before
shown to him), and he can read them, the evidence of his
simulating is clear ; for if the second eye had really been
blind, he would not have been able to recognize the red
letters through the red glass. — Medical and Surgical Rt'
porter^ May 31, 1884,
Vinegar in Post-Partum Hemorrhage. — Dr. Grigg
relates in the British Medical Journal the case of a
" flooder " in whom a profiise hemorrhage was almost in-
stantaneously arrested by the administration of vinegar.
The uterus, which was flaccid and gradually dilating, con-
tracted at once after the patient had been given a wine-
glassful of vinegar, and after the second dose of the acid
the hemorrhage ceased entirely. He states that the
pupil midwives are accustomed to give this remedy in
preference to ergot, as its action is more rapid and cer-
tain. So rapid, indeed, he asserts, is its action, that he
counsels against its use until after the expulsion of the
placenta, for fear of causing a retention of that body.
The Treatment or Phthisis by Overfeeding.-^
Drs. Broca and Wins believe with Debove that anorexia
is one of the chief causes of exhaustion in phthisis, and
that a systematic overfeeding of consumptive patients
by means of the stomach-tube exercises a most bene-
ficial influence on the disease itself. Nitrogenous food is
thebest, especially milk, eggs, and meat-powder. The
quantity introduced into the stomach at a time must
never exceed one litre. In most cases the food was well
digested, the perspiration, cough, and dyspnoea dimin-
ished, and the patient increased in weight. In several
cases the signs of excavation in the lungs became less
distinct, though they never disappeared entirely. — I^
France MhdicaU.
Contraindications in the Use of Quinine. — Dr.
Rabuteau has observed several cases in which nausea,
vomiting, and pain in the stomach were caused by the
administration of iodide of potassium and sulphate of
quinine in combination. He cautions against the simul-
taneous administration of these drugs, and believes that
the unpleasant symptoms were due to the setting free of
pure iodide. He further asserts that quinine is con-
traindicated in women during menstruation. He cites
instances in which women, who at other times showed
no idiosyncrasy in this respect, were imable to take
quinine while menstruating, because of the intense hypo-
gastric pain which invariably followed. — Allgemetne
Medicinische Ceniral'2^eitung^ May 17, 1884.
July 19, 1884.]
THE MEDICAL RECORD.
67
Herkpitary Ataxia. — Dr. Lucas Championni^re de-
scHbes this afifection, also called Friedreich's disease,
wiu'cb partakes of the characteristics of both multiple
spinal sclerosis and progressive locomotor ataxia. It
makes its appearance in childhood or in youth, thus dif-
fering from ataxia proper, which occurs during the second
period of life. Like both the diseases which it resembles,
Friedreich's disease usually occurs in individuals who are
affected with some form of nervous disease, as hysteria,
epOepsy, general paralysis, etc. Its peculiar feature is
that it may attack several children in the same fieunily.
As yet it has been observed only a few times, Friedreich
himself having seen but nine cases, in three fiunilies. An
English writer has seen five children, in a family of nine,
who suffered with it Its course is regularly progressive
to a fatal issue, again resembling ataxia proper. As to
the lightning-pains, and habitual anaesthesia or hyperaes-
diesia in spots which occur in locomotor ataxia, these are
wanting in hereditary ataxia ; but there are present motor
inco-ordination to an exaggerated degree, and impaired
or abolished reflexes. Like multiple spinal sclerosis, this
disease exhibits nystagmus, paralysis as to associated
ocular movements, and disturbances of speech, while
paralytic myosis and blindness are absent. There is also
an absence of the bladder troubles, which are so fre-
qoently seen in locomotor ataxia, as well as of the gastric
and laryngeal crises, and trophic disturbances. It will
duis be seen that this disease resembles true ataxia in re-
spect to the spinal symptoms, while it presents charac-
teristics which prevent mistaking it for multiple spinal
sclerosis. The anatomical lesion is located in the pos-
terior columns and lateral fasciculi, which explains the
clinical resemblance to both of the diseases with which
hereditary ataxia has been compared. — Archives of Pe-
£airuSf May 15^ 1884.
Multiple Spinal Arthropathies. — Dr. J. Boyer re*
ports in Lyon M^ical of June i, 1884, the case of an
ataxic, forty-five years of age, in whom the trophic dis-
turbances were an early symptom and occurred several
jears before inco-ordination of movement was marked.
The joint troubles were manifested first by a spontaneous
loxation of the hip, then the knees became swollen, and
inally both feet became also swollen. The tumefaction
of the feet was at first oedematous, and later became of a
kffd osseous consistency, most marked on the dorsal
surface. The lesions in the feet were found after death
to consist in an cedematous infiltration of the soft parts
of the tarsal and metatarsal regions, marked hypertrophy
of the head of the astragalus, of the os calcis, and of the
scaphoid bone. At the tarso-metatarsal joint there was
a complete union of the cuboid and three cuneiform with
tbe metatarsal bones, with hypertrophy, softening, fria^
bOity, and spongy degeneration of the anchylosed articular
saifaces. Artlu-opathies of the feet in locomotor ataxia
are of comparatively rare occurrence, yet, as has been
^wn by Boyer, Page, Charcot, and F^r6, are not so in-
frequent as was formerly supposed.
The Diagnostic Value of Certain Symptoms in
THE Diseases of Children. — Professor S. M. Politzer
formulates the following concerning the significance of
indiridual symptoms in children's diseases {Deutsche
Mdicinal-Zeitung, May 19, 1884) : i. The sjrmptom of
a strongly-marked nasal tone in crying points to the
probable existence of a retropharyngeal abscess. 2. A
Inid and very long-continued expiratory sound, with
nnnal mspiration and the absence of dyspnoea, is signifi-
cant of chorea major. Sometimes this sound resembles
(be bellowing of an animal, and may continue for a long
time as the only symptom of chorea. 3. A thoracic,
i^^g inspiration indicates cardiac weakness. This is
ooe of the hrst symptoms, appearing before cyanosis or
pllor of the face, thready pulse, coldness of the extrem-
ftes, or the other well-recognized signs of weak heart.
4- A marked diaphragmatic expiration, accompanied with
a fine, high-pitched whistling, points to bronchial asthma.
5. A marked interval between the end of expiration and
the beginning of inspiration renders the diagnosis of
catarrhal Iar3mgiti8 without exudation probable. 6.
There is no special significance in the loud, sort of bleat*
ing, expiratory sound sometimes observed in infants dur-
ing the first months of life. It seems to depend upon a
modified innervation within physiological limits, and re-
sembles the want of rhythm in the cardiac movements
occasionally met with in the early years of childhood.
The following symptoms are given by the author as of
value in the early diagnosis of cerebral diseases : i. A
peculiar drowsiness, continuing for several da^s, unac-
companied by fever or other disturbance, is indicative of
basilar meningitis. This is a more valuable sign than
headache, vomiting, or a slow, irregular pulse, since the
latter may occur in various extracranial diseases. 2. A
tense, elevated anterior fontanelle points to intracranial
effusion. If it be very prominent, resistant to pressure,
and without a sign of pulsation, there is almost certainly
an intermeningeal hemorrhage. A deeply-sunken fon-
tanelle indicates inanition and a diminished volume of
blood. 3. Very slow movements of the eyes, followed by
fixity in one position, a vacant stare, and a peculiar lazy
closing of the lids are signs of a beginning basilar menin-
gitis. The character of the cry is of value sometimes in
the diagnosis, i. A fit of shrill crying, lasting for two or
three minutes, accompanied by an expression of fear in
the face, and-coming on regulariy an hour or an hour and
a half after the child has gone to sleep, is the expression
of night-terrors. Quinine, given in rather large dose
one or two hours before bed-time, is an effectual remedy
against this trouble. 2. Periodical crying-spells, of five
or ten minutes' duration, commg on sometimes during
the day but more frequently only at night, point to
cramps in the bladder, provided that we can exclude in-
testinal or gastric colic. This is speedily cured by emul-
sion of lycopodium with or without belladonna. 3. Cry-
ing while at stool and an evident dread of the act of
defecation are signs pointing to fissure of the anus. 4.
Hard, continuous crying, expressive of severe pain, to-
gether with firequent putting of the hands to the head
or rolling of the head in the pillow, are evidences of
otitis media or pain in the ear from some other cause.
5. When for days and weeks the child cries on being
moved, and when there is also profiise sweating and an
elevated temperature, the disease is rickets. 6. Fre-
quent crying, with habitual sleeplessness during the
first two years of life, are found in anaemic and poorly-
nourished children, or in those with congenital syphilb.
Finally, Professor Politzer recounts some other single
symptoms which aid in forming a speedy diagnosis, i.
The peculiar physiognomy of children suffering from
congenital syphilis. The sinking in of the root of the
nose, the sallow complexion, the scanty eyelashes, the
yellowish edges of the eyelids, and the rhagades on the
underlip are characteristic of hereditary syphilis. 2. . A
falling together of the alae nasi, and an absence of all
motion in them during inspiration, point to hypertrophy
of the tonsils. 3. A weakness and loss of motion out of
all proportion to the gravity or duration of the accom-
panying illness should raise a suspicion of infantile pa^
ralysis. 4. A partial loss of hearing after a sickness is
often due to a circumscribed meningitis at the base of
the fourth ventricle. 5. Depression of the mental fac-
ulties occurring after a severe infectious disease is fre-
quently indicative of a beginning acquired idiocy.
Strychnine exerts a favorable influence in these cases.
6. Retarded ossification of the skull may imply rachitis.
7. A stiff carriage of children in walking, standing, sit-
ting down, or stooping, is observed in commencing Pott's
disease. In children who do not walk there is a painful
contraction of the features when they are lifted up or set
down. 8. Constant vomiting of all ingesta, lasting for
several weeks, in children with large heads but closed
fontanelles, is a sign that an acute hydrocephalus is en-
grafted upon the chronic condition.
68
THE MEDICAL RECORD.
[July 19, 1884.
The Morbid Anatomy of Malarial Fever. — ^Vino-
gradoff, of St. Petersburg, has published an elaborate
paper on this subject, based on his extensive experience
in Bulgaria during the Russian-Turkish war, 1877-78.
Some of the main results of his investigations are as
follows: Like other infectious diseases, malarial fever
manifests itself in a series of lesions of internal organs.
The most generally spread lesions is parenchymatous in-
flammation, which affects chiefly the liver, spleen, heart,
and kidneys, but occurs also, though less constantly and
in a less considerable degree, in the lymphatic glands,
nerve-centres, gastro-intestinal and sudoriferous glands,
testes, and striated muscles. The parenchymatous
changes consist mainly in opaque swelling o( cellular
elements, with their subsequent hyperplasia, or atrophy,
or degeneration. In the liver the most frequent issue of
a parenchymatous inflammation is local limited atrophy
(though in some cases there occurs a diffuse hyperplasia
of the parenchyma, as Kelsch and Kl^ner's observations
show). The malarial parenchymatous inflammation of
the kidneys, in a certain proportion of cases, shows a ten-
dency to take a progressive development and to pass into
an ordinary form of Bright' s disease. The parenchyma-
tous alterations in the heart consist in slight opacity and
swelling, as well as in atrophy and brown pigmentation
of muscle-cells. The parenchymatous changes in the
spleen are almost exclusively limited to the lymphoid
elements of the pulp. The malarial interstitial inflam-
matory process is spread less extensively than the former,
and affects mainly the liver, spleen, and kidneys. The
interstitial inflammation of the liver is characterized by
the development of older fibrous tissue and young gran-
ulation-structure. The formation of the new interstitial
tissue is not spread uniformly all over the organ, but is
limited to certain regions, being localized mostly in the
neighborhood of branches of the portal vein and between
the lobules. In the spleen, the development of new in-
terstitial tissue proceeds along the veins of the stroma ;
Ihe capsule, also, being not unfrequently found thick-
ened In the kidneys the development of the intersti-
tial tissue is observed both in the cortical and in the me-
dullary substances, and, as in other organs, is of a diffuse
character. The interstitial changes occur also in the
deep muscular layers of the heart, in the testes, and in the
lymphatic glands, especially in those situated within the
abdominal cavity. The distribution of melanotic pig-
ment over the organs is connected with lesions of blood-
vessels. The vascular changes consist at first in swell-
ing of the epithelioid lining of the capillaries, which may
be so considerable as to lead to complete obliteration of
the lumen of the vessel. Red blood-corpuscles become
impacted between the enlarged epithelioid cells, and are
gradually transformed into fine granules of yellowish and
light-brown coloring matter. The latter is taken up by
leucocytes and epithelioid tissue. The epithelioid cells
undergo either proliferation, or fine granular disintegra-
tion, leaving then heaps of pigment-granules in the shape
of scales, described by Frerichs and others. Fatty de-
generation of the epithelioid lining of the capillaries of
the brain is, according to the author, a most constant
phenomenon in malaria, and is especially pronounced in
the sites of extravasations. Pigment-masses are accu-
mulated mainly in the spleen ; and here again chiefly in
the pulp, interstitial tissue, and vessels. The cells of the
reticulum undergo partly proliferation with subsequent
transformation into fibrous products, partly regressive
modifications (albuminous and fatty degeneration). In
the period of swelling many of these cells, as well as
large lymphoid elements, absorb blood-corpuscles, which
are slowly disintegrated and disappear, leaving light and
dark-brownish pigment. In the bone-marrow, pigment
is mostly found in the stellated cells of the reticulum.
The pigment-masses accumulated in the liver are not
formed on the spot, but arrive from the spleen through
the vena portse. Two main sources supplying pigment
in melanaemia are the spleen and the bone-marrow. Ac-
cording; to the author, this fact is proved by the occur-
rence m them of striking phenomena of disintegration of
blood-corpuscles, by a considerable accumulation in
them of coloring matter, and by their anatomical ar-
rangements allowing pigment to easily enter into the
circulation. Another source of pigment-formation is
given in the migration, with subsequent disintegration, of
red blood-corpuscles, observed in the brain. When dis-
integrating, some of the blood-corpuscles coalesce and
form hyaline or diaphanous bodies or scales, identical
with those found by Popoff in the brain of uraemic men
and of uraemic and cholaemic dogs. Beside the liver,
spleen, bone-marrow, and brain, the author observed
deposition of coloring matter in the capillaries of the
testes, gastro-intestinal mucous membrane, and papillary
layer of the skin : in the lung it was seen in the intersti-
tial tissue and epithelium of the alveoli ; in the lymphatic
glands it was present chiefly within leucocytes. As to
the pigment itself found in malaria, it does not difier in
any way firom that derived from red blood-corpuscles in
other diseases. — London Medical Record^ June 16, 1884.
Jequiritv in Persian Practice. — A Persian physician
stated to Dr. Polak that jequirity was in frequent use by
the oculists in his country in the treatment of pannus,
corneal opacities, and pterygium. For the ensuing in-
flammation, usually lasting three days, they used local
applications of milk, decoction of althaea, and mucilage
of plantago psyllium (fleawort). If necessary, the treat-
ment is repeated in fifteen or sixteen days, but never
more than four times in succession. — Ceniralblatt fur
Praktische AugenheilkundCy May, 1884.
Resection of Muscles in Infantile Paralysis.—
Mr. Keetley has recently undertaken the resection of
part of the quadriceps extensor femoris in a case of in-
fantile paralysis causing inability to extend the right
knee. By shortening the weak, relaxed, and partly
atrophied muscle, the operator hoped to increase its
strength, with the aid of electricity during recovery firom
the operation. Mr. Willett has already resected the
tendo-Achillis in paralytic talipes calcaneus, with good
results, finding that the shortening of the abnormally
elongated tendon enables the muscles of the calf to
regain some portion of their lost functions, especially
when the muscular wasting has been chiefly due to dis-
ease, and has not advanced too far. Mr. Keetley's
patient was a boy aged six, who had suffered from pa-
ralysis of the right lower extremity for four years, and
the muscular atrophy was not complete, yet sufficient to
prevent thorough extension of the knee. A longitudinal
incision was made in front of the thigh, about three
inches in length, ending an inch above the patella ; the
skin was held apart by retractors, and one inch of the
entire substance of the quadriceps was cut away with
scissors, about two inches above the patella. The
separated ends were united by means of about one
dozen carbolized catgut-ligatures. Esmarch's bandage
had been applied before operation, and only one small
artery required ligature. The wound was dressed with
a small iodoform-pad and carbolic gauze, and the limb
placed on a back-splint at an angle of sixty degrees with
the bed. The wound healed rapidly and perfectly, but
as the operation was performed on May 5th, it is as yet
too soon to determine the results as regards the function
of the limb. — British Medical Journal^ May 31, 1884.
Treatment of Furuncle. — ^The following treatment
of furuncles is highly recommended in the Revue Mkdi
cale of June 7, 1884. The boil itself and the inflamed
zone surrounding it are covered with a soft paste of hone]
and powdered arnica flowers, spread upon linen. Thi
application is renewed every two hours until the pain an<
soreness have entirely disappeared, which they do by th<
second or third day at the latest. If the application i
made in the initial stage, the boil is aborted within twenty
four hours.
July 19, 1884.]
THE MEDICAL RECORD.
69
False Pregnancy. — Dr. Delgado reports the follow-
ii}g rather remarkable case, of spurious pregnancy : A
woman, aged thirty, married, separated accidentally
from her husband for several months, presented herself
in the hospital at Valladolid for advice, saying that she
«as pregnant and out of her reckoning. The greater
part of the signs of pregnancy existed — suppression of
the menses for about nine months, gradual enlargement
of the abdomen to full-term size, increase of the breasts
with pigmentation of the nipples, vomiting at the begin-
ning and end of the pregnancy. She said she felt the
movement of the child. On examination, ballottement,
movements of the foetus, and foetal heart-sounds were
absent After four days in the hospital, labor-pains be-
pn, temiinating by the expulsion of a great quantity of
blood in dark clots and liquid by the vagina. At the
same time there was violent haematemesis, which had to
be controlled with ice and perchloride of iron. Three
/ears later, when she had again been living with her hus-
band for eleven months, the same series of phenomena
occurred ; the haematemesis, however, being less intense.
On the most careful examination, no trace of mole, or of
remains of placenta or foetal membranes, could be dis-
covered.
An Instance of Nervous iMPRESsroNABiLiTv. — Dr.
filfiaerts relates a curious case of a boy, thirteen years
of age, who resembled Samson in that the cutting of his
hair exerted an extraordinary influence upon him. At
the first dip of the scissors he would begin to tremble,
then he would suffer from ringing in the ears, vertigo,
and dimness of vision. Then the pulse would become
thready, and soon a state of complete syncope would
come on. This would last for five or six minutes, and
would then be succeeded by vomiting. The child was in
apparent good health, but never had convulsions, and
came firom a family free from epilepsy. The treatment
consisted in first accustoming the boy to handle the scis-
sors himself and to snap the blades together. Then for
a time one hair was cut each day, then a lock, and so on,
nti] finally the peculiar impressionability was entirely
overcome.— Z^ Progrh MUiccd, June 21, 1884.
Some Points Concerning the Phvsio-pathologv of
THE Blood-vessels. — ^According to Ferraro {London
Medical Record) the blood of tabetic patients under
BHcroscopic examination presents nothing characteristic
to distinguish it from that of a healthy individual. The
spmitaneous coagulation takes place normally. In dia-
betics, the blood may coagulate in any point of the cir-
culatory system, and give rise to the formation of
tlirombi causing more or less obstruction, wherever the
emditions favorable to its spontaneous coa^lation are
{nmd. The blood of rabbits surcharged artificiallv with
^cose coagulates, but more slowly. When the mtima
flfa large artery (the carotid) of a dog is destroyed either
bjr mechanical or chemical means, or by a very high
temperature, if the vasa vasorum be not injured at the
ome time, the blood circulating in the artery does not
coagulate. On the other hand, there is thrombotic oc-
dusion of the artery whenever the middle coat is injured
s veil as the intima, and especially if, besides the
^ na, the vasa vasorum have been destroyed. This ex-
peimental lesion of the intuna of the carotid of the dog
Bsimilar to that which diabetes mellitns produces in man,
iiwhonithe intima of the arteries is often lost from des-
fUDation of its cells, endoartcritis diabetica desquanui-
^ In both cases the circulating blood does not
^oagolate in the arteries despoiled of their intima, if the
«st of the wall of the vessel be alive and nouri^ed as
^ the normal state. Endarteritis diabetica, desquamative
^form, described by the author in the organs of five
vbedcs, finds support in these experiments, the object
J^vluch was to produce in animals hy other means a
^OQ of the intima of the arteries similar to that which
JBbetes produces in man. The results obtained agree
•Aowing the influence of a vessel-wall thus altered on
the blood circulating in the vessel. It is then possible
that from certain morbid conditions the epithelioid lining
of an artery or the whole intima may be lost, and yet for
the blood traversing this vessel not to coagulate and not
to form a thrombus, if other circumstances favoring
thrombosis do not intervene. This being possible, since
demonstrated by pathological observation in diabetes
mellitus and by experiment, it must be held that the in-
fluence of the living arterial wall on its contained blood,
by which its spontaneous coagulation is prevented, is not
due exclusively to the epithelioid layer investing the in-
ternal surface, but also to the rest of the wall of the
vessel. If the epithelial stratum be destroyed by any
morbid condition whatsoever, the rest of the wall, if
alive, may exercise the same influence on its contained
blood. In the normal condition, the intima of the arteries
receives the nutritive plasma partly from the blood cir-
culating in the interior of the vessel, by which it is con-
stantly bathed, and partly from that circulating in the
vasa vasorum of the contiguous middle coat. If the vasa
vasorum be destroyed, the neighboring intima is not al-
ways able to retain its vitality.
Cure of Hydrarthrosis by ELECTRicrrY. — ^A patient
was admitted to the service of Dr. Castano, of Buenos
Ayres, suflering from hydrarthrosis of the knee. After a
varied treatment by flying blisters, cauterization, com-
pression, etc., had been tried without success, it was de-
termined to employ the constant current from a battery
of thirty-six elements. The result was most gratifying.
By the fourth day the circumference of the articulation
had been reduced some four-fifths of an inch ; on the
seventh day no fluctuation could be perceived, and on
the ninth day the joint measured exactly the same as its
fellow. Walking was difficult at first, but was much fa-
cilitated by the application of an elastic bandage. — Revue
Midicale^ June 7, 1884.
The Formation of Urea. — MM. Gr^hant and Quin-
quand have been conducting some further investigations
as to the places of formation of urea in the economy.
They have estimated several times the amount of urea in
the blood going to, and in that coming fi-om, the spleen
and liver. The blood from the hepatic, portal, and
splenic veins always contained more urea than arterial
blood taken firom the carotid arteries. From this they
conclude that the abdominal viscera form urea. It is
also asserted that the proportion of urea is practically
the same in arterial and venous blood from the limbs and
head. Lymph and chyle collected from the thoracic duct
after section of the medulla oblongata and the employ-
ment of artificial respiration have always been found to
be richer in urea than venous or arterial blood. — The
Lancet, June 14, 1884.
The Death-rate of Phthisis. — In a work recently
published by Dr. Wiirzburg on "The Influence of Age
and Sex on the Mortality Due to Tubercular Phthisis,"
some of the generally accepted notions on this subject
are overthrown. The opinion seems to have been com-
monly entertained that the greatest number of deaths
firom consumption occurred at about the twentieth year.
But the statistics collected by Dr. Wiirzburg prove that,
after a large percentage of infancy, the minimum death-
rate is met with from three to fifteen years, and that then
the rise is a gradual and steady one up to the period be-
tween sixty and seventy years. After that age a rapid
decline is noted. These statistics are for Prussia, and
embrace a period of five years from 1875 ^^ i^79« T^©
same condition has been noted in Sweden and the United
States, with this difference, that in these countries there
is no decline after the age of seventy years. In England,
however, the highest death-rate falls between twenty and
thirty years, and the lowest between fifty and seventy
years. There is but a very slight difference in the per-
centage of deaths from tubercular phthisis between the
city and the country. — MediccU and Surgical Reporter
June 14, 1884.
JO
THE MEDICAL RECORD.
[July 19, 1884-
The Medical Record
A Weekly yournal of Medicine and Surgery.
GEORGE F. SHRADY, A.M., M.D., Editor-
Published BY
WM. WOOD & Co.. Nos. 56 and 58 Ufayette Place.
New York, July 19, Z8S4.
PERVERTED SEXUAL INSTINCT.
Sir Thomas Brown once wrote, platonically, that the
act of procreation was '' the fooiishest act a wise man
commits in all his life. Nor is there anything that will
more deject his cooled imagination.*' The physician
learns, however, that man, so far from tending toward
this ideal, is more apt to show instincts of a violently
opposite character, and finds, far down beneath the sur-
face of ordinary social life, currents of human passion
and action that would shock and sicken the mind not
accustomed to think everything pertaining to living crea-
tures worthy of study. Science has indeed discovered
that, amid the lowest forms of bestiality and sensuous-
ness exhibited by debased men, there are phenomena
which are truly pathological and which deserve the con-
siderate attention and help of the physician.
Some twenty years ago, a lawyer of Hanover wrote an
article describing a form of sexual perversion to which
he was himself subject, and defending the acts to which
his morbid instincts prompted him.
In 1869 Westphal reported two similar cases, and de-
scribed the condition as a congenital sexual perversion
(contrSire sexualempfindung) . Subsequently several other
such histories were published, and in 1877, Krafft-Ebing,
in reporting an additional case, gave a careful analysis
of the condition, classifying it among the psycho-degen-
erative states. Drs. J. C. Shaw and G. N. Ferris, in the
Journal of Nervous and Menial Diseases for April, 1883,
presented a collection of previously reported histories,
omitting, however, one which was piiblished in The Med-
ical Record. These gentlemen also related a case of
their own. Up to that time only twenty-one cases were
on record, three being reported by Americans, the rest
mainly by Germans, and none at all by English ob-
servers.
In a recent number of the Irrenfreund {yo\. xxvi., No.
I, 1884), Krafft-Ebing has reported six more cases.
One of these was that of a merchant, now living in
America, who wrote to Krafft-Ebing a letter which can
but strike the attention. The patient says : " I have
read your article in the TUitschrift fur Psychiatrie.
Through it I am, in common with thousands of others,
rehabilitated in the eyes of every thinking and generous
man, and I offer you for it my warmest thanks. You
very well know how those in our condition are despised
and execrated. Though science at this late time has
undertaken to investigate it, it still remains the object of
detestation. I think that Ulricbs [the Hanoverian lawyer
referred to] underestimates the number of its victims.
In my native city (of 13,000 inhabitants) I knew per-
sonally twelve ' Umings.' In a city of 60,000 inhabitants
I know at least eighty." The writer then goes on to re-
late his own history.
The victims of this perverted instinct have been termed
by Ulrichs and others " Umings." If their number is as
great as Krafft-Ebing's correspondent indicates, it is cer»
tainly a matter of importance. It is not improbable^
however, that some of these are rather examples of vie*
ious lust than of pathological perversions.
These so-called *' Urnings " are persons whose sexual
feelings can only be aroused by intimacy with their own
sex ; they have an irrepressible desire to act the part
of the opposite sex. If men, as is generally the case,
they try to dress, or walk like, and imitate the habits of
women. The very act of dressing in women's clothes
excites the sexual sense. They have a repugnance to
normal sexual intercourse, and have no desire for it
They attach themselves to some other man, and form
sometimes purely platonic friendships ¥rith him. More
generally they find some fellow ** Uming" with whom the
sexual passion is easily excited by mutual masturbation
or intercourse per anum. They sometimes form attach-
ments for boys * or old men. They often masturbate
while having lascivious images of the male beloved before
their imagination.
In the reported cases of congenital perversion, the ab-
normal instinct begins oftenest as early as the eighth or
ninth year, but shows itself at first, perhaps, only in an
inclination to adopt the manners and practices of girls or
women. The victims show the somatic basis of their
trouble in various ways. There is often an hereditary
psychopathic or neuropathic taint. Epilepsy is some-
times present. There are noticed in some cases, though
not often, defects of the genital organs, such as hypo-
spadias or epispadias, small or defective testicles. The
hair on the face is sometimes thin, the voice almost al-
ways soft. The "Urnings" have a mincing gait, and
sometimes the hips are broad like those of women. Ex-
acerbations of the perverted feeling appear periodically*
It may be accompanied with melancholia and end in in-
sanity or suicide.
The mental peculiarities of these unfortunates have
much in common. They are of the artistic, poetical^
and imaginative temperament, often exhibiting a ten-
dency to rather weak philosophizing. Sometimes they
are of a vigorous understanding. In most cases there is
great mental distress felt through a consciousness of their
unnatural instincts. Two or three have, like Ulrichs,
boldly defended their practices.
Medical jurists have devised a number of technical
terms to cover the practices that follow from these sexual
aberrations, which, it should be borne in mind, are still
classed in all cases as crimes. The intercourse between
woman and woman (Lesbian love) is known as tribadism.
That between man and man, or unnatural intercourse be-
tween man and woman, is known as sodomy. When the
victim is a boy it is known as paederasty.
If congenital perverted sexual instinct is a pathologi-
> *'Thou shall not corrupt boys." is one of die commandmcnu in die Teadiings-
of the Twelve Apostles.
July 19, 1884.]
THE MEDICAL RECORD.
7J
cal rather than a vicious condition, the query arises
whether there is any r^nedy for it The history of cases
reported shojnrs that sometimes the instinct is cultivated
and intensified by bad surroundings in childhood, such as,
for example, the exclusive society of women and im-
moral nurses^ Excessive sexual indulgence seems to in-
crease it, and we may question whether in a few cases
the condition would have ever developed,: were it not for
an early abuse and misdirection of the sexual powers.
In conditions of nervous exhaustion and weakness, the
symptoms are exaggerated, and Krafit-Ebing, in his last
communication, reports the case of a married man, pre-
vkmsly healthy, who experienced an entire change in the
sexual feeling, which lasted for twenty-five years. He
was then cured by general faradization and other tonic
In conclusion, we believe it to be demonstrated that
conditions once considered criminal are really patho-
logical, and come within the province of the physician.
We have undertaken, therefore, the disagreeable task
of laying some of the facts regarding sexual perver-
sion before our readers. The profession can be trusted
to sift the degrading and vicious from what is truly
moriMd.
Wc cannot do better than append the conclusions
which Krafft-Ebing has reached upon this subject He
says : •^ i. There exists a congenital absence of sexual
feeling toward the opposite sex, at times even disgust of
sexnal intercourse. 2. This defect occurs in a phy-
sically differentiated sexual type and with a normal
development of the sexual organs. 3. Absence of the
psychical qualities corresponding to the anatomical sex-
ual type, but the feelings, thoughts, and actions of a per-
verted sexual instinct 4. Abnormally early appearance
of sexual desire. 5. Painful consciousness of the per-
verted sexual desire. 6. Sexual desire toward the same
sex. 7, The sexual desire remains purely platonic or
finds gratification in mutual onanism, or in feeling of the
, object of the affections. Often there is self-pollution,
but for die want of something better. 8. There are symp-
toms of a morbid excitability of the sexual desires, to-
gether with an irritable weakness of the nervous symp-
toms, so that sensuous feelings, magnetic sensations, and
even pollutions occur in simply touching the object of
the affections. 9. The perverse sexual impulse is ab-
nonnaUy intense and rules all thought and sensation.
The love of such individuals is excessive even to ado-
ration, and is often followed by sorrow, melancholy, and
jwlonsy. 10. People afflicted with this abnormity fre-
qaendy possess an instinctive power to recognize one
another."
In diis last conclusion we cannot agree. The power
of mutual recognition ii not instinctive but acquired.
GERMAN MEDICAL JOURNALS.
Thi German-speaking race is abundantly supplied
vith medical journals of every conceivable kind, and
they reflect very well the character of the German medi-
al mind. The number of special journals is particularly
peat There are quarterlies, and monthlies, and even
weeklies devoted to gynecology, neurology, psychiatry,
etc.
The leading journals are the large weeklies : the Btr*
liner Klinische Wochmsckrift^ the Deutsche Medkinische
Wochenschrifiy the Wiener Medizinische Wochensckrifty
etc. These are not framed upon the English or Ameri-
can plan. They rarely contain any formal editorials,
and but veiy brief notes of current events. They are
filled veith ^eavy original articles, most of which are so
laboriously scientific and minutely technical that they
would appear to the American mind extremely dull.
Interspersed vwth these, however, there are not rarely
the rich original contributions to medical science which
makes Germany so famous. A characteristic of German
periodical literature is that it is almost all written by the
Professors or their assistants, or by some of the various
instructors at the universities. One hears almost noth*
ing from the general practitioner who is so prominent a
person in American journalism* There has of late, to
be sure, been something of a revolt started. Dr. Julius •
Grosser, a practising physician at Prenzlau, has dared
to start a weekly journal in the interest of his confreres,
and despite the frowns of the great men of the universi-
ties. His journal, the Deutsche Medizinal-Zeitung gives a
practical summary of progress in all departments of med-
icine, and must prove extremely useful^ A few other
journals of a somewhat similar character exist, one, the
CentraUZeitung, being published, like some of the French
journals, three tunes a week. A further evidence of the
effort which is of late being made by German journalists
to supply the practical needs of the physician is the
growth of therapeutical literature. There has recently
been established an excellent journal devoted to thera-
peutics alone, and a popular and often-quoted month-
ly journal, called Memorabilien, edited by Dr. Betz, de-
votes itself chieffy to therapeutics. The Zeitschrift fUr
Therapie is almost everything but therapeutical.
The various Archives^ in which are contained the re-
sults of laborious researches in physiology, pathology,
pharmacology, and clinical medicine, embody a mass of
literature to which there is no parallel in other coun-
tries.
A very large part of German periodical literature con-
sists of minute, carefully recorded observations, patho-
logical, physiological, and clinical. These cover not
only things which are practical but also everything hav-
ing a bearing on medicine. This habit of careful obser-
vation and detailed statement makes an article very te-
dious ; but it is the method which ensures progress in a
science like that of medicine. In order to furnish the
essentials of all these elaborately recorded studies, and
to allow a person with moderate leisure to follow the
progress in the various departments, journals devoted
simply to abstracting and condensing are published, and
have now become quite numerous. There are the va-
rious monthly and yearly Jcthrbucher and Jahresberichtey
besides three or four weeklies, which aie entirely devoted
to this kind of work. Indeed, the summaries of medical
progress are nowhere done with so much painstaking
conscientiousness as by our German confreres. They
err only in sometimes analyzing with too much care arti-
cles which are worthless. In this kind of work, the Ger-
mans can teach the profession of other nationalities. In
the technical part of journalism, or journalism proper,
they arc far behind England and America. The jour-
72
THE MEDICAL RECORD.
(July 19, 1884.
nals do not voice the opinions of the profession at large ;
they have no strong writers, and when the weekly notes
are lengthened out into the dignity of editorial it is gen-
erally to express some comment on local and personal
matters.
A CRITICISM UPON THE VALUE OF SULPHATE OF
CINCHONIDIA (CINCHONIDINE).
It is known that the sulphate of cinchonidia is very
much used as a cheap substitute, and probably as an
adulterant, of quinine. A recent contribution to the
pharmacology and therapeutics of this drug, by Professor
J. Marty, of Rennes {Bulletin Gin^ral de Th/rapeutique,
May 30, 1884), is, therefore, of much interest. Having
given it to healthy persons, and in various types of
malarial fever, he comes to the conclusion that cincho-
nidia has two serious defects : i. Its extreme variability
of action in healthy and sick men. 2. The ease with
which it may provoke toxic manifestations in doses neces-
sary to produce its therapeutic results.
Professor Marty thinks that it should be given in doses
double those of quinine, and that it is then an efficient
agent in the benign types of malarial fever. For the
pernicious types it should not be trusted. It does not
act well in the various forms of malarial headache and
neuralgia.
We believe that Professor Marty's conclusions will be
found to harmonize in the main with the practical ex-
perience of those who have used it in this country.
Cinchonidia is a very useful substitute for quinine in the
milder affections in which that drug is indicated, but
it is liable to disappoint the physician in some cases.
RECTAL ANAESTHESIA.
M. A. PoNCET publishes in the Lyons M^diccUe an in-
teresting contribution to the subject of rectal anaesthesia.
It appears that M. Roux, in 1847, first thought of and
suggested the plan of giving ether by the rectum {Compt
rendu de VAcademie des Sciences^ February i, 1847, p.
146). He did not, however, try it himself. Three
months later Dr. Vincente-y-Hedo published the results
of his experiments in injecting liquid ether into the rec-
tum of rabbits {Gazette mklicale de Farts, 1847, ?• 317).
Naturally, these experiments led to no practical results.
A little later M. Marc Dupuy injected ether and water
into the rectum of animals and produced insensibility,
but with so much injury to the mucous membrane that
the experiments were not repeated on man. In the
same year, 1847, Pirogoff, of St Petersburg, first pro-
duced anaesthesia in man by the introduction of ethereal
vapor into the itctam (Recherches pratiques et physiolo-
giguessur P etherization^ Saint-Pctersbourg, 1847). He
employed the new procedure in a number of cases, rec-
ognized its advantages, and urged its adoption. Dif-
ferent apparatuses were constructed, and the use of
ethereal vapor per anum was adopted by Simonin at
Nancy, for a year or two subsequently.
After this, it seems that the subject was dropped
-entirely for over thirty years. According to M. Poncet,
there is no'record of the employment of rectal anaesthesia
until M. MoUi^re reported his cases last spring. Since
that time, aside firom ten trials made in this country,
rectal anaesthesia has been made the subject of a com-
munication to the Soci6td de Biologie by M. Bebierre
{Journal de Midecine de Paris y April 19, 1884). M.
Delore has published an article upon the same subject
{Gazette des Hopitaux^ March 20, 1884), and M. Dubois
has recommended the use of chloroform vapor per rectum
instead of ether.
M. Poncet now comes forward with the record of five
cases in which he has himself employed rectal anaesthesia
with ether vapor ; and he sounds a note of warning s^ainst
this new procedure. In four of his cases, success was
tolerably good, but in the fifth, that of a woman thirty,
seven years of age, severe collapse took place after
insensibility had been produced, and it was with the
greatest difficulty that the patient was restored.
M. Poncet is most decidedly of the opinion that the
administration of ether per rectum is a dangerous pro-
cedure, and one not to be adopted by careful surgeons.
This is the view which is now held in New York.
PROFESSIONAL "PIDGEN" ENGLISH.
No ; not quite that bad perhaps, but some of the lucu-
brations of our writers are more remarkable for ambigu-
ity than for scientific value, and certainly far richer in bad
grammar than in sound pathology or therapeutics. We
are aware that not every practitioner has had the advan-
tage of a collegiate education ; some apparently never
graced the benches of an " old-field " school. But there
is a notable proportion of college-bred men in the profes-
sion, men who have an A.M. or an LL.D. after their
names, but who write vile English, both as regards the
wrong use of words and the wrong use — or non-use — of
grammar.
A very generally abused word in medical literature
is, perhaps, **apt." The persistency with which writers
use this word for " likely " and *' liable " is reaUy marvel-
lous. The following are a few examples of the wrong use of
words, found within a few minutes during a cursory glance
at current journals : medical doses for medicinal doses,
dilation for dilatation, ligated for ligatured, diagnosed for
diagnosticated, teaspoonsful for teaspoonfuls, ofi&cial for
officmal, analogous for similar, and entroitus for introitus.
There is very common misuse of " where " for " in
which." Some-— almost every — writer speaks of a " case
where," e.g.^ " cases are on record where post-mortem
of persons," meaning "in which the post-mortem ex-
amination," for post-mortem should never be unaccom-
panied by the examination. A writer in a current jour-
nal says : " We have two classes to treat — ^young women
and married women,'' leaving the reader to infer that all
young women are single and all married women are old.
Another has manufactured a new word— diuretico-muci-
laginous. We have an idea that he is the same who
says : " He began to pass large quantities of dissolved
stone," though he was not the author of the following :
" Dr. , of y wants treatment for cross-eyes that
came suddenly on a girl This is paralysis of the recti-
muscles of the eyeball, internal or external accordingly as
the squint is con or divergent" It has long been known
that woman rules the household, but a correspondent of
a St Louis Comic Medical Journal says : *• Menstru-
ation is evidently the chief governor of woman and her
July 19' 1884-]
THE MEDICAL RECORD.
11
^ily relations." This is important information, and
should be strictly kept from the ears of " woman's rights "
women. Another writer in the same journal has with a
stroke of the pen cured every adult dyspeptic in the coun-
try: "Dyspepsia is par excellence a disease of infancy."
We wish it were true. But there is a dangerous man some-
where whose friends especially should know about him.
He says: "I have found the following to be very bene-
ficial in the treatment of gonorrhoea, which I would like
to give to any one who wants it, hoping it will be of some
benefit to the medical fraternity." He should mend
both his morals and his grammar. But seriously, the
bad English of the profession is deplorable.
THE PROPOSED S. D. GROSS PROFESSORSHIP OF
PATHOLOGICAL ANATOMY.
We have received a circular asking us to assist in the
effort io secure, ** in some medical school,*' the endow-
ment of a memorial professorship to be designated the
S. D. Gross Professorship of Pathological Anatomy.
We will cordially support any movement looking to-
ward the commemoration of the remarkable work and
Doble character of the late Professor Gross. We but
voice the sentiments of many, however, when we ask if
some fitter memorial for the general profession to con-
tribute to could not be found than that of a professor,
ship in a private medical college. This chair naturally
should be in Jefferson Medical College, though it is not
so specified. And many, perhaps most, physicians would
prefer to contribute simply to the memory of Gross, not
at the same time to the resources of a prosperous
medical institution.
A LESSON TO BE REMEMBERED.
On the morning of Friday, September r, 1854, the chol-
era suddenly attacked a number of persons residing in
flie sub-district of Berwick, in the city of London. The
outbreak was confined to the immediate vicinity of a
veil situated on Broad Street.
This well was the centre of an infected district : "a
person starting from thence and walking at a moderate
pace would have got beyond its limits in three minutes"
(English Rivers Pollution Reports). During the month
d August preceding the outbreak, only twenty-six
cases of cholera were reported to the London authori-
ties fi-om this district (Berwick).
The epidemic reached its height on September 2d, and
declined about fifty per cent, on the 5th ; after which it
dwindled off until the 20th, this day being the first on
which no death took place. The total number of deaths
in the district from the ist up to this date was 609.
Investigation showed that about seventy-eight hours
before the great outburst of the disease a child was at-
tacked with cholera in the house No. 40 Broad Street,
and its dejections were emptied into a drain which ran
within a few feet of the well. The water from this well
was very popular with the neighborhood.
Analysis showed that it contained in 100,000 parts
137 parts total solids and 7.72 parts organic and vola-
tile noatter. It was clearly shown that nearly all the
persons attacked with the disease had drank the water
^sm this well.
In one case, an old lady and her niece, residing at a
distance, had been in the habit of having the water
sent to them daily. They both had cholera, while none
of their neighbors contracted it.
The history of this well should be engraved on the
mind of every sanitarian. The activity displayed by
health authorities in searching out and stopping the water
from city wells shows that it has not been lost on them.
The use of such water for the preparation of aerated
drinks is the more dangerous, since such beverages are
prescribed for invalids.
The history of the cholera in Manchester and Glasgow
illustrates most forcibly the importance of a pure water
supply for cities. Until 1851 the people of Manchester
and Salford obtained water partly from wells and partly
from the River Irwell. Both these sources were much
polluted with excrementitious matters.
In 185 1 a pure supply of water was introduced into
these towns. The following figures, taken from the re-
port of the Rivers Pollution Commission, show the mor-
tality during the polluted and pure-water periods :
Total mortality in Manchester and Salford, polluted-
water period: 1832, 890; 1849, 'j^'SJ pure-water
period : 1854, 50 ; 1866, 88.
The history of the disease in Glasgow affords evidence
equally conclusive. Until 1859 ^^ water supply was
drawn from the Clyde, and was polluted by the drainage
of towns higher up the river. After that year a pure supply
was obtained from Loch Katrine.
Total mortality in Glasgow, poUuted-water period :
1832, 2,842; 1849, 3»772; 1854, 3,886; pure-water
period : 1866, 68. Mortality per 10,000 of population,
polluted-water period : 1832, 140; 1849, ^^^\ i854»
119; pure-water period : 1866, 16.
These facts are not new to sanitarians who have
studied the subject, and they can be multiplied to any
extent desirable to prove the intimate connection of
cholera with water supply. We repeat, then, we are glad
to see that the health authorities in this city are so thor-
oughly alive to the necessity of inspection of wells, and
are so strenuously in favor of preventing the use of the
water from them for drinking purposes.
Cholera and the Price of Disinfectants. — ^The
alarm over cholera has caused a marked increase in the
demand for disinfectants and cholera drugs. A member
of a large drug firm in this city states that opium has
advanced twenty-five cents per pound in the past few
days. It may be questioned whether the rise in opium
comes from the scare or the shortness of the crop this
year. Sulphate of morphine is twenty cents per ounce
higher and oil of peppermint has recently advanced. The
demand for camphor is increasing, and a rise is expected.
Chloride of lime is being largely purchased, and is
twenty-five cents per hundred pounds higher. Carbolic
acid crystals have advanced from twenty-five to thirty
per cent. There is considerable buying by France in
England also.
The Chicago Medical Journal appears in a new
and much improved dress, and announces as its editors
Drs. James Nevins Hyde, W. W. Jaggard, and Harold
N. Moyer.
74
THE MEDICAL RECORD.
Duly 19, 1884
^enrs at tite WISiziU.
Death from the Bite of a Rattlesnake. — ^A snake*
charmer in this city, named James Reilly, was bitten in
the hand by a rattlesnake, and died in forty-eight hours
in consequence. Large amounts of whiskey and am-
monia were given, but without avail. An autopsy on
the body was made by Dr. W. H. Welch.
The Summer Corps of Sanitahy Inspectors went
to 4,504 houses last week, and visited 24,099 families,
finding 811 sick persons, to whom they gave prescrip-
tions or medicine, and tickets for excursions. Of the
patients, 365, nearly all of whom were children, suffered
from diarrhoea, 118 had trouble with the respiratory or-
gans^ and 70 were sick of diseases.
Lepers to be Put on Exhibition. — A unique variety
of the moral show has been devised by a Californian,
calling himself Dr. C. C. O'Donnell. He has secured
two Chinese lepers with a large portfolio of photographs
of other cases, and he proposes to travel East and
exhibit them. The show is in the interest of anti-
Chinese immigration. Dr. O'Donnell claims that there
are between two hundred and two hundred and fifty
lepers in San Francisco already, and that the disease is
increasing.
Faith-Surgery. — The following is an, interesting
specimen of advertisement that appeared recently in a
daily paper : " Faith Surgery. — My dislocated shoulder
and broken collar-bone instantly set and cured by Rev.
Dr. , Christian Healer [address is here given]. Was
able to do heavy family washing next day. Mrs. •
Doccors and ministers can interview me.''
The Congress of German Naturalists and Phy-
sicians will be held at Magdeburg, September 18 to 23,
1884. The medical and surgical work at this meeting
promises to be very considerable. Sections are organized
for all the specialties, and many prominent physicians
have already furnished the titles to the papers.
Prizes for Surgical Essays. — ^The Medico-Surgical
Society, of Bologna, has offered two prizes of 500 lires
each. First prize, Sgarze, for the best essay on The
Surgical Treatment of Pulmonary Cavities. Second
prize, Gajani, The Surgery of Diseases of the Stomach.
The essays must be written in Italian, French, or Latin.
The Progress of Cholera in Europe. — ^The epi-
demic of cholera continues to increase, as will be seen by
the accompanying figures of deaths : July 9th, Toulon, 1 1 ;
Marseilles, 23. July loth, Toulon, 11; Marseilles, 59.
July nth, Toulon, 13 ; Marseilles, 74. July 12th, Toulon,
22; Marseilles, 65. July 13th, Toulon, 35; Marseilles,
57. July 14th, Toulon, 11 ; Marseilles, 66. July 15th,
Toulon, 20 ; Marseilles, 69. Cases of cholera are said
to have occurred in the surrounding country. Two cases
have been reported also in Transylvania and one at
Nimes, France. The reported occurrence of cases in
Paris and Lyons is denied. Dr. Koch continues to
assert that the disease will spread throughout Europe,
but thinks that it may be kept from America this year at
least. The Paris Acad^mie de M6decine has been asked
to give an official opinion regarding the cholera, its mode
oif prevention, etc. This the Acadtoie seems disinclined
to do because the Government refused to take its advice
as to holding the fUte of July 14th. If the Acad6mie
treats cholera in the same discursive manner that it did
typhoid fever, it will be a year before its opinions will
be formulated. Nearly all countries have quarantined
against the French Mediterranean ports. Our own
Government will oblige vessels from Europe bound for
the United States to have certified clean bills of health
from the American consuls.
The Number of Cases of Small-pox in London
last week was 1,200. Some parts of the city are reported
to be in a very filthy condition.
Disinfecting Toulon. — " Every means of disinfection
at Toulon," says The British Medical Journal^ ** has been
adopted. The city is watered with a solution of carbolic
acid and chloride of lime. Those who have died from
cholera are buried at a great depth underground. Rail-
way travellers are sprinkled with carbolic acid solution.
The soldiery are encamped outside the town. The sick
sailors are put on board the Entreprenaule to be ex-
amined; the cholera-patients are removed to the St.
Maudrier Hospital, which is reserved for them. The
crews have been placed on vessels at anchor outside the
port. The Ministers of War and the Marine have given
orders to the authorities of arsenals to deliver to the civil
authorities all the material for camping out that they may
require. MM. Brouardel and Proust arrived on Tuesday,
June 24th, at Toulon, with a Ministerial decree to effect
whatever measures they judge necessary for the public
safety ; to ordain the evacuation of entire districts, and of
the city itself, if requisite. Dr. Rochaud left Paris for Tou-
lon on Tuesday evening, also MM. Strauss and Rout, in
order to continue their scientific researches. They are
also commissioned to make a strict inquiry into the
origin of the outbreak.**
Fifty-second Annual Meeting of the British
Medical Association. — ^This association will hold its
annual meeting at Belfast, on July 29 to August i,
1884. President, Dr. A. T. H. Waters, of Liverpool.
President-Elect, Dr. James Cuming, of Belfast. The
address in Medicine will be delivered by Dr. William M.
Ord, of London ; that in Physiology by Dr. Peter Red-
fern, of Belfast ; that in Obstetrics by Dr. Oeorge H,
Kidd, of Dublin. A number of special discussions have
been arranged. Among them we note one on Albunii*
nuria, introduced by Dr. George Johnson ; one on the
Plaster Jacket, introduced by Dr. L. H. Sayre ; one on
Extra-Uterine Foetation, introduced by Lawson Tait ;
one on a New Antipyretic, introduced by Dr. Alexander
Collie and by Dr. Dujardin-Beaumetz. There will be
the usual annual museum, and a large number of excur-
sions and entertainments have been planned.
Precautions Against Cholera. — ^The members of
the summer corps of visiting physicians and the Fruit
Inspectors, recently appointed by the Health Depart-
ment, have received supplementary instructions in regard
to their duties from Dr. E. H. Janes, the Assistant Sani-
tary Superintendent, in view of the possible advent of
cholera in this city and its vicinity. All cases of con-
tagious disease discovered, whether the patients are
July 19, 1884.]
THE MEDICAL RECORD.
75
under treatment or not, are to be immediately reported
to the health bureau, giving name, age, and residence of
the patient. In view of the possible advent of cholera,
special attention is to be paid to shanty neighborhoods
in uDsewered portions of the city, where excreta^ are
deposited in shallow vaults or upon the surface of the
ground, and where the water supply is from springs or
suface wells»
The Minnesota State Medical Society. — ^The
phjrsicians of Minnesota need stirring up, as well as
those of Louisiana, according to the Northwestern
Lancet. The last State meeting was a success socially,
bat in scientific and practical work and in attendance
it was a failure.
The Hospital Saturday and Sunday Funds in
England amount to about a million and a quarter of
dollars annually.
Death from the Administration of Bichloride of
Mkthylene. — Another death must be scored against
the comparatively little used anaesthetic, bichloride of
methylene. In this case the victim was the daughter of
a physician of Lancashire, Enghind. The young lady,
twenty-three years of age, was to be submitted to a
slight surgical operation. The anaesthetic had been
given only three minutes, and scarcely ten minims had
been inhaled, when the heart suddenly ceased to beat
Respiration also stopped. All efforts at resuscitation
proved unavailing. A previous examination had failed
io show any signs of heart or lung disease.
The True Use of a Porous Plaster, according to
a Milwaukee druggist, is ««to retain the back in its
proper |place and let the pain crawl out through the
holes."
Is Conviction for Abortion Possible in Ohio ? —
Under this head the Columbus Medical JourruU cites a
nnmber of cases in which abortionists failed to be con-
victed, and sums up the state of affairs as follows : '' i. If
the abortionist does his work, his victim alone being
prify to it, he is safe ; for if she lives, she will not inform
against him, while if she dies, her statements are entirely
worthless as evidence. 2. If others are privy to the act,
the prosecution must prove that the foetus was actually
Mng at the time of the operation ; and this, at least
after 'quickening' — and even then only on the testi-
mony of an expert making an examination at the time —
is of course impossible."
A Congress of Polish Doctors and natural philoso-
phers took place at Posen, ending on June 4th. There
were three hundred present, some having come from
Egypt, India, and other distant parts for the purpose,
The next congress will be held at Warsaw or Lemberg.
Louisiana Doctors Asked to Wake up.— We sin-
cerely commend the efforts of Dr. Richard H. Day,
President of the Louisiana State Medical Society, to
aioose the slumbering intellects of the Louisiana doctors
into greater activity. " Respected confreres," he says, in
a dnnilar letter, " when contrasted with the esfrit de
corps of the medical profession in other States, and es-
pecially with the glowing enthusiasm of the late Texas
State Medical Meeting in Belton, the languor and in-
ference of the phjrsicians of Louisiana in all that per-
tains to the unity and advancement of the medical pro-
fession must be profoundly humiliating to all true lovers
of the science and the art of medicine. Brothers of
the medical profession wake up! start into a new
and more vigorous life ! Let your medical and lite-
rary attainments and capacity for usefulness be no longer
hid in slothfiilness, but let us begin at once and or-
ganize the regular medical practitioners of the whole
State into town, parish, and district medical societies, and
bring up to our next State meeting an organization and
a work and a live membership that shall thrill our very
hearts with joy, and place our State Society upon a solid
and sure foundation." Louisiana medicine is dead in-
deed if, with the' incitement of such an appeal and a
prospective Exposition, it does not arouse itself.
THE SIMS MEMORIAL FUND.
To the Medical Profession and Others throughout the
World:
The great achievements of Dr. J. Marion Sims call
for some more lasting testimonial than obituaries and
eulogies. To him medical science is indebted for much
brilliant and original work, especially in gynecological
surgery. Those who have been benefited by his teach-
ings and new operations, and such as have had the direct
advantage of his personal skill are among the first to
recognize and ackiiowledge this debt
To him is due the honor of giving the first strong im«
pulse to the study of gynecological surgery in America.
It is believed that the medical profession everywhere,
the vast number of women who owe their relief from
suffering directly to him, and those who realize the
benefits he first made possible, will gladly unite thus to
honor the man through whose originsd and inventive ge*
nius such blessings have been conferred upon humanity.
At the suggestion of many fiiends, therefore, the sub-
joined committee has been organized, and it is proposed
that a suitable monument be erected to his memory in
the city of New York.
To this end the active co-operation of the medical
profession and the many other friends of Dr. Sims
throughout the world is respectfiiUy solicited. Contribu-
tions of one dollar and upward may be forwarded to the
journal which has been constituted tlie treasury of this
fiind — The Medical Record, New York.
FORDYCE BARKER, M.D., Chairman.
GEORGE F. SHRADY, M.D., Secretary.
Thomas Addis Emmet, M.D., New York.
T. Gaillard Thomas, M.D., "
William T. Lusk, M.D., '*
William M. Polk, M.D., "
Paul F. MundA, M.D., "
S. O. Vander Poel, M.D., «
Frank P. Foster, M.D., "
E. S. Gaillard, M.D., «
Alex. J. C. Skene, M.D., Brooklyn, N. Y.
Samuel D. Gross, M.D., Philadelphia, Pa.
WiLLLAM Goodell, M.D., "
James R. Chadwick, M.D., Boston, Mass.
William H. Byford, M.D., Chicago, III
A. Reeves Jackson, M. D., "
Thad. a. Reamy, M.D., Cincinnati, O.
C. D. Palmer, M.D., «
George J. Engelmann, M.D., St. Louis, Mo.
R. Beverley Cole, M.D., San Francisco, CaL
H. F. Campbell, M.D., Augusta, Ga.
R. B. Maury, M.D., Mempms, Tenn.
E. S. Lewis, M.D., New Orleans, La.
J. T. Searcy, M.D., Tuskaloosa, Ala.
76
THE MEDICAL RECORD.
[July 19, 1884.
R. A. KiNLOCH, M.D., Charleston, S. C.
Hunter Maguire, M.D., Richmond, Va.
S. C. BijSEY, M.D., Washington, D, C.
Harvey L. Byrd, M.D., Baltimore, Md.
W. T. Howard, M.D., "
D. W. Yandell, M.D., Louisville, Ky.
Seth C. Gordon, M.D., Portland, Me.
Frank E. Beckwith, M.D., New Haven, Conn.
A. W. Knox, M.D., Raleigh, N.C.
L. W. Oakley, M.D., Elizabeth, N. J.
A. T. Woodward, M.D., Brandon, Vt.
Albert H. Crosby, M.D., Concord, N. H.
E. S. DuNSTER, M.D., Ann Arboi, Mich.
Alex. J. Stone, St. Paul, Minn,
List of Additional Subscribers.
F. A. McGuire, M.D., New York $1 00
A. H. Fridenburg, M.D., '* 2 00
J. G. Wallach, M.D., '' i 00
A. A. Davis, M.D., " i 00
H. T. Hanks, M.D., ** 5 00
Geo. V. Hann, M.D., " i 00
W. J. Morton, M.D., " 5 00
S. H. Dessau, M.D., ** 3 00
Cash, ** 1 00
James Mitchell, M.D., " i 00
B. Morje, M.D., " i 00
K Flies, M.D., ** i 00
D. F. King, M.D., ** 2 00
E. Hochheimer, M.D., ** 2 00
A. Friedman, M.D., " i 00
G. W. Jacoby, M.D., " 2 00
A. A. Hill, M.D., Lexington, N. C. . . 3 00
Drs. R. L. Payne (Sr. and Jr.), Lexington, " . . 3 00
S. B. Evans, M.D., StatesvUle, " . . i 00
Thos. E. Anderson, M.D., " ** . . i 00
L. Harrill, M.D., " " . . i 00
Mrs. M. D. Miller, " " . . i 00
Mrs. W. J. Coite. " " . . i 00
J. S. Knight, M.D., Penny Hill, Pitt Co., " . . 5 00
P. H. Mayo, M.D., Falkland, ** " • • 5 00
F. C. James, M.D., Bethel, " " . . i 00
Chas. J. O'Hagan, M.D., Greenville, " «* . . 5 00
W. M. B. Brown, M.D., " " " . . 5 00
Zeno Brown, M.D., '' " '* . . 5 00
Frank W. Brown, M.D., " " " . . 5 00
Robert J. Gill, M.D., Henderson, ** . . 2 00
J. H. Tucker, M.D., " " . . 3 00
T. S. Royster, M.D., Williamsborg, " . . 2 00
W. H. Lilly, M.D., Concord, " .. i 00
C. G. Smith, M.D., Mill Hill, ** . . i 00
J. W. Vick, M.D., Selma, " . . i 00
B. W. Robinson, M.D., Fayetteville, " . . 5 00
Thos. F. Wood, M.D., Wilmington, '* . . 5 00
Geo. A. Foote, M.D., Warrenton, " . . 2 00
W. O. McDowell, M.D.,. Scotland Neck, " . . i 00
Geo. W. Long, M.D., Graham, ** . . i 00
Mrs. J. W.White, '* " . . 2 00
Eugene Grissora, M.D., Raleigh, " .. 5 00
W. J. Royster, M.D., " " . . 5 00
R, H. Lewis, M.D., " «* . . 10 00
E. B. Haywood, M.D., " " . . 5 00
A. W. Knox, M.D., * '• . . 8 50
P. E. Hines, M.D., " " . . 2 00
F. T. Fuller, M.D., " " . . i 00
James McK.ee, M.D., ** " . . i 00
Sion H. Rogers, M.D., " *« . . i 00
Clinton Wagner, M.D., New York 50 00
J. C. Acheson, M.D., ** 3 00
P. J. Lynch, M.D. , " 200
Little Rock and Pulaski Co. Medical Society,
Little Rock, Ark 25 00
Alumni Association of the Faculty of Physic, Uni-
versity of Maryland, Baltimore, Md 25 00
From a I^ady in Baltimore, Md $3 00
Gasper Griswold, M.D., New York c 00
M. H. Henry, M.D., « 500
L. Waldstein, M.D., " 2 00
W. T. Alexander, M.D., ** 5 00
J. B. White, M.D., . ** 500
H. W. Mitchell, M.D., " 5 00
W. R. Birdsall, M.D., '* 500
Louis Elsberg, M.D., " 5 00
E. H. M. Sell, M.D., " 5 00
Robt. A. Murray, M.D., ** 5 00
S. B. W. McLeod, M.D., " 5 00
E. R. Chadbourne, M.D., " 2 00
Cash, " 10 00
J. P. Munn, M.D., " 5 00
W. Thurman, M.D., " 10 00
Charles C. Lee, M.D., " 50 00
Mrs. D. L. Yulee, M.D., Washington, D. C 10 00
J. F. Hartigan, M.D., " " 5 00
Albert Smith, M.D., Philadelphia, Pa 100 00
Theophilus Parvin, M.D., " " 100 00
EUwood Wilson, M.D., " ** 50 00
Wm. H. Parrish, M.D., " " 25 00
D. Hayes Agnew, M.D., " " 50 00
J. M. Da Costa, M.D., " " 50 00
Wm. Pepper, M.D , " " 50 00
J. Ewing Mears, M.D., " *' 25 00
Wm. H. Pancoast, M.D., " *• 50 00
W. H. Warder, M.D., " '* 50 00
John Brinton, M.D., ** " 25 00
Addinell Hewson, M.D., '* " 25 00
R. M. Girvin, M.D., ** " 25 00
W. V. Keating, M.D., " " 10 00
J. M. Keating, M.D., ** " 10 00
W. M. Welch, M.D., *< ** 10 00
Henry Beates, M.D., *' " 10 00
C. H. Thomas, M.D., *< " 5 00
D. F. Willard, M.D., " ** 10 00
Wm. Thompson, M.D., «» " 10 00
M. Franklin, M.D., «« ** 10 00
Samuel Lewis, M.D., " ** 10 00
R. J. Dunglison, M.D., " " 10 00
M. B. Musser, M.D., " " 5 00
S. S. Stryker, M.D., " ** 5 00
K. Y. Evans, M.D., " " 5 00
Wharton Sinkler, M.D., " " 10 00
Wm. Hannah, M.D., Wilson County, Tenn i 00
W. W. Prater, M.D., " ** i 00
J. L. Fite, M.D., Lebanon, ** i 00
Geo. Rustedt, M.D., Shrewsbury, Vt i 00
E. N. S. Morgan, M.D., Bennington, Vt i 00
R. W. Bennett, M.D., « " i 00
E. O. Rogers, M.D., " " i 00
J. H. Putnam, M.D., Rutland, " i 00
D. K. Crane, M.D., '* " i 00
Walter Carpenter, M.D., Burlington, " i 00
L. M. Bingham, M.D., " •* i 00
A. P. Grinnell, M.D., " ** i 00
Geo. C. Briggs, M.D., " " i 00
Jno. B. Wheeler, M.D., *« " i 00
L. Woods, M.D., Pittsford, " i 00
H. H. Swift, M.D. " " X 00
C. A. Flanders, M.D., ** <* i 00
Chas. W. Peck, M.D., Brandon, " 1 00
J. J. Tobias, M.D., '* " i 00
O. G. Dyer, M.D., " " i 00
Chas. S. Boynton, M.D., " " i 00
A. T. Woodward, M.D., ** " 5 00
Wm. P. Wright, M.D., Whiting, " i 00
T. E. Wakefield, M.D. Fair Haven, " i 00
E. D. Ellis, M.D., *' " I 00
R. Lape, M.D., ** « i 00
Charles D. Smith, M.D., New York 10 00
Charles A. Leale, M.D., " 10 00
H. Skelton Carter, M.D., " 5 00
S. Waterman, M.D., " 5 00
July 19, 1884.]
THE MEDICAL RECORD.
n
iljejjrorrts 0f J^ocietieB.
THE ACADEMY OF MEDICINE OF PARIS.
Stated Meetings June 1 7, 1884.
M. A. GuiRiN, President, in the Chair.
(Special Report ftnr Ttas Mksical RsoMtDb)
AfTSR the members had been called to order, the Presi-
dent aonounced that at its next meeting the Academy
would resolve itself into the committee of the whole to
hear the report upon the applications for corresponding
membership.
M. Cusco then exhibited a new form of
urethral sound,
made according to his directions by M. Collin. It was
partly rigid and partly elastic, and so constructed as to
follow with ease the curves of the urethra.
M. Legouest stated that since the last meeting of the
Academy he had read an article in the Lyon Medical^ by
MM. Deperet and Boisset, on
THE microbe of THE BISKRA BUTTON.
These gentlemen had also cultivated the microbe, and
had injected it into a number of animals of different spe-
cies, and had obtained results corresponding exactly with
those recorded by M. Duclaux. In one case a slut,
brought from Biskra, had the specific boil on its leg.
This animal subsequently gave birth to two puppies who
also had the Biskra buttons. Notwithstanding this addi-
tjonal testimony, M. Legouest was still somewhat skep-
tical as to the specific nature of the microbe found in
these cases of Aleppo evil
M. Marc S6e desired to call the attention of the mem-
bers to the excellent results obtained by
COMPRESSION in THE TREATMENT OF HYDRARTHROSIS.
He thought it superior to the method advanced by M.
Labb^ at the previous meeting. He made compression
by Dieans of an ordinary Esmarch's bandage. He prom>
isedtogive a more extended description of the procedure
at some future meeting.
M. A. Gautier then read a note upon the
SYNTHESIS OF XANTHINE,
which he had succeeded in accomplishing. This was, he
claimed, the first step made in the synthesis of albuminoid
bodies. Xanthine differs from uric acid only in contain-
ing one atom less of oxygen.
K. CouN, of Alfort, then read a paper upon
SEPTICiEMIA,
in which he came to the defence of the micro-organisms,
daiming that it was by no means proven that the part
plajed by them in the production of disease was so great
as it was now the fashion to believe. He maintained
that the experiments of M. Duclaux, described at the
last meeting, were improperly conducted. The microbe,
be said, is endowed with such a marvellous power of re-
production that it would be sufficient for the purposes of
the experiment to inject a fraction of a drop, instead of
twenty drops, as had been done.
Septicaemia, he continued, is on^ of those as yet im-
perfectly undlerstood conditions in which the changes
occurring may be due to one or several of a number of
Guises — ^microscopic organisms, septic agents, ptomaines,
etc Among certain animals, such as rabbits and birds,
septicaemia could be very readily produced, while others,
^ dogs, oxen, and sheep, were hardly at all susceptible
to the disease. The affection known as
GANGRENOUS SEPTICEMIA
is not certainly specific in its nature. It cannot be dis-
^nished, in animals at least, fi*om the other forms of
septicaemia. It is not proven that the virulence of the
disease resides elsewhere than in the fluids of the affected
organs, nor is it proven that it is transmissible by inocu-
lation even from one animal to another of the same
species. The assertions that are made concerning the
carrying of the disease by instruments suppose an ex-
treme degree of virulence which is, to say the least, very
doubtful, and is not supported by experiments. The
septicaemic virus, whatever it may be, is destroyed by a
temperature of 212^ F., and also by numerous antiseptic
agents. The poison may be rendered innocuous, even
after it has been deposited upon the surface of a wound,
provided it be as yet unabsorbed. The difficulty, how-
ever— a difficulty which is often insuperable — is to de-
stroy this substance once it has been absorbed and scat-
tered through the system.
M. FouRNiER thought that the speaker was not quite
just in his strictures upon M. Duclaux. There was
nothing in the symptomatology of the Aleppo evil at all
resembling septicaemia, and the experimenter was cer-
tainly able to recognize the latter disease, especially when
he was on the lookout for it and had taken every precau-
tion to prevent its occurrence. If the effects produced
depended upon the amount of the culture fluid injected,
it was strange that they should have varied so greatly ac-
cording to the age of the fluid, the same number of cfrops
being injected each time. And again, if the morbid
symptoms were due to putrefaction, the results of inocu-
lation should have become more marked in proportion
to the age of the fluid. But the exact contrary ob-
tained.
M. Colin held to his original assertion. The presence
of decomposing animal matters rendered the experiment
inconclusive. If the same results were obtained by the
injection of the microbes suspended in pure water, then
they might justly be ascribed to the action of the micro-
organisms.
M. AuGUSTE VoisiN then related the histories of five
cases of
RETARDED DEVELOPMENT IN CHILDREN,
in which he had had an opportunit}- to study the lesions
found post-mortem. Certain cerebral troubles are al-
most constantly associated with retarded ability to walk
in young children. These are manifested by slowness in
learning to talk, awkwardness in the movements of the
upper extremities, especially when learning to write, in-
continence of urine, malformations of the ears, etc In
every case he fomid a more or less complete
ATROPHY OF THE CONVOLUTIONS SURROUNDING THE
FISSURE OF ROLANDO
at its upper extremity. The lesions were the same in
kind and situation in each of the cases examined by him,
and differed only in the degree of atrophy.
The Academy then adjourned.
Treatment of Gonorrhcea by Open-wire Bougies.
— Dr. D. C. McVail uses a little contrivance made of
three wires soldered together at one end, and bent into
the shape of a sound, in the treatment of gonorrhoea.
The instrument is intended to keep separate the inflamed
mucous membrane of the urethra, and also to allow the
discharge to drain freely away and not lie in the passage
and give rise to renewed secretion. Another form has,
instead of the flanged extremity, a short length of cathe-
ter-tube attached, and to that a short piece of rubber
tube. The solution to be injected is introduced by a
syringe, and when quite full the India-rubber tube is
compressed b^ a spring clip, to prevent the escape of
the fluid. Within from twenty to thirty minutes the in-
jection will be almost wholly absorbed by the urethral
walls, and then the clip may be detached. These instru-
ments are well borne in the urethra, and the patient can
pursue his ordinary avocations whUe wearing them. —
British Medical Journal.
78
THE MEDICAL RECORD.
[July i9t 1884.
THE BIOLOGICAL SOCIETY OF PARIS.
Stafid Meetings June 14, 1SS4,
M, F. Franck, Presidekt, in the Chj^ir.
(SpecuJ Kcport fur Tkk AIadical Rbcobx9.}
The scientific work of the meeting was begun by M.
RocHBFONTAiNE, who presented a communication on be-
half of M. Aphanasieff upon the
TRANSFUSION OF PEPTONIZED BLOOD.
Since the chief danger in this procedure lies in the
possible coagulation of the blood, and since blood con-
taining a certain proportion of peptone loses its coagula-
bility, the author conceived the idea of using blood thus
prepared for transfusion. The experiments were made
only upon animals, but the results obtained were so en-
couraging as to warrant the extension of the application
to man when occasion should arise.
M. Dastre remarked upon the importance of obtain-
ing perfectly pure peptones, and also upon the accidents
sometimes following the introduction of peptones into
the circulation.
M. Regnard said a few words supplementary to a
previous communication that he had made concerning
the
effects of high pressure upon marine animals.
He had determined by experiments that fish subjected to
a pressure of four hundred atmospheres died from hydrae-
mia. Some of the lower forms of marine life, such as
star-fish and sea anemones, could resist a pressure of
one thousand atmospheres, but died if this were ex-
ceeded.
M. ViGNAT had, at M. Regnard's suggestion, studied
the changes in the tissues caused by imbibition under high
pressure, and he recounted at some length these alterations
as they occurred in the epithelium, tendons, nerves,
muscles, and connective tissue.
M. AuBEAN spoke of the satisfactory results obtained
by him in producing anaesthesia by a
MIXTURE OF AIR AND CHLOROFORM.
The experiments were made in the service of M. P^an.
He had found that a mixture in the proportion of seven
or eight parts of chloroform to a hundred of air gave the
best results.
M. Dubois exhibited in this connection an
APPARATUS FOR THE INDUCTION OF ANAESTHESIA.
It was so arranged that a mixture of air and chloro-
form in any desired strength could be administered.
M. Laborde presented, in the name of M. Vigier, a
communication on
ORTHOXYPHENYLSULPHUROUS ACID.
This product, which is also called by the more pro-
nounceable name of sulpho-carbol, is destined, the
speaker said, to supplant carbolic acid. It has a much
less strong odor, and possesses antiseptic properties, to
say the least, as great as those of carbolic acid. It en-
joys the further advantage of being free from poisonous
properties. It had been given to a dog weighing fifteen
pounds, in the ^dose of two drachms per diem, with im-
punity.
M. Regnard then made a few remarks upon
FERMENTATION.
At the beginning of this process there was a period of
inactivity, during which the ferment, of beer, for instance,
produced no effect. He had remarked that the more
nearly saturated was a solution of sugar, the shorter was
this period of calm. He suggested that possibly the
beer ferment required some other substance to excite it
to action.
After the transaction of some general business the
Society adjourned.
THE MEDICAL SOCIETY OF BERLIN,
Stated Meetings June xr, 1884.
Professor Virchow, President, in the Chair.
(Special Report for Thb Medical Rbcord.)
The Society having been called to order by the President^
Herr B. Fraenkel presented a patient who had suffered
for four years from
FACIAL SPASMS,
involving the left side. A varied treatment had beei*
followed without success, and finally the patient was sent
to Dr. Fraenkel on account of pain which she suffered in
the left nostril. A mild periostitis of the nasal bone was
found, which subsided again in a few days. While making
an examination with the rhinoscope he found that the
spasms were excited by any irritation of the nasal raucous
membrane. Even touching this membrane with the
sound was sufficient to induce the one-sided twitchings.
The attempt was then made to cure the spasms by ap-
plications of the galvano-cautery to the mucous mem>
brane of the nose. Even after the first application, the
twitchings became less frequent and less violent. A
complete cure was obtained after five applications, made
especially to the middle meatus, from irritation of which
part the spasms were most easily excited. The patient
had been under observation for six weeks and had had
no relapse.
As regards the changes observed in the mucous mem-
brane, the speaker said that there was nothing to be seen
but some redness and a very slight amount of swelling.
Previous to the periostitis, the patient had never made
any complaint of trouble in the nose which might indi-
cate that this was the starting-point of the spasms.
Several years ago the speaker had read a paper at a meet-
ing of this Society upon
theJrelation of asthma to diseases of the nose,
in which he maintained that attacks of dyspnoea might be
caused by a reflex action, excited by irritation of the
nasal mucous membrane. Since that time considerable
attention has been paid to the reflex neurosis of nasal
origin. The case just presented showed the excellent
results of a properly directed treatment. The patient
had suffered for four years fi-om an apparently intractable
affection, which was nevertheless radically cured by five
sittings with the galvano-cautery.
Herr E. Hahn then exhibited an
IMMENSE tumor OF THE NECK
removed from a man seventy-four years of age. It had
been observed for the first time thirty years before, and
was then the size of a walnut, and situated at the back
of the neck over the sixth cervical vertebra. At first
thercL was no pedicle, but as the tumor continued to grow
it became pendulous and pediculated.
At the time of the operation the tumor weighed seven-
teen pounds and was attached bj^ a pedicle, seven and a
half inches broad and formed of integument, to the back
near the fourth dorsal vertebra. The lower part of the
growth reached down to the level of the fourth lumbar
vertebra. The skin was unchanged and was movable
over the tumor. The latter was as hard as bone in some
places and softer in others. After removal it presented
on section a bright yellow color, and was of the consist-
ency of firm lard in some parts, and as hard as cartilage
or bone in others. These hard portions were found tc
be concretions of lime salts. On the under side of th<
tumor the skin and subcutaneous cellular tissue pre
sented the appearance of having been sown with minuti
fibromata.
July 19. 1884.]
THE MEDICAL RECORD.
79
HekR a. Baginsky presented a specimen of
THE BRAIN OF A CHILD,
vhjch be exhibited as showing that it is possible, in cer-
tain cases at least, to determine the
LOCALIZATION OF CEREBRAL LESIONS
even in very young children. The little patient was but
nine months old when the first symptoms appeared.
The pupil of the ri^ht eye was dilated, and there was
ptosis on the same side. The left eye was rotated out-
ward, and at the same time its axis was directed some-
what downward. There was also complete paralysis of
the left facial nerve. The symptoms argued against
trouble at the base of the brain ; for any lesion in this
situation so extensive as to involve the motor oculi and
facial nerves must have given rise to symptoms of men-
ingitis, and these were completely absent. Being thus
forced to the diagnosis of a central lesion, the location
could be settled with tolerable certainty in the anterior
portion of the pons, where the centres for the motor
nerves of the e3'e are to be found. And since the ptosis
and paralysis of the sphincter iridis were upon the right
side, the lesion was probably on that side also. Further,
since syphilis could be excluded, it seemed most proba-
ble that the lesion was tubercular in its character.
Later there were twitchings in the left arm and leg, an
inclination of the head backward and to the left, and a
general curve of the body to the left side — ^phenomena
indicative of a lesion in die right cms cerebri, as well as
in the anterior portion of the pons varolii. The disease
progressed steadily until the death of the child. The
aotopsy showed a considerable amount of fluid within
the cranium, but not a trace of meningitis or miliary tu-
berculosis. In the right cms was found a collection of
cheesy matter extending forward to the optic thalamus,
and backward into and involving the anterior third of
the pons. Almost the entire portion of the eras had
undergone this caseous degeneration. There was a red-
dish brown zone surrounding the softened portion of the
farain. Examination failed to show the presence of tu-
bercle bacilli.
Herr p. GtlTERBOCK then read a paper upon
HEREDITARV SVPHILITIC JOINT DISEASES.
The author had published an article on this subject in
HbeArMv fur Klinische Chirurgie for 1878, in which
He bad summarized all that was then known about syphi-
litic joint affections in young children. He now desired
to supplement that article with the conclusions drawn
from a further experience with the disease in question.
He opposed the views of several authors, chiefly English,
Aat syphilitic joint lesions in children were of common
occurrence. He had met with but one case of heredi-
tary syphilis out of everjr three hundred patients under
inre years of a^^e. It is important to distinguish this
fonn of joint disease, since the prognosis, wiUi proper
treatment, is ver}' favorable. But, on the other hand,
the chances of recovery in tubercular arthritis are very
BuIL The author gave in detail {he histories of two of
1b cases, one of which he treated by corrosive sublimate
tabs; the other by the internal administration of potas-
wm iodide. Any operative interference in this class of
fceases is usually productive of untoward results. In
o»dnsion, he insisted upon the necessity of an early
^oris and the prompt institution of appropriate
treatment.
The Society then adjourned.
A SncpLK Contrivance for Making Camphor
WATER.-~Dr. James Dunworthie, of Dobb's Ferry, sends
u a bit of glass tubing in which is pushed a piece of gum
^anphor. This can be thrown in a bottle of water and
^ sink to the bottom. The glass holds the camphor in
4c water.
THE ROYAL IMPERIAL SOCIETY OF PHYSK
CIANS IN VIENNA.
Staied Meetings June 6, 1884.
Professor v. Arlt, President, in the Chair.
(Special Report for Thb Mumcal Rbooro.)
The paper of the evening was read by Professor
Billroth, and was chiefly a collection of statistics bear-
ing upon the operation of
extirpation of the kidney.
This operation was performed for the first time by
Simon, fifteen years ago. Since then, according to the
tables prepared by Dr. Schustler, there have been 132
recorded cases of extirpation of the kidney. Of these
cases, 70 recovered and 62 died, a mortality of 47 per
cent. These figures were, however, the speaker main-
tained, misleading, if used as a basis for the prognosis of
individual cases, since the success or failure of the opera-
tion in each case depended so much upon circumstances.
He then proceeded to dissect these statistics, dividing
the cases into classes according to the indications for
operation. In every instance in which the extirpation of
the organ was, so to speak, unpremeditated — that is,
when m operating for the removal of an abdominal tu-
mor— ^it was found necessary, on account of adhesions,
to remove the kidney as well, a fatal result was recorded*
Healthy kidneys had been removed in answer to three
indications : i. In three cases of abdominal wounds involv-
ing the kidney, the injured organ had been removed. 2.
In nine cases of extirpation, on account of fistulae of the
ureter, six had died. 3. Fourteen operations for the re-
moval of a wandering kidney have been recorded, six of
which resulted fatally. The author hoped that some
method might yet be devised by which the kidney could
be fixed, thus avoiding the high mortality attending the
operation.
The extirpation of a diseased kidney has been under-
taken for suppuration (pyonephrosis, perinephritis)
twenty-two times with successful result ; on account of a
tumor, thirty-three times with twenty deaths ; for hydro^
nephrosis, nine times with six recoveries.
The author then detailed the various steps in the two
operations for extirpation of the kidney, giving his pref-
erence for the lumbar incision over laparotomy.
Dr. JuRii had removed a floating kidney success-
fully, after having made two futile attempts to fix it. The
patient recovered, but hanged herself subsequently, being
led thereto by some family troubles.
Dr. Bergmeister then exhibited a paitient with
CONGENITAL DERMOID TUMORS OF THE CORNEA.
The two tumors were of a reddish yellow color, and
were placed symmetrically on the outer side of the cornea,
of each eye, but were of unequal size. The same patient
had also a
CONGENITAL CICATRIX OF THE FACE,
extending from the left comer of the mouth across the
cheek to the ear. The cicatrix was somewhat sunkea
and lightly stretched, and presented at its outer extrem-
ity a little integumentary tumor. The latter had been
cut oflC This cicatrix, Dr. Bergmeister thought, was due.
to amniotic adhesions to the skm. There was one more,
point of interest about the case, and tiiat was an
ASYMMETRY OF THE FACE.
The whole left side of the face was less developed thaa
the right, and the left corner of the mouth was elevated,,
probably from contraction of the cicatrix.
Finally, Professor Rosenthal presented a patient
with
BULBAR paralysis,
and related his history at length. The peculiarity of the
case consisted in the fact that the sclerotic atrophy o
8o
THE MEDICAL RECORD.
[July 19, 1884.
the nuclei began in the upper half of the calamus scrip-
torius, and then extended gradually downward.
Professor Bbnedikt made some further remarks on
CRANIOMETRY,
and exhibited his instruments, and detailed the various
steps of the methods of measurement used by him.
At the conclusion of this demonstration the Society
adjourned.
OUR LONDON LEITER.
(From our Special Correspondent)
THE NORTHWEST LONDON HOSPITAL — DR. JOSEPH ROGERS
— TYPHOID IN SWITZERLAND — DR. COBBOLD ON TRI-
CHINOSIS AT THE HEALTH EXHIBITION.
London, July aS, 1884.
An event which may be fraught with grave consequences
to the management of hospitals has just occurred and
has excited no little attention. The scene of action is
at one of the younger hospitals — the Northwest Lon-
don Hospital. The committee of this institution have
thought fit to dismiss one of the surgeons without assign-
ing any reason. The staff have resented this treatment
by resigning almost en masse. They have at the same
time forwarded a written protest. It appears that the
management is vested in three ladies, one of whom
founded the hospital. Of the other two one is also
acting as matron. The recent appointments to the act-
ing staff were made by these ladies without consulting
the medical officers of the hospital, and the recent dis-
missal of one of the surgeons has been effected in the
same manner. There is a charming frankness in the
way in which it is generally admitted that these three
ladies have really appointed the staff. Such oligarchical
arrangements are not unknown in other hospitals than
that in point, but are not usually so openly acknowledged.
Frequently, though, appointments to smaller hospitals
are really made by one individual — often the founder —
who quietly tells the committee what to do.
On Tuesday last a testimonial was presented to Dr.
Jdseph Rogers, the well-known Poor-law medical officer
and sanitary reformer. The presentation took the form
of a piece of plate and a cheque for ;^i5o, and the
several speakers referred to Dr. Joseph Rogers' well-
known services to sanitary science and reform.
Typhoid fever is still prevalent in Switzerland, especi-
ally around Geneva and Zurich. At this season of the
year, when so many tourists are going to Switzerland, the
health of that country cannot but be of interest to British
practitioners, who, but for the prevalence of typhoid,
might now be sending their patients there. The Swiss
authorities have endeavored to make as light as possible
of the matter, but in Zurich and Geneva twenty-six deaths
from typhoid occurred during the four weeks ending
June 14th.
Perhaps the best lecture as yet delivered at the Health
Exhibition, has been that just given by Dr. Cobbold on
Parasites. A large portion of the lecture was devoted
to the subject of trichina. The life-history of the para-
site was described and epidemics of trichinosis referred
to. Dr. Cobbold said that the only genuine instance of
trichinosis diagnosed in England, .was that in Cumber-
land, described by Dr. Dickinson in the Cantor Lectures.
Several persons were affected in this outbreak. All
other alleged outbreaks were misinterpretations of the
facts observed. A great number of little worms living
in various animals had been described as trichinse by
persons not familiar with parasites, and to this was due
the periodical ** scares " got up by newspapers. As to
these "scares," Dr. Cobbold remarked that ignorant
writers in the daily papers seemed to take pleasure in
creating them. The recent attempt to get up a
"mackerel-scare" fell rather flat. In regard to pre-
ventive measures, the lecturer said he thought the ques-
tion as to the temperature required to kill the trichinae
had been set at rest by the labors of Perroncito, who
found that cooking meat at 120° F. was sufficient to
destroy the parasites. M. Colin had shown that two or
three weeks salting was sufficient to kill them in the
superficial parts of the flesh salted, but the deeper parts
might not be reached for a couple of months.
THE FEEDING OF INFANTS, AND HOW TO
PREPARE PEPTONIZED MILK.
To THK EorroK or Thk MsDiqiL Rboosx>.
Sir : Since the publication of your editorial on the
feeding of infants, I am receiving letters from physicians
asking how to peptonize milk. I am not surprised at
the interest awakened in the subject at this season, when
so many infants are sick from improper diet. Most in-
quirers live at a distance. New York physicians are, I
think, with few exceptions, familiar with the process.
The advice that I give to my families as regards the
preparation of milk is as follows : Scald the milk when
it arrives in the morning, and then place it on ice. Do
not peptonize more than half a pint to one pint at a
time; and what the infant does not take immediately
afterward, should be kept upon ice and surrounded by
ice for the second feeding.
The peptonizing process is as follows : Mix a powder
consisting of five grammes of Fairchild's extractum pan-
creatis, and ten grains of sodium bicarbonate in one
gill of tepid water. Add this gill to one pint of tepid
milk, and place it in a bowl in a pan of water main-
tained at a temperature of 100° or a little over. In one
hour or less time, the process is completed. Too much
peptonizing renders the milk bitter. Some milk is suffi-
ciently digested in thirty or forty minutes, and the nurse
who prepares it should occasionally taste it after the first
twenty minutes, and remove it from the pan of warm
water before the hour has expired. If the least bitterness
be 'noticed, the pancreatic ferments are destroyed by
boiling, and rendered inactive ; but not destroyed by a
temperature near that of ice. We do not wish to destroy
the ferments but wish to have them active in the stomach
of the infant. Hence, the direction to place the pepton-
ized milk on ice, instead of boiling it The object is
to prepare for infants a food which will resemble as
closely as possible human milk in nutritive properties
and digestibility, and peptonized cow's milk appears to
be the nearest approach to it yet obtained.
The great importance of the subject induces me to
send to you for publicat on the following private letter
from Professor Leeds, as perhaps it may aid in saving
life. It is known to most of your readers that Profes-
sor Leeds has made more analyses of infants* foods
than any other chemist, and that no one is better able
to give advice in dietetics from a chemical standpoint
than he. The letter relates to his remarks on infant
feeding at the meeting of the County Medical Associa-
tion on June 16, 1884.
" Sir : The formulae which I ventured to suggest for
the preparation of humanized cow's milk was as follows ;
1 gill of cow's milk,'fresh and unskimmed, i gill of water,
2 tablespoonfuls of rich cream, 200 grains of milk su^ar,
i^ grams of extractum pancreatis, 4 grammes of sodium
bicarbonate. Put this in a nursing-bottle, place the
bottle in water made so warm that the whole hand
cannot be held in it without pain longer than one
minute. Keep the milk at this temperature exactly
twenty minutes. The milk should be prepared just
before using. . . . Yours truly,
"Albert R. Leeds."
The summer season, when infantile diarrhoea is so
prevalent, affords the opportunity for testing peptonized
milk, and it is my opinion, from a considerable number
July 19, i8«4.]
THE MEDICAL RECORD.
81
of observations, that it is the safest and best substitute
for breast milk. Moreover, it appears to be good food
for children in the second and third year, who are sick
or have feeble digestion. The profession are indebted to
the Messrs. Fairchild for a cheap and reliable extractum
pancreatis. Yours, J. Lewis Smith, M.D.
NwYoK, July II, 1884.
CONCERNING THE CONDUCT OF THE EX-
AMINERS OF THE ROYAL COLLEGE OF
SURGEONS, ENGLAND.
To THB Editok op The Medical Record.
Sir: The statements contained in your London cor-
respondent's letter of May 24th, respecting the examiners
of the Royal College of Surgeons, are incredible. This
insiouation that many of them are not gentlemen is
grossly unfair, but is a little vague, no one having yet
tit upon a quite satisfactory definition of that honorable
title. But it is certain that all the examiners have been
and are men of good professional standing and attain-
ments. It is quite incredible that a candidate could be
"dragged around the room by his coat" when we re-
fflcoiber that all the examiners and examinees are in
one, not very large, room, containing four tables and as
many sets of examiners. As to the other story of the
examiner who swore at the candidate and kicked up his
heels, that is equally unlikely. I may say that complaints
have often been made of the examinations at the College
and even of the behavior of examiners, but this has never
refen^ to anything but harshness of manner or sarcasm,
vhich certainly are not desirable in an examiner. Your
correspondent's tales are merely high-flavored articles for
exportation and would only be laughed at here.
Yours faithfully, Robbrt Saundbv.
jKhthall Stkkbt, Bikmingham, Eua,
June 33, x884.
THE TREATMENT OF TAPEWORM— PELLE-
TIERINE.
To THE Editor op The Medical Record.
Sir: Having noticed several several inquiries in the columns
of your journal recently in regard to the most successful
method of disposing of tapeworm, and having treated a
Qoinber of cases with the remedy which heads this article,
I have concluded to give the profession the benefit of my
experience.
Few practitioners of large experience have escaped the
annoyances spoken of by your correspondents. In a
practice extending over twenty-four years I have treated
about twenty cases, some of which have been very per-
plexing, especially the /ania saginati, or beef-worm.
Almost any of the remedies ordinarily used will destroy
4c Utnia solium or pork-worm. The popular idea that
the foraier, or unarmed variety, is the easiest to destroy is
erroneous. 1 have succeeded with almost all the reme-
dies which 1 have tried in destroying the solium, but
only occasionally have I been successful in expelling the
saginati entire with anything except the pelletierine. The
prevalent opinion that the solium is the more prevalent
of the two worms is also a mistake as I have met about
tiiree of the former to one of the latter.
Case I. — On July 2, 1883, I administered pelletierine
to a vigorous healthy male patient, forty-five years of age.
He had been afflicted with the worm for fifteen months.
He had taken June 25, 1882, fluid extract kamela, and
passed about twenty-five feet of the worm, but no head.
Ib about three months the ripe segments began to pass
^ain. At this time he took fluid extract male-fern with
a result similar to the kamela. In December following,
^ took kousso with the same result, passing about
twnty feet of the parasite. In March following, a mix-
tnre of male-fern and kamela was given the patient with
*e usual result. On July i, 1883, twenty grains of
fek*s tannate of pelletierine was given. No part of the
worm was dislodged, but upon the following day, at 5
o'clock A.M., one ounce of Tanrefs pelletierine was ad-
ministered, followed by four ounces of infusion of senna,
and at 7 a.m. the parasite, unbroken, was passed, to the
great relief of the patient.
Case II. — Wife of Case I., contracted the disease
at the same time, both being afllicted with the taenia
saginati. Patient had similar treatment with no better
results. Pelletierine was administered July 4th, at 3
o'clock A.M., followed in one hour with the infusion of
senna. Parasite passed entire at 6 o'clock a.m., making
the entire family happy.
Case III. — Was that of a German, aged fifty-seven.
Had been afflicted five years. Had taken medicine sev-
eral times without success. Was unable to ascertain
what remedies had been used. Two years before con-
sulting me had an attack of typhoid fever, which lasted
six weeks, during which time several feet of the worm
passed. May 2 1, 1883, gave him fluid extract kamela, after
the usual preparations. Passed about fifteen feet of the
parasite, but no head. Three months afterward the pa-
tient returned for further treatment. Gave him pelle-
tierine, but a portion of it was lost by vomiting, repeated
the dose in three hours, followed by one ounce of com-
pound tincture of jalap. Worm passed unbroken, in one
hour after the last dose.
Case IV. — Male, aged thirty-four ; carpenter by oc-
cupation ; had been passing proglottides about a month.
Had taken medicine from a physician which pureed him
violently, but with no result. Gave him pelletierine after
the usual preliminary treatment, following it with com-
pound tincture of jalap, which did not move bowels for
nearly six hours. The parasite passed unbroken not-
withstanding the delay.
Case V. — Was a young man, aged twenty-one ; stu-
dent, who had been afflicted over two years, but had
taken no treatment. Gave medicine in the usual way,
with a perfect success.
Case VI. — Was a young lady, aged fifteen. Had been
afflicted two' years. Had tsdcen kamela, kousso, and male-
fern without success, passing several feet of the worm
at each administration, but no head. I gave her the
pelletierine in the usual way, with the same success as in
the other cases.
All the preceding cases were of the taenia saginati.
Perhaps one reason why I have met the saginati oftener
than the solium is because I practise in a blue-grass,
beef-producing region, and where a majority of the in-
habitants eat their beef underdone.
No symptoms were present in any of my cases which
would indicate the presence of tapeworm, except the
passing of the ripe segments. The patients had none of
the symptoms laid down in the books. They all enjoyed
vigorous health, and complained of nothing save the an-
noyance caused by passing the proglottides, which was
liable to occur at any time without warning.
Pelletierine is the alkaloid of the pomegranate bark,
and is manufactured by Charles Tanret, 64 Rue de Ram-
part, Paris, France. Tanret is a student of Pelletier,
who first succeeded in extracting the alkaloids from the
cinchona bark. A desire to honor the name of his illus-
trious preceptor is sufficient cause for the name of the
alkaloid.
It is a pleasant, safe, and speedy remedy. When
stirred in a glass of sweetened water it is as pleasant to
the taste as a glass of lemonade. It is followed in a few
minutes by a transient dizziness or vertigo, which in
some of my cases was quite severe. It should be fol-
lowed in half or three-quarters of an hour by a brisk
cathartic— compound tincture of jalap or infusion of
senna. A neighboring practitioner gave the cathartic
before administering the remedy, and the worm was ex-
pelled in less than an hour after taking the pelletierine,
but it was a taenia solium. G. C. Smyths, M.D.
GRimNCASTLB, InIX,
June 24, 1884.
82
THE MEDICAL RECORD.
[July 19, 1884*
To THB Editor op Thk Medical Record.
Sir : In the Medical Record of June 21st, Dr. Thomas
Wilde offers a prescription for the removal of tape-worm,
which has so great a similarity to a mode of treatment used
by myself for several years with such unvarying success
that I am induced to offer it to you as an appendix to
Dr. Wilde's article. It has, however, this advantage,
that the time required to produce its effect is only about
twelve hours, instead of being drawn out for a week.
The formula, I believe, originated with Dr. A. J. Shafish,
of Washington, D. C, and was published over the signa-
ture of Dr. Trumbull in the Medical and Surgical Re-
porter. My attention was called to it by Mr. Byron
^tednian, a most excellent pharmacist of this city, who
obtained it from the records of the Brooklyn Dispensary,
with which institution he was at one time connected,
who prepares it with more than ordinary skill. During
the past year I have treated eleven cases, in each and
every case the entire worm has been expelled at once.
In the majority of the cases the head has been discov-
ered, while in those in which it was not found the tenuity of
the cephalic extremity left no doubt in my mind but that
the head had passed away and been lost among the fecal
<lischarges. At any rate, the non-return of the parasite
in those cases in which the head was not found proves
the destruction of the unwelcome tenant. I have used
it in delicate women and children, and beyond a tem-
pora.ry prostration have witnessed no bad effects. My
usual course is to ask the patient when he can con-
veniently attend to the removal, and setting a day, mak-
ing no change in his diet whatever, give at bed-time half
an ounce of Rochelle salts. The following morning at
about ten o'clock — all food having been omitted — I give
^he following, prepared as I shall state :
$. Cort. rad. pomegranate 5 ss.
Pumpkin seeds f j.
Kernel of ergot 3 ss.
Ethereal ext. male-fern f 3 j.
Gum arable 3 ij-
Croton oil gtt. ij.
Aquae f S vj.
M.
In about two hours the worm is expelled. The success
of this mode has been unvar3ring. The foregoing draught
IS intensely bitter, and tends to nauseate, but by direct-
ing the patient to drink it quickly and lie down imme-
diately, the tendency to vomit is arrested. After the
worm is discharged, I order a strong milk-punch, and if
the bowels seem irritable or are painful, a dose of opium
or morphia removes the trouble. In a day or two an
iron tonic is given.
In the preparation of the anthelmintic bruise the bark,
pumpkin seeds, and ergot in a mortar to moderately fine
powder, heat for half an hour in the water in a water-
bath, strain, and on the residuum pour enough hot water
and strain with pressure to bring the quantity of strained
fluid up to six ounces. Put the oil into the gum arable,
add the male-fern — emulsionize the whole. With care a
6ne emulsion is produced.
I am looking for a remedy against **pin-worms** which
-shall prove as successful and prompt as is the one I have
igiven you against the taenia. H. Lvle Smith, M.D.
Hudson, N. Y., June 33, 1884.
To TKB Emtor of Tub Mbdical Rbcordw
Sir : In response to a request of a subscriber for the
treatment of tapeworm I will say that I once saw in an
bid number of Braithwaii^s Retrospect an item advising
the use of creasote in persistent cases, since that I have
used that agent after all others had failed, with invariably
successful results. I have given one drop in an emulsion
of acacia three times daily for two days, then increased to
two drops three times daily for two days, then to three
<lrops for two or three days, when the head has universally
•come away. Finlev Ellingwood, M.D.
Mantsno, III., June xj, 2884.
To THB Editor op Thb Mbdical Rkcord.
Sir : For the benefit of your subscriber who seeks infor-
mation upon the best treatment of tapeworm, I would
suggest to him the use of Tanret's pellerierine. I have
used the remedy in six cases, five of them being successful.
Fougera & Co., New York City, are the agenU for
Tanret's pelletierine in this country.
Yours, very respectfully, H. Wilfert, M.D.
Cincinnati, June x6, 1884.
To thb Editor op^Thb Mbdical Rbcord.
Sir: In reply to a request of one of your subscribers
(Medical Record, p. 682, June 14, 1884), and for the
information of those interested in the subject, a mode
of treatment for tapeworm is given below which has
proved in my hands to be better than any other, and has
have given most satisfactory results. A reliable remedy
for the relief of tapeworm is a valuable addition to the
therapeutical knowledge of every general practitioner,
for whatever the opinion of medical minds may be about
the severity of disturbances caused directly by the pre-
sence of parasites in the alimentary canal, it cannot
be disputed that laymen attribute great importance to
their presence. I have seen a large number of cases of
tapeworm, and have given a fair trial to the variety of
remedies which are generally administered in such cases,
including the infusion of pomegranate root, as recom-
mended by Dr. Thomas Wilde (Medical Record, May
31, 1884). The principal objection to the use of the
latter is its unpleasant taste and the large amount of
fluid which has to be taken ; in a number of cases where
the pomegranate infusion had been used it produced
violent emesis, and some patients were unable to retain
it, even in small doses. In four cases out of fifteen the
entire worm had been expelled and the head found, but
almost all the patients complained of the harsh treatment.
The treatment which has been followed by the best
results is a simple one, any reliable apothecary can pre-
pare the prescription, and patients will take the medi-
cine without difficulty. Although it is not essential to
have the patient fast for any length of time, still it is
advisable to allow only moderately of food during the
afternoon and evening of the first day, and to abstain
from food entirely while taking the medicine in the
morning from 8 to 10 a. m. The following are the pre-
scriptions to be given as directed :
8 . Hydr. chlor. mite gr. x.
Pulv. jalapse 3 ss.
Pulv. aromat gr. x.
M. Ft. pulv. No. 2.
S. — Take one powder at 4 p.m. and the other one at
bed-time.
5. Ext. male-fern ether 3 iij.
Ext. sennae fid 3 iij.
Ext. hyoscyami fid.,
Tr. menth. pip aa 3 ss.
M. Ft. mist.
S. — ^Take one teaspoonful (good sized) every half
hour — to commence at 8 a.m. the day after the powders
have been taken.
The use of hydr. chlor. mite as a preparatory remedy
has been suggested by Dr. R. Kuchenmeister in Dresd«P. .
Paul H. Kretschmar, M.D./t
Brooklyn, N. V. JRI
P
Nux Vomica as a Galactagogue. — Dr. Poln<^da
Arango speaks very highly of the good effect ofonCaux
vomica as a stimulant to the secretion of milk. He^tl) gives
ten drops of the tincture three times a day, and exi just^
its galactagogue properties by its action on the j ^'
mary gland, exciting it to secretion, and by its stimufi*' M
action on the stomach facilitating digestion. He r^ sOgcom-
mends strychnia in recent cases of complete suppr)ii2e<!^oA
of the secretion. — London Medical Record. 4mbei
July 19. 1884.]
THE MEDICAL RECORD.
83
THE QUESTION OF THE FLORIDA CLIMATE.
To TUB Editqr or TUB Mboicax. Rbookd.
Sir : On April 26th last you published in The Record
a letter from Dr. Boyland, of Baltimore, upon " Florida
as a Health Resort" As some of his statements were
50 opposite to my observations, I felt like rushing into
print and criticism of the Doctor's paper. But as it is
now over two years since I was last in Florida, and not
knowing what wonderful changes might have occurred
there meantime, I immediately wrote my friend Dr.
Phillips, of Gainesville, Fla., for a few statistics. Un-
avoidable accident delayed his answer and consequently
this of mine. His letter is now before me, but as time
cures almost every curable thing, my first impulse to
criticise shall be modified and confined to a few items
relative to the respective advantages as sanitariums of
{Gainesville and Cedar Key (not " Keys "). Dr. Boyland
disparages Gainesville by complaining of its level surface
and defective drainage, also on account of the vast num-
ber of consumptives whom he seems to believe do con-
gregate there in shoals and nations, and the almost daily
deaths among whom (as he says) exert a ** deleterious
effect upon other and non-phthisical cases.'' Bad ! bad
enough, if true, but Dr. Phillips says (and I will vouch
for h^ truthfulness) '^ there were not to exceed six cases
of deaths among the visitors at Gainesville from Nov-
ember, 1883, to May, 1884."
How about ** the almost daily deaths " reported by Dr.
Boyland ? As to the level surface and defective drainage,
I can speak for myself. I say the ground is rolling, that
most of the streams are situated in deep ravines, and the
currents lively. I say further that Gainesville is drained
by a natural sink, about two miles south of the town.
The streams of the surrounding districts pour down the
j^eat throat of this inlet to the vast cavernous passage
below the limestone stratum; where the water again
comes to the surface no one knows, but from the direc-
tion of the line of depressions, marking the course of the
subterranean stream, it probably runs north and directly
under Gainesville^ for about two miles north of the town
is one of these depressions (and the largest of them all)
where one can go down dry-shod from the pine-covered
sand above, over one hundred feet to the coral rock bed
or backbone of the State. So much for the level surface
and want of drainage of Gainesville.
Now, as the Doctor recommends Cedar Key to those
who desire a seaboard resort, I must conjecture tliat his
icquamtance with that city is secondary, also that his in-
formant (if informant he had) does not eliminate truth
freely.
The drainage of Cedar Key is largely into the wells,
the air is redolent of bilge- water and putrid things.
With the periodic winds, quotidian fogs, perennial fleas,
nocturnal mosquitoes, with nothing to please the eye,
ererydiing to offend the nose, and not one drop of clean
well-water to cool the mouth, I would recommend Cedar
Key to no one, except a scavenger, and him one of about
&e nine hundred and ninety-ninth " stage." As a sani-
tarium I prefer Gainesville to any other town in Florida
bown to me ; Cedar Key I would place last in the fullest
catalogue. Wm. B. Bradner, M.D.
Wunnac, N. Y., May a6, 1884.
SHALL OFFICERS OF THE ARMY ENGAGE IN
PRIVATE PRACTICE.
To THE Editor op Ths Mbdical Rbcoko.
FSdl: Some time ago I wrote to the Surgeon-General of
I ie Army for information respecting some points of prac-
tical importance to physicians, and in reply received
rd that not only was there no rule or regulation pre-
itiiig post surgeons from engaging in general practice,
iltt that it was his custom to advise post surgeons to
waU the practice they could outside, so that they might
yttg-m rusty.
As this seems to me anything but a fair and proper
course to pursue ; and as an earnest protest on my part
has received absolutely no notice whatsoever, I wish
through your columns to inform those physicians who
are so unfortunate as to live where army surgeons are
stationed, of just what they may reasonably expect. If
there is no impropriety, not to use a harsher term, in
attempting to secure outside practice, while drawing full
and presumably adequate pay from the Government,
then I must confess myself so mentally obtuse as not to
perceive it.
In the first place it is unfair competition. The army
surgeon is backed by an assured salary. The offiqe he
occupies and the horse and buggy he uses are in part
paid for by the very physicians against whom he comes
in competition. To the military medical mind this may
seem fair and honorable. To the civilian, however, it
certainly does not.
In the second place, the fear t?iat the army surgeons
may grow rusty affords no manner of excuse for pirat-
ing outside of the post. If there is not enough for the
surgeons in the army to do, then cut down the num-
ber ; or else give them more soldiers to look after. It
is the Government's fault that there are too many sur-
geons for the number of soldiers. Let the Government
remedy that and not advise their subordinates to encroach
on ground not legitimately their own. Have civil prac-
titioners no rights as opposed to salaried Government
officers? Were there a dearth of local physicians an
army surgeon might be excused for answering calls in
emergencies. Such conditions, however, do not obtain
here in the East
I hesitate to believe that the majority of army sur-
geons would follow any such advice as has emanated
from the Surgeon- General, having been informed by
gentlemen of the army that practising outside of posts
has not been customary in the past, except in such places
where physicians were few and far between, as in the far
West ; and moreover such practice has always been re-
garded as not strictly fair and honorable, except under
the exceptional conditions just mentioned.
Very truly yours,
John G. Stanton, M.D.
Nkw London. Conn.,
July 8, Z884.
^vm^ and S^tig ^jettrs.
Official List if Conges in the Stations astd Duties of Officers
serving in the Medical Department^ United States Army,
from July 6 to July 12, 1884.
Perin, Glover. To be Assistant Surgeon-General,
with rank of Colonel, promotion to date from July 2,
1884.
Smith, Andrew K. To be Surgeon, with rank of
Lieutenant-Colonel, promotion to date from July 2,
1884.
MiDDLETON, Passmore. To be Surgeon, with rank
of Major, promotion to date from July 2, 1884.
Clements, B. A., Major and Surgeon. Also directed
to relieve Surgeon J. P. Wright of his duties as Acting
Medical Director, Department of the Missouri. S. O.
138, par. I, Headquarters Department of Missouri,
July 8, 1884.
Promotions. — ^To be Assistant Surgeons, with the rank
of Captain after five years' service, m accordance with
the Act of Congress of June 23, 1874. Assistant Sur-
geons John J. Kane, John M. Banister, Aaron H.
Appel, Charles Richard, W. Fitzhugh Carter, June 3,
1884.
Birmingham, H. P., First Lieutenant and Assistant
Surgeon. From Fort Bayard, N. M., to Fort Bliss,
Texas. S. O. 137, par. 3, Heaidquarters Department of
the Missouri, July 3, 1884.
84
THE MEDICAL RECORD.
[July 19, 1884.
Official List of Changes in the Medical Carps of the U. S.
JVavy, during the weeh ending July is, 1884.
LuMSDEN, G. P., Passed Assistant Surgeon. Ordered
to U. S. S. Wyandotte.
Persons, R. C, Passed Assistant Surgeon. Detached
from U. S. S. Wyandotte and placed on waiting orders.
Official List of Changes of Stations and Duties of Medical
Officers of the U, 5. Marine Hospital Service^ April i
to June 30, 1884.
Bailhache, p. H., Surgeon. Detailed as chairman of
Board to examine candidate for appointment into the
Revenue Marine Service, May 17, 1884.
Vansant, John, Surgeon. To proceed to Empire City,
Oregon, as Inspector, April 2, 1884.
HuTTON, W. H. H., Surgeon. Granted leave of ab-
sence for twenty-five days, May 14 and June 9, 1884*
Miller, T. W., Surgeon. Granted leave of absence
to attend the meeting of the American Medical Associa-
tion, May I. To proceed to Pittsburg, Pa., Ashtabula,
O., Buffalo, N. Y., and Detroit, Mich., as Inspector, May
10, 1884.
Wyman, Walter, Surgeon. To proceed to Crisfield,
Md., as Inspector, April 1 1, 1884. Detailed 'as president
of Board for physical examination of candidates for ap-
pointment as cadets in the Revenue Marine Service, May
20, 1884. To examine cadet-graduates Revenue Marine
Service as to physical qualifications. May 31, 1884. De-
tailed as member of Commission to inspect United States
buildings at Quarantine Station on the Delaware River,
June 16, 1884. Detailed to represent the Marine Hos-
pital Service as Delegate to the American Medical Asso-
ciation, April 17, 1884.
Austin, H. W., Surgeon. Granted leave of absence
to attend the meeting of the American Medical Asssocia-
tion, May 2, 1884.
Gassaway, J. M., Surgeon. When relieved by Passed
Assistant Surgeon Mead, to proceed to Portland, Me., and
assume charge of the Service, April 16, 1884. Granted
leave of absence for thirty days, May 28, T884.
Stoner, G. W., Passed Assistant Surgeon. When re-
lieved by Surgeon Gassaway, to proceed to Cairo, 111., and
assume charge of the Service, April 16, 1884. When
relieved by Surgeon Gassaway, to report in person to the
Surgeon-General, June 20, 1884.
Irwin, Fairfax, Passed Assbtant Surgeon. Granted
leave of absence for twenty-one days, June 19, 1884.
Mead, F. W., Passed Assistant Surgeon. When re-
lieved by Assistant Surgeon Devan, to proceed to Phila-
delphia, Pa., and assume charge of the Service, April 16,
1884. Detailed as recorder of. Board for physical exami-
nation of candidates for appointment as cadets in the
Revenue Marine Service, May 20, 1884.
Carter, H. R., Passed Assistant Surgeon. To inspect
unserviceable property at the San Francisco Hospital,
May 24, 1884.
Wheeler, W. A., Passed Assistant Surgeon. To in-
spect unserviceable property at the Chicago Hospital,
May 24, 1884.
Benson, J. A., Passed Assistant Surgeon. Granted
leave of absence for thirty days, April 14, 1884. When
relieved by Passed Assistant Surgeon Stoner, to report to
him for temporary duty. May 19, 1884.
Banks, C. £., Passed Assistant Surgeon. Detailed as
member of Board to examine physically candidate for ap-
pointment into the Revenue Marine Service, May 17,
1884. To inspect unserviceable property at Baltimore,
Md., New York, N. Y., and Boston, Mass., May 26 and
June 2, 1884.
Bennett, P. H., Assistant Surgeon. Granted leave
of absence for twenty days, June 28, 1884.
Devan, S. C, Assistant Surgeon. To proceed to Port
Townssnd, W. T., relieve Passed Assistant Surgeon
Mead, and assume charge of the Service, April 14, igg.
Urquhart, F. M., Assistant Surgeon. Granted leave
of absence for thirty days. May 22, 1884.
Yemans, H. W., Assistant Surgeon. To report to
Captain M. A. Healey for duty as Medical Officer during
cruise of Revenue Cutter Corwin, April 16, 1884.
Glenn AN, A. H., Assistant Surgeon. To proceed to
Mobile, Ala., for temporary duty during sickness of
Passed Assistant Surgeon Goldsborough, June 17, 1884,
Brooks, Stephen D., M.D., Massachusetts, having
passed the examination required by the Regulations, was
appointed an Assistant Surgeon by the Secretary of the
Treasury, May 15, 1884. (Dr. Brooks had previously
served as an Acting Assistant Surgeon from March, 1883,
to May, 1884).
ptiedicaX Items.
C0MTA010U8 D18KASBS — ^WuKLY Statkiibnt.— Re-'
port of cases and deaths from contagioai diseases re-
ported to the Sanitary Bureau, Health Department, for
the week ending July 12, 18S4 :
WeekEndinff
Ctues,
July 5, 1884....
July 12, 1884. .,
Deaths.
July 5, 1884.. .
July 12, 1884..
I
156
187
A Case of Successful Replantation of a Tooth
is recorded in the Weekly Medical Reidew by Dr. A. B.
Bamette. He writes that he extracted the tooth, cleaned
the cavity, washed the tooth well and put it back. Inside
of a month it was firm and he had it filled.
The Cholera Germ and the Local and Time
Factors. — Professor von Pettenkofer, of Munich, has
written an article in the Neuesten Nachrichien in which
he shows that a bacillus or germ is not alone sufficient
to explain the causation and transmission of cholera.
There must be certain conditions of season and soil
which favor its development. These he calls the '* local
and time factors."
F. Hebra's Prescription for Baldness. — ft. Tinct.
macis, 5 grammes; olei dulcis, 50 grammes. M.
YvoN*s Paraldehyde Elixir for Insomnia. — 9-
Paraldehyde, 10 grammes ; alcohol at 90^, 40 grammes;
tinct. vanillas, 2 grammes ; aquse, 30 grammes ; syr.
simpl., 60 grammes. M. Dose 3 j- to 3 ij-
Removal of a Wandering Spleen. — According to
an account published in the American Medical Jiofirnal
of July, 1884, Dr. E. Younkin, of St. Louis, has success-
fully removed a spleen, which had committed the offence
of being dislocated and causing distressing pains. The
organ was, before removal, two or three times larger
than normal. After removal its parenchyma was found
to be healthy. The patient was a married woman, aged
thirty-two, of slight build, and was in tolerably good
health.
The Last Form of Mercury recommended for me-
dicinal use is the hydrarg^m tannicum oxydulatum,
which has been prepared in the laboratory of Professor
Ludwig, of Vienna. It is a greenish, tasteless powder.
Dose, o.i gramme.
The Medical Rec
A Weekly yournal of Medicine and Surgery
Vol. 36, Ho. 4
New York, July 26, 1884
Whole No. 7x6
SOME REMARKS ON AFFECTIONS OF THE
HEART.
By J. MILNER FOTHERGILL, M.D. Edin., Hon. M.D.
Rush Med. Coll., Jll.
^ifsooATB nuxm or tub oollsgb or physicians or philadblphia, physician
TO TflB QTY OF UHfDON HOSPITAL FOR CISKASBS OP THB CHBST.
IV.
CARDIAC NEUROSES.
YThex a patient presents himself, and still more herself,
before a doct<M: at first-hand, complaining of the heart,
''^ is all Buckingham Palace to a sentry-box the case is
one of a cardiac neurosis, and not organic disease. It is
some ontcome of the latter, as shortness of breath, for
iostance, which leads the subject to the doctor's office
then the case is one of organic disease. Then, when
die patient complains of pain at or near the heart, re-
member disease of the heart does not produce pain.
Aogina pectoris is the only pain linked with disease of
the heart or arteries. You can at once say, " Pain has
nothing to do with heart disease." The patient ma^
lave some heart trouble as a coincident matter ; but, if
10, this has no relation to the pain complained of. But
Wever clear you may be about the matter yourself, you
liU find it no easy matter to convince the patient
Baving laid down these two broad rules, the different
cardiac neuroses may now be sketched in outline.
First comes palpitation. Palpitation linked with efifort
isasaaliy muscular adynamy, and points to the heart as a
muscle. Palpitation coming on at other times than when
eft»t is made points either to vaso-motor disturbance
(goaty), or is neurosal. When a lady is wakened up in the
i^t widi her heart beating violently, and yet now and
again halts, as if it was going to stop, she is naturally
very nnich alarmed. And yet usually she need not be
aknned. Such an experience is common with women
at the menopause ; and there may or may not be an
asthenic condition of the heart-wall present. There may
ke DO gout in the case ; often there is. Very often in
9^ cases there is a weak state of the heart-wall which
nquires attending to by appropriate measures. In some
the attacks are due to some derangement in the in-
Knradon of the heart, connected with the accelerator
of the vagus. A start will cause palpitation in
■any persons, and especially females liable thereto. The
Kxral act will not uncommonly set up violent palpitation,
continence may bring on paroxysms of palpitation,
efiared by intercourse. Indulgence in tea, and to a
extent in coffee^ commonly leads to a condition of
heart where palpitation is experienced on slight
In exophthalmic goitre (Basedow's disease) a
It action of the heart is one of its main features,
dwrea tumultuous action of the heart is usually pres-
L But among all these conditions palpitation pro-
ved by efifort is what puts you on the qui vive for
'iSsease" as compared to *' disorder" of the heart.
Then palpitation may be set up by far-away irritation,
btkin tells of a case where it was set up by a floating
It is common with a misplaced womb, and dis-
when the uterus is restored to its normal posi-
I haye seen it linked with prostatic trouble, and
vith anal eczema. When paroxysms of palpitation
come on without obvious relationship, always institute a
careful search; if you can find something, and put that
something right, you will usually find the palpitation take
its departure.
There is one form of palpitation which has such distinct
relations, and is so commonly met with (when the doctor
has learned to see it), that it deserves a few words. It
is ovarian in its origin. The patient, usually a woman
of child-bearing age, complains of more or fewer of the
following symptoms, sometimes one being more prom-
inent than the other : She has pain in her side with
palpitation. She has vertical headache, with sense of
weight and lowness of spirits, and readily weeps. She
has nausea, indigestion, and often vomits her food : yet
her tongue is clean (this is " clean-tongued " dyspepsia).
She may be said to have inflammation of the stomach,
and her friends are gravely alarmed about her ; and every
medical man of experience could relate such cases. She
has leucorrhcea and often menorrhagia, with a large, heavy
uterus. She cannot hold her water properly, and spasm
is readily and easily produced (the centres for the bladder
a;id the reproductive organs lie near together in the cord,
and are therefore a£fected by the same causeV Beyond
this the patient has times of heat, itching, ana dryness at
the seat and in the vagina. In well-marked cases all
these symptoms are present The cause of all these
linked phenomena is an irritable ovary — when hunted
down. Usually there is pain on defecation if the ovary
lies over the bowels ; if in front, pain in making water.
Usually the ovary can be found swollen, and exquisitely
sensitive to the touch. The sexual act becomes im-
possible from the contact of the glans penis ^dth the ten-
der ovary in many cases. Pressure over the ovary makes
the patient feel deadly sick, and as if she would faint, or
fall in a swoon. Her sensations are reflected on her
face. This is a malady with distinct and unusually well-
marked features, yet it has not found its way into our
text-books. It is common enough to well repay study.;
and in a well-marked case, when symptom after symptom,
into the arcana of her most private sensations, is asked
after, the woman stands as if in the presence of a magi-
cian. Such apparently widely separated phenomena ap-
parently have no connection with each other ; yet their
causation is identical, viz., a troublesome ovary. Waves
of nerve-irritation set up in the ovary travel along difier-
ent nerve-fibres, and find varied terminations. In one
case they set up forcible contractions in the stomach, in
another they are felt in the terminal fibres of the inter- '
costal nerves as gusts of neuralgic pain. In all they
keep the uterus in a state of turgescence, and in most
there is leucorrhcea and heavy menstrual losses. Slowly,
gradually, step b^ step, this Proteus revealed itself to me
on patient persistent attention to it Those to whom I
have shown a typical case never forget it. Whether an
equally vivid impression can be made by a mere descrip-
tion of the case is another matter. It requires the pa-
tient to be there to make it believable ! with her present,
conviction is unavoidable: without her, it looks — ^well,
'Mike a traveller's tale." Such cases are very common.
They do not readily yield to treatment, but a blister over
the ofiending ovary, especially when the menstrual period
is due, bromides and laxatives, usually in time produce
the desired eflect The most marked case which ever
came under my notice was that of a ladv whose ovaries
had been forced down on each side m fi-ont of her
bladder by obstinate constipation in youth, and been
86
THE MEDICAL RECORD.
Duly 26, m^.
pinned there by adhesions. She was barren, and incur*
able, it is needless to say.
Then there are hearts which do not exactly palpitate,
but beat tiunultuously always, with paroxysms of true
palpitation at intervals ; much like the heart in cases of
Graves' or Basedow's diseases. Like all disorders of the
heart these cases yield but slowly to treatment ; and my
impression is strong that in cardiac neuroses belladonna
is more useful than digitalis. .1 may remark that the
effect of belladonna (administered internally) upon the
pupil is so fitful and capricious as to form no guide to
its use ; and still more its disuse !
Dryness of throat and impairment of vision are more
to be relied upon ; still the drug need npt be given up
even for them.
Then there is the condition of " irritable heart," first
described by DaCosta, a mixture of neurosis with atony,
unfitting the owner of it for hard work ; requiring rest
for its cure, and patience too. It is most common in
my experience among doctors of sympathetic tempera-
ment, hard-workers, who carry some of their patients'
cares ; good fellows who take their professional cares to
bed with them — a practice Clifford AUbutt condemned.
The immediate cause of the oncome is usually some
extra demand involving broken rest, and then the heart
becomes irritable and unequal to the demand upon it.
Rest is an essential factor in the treatment of such cases,
which get well, but only very slowly. It does not ap-
pear, fi"om my experience, that the irritable heart ever
passes on to structural change ; further experience may
not corroborate this opinion, but so far it holds good.
Then comes the disturbances of the heart's rhythm,
intermittency and irregularity. Irregularity is, as all
know, connected with a dilated heart, especially when
combined with a mitral lesion. But intermittency may
be a mere trick, as when a hale, old North Country woman
observed " the tick of her heart had gone wrong." It is
not uncommon as a distinct halt in the heart, at varying
intervals, sometimes at long intervals, sometimes fre-
quent, in elderly persons, unaccompanied by any evi-
dences of real mischief afoot. At other times it is found
with senile changes, and as the muscular wall of the
heart is no longer well-fed, so some defective nutrition
in the cardiac ganglia may affect the rhythm. When found
with hard arteries and a feebly acting ventricle, where a
number of the ventricular contractions fail to produce an
impression on the radial pulse, then it is at once sugges-
tive and significant. But frequently intermittency is
found in young healthy subjects, who feel no inconve-
nience therefirom unless they are either medical men
themselves, or have consulted some one. Diseases of
the heart, other than valvular lesions, are so imperfectly
taught in the usual hospital career, that most men have
but hazy views of cardiac maladies, and consequently the
doctor falls back on what he knows, or rather guesses,
that there is something serious, and he will not be caught
napping in his estimate of the gravity of the case. Cases
tejected for insurance, cases rejected for the services,
cases where some one had applied a stethoscope without
the requisite knowledge to wield it wisely, and so taken
alarm and communicated it to the patient, come con-
stantly under my notice ; and the apprehensions of the
patient can usuaUy be set at rest. There seems no raison
ditre for this arythmic condition in many cases.
Then again there is the intermittency so well and ably
described by Dr. B. W. Richardson, F.R.S., which dates
firom some definite time. A shipwreck, some intense
emotion, or other exciting cause, and the action of the
heart is disturbed. A marked instance of this came
under my notice some time ago in the person of a Ca^
nadian store-keeper, whose store caught fire one night,
and by desperate exertions (personal) he succeeded in
quelling the conflagration. Next day he felt his heart
intermit. He consulted several medical men at home
without satisfactory result, so at last came over here,
when I was able to send him away rejoicing ; and some
eighteen months afterward he called to say how very
much better he was ; and certainly the heart had largely
forgotten that night of effort and excitement.
A common form of intermittency is that found after
indigestible meals. Here the old dogma, "irritation of
the gastric fibres of the vagus," may be used to conceal
our lack of more precise knowledge, or in some cases the
presence of elastic ^ in the stomach, acting upon •the
heart through the thin diaphragm, may be the cause of
the disturbance. Commonly such disturbance is seen m
females of a highly developed nervous system ; but is by
no means confined to them. It is met with in persons
of firmer tone after a debauch, or a period of watching
with little sleep, or any other cause which may sap the
energy of the nervous system. When such disturbance
is found, with evidences of asthenia in the heart, as the
result of a hard spell of nursing, for instance, time must
be allowed for the heart to regain its tone.
Marked slowness of the heart's action is generally a
congenital or family affair; but exceeding rapidity of
the heart's action is found in certain cases as a new feat-
ure in cardiac disorders. Suddenly the heart will run off
at the rate of two hundred beats a minute, and keep this
up for hours, the attack passing away as suddenly as it
came on, leaving the patient exhausted ; and no wonder,
for the heart must be like a tetanized muscle with this
tremendous activity. The explanation of such cases
seems to me to be a rapid discharge of the centres of the
accelerator fibres of the vagus in the medulla — a species
of discharge allied to that of the motor centres which
gives epilepsy.
Then there are cases of arrested action of the heart
which may have varied causal relations. Certainly sup-
pressed gout will produce surprising lack of energy in
the heart ; so much so that I have seen a robust man
confined to his bed and feeling as if he would faint on
attempting to rise, the whole passing away with an
attack of gout, and leaving not a wrack behind to tell
of it In other cases the effect is less pronounced ; yet
the 83rmptoms of heart-failure are closely simulated,
causing much alarm and apprehension of fatty degenera-
tion ; such condition also passing away with an explosion
of gout
Comparatively sudden failure of the heart's action is
not rarely seen m over-worked men at the present day,
and is a malady of which we shall see more ere long, in
my opinion. It may occur in stalwart men, and one
marked case in a remarkably strong man came under my
notice last summer. A 3rachting tour has resulted in my
seeing no more of him. This failure of the heart's ac-
tion may be due to distinctly different causes. Two
illustrative cases will demonstrate this. A lady of ad-
mirable physique was severely ill-used by her husband,
and left him. At that time she suffered from want of
tone in her heart, with attacks of palpitation. Soon she
got all right But she was induced to return to him ; he
again ill-used her ; «an attack of bronchitis confined her
to the house, it being winter, so she could not escape.
When she did the heart was found acting feebly, and, in
place of the attacks of palpitations, she was subject to
S3mcopal attacks, in which the heart's action was very
feeble, though she never actually fainted. She recovered
completely from this condition. Thus there seemed to
be exhaustion of the organic nervous system, as the cause.
The next case contrasts with this. A medical man of
magnificent ph3rsique, and great prowess as a swimmer,
came into my room one day leaning on his stick. He
complained of inability to exert himself, and^ at times,
of feeling as if he would faint when the heart's action
was at once feeble and slow. The heart was sound
enough. He also complained of pain betwixt his
shoulders. He was rather surprised when I suggested
we should step over to Dr. Fevrier's and ascertain whal
it was that was wrong in the spine. He decided tha
there was some rheumatic thickening of the spinal men
inges, and advised counter-irritation. As we returned
July 26, 1884.]
THE MEDICAL RECORD.
87
I explained that this was evidently the cause of his at-
(j^:b— that, in my opinion, they were due to some irri-
tatioa acting through the inhibitory fibres of the vagus.
This was a new light to him ; but the consequence has
been that with the disappearance of the spinal symptoms
the heart symptoms have vanished* and he is now as ac-
tive and energetic as ever he was.
Such, then, is some account of a subject yet very far
^001 clear. As to valvular affections and their recog-
nition, probably we have little more to learn. As to
changes in the muscular wall, whether gross or histologi-
cal, our ideas are clearing. But about neuroses of the
licart we have still a very great deal to learn. 'They
are on the increase at the present time, like all neurosal
maladies. The older men have not described them, in
great measure owing to the fact that they did not see
them as we are doing. In another generation they will
have become so important that a general recognition of
them is certain. In the meantime reflex palpitation is
being clearly established, though reflex inhibition is a
leccnt step forward. The effects of disturbance acting
tough the inhibitory and through the accelerator fibres
of the vagus are just dawning upon us. When these
maladies can be described in the noontide daylight of
foil knowledge, the writer of these articles will be but a
memory being rapidly lost in the bn?y activity of a future
time.
THE PREVENTION OF SUMMER COMPLAINT.
By henry DWIGHT CHAPIN, A.M., M.D.,
ArnDTonfc physician to thb oitt-door dkpartmbnt, bbllbvuk hospital
(ouldsbn's class).
Ukdbr the general term " summer complaint " are com-
prised a number of different conditions, including simple
flmctional diarrhoea, inflammatory diarrhoea, dysentery,
and cholera infantum, as they occur during early life in the
heated part of the summer. Cholera infantum is rather
a nure disease, and occurs infrequently in comparison with
the other affections just mentioned. The term is often
loosely applied to every form of infantile diarrhoea occur-
ring in summer, but it should only be used when true
choleraic discharges are present. The heavy mortal-
it? of the summer diarrhoea of infancy and the diffi-
cnltyof controlling it, suggests the inquiry whether more
cannot be done in the line of prevention. The causes
are well known, but do we insist with sufficient stress
upon thehr palliation or removal ? One of the most fre-
quent, and to a great extent preventable causes, is im-
proper feeding. The carelessness and indiscriminateness
of die diet allowed to young children is a matter of con-
tmoal surprise. Frequently mere babies are allowed to
St at the table and partake of the same food as adults. I
bare recently attended a baby, nineteen months old, who
experienced some inconvenience after eating huckleberry
pie with the rest of the family ; and in another case a
mother had given her baby, aged fifteen months, a little
corned beef hash. Although an unwholesome diet may
wnetimes be apparently taJcen with impunity, there still
Ubws an impairment of the digestive power of the
stomach and intestines that is a continual predisposing
Cfflse of diarrhoea. Nor is it easy to understand how
Ais could be otherwise. The undigestible contents of
fte stomach and intestines speedily undergo fermentative
^ges that eventuate in the formation of butyric and
^adds. These irritating acids frequently stimulate
(he intestinal follicles to excessive secretion and increase
tfc peristaltic movements. The marked acid odor of the
iwrited matters and fecal discharges, and the accompa-
^fing excoriation of the buttocks, are frequently evidences
«f tfis fermentative process. Too early weaning of in-
iwsj especially just before, or during the hot months, is
ifrahfol source of trouble, and should always be avoided,
hi order to show the dangers of summer diarrhoea to
«ificially.fed babies, the Bureau d'Hygidne of the city
of Rheims, France, in July, 1882, made a slight change
in the form of death-report required in cases of infantUe
diarrhoea. Children dying from this disease were divided
into two classes — ^those nourished by mother's milk, and
those brought up by hand. From July ist to December
31st, thirty-one infants nourished at the breast and two
hundred and seventy-two brought up on the bottle died of
infantile diarrhoea. While these figures show a larger
relative mortality in hand-fed babies than we are accus-
tomed to see here, they nevertheless enforce an impor-
tant fact. And yet babies are often removed fi-om the
breast at this season for the most trifling reasons. Even
serious objections to nursing must be carefully considered
before taking the risks of an exclusively artificial diet
in hot weather. Despite menstruation, and even of
pregnancy, it is often better for the infant to continue
nursing until the weather becomes cooler. The thirst
naturally produced by the heat causes the baby to wish
to nurse or take the bottle very frequently, and as a re-
sult colic and indigestion are soon induced, which often
eventuate in diarrhoea. The cause of this is evident.
There is a continual rapid evaporation from the skin, and
as a result of this flmid loss the watery parts of the food
are quickly absorbed to make up the deficiency, leaving
the thickened solid part to ferment and cause irritation.
This cause of diarrhoea can be removed by giving mUk
or other nourishment only at suitable intervals, but allow-
ing the baby to drink frequently of water, administered
in small quantities at a time. The avidity with which it
drinks will confirm the indication for its administration.
Thin barley-water often agrees better with the stomach
in hot weather, except in very young babies. Restricted
nursing and a more liberal supply of water would pre-
vent many attacks of diarrhoea in infancy.
It will be impossible to cite all the common errors in
infantile diet that help to form such a heavy mortality
during the summer months. Every physician can do
much in individual cases to lessen this mortality by find-
ing out and preventing these errors. I think that
mothers, especially those living in tenement-houses,
should receive minute and explicit directions as to the
diet of their babies at different ages, and any society that
will attempt such a work can do vastly more good than
in trying to teach ladies how to support a mangled limb
until the doctor arrives.
The intense and all-pervading heat of the summer
months forms a factor in infantile diarrhoea that is not
so easy to eliminate. And yet much can be done even
here in the way of prevention. Heat acts directly and
indirectly in causing the mortality due to summer diar-
rhoea. It acts directly on young children by depressing
and rendering more susceptible their nervous energy,
by enfeebling the digestive organs, and by increasing but
weakening the action of the heart. The indirect effects
of heat are caused by fermentative changes in the food
of infants and in surrounding domestic and civic filth.
The direct connection between decaying refuse matter
and summer complaint is shown by the fact that where-
ever the filth is greatest the death-rate from this cause
is highest. There is a plain indication here for pre-
ventive treatment. The physician must insist upon the
most scrupulous personal and domiciliary cleanliness
during the hot months, while boards of health look after
the condition of sewers, streets, and drains. Fermenta-
tion changes in milk can be largely obviated by boiling
it when fresh to destroy all germs, and then adding a
little alkali.
The direct effect of heat, aside from any increased
foulness of the air that it induces, is an interesting
point to consider. I have prepared the following table
from statistics derived from the Board of Health. It
consists of a comparison of the death-rates fi'om diar-
rhoeal diseases between two winter months and two
summer months, together with the mean temperature of
each month. Under diarrhoeal diseases are included
simple diarrhoea, dysentery, entero-colitis, cholera infan-
88
THE MEDICAL RECORD.
[July 26, 1884.
tuna, cholera morbus, Asiatic cholera, diarrhoeal gastro-
enteritis, and diarrhoeal enteritis.
Deaths from Diarrheal Diseases in New York.
1882.
JaK. Feb. July. Augusts
Mean temp., Fahr 28.77" 35-21'' 75.79* 7342"
Deaths under five years 34 32 1,533 817 \
Deaths over five years 14 15 131 149
1883.
Mean temp. , Fahr 25. 1 8** 30. 24° 74.46" 70.40'
Deaths under five years. 32 32 Ii355 507
Deaths over five years 14 16 125 1 16
A glance at this table will show the tremendous in-
crease in the death-rate under the age of five years in
coniparison with that occurring above that a^e, the dif-
ference in winter being about double, while in summer
it is vastly higher than that proportion. It also shows
that the month having the highest mean temperature,
July, has much the highest death-rate in children under
five years, while in cases above five years of age there is
no appreciable diflference between July and Augugt. In
1882 and 1883 there was an increase of the mean tem-
perature of July over August of from 2.37° to 4.06°
Fahr. The difference in heat represented by these few
degrees doubled the death-rate in children under five
^ears. As tenement-houses and streets are no cleaner
in August than in July, and as there is quite sufficient
heat and moisture during August to cause free fermenta-
tion in any filth, it is evident that the increased infantile
mortality during July is due to a slight increase in the
heat, as the other elements causing it are about the
same. It is an impressive commentary on the inability
of infants to stand a high temperature well, that in
1882 an increase of 2° in temperature was sufficient to
raise the death-rate by just 716 young children in one
month. It is also seen by referring to the table that the
mean temperature of July, 1882, was 1.33° higher than
that of July, 1883, and there were 178 more deaths in
children under five years in the former month. One
explanation of the much higher death-rate of July over
August may be that most of the weak, bottle-fed babies
die during the first heated period ; but this can be offset
by the fact that infants a little stronger and having more
resisting power finally succumb in August, exhausted by
the long-continued heat. I think that sufficient stress
has not been devoted to the injurious effects of heat
itself upon young children by writers on this subject,
and that relatively too preponderating an influence has
been given to impure air. The disastrous effects are
due to such an intimate combination of these two agents
that it is somewhat difficult to estimate their separate
influences. But while it is easy to understand the in-
jurious effects of breathing a foul atmosphere, and its
depreciating consequences are constantly seen, yet the
system, in a sense, gets accustomed to impurity, and
throws it off more or less readily. Young children live
for months shut up in filthy apartments without dying,
and even seeming to enjoy tolerable health.
Of course they grow scrofulous and readily fall victims
to disease ; but, after all, the organism seems to estab-
lish a sort of toleration for filth, just as for arsenic and
many other poisons. Continuous and intense heat does
not seem to allow of any such escape. It is difiicult to
explain exactly the reason that excessive heat produces
such fatal results in early life. It has been affirmed ^at,
in accordance with the physiological law of vicarious
functional action, the over-stimulation of ^reat heat in-
terferes with the secretive powers of the skin, and hence
the mucous membrane is excited to a morbid activity. If
such a relation exists, it is probably more intimate in
children than in adults. Again, the depressing effect of
great heat upon the nervous system is familiar to every
one. In infants, as the vegetative processes are most
active, the great sympathetic ganglia presiding over them
hold a very prominent position m their nervous econ-
omy, and are hence markedly affected by depressing
agents, as heat. Impaired innervation of the stomach
and intestines follows, which results in a diarrhoea upon
the slightest irritation. Physiological processes, under
the especial control of the sympathetic nerves, require a
longer time to be influenced by perturbing causes than
those controlled by the cerebro-spinal system. Accord-
ing to Dalton, inflammation of any internal organ is
rarely established until twelve or twenty-four hours after
the exciting cause. The increased mortality in young
children does not usually commence until a day or so
after the great heat begins, and continues a like period
after the cessation of the heated term. While there may
be some uncertainty as to the exact way in which heat
acts, its unmistakable effects lead us to ask whether even
here some preventive measures may not be of avail. The
free use of the bath, which is apt to be too much neg-
lected, especially among the poorer classes, will do much
to obviate the depressing effects of excessive heat
In an exhaustive monograph, " On the Effects of High
Temperature upon the Public Health," Professor Stephen
Smith has thoroughly discussed the subject of warm and
cold bathing in this connection. The cold bath is gen-
erally used for cooling the body ; as it quickly abstracts
heat from the surface by conduction, there follows a sud-
den reduction of the temperature. By constringing the
vessels of the skin, however, the blood is forced to the
internal organs, which are thereby stimulated to func-
tional activity, and hence as a secondary effect heat is
produced. At the same time the mass of blood, by
leaving the surface, ceases to remain in contact with the
cool medium. After this temporary rise, the tempera-
ture soon falls to normal, and equilibrium is restored.
The effect of a cold bath upon the l)ody temperature
would be thus represented by a curve indicating first a
fall, next a rise above normal, and finally a return to the
average. When a warm bath is used heat is communi-
cated to the body by conduction, and the temperature is
elevated. At the same time, by relaxation of the blood-
vessels and skin, the cutaneous secretions are increased,
the blood is withdrawn from the viscera, and a cooling
process takes place by means of active evaporation. In
a warm bath, therefore, the curve first rises, but next
falls below normal, and finally reaches the average. An
increased coolness follows its administration, while a
warm sensation often follows a cold bath on a very hot
day. Wunderlich states that in tropical countries, and
very hot seasons, no means of cooling is so lasting as a
bath or douche of very warm water. The bad effects of
great heat upon young children can, then, to a certain
extent, be obviated bjr eiving them a suitable bath every
afternoon. If the cmldren are old enough, place them
in a tepid or warm bath, and let them play there for an
hour. The skin will thus be kept active, the blood
cooled by being brought to the surface, and evap>oration
continue for some time. Of course the water should not
be used so warm as to produce relaxation. In the case
of babies too young for the bath, frequent spongings of
the whole body with lukewarm water will fulfil the same
indication. A little vinegar or alcohol may be added to
the water to aid evaporation. If an infant begins to
droop, it is well to give whiskey or brandy, in doses of
from two to three drops for every month of its age up to
a year, and repeated several times a day. Finally, in-
fants should be taken daily, in the early morning or even-
ing, to parks, or on a ferry-boat, where they can get
pure air. If well babies could be thus daily refreshed
they would be much less likely to fall victims to summei
complaint. In the tenement-house districts of this city
they are often confined to the house for days. The
slightest manifestation of diarrhoea in children during the
hot months should be speedily arrested. Many mothen
have an idea that a diarrhoea occurring during teething
should not be quickly checked. Very frequently babiei
July 26, 1884.]
THE MEDICAL RECORD.
89
are brought during these hot days to my clinic at Belle-
vDe half dead, or d3ang, from summer diarrhoea that has
been allowed to run on a week unchecked, because it
occnned during dentition. Many deaths occur annually
from this mischievous notion on the part of mothers.
Just now, as we are beginning to hear much of chol-
era, adults will also be warned against allowing a diar-
rhoea to continue unchecked. It is peculiar to notice in
this connection that while summer diarrhoea attacks bv
preference young childrexi, Asiatic cholera, to which it
bears some resemblance in many of its symptoms and
pathological changes, does not attack, as a rule, the pe-
riod of childhood.
A CONTRIBUTION TO THE LITERATURE OF
PLACENTA PREVIA, WITH A HISTORY OF
EIGHT CASES.
By E. p. CHRISTIAN, A.M., M.D.,
WYAMSOTTBy WIS.
The comparative rarity of this accident of parturition
with others of the dangerous complications, and the dis-
mal records of its literature, are reasons sufficient for any
physician having had any considerable recorded expe-
rience with such cases for giving their histories and re-
sults to the profession. Even though the results of one's
experience may not differ from the average, and he may
have no new suggestions to offer as regards their manage-
ment, yet the recorded histories of their individual
peculiarities, indications^ and results serve to increase
the rather meagre statistics on which, as yet, theories
and conclusions are based, and will help to the increase
of that larger mass of facts upon which more reliable con-
dosions majr be built in the future. Fortunate for the
parturients is it that the danger of exposure to this ac-
ddeiit is so small, but unfortunate for obstetric science
that its comparative rarity affords any one individual so
limited experience from which to generalize. This
infrequency, I suppose, arises not merely from its being an
onnatural condition, the sequence of conception occur-
ring in an abnormal state or condition of the uterus, or
from accidental violence to the mother disturbing the
ovuin in its earliest period of intra-uterine existence.
Ifthu were all, we might expect the accident of placenta
pneria to be of even much more frequent occurrence
than it is. But I suppose it to be in that wonderful pro-
vision against the future danger to the mother, of child-
birth at term, in the fact of the natural tendency of this
condition to terminate in an early abortion. This con-
dition I believe to be the cause of very many early
abortions, often sufficient of itself, oftener perhaps re-
quiring only the slightest accidental violence superadded
to induce the abortive process, and which latter accident
invariably is alleged as the cause. That the condition
of placenta praevia has existed in numerous early abor-
tions of which I have had the care, I have certain and
tadobitable proof from observation ; and when the patient,
other by sufferance of nature or the aid of medical art,
kas advanced to later stages of pregnancy, the tendency
to miscarriage still continues, as is evidenced by the pre-
maturity of so many labors after the stage of viability of
tile child has been reached ; and when the tendency to
tarly abortion has been surmounted, the woman has es-
caped that accident only to become exposed to increas-
ing dangers at parturition in proportion to the stage of
advancement toward full term. And as this condition —
fbcenta praevia — ^is a frequent cause of abortion, so is the
reverse equally true, that frequent abortions are a cause
^placenta praevia, or of the condition of the uterus
1^ predisposes to the accident. I suppose there is
>o more frequent cause of a subinvoluted and enlarged
ttd patulous ntems than frequent abortions. Such an
■tons, with its unopposed walls, fails to retain the ovum
ititi fundus on its arrival and entrance from the Fallopian
^^ and it falls by gravity or is washed down by men-
*tel secretions, or is displaced by ritght jars or other
violence, and reaches the lower portion of the uterus,
there to form its attachment.
I have stated that the literature of placenta praevia
presents but dismal records, which fact is sufficiently well
understood by the profession in a general way, but only
realized in its full significance by one's individual expe-
rience. During the past year there have been a number
of contributions to the literature of the subject in the
medical journals, and which exhibit better results, as far
at least as fatality to the mother is concerned, than
we can be justified in drawing from the statistics of text-
book authorities. Perhaps this ma^ be in some measure
because the more favorable exhibits are the most likely
to reach the light of publication. I shall make reference
to such of this recent literature as has come under my
notice, both for the statistical results, for comparison's
sake, and also by reference to some of the conclusions.
As to the general average of fatality in placenta praevia,
Churchill states (edition of i860) : " In placenta praevia,
under ordinary management, one in three, or thereabouts,
of the mothers are lost, and more than half of the chil-
dren. ** This statement has been criticised as exaggerated.
If it represents that of all cases occurring, the unpub-
lished as well as the published, it is probably not an ex-
SLggerated statement. In fact, as to the fatality to chil-
dren it probably does not represent that sufficiently high
even under skilful management.
T. Curtis Smith, M.D., of Aurora, Ind., in a paper
published in ne Medical and Surgical Reporter of
Philadelphia, July 14, 1883, states that Dr. K W. King,
of New Albany, Ind., has gathered two hundred and fifty
cases occurring in the practice of physicians of that State.
" Of that number there was a loss of fifty-five mothers,
or twenty-two and one-half per cent. The mortality
among children was one hundred and thirty-five, or
over fifty-seven per cent'' These figures would give
a loss of mothers of i in 4.4. ^' Of three hundred
and thirty-two cases collected by Schwartz, there was
one death in 3.86." <* Simpson states a mortality of
I in 3.6." "Trask (Prize Essay) i in 3.95." Dr. Smith,
author of the paper, ^ves a history of three cases in
his practice, one of which was of central implantation —
delivery by version. All the mothers were saved, and
two of the children. Dr. Smith remarks : '< It is an un-
happy fact that a larger proportion of cases of placenta
praevia give mal-presentations than where the placenta
is otherwise normally attached, and hence version is
often a necessary procedure and often causes a fatal
issue."
In Dr. Simpson's tables a large number, twenty-three
in ninety-one, or about twenty-five per cent , were of mal-
presentations, as of shoulder, arm or hand, and head.
This frict, besides its bearing on the rate of fatality, has
another interest to us in its bearing, or the hint it gives us
of the causes of this accident — ^placenta praevia — to which
we have made reference, and shall do so again further
on.
D. C. Davis, M.D., of Columbus, Wis., read a paper
on this subject before the Wisconsin State Medical
Society, and published in the "Journal of the American
Medical Association, September 15, 1883," in which he
records the exceptional experience of having met with
seventeen cases of placenta praevia in sixteen years of
practice. He had saved all the mothers, and saved but
one child. He gives a brief history of two cases in
succession of centndly implanted placenta terminated by
perforation and turning, and formulates the following
conclusion, emphasized in italics : " TTuil without doubt
rapid perforation^ version^ and delivery ofers the easiest^
speediest, and sqfest chance of life to the child and safety
to the mother of any manner or mode of management here^
tofore culvocated and known to me**
He also makes the following statement of a fact re-
marked also by others, and so markedly corroborated by
my own experience, and a truth of such import and
relevancy, that I consider it worthy of special emphasis :
90
THE MEDICAL RECORD.
[July 26, 1884.
"Another fact in favor of this mode of procedure is the
dilatability of the os and cervix in cases of placenta
praevia hemorrhage, for I know whereof I spes^ when
I aver that the uterus, from loss of blood in these cases,
is rendered more passive and dilatable, and consequently
version is more easy of accomplishment than in any
other mal-presentatibn/'
Dr. J. K. Bartlett, Chairman of Section of Obstetrics and
Diseases of Women, in his report at the meeting of the
American Medical Association in 1883, has the following
on this subject : " The report of Mr. Hofiman, of Berlin,
on this subject deserves notice from its unusually favorable
results. He cites forty-six cases. Of these, three were so
near death when seen that there was no opportunity for
treatment. Of the remaining forty-three, six were treated
by the waiting method and the tampon. In the other
thirty-seven no tampon was used. Of the six treated by
tampon at an earlier date, one died, two had a long and
severe illness, and four children were dead. Of the
thirty-seven treated differently one mother only died,
and she had been treated by tampon for twenty-four
hours, and the placenta was offensive when delivered."
(No statement of results to children.)
With this cursory review of some of the recent litera-
ture of placenta praevia as an introduction, I will now
give briefly the histories of my own cases, eight in all.
Case I. — Mrs. C y American;- seventh labor.
Patient weakly and delicate, but obliged to do her own
housework. The subject of several abortions. No com-
plications in previous labors at term. Commenced flaw-
ing at about seven and one-half months ; controlled each
time by tampon. Labor was ushered in and accom-
panied by fearful and exhaustive flooding. Placenta im-
planted centrally over the os, and was expelled in ad-
vance of the child's head, wUch was immediately after
delivered by forceps. The child presented evidences of
having been dead for probably some days previous, by
reason of commencing decomposition. Woman had a
very slow and tedious recovery. This, my first case, and
at a very early period of my practice, was the worst case
I have ever had. With my present knowjedge and experi-
ence, in a similar case, I should perforate, turn, and de-
liver. This, as was shown after delivery, would have
made no difierence as far as the child was concerned,
but would have terminated the labor more rapidly and
have saved the woman considerable blood.
Cass II. — Mrs. S , English ; ninth labor. Heavy
flowing came on at 2 p.m. ; easily controlled, and labor
pains set in at 8 p.m. Examination showed marginal
attachment of placenta, and head already descended so
as to check the hemorrhage. The child was speedily
born, the placenta coming away immediately after. No
interference was necessary to hasten labor, and the
woman quickly recovered. The child was dead.
Cass III. — Mrs. H , Irish; first labor. Flowing
at frequent intervals for past month. Had pains since
morning, with hemorrhage. I saw her for first time at
9 P.M., when she was flooding. Found marginal attach-
ment of placenta. Os only dilated to admit two fingers,
but soft and easily dilatable, notwithstanding this was a
primipara. There had been great losses of blood, and
of course great prostration and relaxation. I dilated
rapidly with my hand, turned readily, and delivered
speedily. Child dead and decomposing. Mother had
felt no life for five days previous. Mother [recovered
quickly.
Case IV. — Canadian French ; sixth labor. I was
called to the patient on account of dangerous flooding.
Examination showed the os already well dilated, with
head presenting, and marginal attachment of placenta ;
pains feeble and inert, as usual after excessive loss of
blood, and insuflicient to press the head down with suf-
ficient force to check the hemorrhage, I applied the
forceps, bringing down the head, which immediately
checked the flow, and readily and easily delivered a large
and living boy. A slight incident in this case illustrates
how, without great carefuhiess in the application of the
blades in such cases, a serious accident might occur, and
one in regard to which I do not recollect to have seen
any caution, perhaps because writers usually advise
against the use of the forceps in placenta prsevia. Hav-
ing applied the blades, I commenced with a gende trac-
tion, upon which the woman screamed out that I was
tearing her. I unlocked the blades and carefully re-
applied, with no further complaint on traction. I had
doubtless grasped a part of the membrane of the pla^
centa between the blade and head. The woman made
a speedy recovery.
Cass V, — Mrs. G. B— , Canadian French; tenth
labor. I was called to this patient some distance b
the country, on account of dangerous flooding, the
woman being in eighth month of pregnancy and not yet
expecting labor. Examination showed os uteri soft and
dilatable, but as yet dilated only to admit finger, and
central implantation of placenta ; very feeble pains, as
usual after excessive hemorrhage, and woman danger-
ously prostrated for so unadvanced a stage of the labor.
I commenced giving er^ot to promote contraction, as-
sisted with digital dilatation, and, as soon as practicable,
separation of placental attachment on one side until the
bag of waters could be felt, which was ruptured. This,
with the increasing ergotic contractions, brought the
head against the bleeding surface, checking the hemor-
rhage. Labor progressed favorably, and die child was
bom, the placenta having become totally detached by
the advancing head, and coming before it The child
was dead.
Cask VI. — Mrs. J , Canadian; seventh labor.
Threatened abortion at fourth month, with hemorrhage ;
agaui at fifth month in increased quantity ; recurring at-
tacks in increasing frequency up to the seventh month,
when indications of labor set in with such terrific losses
of blood that on my arrival I considered it necessary to
terminate labor as speedily as possible to save the
woman's life. The safety of the child, under the cir-
cumstances, was considered a small matter, especially as
the woman was only at the seventh month, and I con-
sidered that the previous long-continued hemorrhages
had in all probability compromised its chances of hfe.
At any rate, it was necessary that assistance should be
given promptly to the mother or she would be lost
Examination showed central implantation ; os dilated to
some extent; easily dilatable and soft; pains inert
Gave ergot liberally ; accomplished rapid manual dila-
tation ; detached placenta ; performed version, and
delivered a dead boy. Woman recovered, but required
time to recuperate from her excessive prostration.
Case VII.— Mrs. C. S , German ; fifth labor. Pos-
terior marginal implantation of placenta, with presentation
of left arm and prolapsed funis ; patient attended by a mid-
wife, who sent for me on account of the mal-presentation
and severe hemorrhage since commencement of labor,,
which was at full term. Os sufficiently dilated on my
arrival for immediate assistance, which I proceeded to-
render by turning the child and delivering by the feet,
and which was readily accomplished, and the woman de-
livered of a dead boy. Woman speedily recovered.
Case VIII. — Mrs. G , German; mother of two
healthy children, born at full term, by first husband, and
of numerous abortions by her second The case was
one of miscarriage at sixth month, and unaccompanied
or preceded by henoorrhage until after perforation of pla-
centa, and then comparatively insignificant. The case
was peculiar and unique. Threatened abortion, as usual^
at about the third month, with discharge of water, but
without hemorrhage. Water had continued dribbling
away ever since. Labor came on and progressed very
slowly on account of inefficiency of pains. The os hav-
ing after many hoiu^ become well dilated, I concluded
to rupture what, from the undeveloped condition of pla-
centa at that stage of gestation, firom its being free from
attachment in the neighborhood of the os and jdelding
July 36, 1884.]
THE MEDICAL RECORD.
91
before the pressure of the finger, and from the absence
of bemonfaage, I did not suspect to be the placenta, but
the amniotic bag, for the purpose of engaging the foetus
in the mouth of uterus, and increasing the force of the
inert pains. I found this unusually thick, and more diffi-
cult of penetration than usual, and its accomplishment
was followed by a discharge of blood for the first time.
A leg was found presenting and brought down, and the
body engaging the hemorrhage ceased and child was
soon bom. It was felt to move during extraction, but
showed no indications of life after it was bom, probably
owing to some delay with the head Attention was now
given to extraction of the placenta, which was found
covering the os and firmly attached away from its mar-
gins. So firmly adherent was it, and so sensitive the os,
and 80 painful were manipulations, that it was necessary
to pat the patient under chloroform for that purpose.
Exunioation of the placenta showed the rent near one
border, through which the child had been extracted.
The separation of the placenta, in this case, I suppose to
have been going on gradually since the rupture of the am-
niotic sac in the third month, and accompanied by inflam-
matoiy changes in the parts, such as to close the mouths
ci exposed vessels and prevent hemorrhage. Dr. Simp-
son has given as one of his therapeutical deductions in re-
gard to the physiology and treatment of placenta praevia,
« that inflammation of the uterine structures, particularly
of the cervix, is especially likely to supervene when de-
livery is attended by placental presentation." This was
a oomplication of my first case also, notwithstanding
numerous exhausting hemorrhages, and which retarded
her recovery. In diat case it may have been in part
due to^ or aggravated by, the use of the tampon.
These are ail the cases of placenta praevia it has been
017 good, or bad, fortune to meet in a practice extend-
ing over thirty-two years. I have met with three cases
in one year, and then again have passed a period of ten
jeaxs without meeting a case.
Analysis of the cases shows four of them central or
completely covering the os — Cases I., V., VI., and VIII.;
and four marginal — Cases II., III., IV., and VII.
Two cases were delivered by forceps, one of central
implantation, in which case the child showed evidences
of having been dead for days before labor set in; the
olher, a case of marginal implantation, the child was bom
alive and healthy, the os being sufficiently dilated to
admit of easy application of forceps on my arrival. This
was the only living child of the whole eight cases.
Three cases were delivered by version ; one of central,
in which the placenta was detached for that purpose, and
two of marginal : one of the latter was complicated by
descent of funis and an arm. One case by perforation
of placenta and delivery by presenting feet One case
bf manual dilatation and ergot only, and one requiring
absdutely no interference, a speedy and easy delivery,
•nd yet die child was bom dead. In all the cases of
reision or manual dilatation, the os was found soft and
easily dilatable, in accordance with the observation of Dr.
Bavis, ** that the uterus, firom loss of blood in these cases,
is rendered more passive and dilatable, and consequently
version is more easily accomplished than in any other
oal-presentation." All the mothers were saved, and
bat one child. But how little bearing the manage-
ment of the cases during labor has had on the rate of
mortality to the infants will be shown by a consideration
of die drcomstances of their histories. Two of the chil-
dren showed evidences of having been dead for days
pievious to labor — destroyed by the previous hemor-
doges, by asphyxia, as Cazeaux states, from interference
vith dke placental circulation. One was a case compli-
cated wiUi other mal^presentations, rendering version
necessary, and in such cases alone the mortality is very
pMi and when superadded to placenta praevia leaves
^ a hopeless chance for the safety of the child. One
vas a case of premature delivery at six months, in which
^ child would have been in any case lost, because of its
immaturity. This would leave but four cases, or fifty
per cent., in which the accidents or management of labor
could be at all supposed to have affected the rate of mor-
tality to the infants. But in addition, Case II. was an easy
and speedy labor, with absolutely no call for interference,
and yet here the infiint was bom dead, destroyed, doubt-
less, by the preceding hemorrhage,' only a few hours be-
fore; and again two more of the cases (V. and VI.) were
premature deliveries at eight and seven months, in which
cases, if not destroyed by the hemorrhages, the chances
of life to the children were correspondingly lessened by
their prematurity. In Cases I. and V., the placenta came
in advance of the child, which would seem to be a cir-
cumstance almost certainly fatal to the infant, and very
dangerous to the mother. Chiurchill remarks in r^;ard
to such cases, "the mother is not always lost in these
cases ;" and again, **• now it appears that these instances
are not so rare as was supposed.*' He states that Dr.
Simpson has coUected one hundred and thirty cases in
which the placenta was either expelled or extracted first,
and that in all ten women died, or one in thirteen — and
of one hundred and ten cases the infant was bom dead
in seventy-three, or sixty-nine per cent, and saved in
thirty-three, or thirty-one per cent. Acting on the now
generally recommended and accepted method of perfora-
tion of placenta and version, this accident will be less
likely to occur, and yet we venture to say that this opera-
tion will not always prevent the extrusion of the placenta
in advance of the child. I have had more than once
separation of a normally attached placenta in the opera^
tion of turning for abnormal presentations, and have lost
the child probably in consequence. It will be no less
likely to occur when attached about the os.
The one only child saved of my eight cases was de-
livered by the generally disapproved method of the for-
ceps. No doubt the timely and opportune application
was proper and correct in this case.' The summary of
results from the cases given in the papers to which I have
made reference is as follows :
i Number
of cases.
1
Mothers' Per j Children
saved. |. cent | saved.
1" 1
Per
cent.
T. C. Smith 3
D. C. Davis 17
Hoffman 1 46
My own 8
3 100
17 100
41 89
8 I 100
2
I
67
6
"•5
; 74
69
97.25
4
14
These results, so far as any conclusions may be legit-
imately drawn from such meagre records, show much
more fiivorably for the mother, and contrariwise for the
infant, than the results commonly given by writers ; and
that while there seem to be good reasons for believing
there has been an improvement in the chances for the
mother, that no such encouragement is warranted as
regards the child ; nor from a consideration of the nature
and circumstances of the accident does it seem probable
that any great improvement in that respect can be at-
tained for the following reasons :
1. If my cases are a fair average exhibit, from twenty-
five to thirty-three per cent, of all will be destroyed by
disturbances of the circulation previous to labor.
2. From Simpson's statistics twenty-five per cent, of
all cases will be complicated with other mal-presenta^
tions, compromising the life of the child in a very large
proportion of them.
3. From twenty-five to thirty-five per cent of all will
be premature births. If, then, to these circumstances we
add the risks from hemorrhage in labor, besides the risks
from version and other artificial interiference and aids,
we can understand that the risks to the child must al-
ways remain so great as to permit of the safe delivery of
but a small proportion, and we may also understand why
92
THE MEDICAL RECORD.
[July 26, 1884.
nature, in her beneficence, looking to the safety of the
mother in the great majority of the cases, probably pre-
fers the sacrifice of the o£fspriug by an early abortion.
In conclusion, what are the causes of this accident of
parturition whidi, despite of all proposed methods of
management, continues, in its fatality to children, as
merciless as the execution of the Herodian edict for the
slaughter of the innocents, and, more merciless than that,
destroys also a large percentage of the mothers, causing
lamentation and mourning in households, and anxious
care and harassing disappointment, and vexatious dis-
satisfaction to the physician with the results of his most
energetic and conscientious efforts to bring the labor to
a safe and happy termination, not only as re^rds the
mother but to save her o£fspring ? The condition is un-
physiological, and I should suppose peculiar in and pos-
sible only to the human female, unless, peiiiaps, the quad*
rumana may be exposed to it. Writers have particiilarly
called attention to the fact of the frequent complication
of this accident with other coincident mal-presentations.
Dr. Simpson^ as we have stated, gives a table of twenty-
three cases of other mal-presentations in a table of ninety-
one cases of placenta praevia. Dr. T. Gaillard Thomas, in
a clinical lecture on " Causes and Treatment of Abor-
tion," published in the New York Medical Journaly Janu-
ary 24, 1884, states that '^ there are two great causes of
abortion — ^first, a posterior displacement of the uterus,
which interferes with a proper development of the organ ;
second, syphilis.'* But the first is the only one which has
any relevancy to our subject, and this because it is evi-
dence from eminent authority of that condition as the
most frequent cause of abortion which we regard as the
most prolific cause of mal-positions and placenta prsevia,
not posterior displacement of itself, but the cause of pos-
terior and of other displacements. For what is the cause
of these displacements ?
The cause is in the increased bulk and weight of
the uterus firom subinvolution, as is also that of un-
natural relaxation and patency. In a paper before this
Society, two years ago, on some mal-presentations, I
I stated this as the prolific cause of mal-presentations,
placenta praevia, ancl abortions. These accidents — mal-
presentations and placenta praevia — occur for the most
part in multiparas or in multipregnant women, and fre-
quent conceptions, but more especially repeated abor-
tions, are the most prolific cause of unnatural relaxation
and patency, and are, again, the cause of too frequent
conceptions. A relaxed uterus with an enlarged and
patulous cavity fails to arrest and detain the ovum on
its arrival in the uterus from the Fallopian tubes, or it is
washed down by the menstrual secretions, or is more
readily displaced by the movements of the mother, or by
any violence or shock, and is thereby caused to form an
unnatural attachment, and the same conditions may
favor unnatural positions in the developing and growing
^erm from the very commencement of intra-uterine ex-
istence.
An Old Mode of DErBcriNG Kabibs. — To enable a
person who had been bitten by a dog to ascertain whether
or not the animal was rabid, the Universal Magazine^ a
London monthly publication, in its issue of November,
^ 753> published the following, which is accredited to " The
Memoirs of the Royal Academy of Sciences at Paris:'*
*• When a person hath been bitten by a dog that is ap-
prehended to be mad, it commonly happens that the dog
18 killed before one is assured of his condition, and the
person bitten continues in a cruel uncertainty. Mr.
Petit, the surgeon, hath an expedient for putting an end
to this uneasiness. He rubs the throat, the teeth, and
the gums of the dead dog with a piece of meat that hath
been dressed, taking care that there be no blood to stain
ity and then ofiers it to a living dog. If he refuses it
with crying and howling, the deaid dog was certainly mad ;
but if the victuals have been well received and eaten,
there is nothing to fear."
ON THE UNTRUSTWORTHINESS OF FLUID
EXTRACTS,
With Practical Notes Rbgarding Rhus Toxi-
codendron, Pulsatilla, Cereus Bonplandi, and
OTHER Plants.
By N. L. north, M.D.,
BROOKLYN, N. Y.
" Untrustworthy '* ought to be written after the name
of many of the fluid extracts of medicinal plants as
usually found on our apothecaries' shelves. I have a
habit of tasting, at a subsequent visit, of nearly all the
medicines I prescribe, and I find there is a large number
of the fluid extracts in many of the officinal and ud-
officinal V forms prepared for our use by the pharmacists
which taste exactly alike. That taste is a peculiar, stale,
dirty, gritty one, often entirely wanting in the special
aroma peculiar to each plant in the green state ; and
just here, I make no doubt, is the secret of the untrust-
worthiness of many of these "medicines." Instead of
the fluid extract being made from the recent or fresh
green herb, it is too often made from a dried, more or
less inert plant, from which the volatile, and often the
active principle has, perhaps, wholly evaporated.
This fact will no doubt go far to explain the sentence,
" The medical virtues of this plant are too uncertain to
inspire any confidence in it," or something meaning the
same thing, so often found in the di^ensatories. To
particularize : The article rhus toxicodendron, which
is dismissed by the National Dispensatory with the re-
mark quoted above, after being thought worthy to be
considered officinal under the head of Toxicodendron, is, *
there can be no doubt, a plant of definite and consider-
able power medicinally, if rightly prepared and properly
used. Dr. Thomas Giflbrd, of Laurel, Ind., speaks veiy
highly of its curative action in sciatica, having used it
successfully for many years, even in cases of one, two,
and three years' standing. Dufresnoy called attention
to the rhus toxicodendron as a remedy in herpetic and
eczematous diseases as early as 1 798. Phillips, in his
work on *<The Materia Medica, etc., of the Vegetable
Kingdom,'' refers to the rhus as a very powerful thera-
peutic a^ent in "various subacute and chronic rheu-
matic affections of the fibrous tissues generally." Dr.
H. G. Fiffard, of New York, in an editorial note in Dr.
Phillips' book, confirms its usefulness. Speaking of the
probable error sometimes made by physicians, mistaking
the '^ worse-at-night " rheumatism for syphilitic rheu-
matism. Dr. Piffard says : " In a number of these cases
we have obtained most decided and prompt relief from
rhus." The whole matter turns upon the mode of prep-
aration. The officinal fluid extract, of which it is ad-
vised to give from one to ten drops, is probably good for
nothing. Dr. Gifford makes a strong tincture (one part
to two of alcohol) from the green herb, gathered the last
of May or the first of June, previous to the flowering of
the plant. It is gathered after sundown of a lowery day.
He likely in this way preserves the toxicodendric acid.
Of this tincture he gives from one-tenth to one-filth of a
minim in a spoonfiil of water twice a day, and in some
cases he advises even smaller doses. Dr. Phillips ad-
vises a tincture made by macerating one part of fresh
leaves in two parts of alcohol ; of this he advises a small
fraction of a minim in rheumatic and cutaneous afifec-
tions. The tincture of the German Pharmacopoeia is
made from five parts of the fresh leaves to six parts of
alcohol.
Again, in the National Dispensatory we find after the
description of Pulsatilla, lately made officinal, ^' No suf-
ficient grounds exist for its use in therapeutics." Never-
theless Pulsatilla is often spoken of in the journals and
1 1 mention in diii ooonectioa die so-called ^m^jficmml mBdicbud^preparatiiHis
because it is a well-knoMrn ikct that there are a larve number of what tne makers ol
our pharmacopoeias fiul to recogniae as offieituU, lac decade after decade, whacfa
are, nevertheless, "in the shops,** and oonstandy being used by
practitioners.
July 26, 18^.]
THE MEDICAL RECORD.
93
10 otber waj$ by such men as Sturgis^ Pifiard, and Fox,
of New York, and Borchiem, of Atlanta, Ga., as a
jemedy of much value in glandular inflamniations and
particularly in epididymitis. Phillips {" Vegetable
Materia Medica "^^^ after advising its use in several in-
flammatory conditions, says, '* The fluid extract is un-
reliable," and recommends a tincture made of equal
parts d the expressed juice and alcohol, of which he
ffives from one-tenth to five minims.
There is another article or herb product which I have
been in the habit of using and recommending for some
eight to ten years, more especially for cardiac insuffi-
oency, that I fear may soon be hard to obtain in its
proper form, as I learn that one, at least, of the drug
manufacturers is already preparing and recommending a
fluid extract of it. I refer to the cereus bonplandi. It
is not mentioned in any of the regular works on Materia
Medica to which I have access. I first saw it spoken of
in the Medical Brief hy a Dr. Goss, who, I think, is an
"eclectic" The preparation he recommended and the
one I have always used, when I could get it, is a strong
liflctnre of the green herb, prepared by a German drug-
gist, R. E. KuDze, 606 Third Avenue, New York. The
tincture should have a decidedly green tint. There is a
preparation of a less decided tint, probably made from a
partially dried herb, which is occasionally used, but is
scarcely reliable. The homoeopathists have a brown prepa-
lation of the cereus grandiflora (night-blooming cereus)
that 1 find sometimes substituted, but which has almost
DO value in my hands. The green tincture of Dr. Kunze
is one of the most satisfactory remedies I use. In ten-
drop doses, three or four times a day, it will correct
^palpitation" and irregular action of the heart from
6mctioDal derangement with so much certainty to the
physician and comfort to the patient, as to be a source
of profound satisfaction. It seems to give tone to the
nerves and centres controlling the heart's movements.
Even in organic disease of the heart, with valvular in-
safficieocy, whether resulting from rheumatic endocar-
ditis or otherwise, this remedy, through its steadying
pover, particularly in young subjects, gives positive re-
lief, and in some cases appears to exert a curative action.
There are many other plants and plant products of
more or less acknowledged usefulness which are gradu-
ally falling into disuse because, possibly, of the prevalent
niodes of preparation. The Phytolacca decandra, a suc-
colent plant, i$ a powerful remedial agent in local in-
^mmaXoiy conditions — ^notably in mastitis — used in-
ternally and externally, and yet the fluid extract of the
^ed plant is of doubtful utility. The silphium gummi-
feram (rosin weed) has probably some virtue in bronchial
catarrh and like affections \ I saw an account from a
French journal, some years ago, in which it was thought
to have cured phthisis. I have used it considerably, with
apparent benefit, in phthisical cases. It is used in the
pruiie districts of the West as a domestic remedy, and
far horses with the '^ heaves.'' The plant probably has vir-
toe, but the only form in which we can get it is the fluid
extiact, and that, as in the case df the others named, and
of many more that might be named, promises but little.
I have before me a long list of fluid extracts as prepared
hf one of the leading wholesale dru^ manufacturers of
New York, of which the dose list in itself is suspicious,
ia that in many cases it would be impossible to follow
directions without danger, if the remedies were made, as
^should be, with the requisite caution and care to
(tein all of curative value each individual plant, at its
best, afi:>rds.i»
1 desire to add, what is evidently apparent from what
1 have already written, that I make no claim to practical
phffmacy. My remarks should not be received as being
Dade in the spirit of criticism, but as an expression of
desire that the evils referred to might be corrected by an
cibrt on the part of our drug-makers and pharmacists to
one thoroughly study indivuiual drugs and plants, and
» treat them as to capture that in them, whether it be
one or many virtues or " active principles," as that there
may be results commensurate with the necessities caused
by disease, and as far as may be possible uniform results
when the medicine is properly administered.
A STAPHYLOMATOUS EYEBALL ENUCLE-
ATED FOR SYMPATHETIC IRRITATION,
CALCIFIED CORNEA, ETC.
Reported by DAVID WEBSTER, M.D.,
PROFESSOR OP OPHTHALMOLOGY IN THE NEW YORK POLYCUNIC, BTC.
Mrs. Henry M , sixty- three years of age, was re-
ferred to Dr. C. R. Agnew by her *family physician on
March 24, 1883, for advice in regard to her eyes. She
gave a history of having caught cold while suffering from
an attack of the measles when she was seven years old.
Both of her eyes were severely inflamed then and for
some time afterward. From present appearances it is
evident that she had keratitis and cyclitis. The cornea
of the left eye is protuberant from softening and dilata-
tion of the eye-wall in the ciliary region, and presents
two large patches of dense, apparently cicatricial opacity.
The iris, indistinctly seen, is shaky, showing a probable
dislocation of the lens and a fluid vitreous, and the eye
is without perception of light. The right eye has corneal
opacities from old keratitis, and is highly myopic with
greatly reduced vision from irregular astigmatism. Both
eyes have been irritable for the last few days.
Enucleation of the left eye was advised at this visits
but was deferred by the patient for nearly a year, during
which time she was troubled with recurring attacks of
conjunctivitis affecting both eyes. At length she con-
sented to enucleation, and the operation was performed
by Dr. Agnew on February 28, 1884.
The eyeball, which seemed to be much elongated an-
tero-posteriorly, was put into Muller's fluid, and was
examined by Dr. T. Mitchell Prudden, who on June 13,
1884, made the following report :
'• Macroscopical examination. — ^The eye was enlarged,
measuring 2.7 ctm. transversely and 3.3 ctm. antero-pos^
teriorly. On section, the lens is loosely attached and
lies considerably behind the iris at one side of the an-
tero-posterior axis of the globe. There is attachment of
the iris to the cornea at one side. The vitreous is soft
and partially disintegrated. Depression of the optic /o-
pilla 1.5 mm. deep. Retina on one side partially de-
tached from the choroid.
^^Microscopical examination, — ^I'he anterior epithe-
lium of the cornea and the substantia propria are uneven,
being in some places thinned and in others thickened.
The substance of the cornea shows in the anterior layers,
chiefly on one side, extensive infiltration with larger and
smaller irregularly spheroidal masses and globules of cal-
cium carbonate (carbonic acid given off on addition of
hydrochloric acid). Cornea also irregularly infiltrated
with spheroidal and variously shaped cells.
" The /rtf, which is in part atrophied and much dis-
torted, is firmly adherent tp the cornea a little to one side
of the antero-posterior axis of the globe, over a small area.
" The ciliary body is drawn backward, flattened, dis-
torted, and partially atrophied.
" The lens shows in a few places hyaline degeneration
of the fibres.
" The choroid is normal except for moderate conges-
tion of blood-vessels in places.
" The retina^ in general, appears normal, except that
there is slight detachment on one side, and scattered
areas of oedema, particularly of the external molecular
layer. There is atrophy of the retina, however, about
the glaucomatous depression of the optic nerve entrance.
'* Anatomical diagnosis. — Keratitis with calcification
in anterior layers of cornea, flattening, and atrophy of
ciliary body, anterior synechia, displacement of lens with
commencing degeneration, moderate congestion of cho-
roid and slight detachment of retina, glaucomatous exca-
vation of optic disk."
94
THE MEDICAL RECORD.
[July 26, 1884,
ELECTROLYSIS IN STRICTURE.
By H. W. STREETER, M.D.,
ROCHBSTBIt, N. Y.
I HAVE seen such remarkable statements, from time to
time, of the effects of electrolysis in the treatment of
urethral stricture, that I am constrained to give the re-
sults of my experience. I would premise by saying that
I regard any contraction of the urethra smaller than the
normal meatus, as tested by bulbous sounds, as a strict-
ure ; and that no case is cured as long as such contrac-
tions can be detected. For although the symptoms may
be relieved for the time, they are liable to return at any
time upon slight provocation. No recognized authority
upon surgery or electricity with which I am acquainted,
claim any such results as these writers in the journals.
Otis says, in a private communication to the writer, he
thinks it more likely to cause, than to cure stricture.
Keyes writes that he had tested it in a series of cases in
Charity Hospital and found it worthless. Particulars of
these cases are found in Keyes and Van Buren on "Ven-
ereal Diseases." Rockwell, one of the authors of Beard
and Rockwell's "Electricity," speaks in very guarded
terms of its effects.
I determined to try it as occasion should present. I
tried it in all upon seventeen patients, several of whom
had heard of it, while the others were bitterly opposed
to urethrotomy, and all had become dissatisfied with dila-
tation. With weak currents of six to eight cells, at in-
tervals of eight to fourteen days, I produced no effect ;
with stronger currents, the only eflfect was irritation and
more or less inflammation. The calibre of these strict-
ures varied from six to sixteen, and my applications varied
from six to twelve in each case. In thirteen of the cases
I used currents which could be barely felt by the patients
(as advised by the writers referred to), and created no ir-
ritation. . With four patients, who wanted anything; rather
than the knife, and in whom repeated weak applications
failed, I tried the stronger currents, with only bad e£fects.
All of these cases I afterward cut with Otis' dilating ure-
throtome, with the result of producing immediate relief,
and in most of the cases, I have reason to think, perma-
nent cure. In no other similar affection — stricture of
the oesophagus, of the rectum, or organized abnormal
tissue, have any such results been claimed for electroly-
sis when applied in such weak and superficial method as
described in the articles referred to. And I know of
no reason — clinical, physiological, or therapeutical — why
such results should be expected, or why the urethra
should be an exception to all the other tissues of the
body. Any deviation from the normal calibre of the ure-
thra is liable to produce local and reflex symptoms, which
will continue as long as the stricture remains. Recent
strictures may be relieved, and some cured, by dilatation,
but I do not think either reason or experience leads us to
expect that many strictures can be permanently cured by
dilatation, and we all know how unsatisfactory even is
the relief given by sounds. Urethrotomy by Otis'
method is based on common sense, and should theoreti-
cally cure stricture. It may be said of it, in the great
majority of cases, that it is simple and easy of perform-
ance, safe, less painful than dilating by a full-sized sound,
1.^., one large enough to do any good, produces imme-
diate relief, and if not permanent cure in every case, it i§
more effectual than any other method yet devised
Medical Students in Germany. — The following
figures show the number of medical students at the chief
German universities during this term : Berlin, 924, in-
cluding 20 from America, 6 from Asia, and 2 from
Africa; Jena, 162 ; Bonn, 289 ; Konigsberg, 267 ; Halle,
282; Grtittingen, 189; Giessen, 126; Tiibingen, 224;
Strassburg, 172. The autumn cyclus of the holiday course
of lectures for practising medical men will take place at
Berlin from September 24th to the end of October.
A PLEA FOR THE USE OF DELICATE TESTS
FOR ALBUMEN IN URINE.
By GEORGE B. FOWLER, M.D.,
PKOFRSSOS OP PHYSIOLOGICAL CHBMISTRY, NKW YOKK POLYCLINIC; VISITING
PKYStaAN TO THB NEW YORK IMPANT ASYLUBL
Whether, in every instance, the presence of albumen in
urine, in any proportion, is necessarily the signal for an
alarming prognosis, is a question destined to receive
much attention in the near future. Yet, whatever be the
verdict, I am convinced that albuminuria is not a physio-
logical condition. And, while many apparently healthy
people may present this symptom in a given case, we
certainly are not yet prepared to say what will be the ul-
timate result.
To be in perfect health implies a condition easier to
comprehend than define. Many trivial indispositions
connected with various organs have, from their tendency
to pass off, taught us indifference. But ignorance on
the part of the patient of the possible significance of his
slight symptoms, and failure or inability of the physician
to apply minute methods of investigation, have too often
proved the source of future regret and disaster.
If we are dealing with a supposed " fimctional " case,
and look anxiously for the gradual disappearance of the
morbid chemical reaction of the urine, how much more
does it not behoove us to be familiar with those delicate
processes, by whose means we shall be enabled to fol-
low the intruder across the pathological territory, and
back into physiological bounds.
And, moreover, if it is ever to be established that a
trace of albumen in the urine is compatible with health,
it will be by a skilful use of the more delicate tests. I
am, therefore, not in harmony with those who say that
heat and nitric acid are sufficient ; for this is equivalent
to the dogmatical assertion that where these reagents
fail there is no albuminuria. It is a significant fact, in
this connection, that neither albumen nor any of its allied
compounds are met with, under normal conditions, in any
of the excretions. In fact, the loss of these substances is
expressly guarded against bv one of their characteristic
qualities, namely, indiffusibility.
The only albuminous derivatives capable of ready
transudation are peptones ; yet, although these are pro-
duced in such great quantity in the stomach and intes-
tines during digestion, their loss is prevented by the pro-
vision that they must pass through the liver before
entering the general circulation. In the liver they are
transformed into matters having no tendency to escape.
As regards the reagents most to be relied upon in
testing for albumen in urine, I will simply say a word,
for much has recently been written upon this matter.
In order to determine the comparative delicacy of some
of the methods, I used the serum of ox-blood, carefully
drawn from a firm clot, and mingled it in var}'ing propor-
tions with normal urine. Now, the composition of this
serum is as follows : Water, 90 parts ; proteids, 8 ; fats,
salines, etc., 2 = 100 pfu-ts.
The proteids consist of two forms of albumen, serum-al-
bumen and paraglobulin, in about equal proportions. As
these two substances are always associated in albumin-
ous urine, and respond to the tests to be enumerated,
their distinctive qualities need not be dwelt upon, and
they are together reckoned as albuminous. But the trial
solutions having been made with serum and water, in
order to know the proportion of albumen detected, we
must go through with a little calculation based on the
proportion of albumen present in the serum. This has
been done, and the results, as given below, are for albumen
calculated as dry. I speak of this because most of those
who have gone over this ground leave us in the dark
whether with any given method (having used serum or
white of egg) the percentage detected means the per-
centage of serum or white of egg respectively, or the
actual proportion of albumen present.
As a result of numerous and very careful trials with
July 26, 1884.]
THE MEDICAL RECORD.
95
beat, nitric add, picric acid, acidulated brine, potassium,
fcrrocyanide and acetic acid, potassio-mercuric iodide,
and other methods, I found the following to be their re-
spective capabilities :
Heaiy in neutral solution, fails with .018 of one per
cent; in slightly acid solution, reacts with .018 of one
per cent
Acidulated brine^ about same delicacy as heat
Picric c^id^ if carefully applied, will detect .008 of one
per cent. But being of low specific gravity it is some-
times difficult to employ the contact method with it. Its
decided yellow color masks its effects and interferes with
its delicacy.
Nitric cuid is satisfactory with Tan .008 of one per
cent solution of albumen, if the contact method is em-
ployed The greater the diameter of the test-tube, and
tbe longer it stands perfectly still, the more marked is
the ring of coagulation.)
Potassium^ ferrocyanide^ and acetic acid. — ^The urine
being first made decidedly acid, and then a few drops of
the ferrojgramde added, feint clouds of opalescence will
be seen in an .008 of one per cent, solution of albumen.
Potassifhmercuric iodide * gives a very manifest reaction
with a .004 of one per cent, solution, and, hence, is the
most delicate of all.
It should be borne in mind that both picric acid and
the potassio-mercuric-iodide solution, also precipitate
peptones, quinine, morphia, strychnia, and perhaps other
alkaloids, and the former may throw down the urates.
All of these precipitates, however, completely disappear
en heating the solution, thereby enabling us easily to
distinguish them from albumen.
These percentages may seem to some very small and
not worth detecting ; but I contend that, pathologically
considered, they are by no means insignificant. Let
OS look at it practically. Serum contains about eight
per cent, of albumen (or proteids precipitable by the
foregoing means). We pass about 1,500 c.a of urine per
day, and urinate about six times. That would be about
150 c.c for each time. Now, i c.c. of serum in each of
these voidings, or 6 c.c. in the whole, would give us .031
of one per cent, of albumen.
So we see that, although the percentage of albumen
may be down among the thousandths, an appreciable
quantity of blood-serum is thereby represented. And, to
my mind, the leakage of 6 c.c. of serum through the
kKlneys per day is abnormal, and suggests danger ahead.
At any rate it is well to be able to know it, so as to keep
a sharp lookout
For those who may desire to learn more regarding the
origin suid development of these new tests, and who are
not familiar with the precautions to be observed in their
application, I append a brief bibliography :
" Urine Testing," Lancet (Am. ed), May, 1883, P-
466; Pavy : "Urinary Test Pellets," Lancet (Am. ed.),
April, 1883, P- 318; Roberts : "Acidulated Brine Test
fcf Albumen," Ztf«^^/, December, 1882, p. 438; John-
son: "Picric Acid as Test for Albumen,*' etc., -ffr/VwA
Medical fourmdy March 17, 1883, p. 504; Johnson:
"Picric Acid as a Means of Distinguishing Albumen from
Peptone," British Medical Journal^ March 31, 1883, p.
64; Ralfe: "Picric Acid as a Urinary Test,'* -5r//tfi4
Medical Journal^ April 7, 1883 ; Johnson : " Picric Acid
as a Test for Albumen," British Medical Journal, May
S, 1883 ; Ralfe : " Peptones in Urine," British Medical
Jmrnal, May 12, 1883; Oliver: "On Bedside Urinary
Tests,*' Lancet (Am. ed.), April, 1883.
A SATIRICAL medical review, called Dr. SangradOj is
published in Madrid. It was begun on November last,
ttid has appeared ey^ry fifth day since that time.
'Fomfat:
Pjtiodid . 332 gnn.
njmg. bKhlond 1.35 gnn.
Aad acetic. ao cc.|
AqBadettiLut.ft xoocc.
Food for thr Febrile. — Dr. Zasetzky {Vratch)
considers the quesdons of food and drink, air, and rest,
for the febrile. He unconditionally repudiates the old
doctrine of keeping the patients on a ** hungry " diet,
consisting of carbohydrates, and insists on the necessity
of their sufficient feeding. Albuminates, fats, and car-
bohydrates must be represented in the food for the feb-
rile exactly in the same proportion as in the food for
the healthy. He supports this demand by the results
of observations, according to which febrile patients as-
similate albuminates, fats, and carbohydrates in the
same degree as healthy subjects. Food must be riven
to the febrile in comparatively small amounts at a time ;
it must be mechanically prepared for digestion and
must well satisfy individual tastes and habits of the pa-
tients. The febrile must be allowed to drink freely, and
to choose for drinking what they like (water, wine-and-
water, tea, coffee, milk, toast-water, syrup and water, or
fruit-juice in water). The temperature of the drink must
vary according to the patient's state (that is, when fever
is high, the drink must be cold ; otherwise the patient
may drink what he likes at the ordinary temperature).
As regards the temperature of the air in which the patient
breathes, the author comes to the conclusion that it must
oscillate between 56° and 63° F., not exceeding the latter
limit. The necessity of most carefully maintaining the
purity of the air in the patient's room is placed by the
author on a level with the necessity of good feeding.
Passing to the last, but not the least, point of his article,
the author substantiates his demand for the greatest
possible amount of rest for the febrile. Having pointed
out the well-known data referring to the influence of
muscular work on various systemic functions, the author
mentions his own experiments on the healthy, tending to
prove that moving about leads to an increase of from
four to eighteen per cent in the excretion of nitrogen
in urine ; most probably the influence of movement on
nitrogenous metamorphosis in the febrile subjects must
be still more powerful.
Gastrostomy, CEsophagostomy, and other Opera-
tions FOR THE Relief of Stricture of the CEsopha-
Gus. — The frequency of carcinomatous obstruction of
the oesophagus in middle life, and of cicatricial or
fibrous stricture, particularly in subjects of tender years,
has led Dr. S. W. Gross to collect, in the July number
of The American Journal of the Medical Sciences^ the
somewhat numerous and scattered instances of the
various operations which have been practised for their
relief, and study and compare their relative value and
disadvantages. To fulfil thb object intelligently he has
considered separately carcinomatous and simple strict-
ures. The four operations applicable to carcinomatous
stricture are gastrostomy, oesophagostomy, internal cesoph*
agotomy, and oesophagectomy, of which the first three
are palliative and the last curative. From the considera-
tion of one hundred and ninety-four cases of opera-
tive procedure. Dr. Gross finds that gastrostomy has
proved to be the simplest, most rational, and safest
of the four operations for the relief of carcinomatous
stricture. Increasing experience demonstrates that
the results are growing better and better, which can-
not be said of oesophagostomy; and there is every
reason to believe that the successes will become more
numerous if it is resorted to as soon as the diagnosis
of the disease has been made, and before the powers
of the patient are materially impaired. The few deaths
do not constitute an argument against its adoption ;
while " every recovery is a clear gain, and a fatal issue
is simply the natural termination forestalled." The
operations which have been practised for cicatricial
stricture are gastrostomy, oesophagostomy, internal oesoph-
agotomy, combined oesophagotomy, and retrograde di-
96
THE MEDICAL RECORD.
[July 26, 1884.
vulsion. Dilatation, Dr. Gross holds, is merely a pal-
liative remedy, and sufficient time has not yet elapsed to
test the value of divulsion through an opening in the
stomach. Combined oesophagotomy for strictures near
the cardia is only applicable to children, and may prove
of value in strictures impassable by instruments intro-
duced through the mouth. Internal oesophagotomy, if
performed at all, should be reserved for comparatively
recent and short strictures, and oesophagostomy is only
applicable when the incision can be made below the ob-
struction. Gastrostomy, he holds, is the best and safest
operation for simple stricture of the oesophagus. From
the great difficulty of managing cicatricial stricture
in children by dilatation, which is due partly to the
struggles of the subjects and partly to the disinclination
of the parents to distress the child, Dr. Gross holds that
dilatation should be resorted to only when the inflamma-
tion has subsided and the denuded surface is in a granu-
lating condition. When the constriction is of some
standing, and efforts at dilatation prove fruitless, gastros-
tomy will prove to be the safest and most beneficial
operation for prolonging life.
Theories of Color-perception. — Dr. Swan M.
Burnett, of Washington, D. C, discusses the various
theories of color-perception, and points out that none of
them accounts, in a consistent manner, for all the phe-
nomena of normal and abnormal colored vision, and
that, moreover, there are certain objections on physical
grounds which, with our present knowledge of the laws
of molecular and wave-motion, are insurmountable.
He advances a theory which, he thinks, meets the require-
ments of the case in the light of recently acquired
knowledge. He holds that it is essential to do away
with the idea of the retina as a differentiating organ, and
that it should be looked upon simply as receiving and
transmitting structure which shall give up faithfully to the
optic nerve the impressions made upon it by the waves
of the luminiferous ether. These impressions are carried
by the nerve to the brain, and are there properly differ-
entiated and converted into sensations. He believes
that by this means ail the phenomena of color-perception
and color-blindness can be explained in a natural and
consistent manner without the necessity of imagining new
tissues, or novel or unusual reactions of these tissues to
light. Dr. Burnett considers the retina to be a sub-
stance whose ultimate structure is such as to allow it to
respond at one and at the same time to a large number
of ethereal vibrations ; at least such a number as shall
be represented by the clearly distinguishable colors of
the spectrum. — American Journal of the Medical
Sciences y July, 1884-
A Case of Tubal Pregnancy. — Dr. Henry Hun, of
Albany, records, in The American Journal of the Medical
Sciences for July, 1884, a case of tubal pregnancy, in
which the cyst burst at about the twenty-fifth day, and
the patient died. Dr. Hun obtained the specimen, and
after having rendered the embryo transparent by oil of
cloves, carefully studied it and made an accurate drawing
of it. In this case the ovum was in the right Fallopian
tube and its corpus luteum was in the left ovary. In a
considerable number of cases of tubal pregnancy the cor-
pus luteum is found in the ovary of the other side, and it
is very possible that this unusual origin of the ovum may
be the cause of the tubal pregnancy, for if the tube bends
over and reaches the opposite ovary it will be apt to be
so bent and twisted that the ovum will meet with great
difficulty in passing through it, or, if an impregnated
ovum passes across the pelvis and enters the tube of
the other side, so much time will be consumed in its
journey that it may develop to such a size before it gets
to the uterus that it cannot pass through the tube, and
will continue its development in this organ. This is the
only cause which can be assumed in Dr. Hun's case, for
there was no occlusion of the tube by tumors, bands of
adhesions, or displacement of the uterus, as are some-
times found in these cases ; neither was there any great
fright or emotion experienced at or near the time of
sexual intercourse, which, in a number of such cases, has
appeared to cause the extra-uterine pregnancy.
Unilateral Swelling of Hysterical Hemiplegia.—
Dr. S. Weir Mitchell records, in the July number of The
American Journal of the Medical Sciences, three cases
of hysteria, in which there was unilateral increase in
bulk at or near the menstrual period, and also at other
seasons, after emotional excitement, and he has been
unable to find elsewhere any narration of similar cases.
Whatever conclusions we may reach as to the immediate
cause of the unilateral differences in size, which Dr.
Mitchell has here described, it is at least clear that they
are under the influence of the nervous system, and vary
with the causes which also increase or lessen the anal-
gesia, or give rise to chronic spasm. Beyond tlus Dr.
Mitchell can as yet hardly go. Most probably, he thinks,
it will be found that in many unilateral hysteric palsin a
like phenomenon exists, and has merely eBcapeid xtteo-
tion because of being the least prominent in a group oC
symptoms. At all events, it adds another to the large
group of resemblances which so closely relate organic
to hysteric hemipalsy.
Treatment of Ingrowing Toe-nail. — Professor Pe-
tersen removes the whole of the soft parts down one
side of the nail, extirpates the nail itself, from antiseptic
motives, and, aiter arresting bleeding by pressure, dresses
the wound rapidly with oxide of zinc and cotton-wool.
Fourteen days' rest in bed, with the foot raiaed, generally
suffices for cure, and the contraction of the cicatrix pre-
vents a relapse to the old condition. Professor Petersen
prefers general to local anaesthesia, on account of the
troublesome bleeding afterward ; and for the same rea-
son he does not approve of Esmarch^s bandage in this
operation.— Ci«. Lancet and Clinic^ June 14, 1884.
Massage in the Treatment of Stricture of the
Urethra. — The difficulty of passing a sound in stricture
of the urethra following gonorrhoea depends, in the
majority of cases, not so much upon the simple narrovring
of the urethra itself as upon proliferation of the connec-
tive tissue in the surrounding parts. This hyperplasia of
the connective tissue occurs in irregular patches about
the urethra in such a way as to render the canal tortuous,
thus increasing the difficulty of passing an instrument to
the bladder. Dr. G^za v. Antal relates a number of
cases {Centralblatt fur Chirurgie, June 7, 1884) in which
he succeeded in inducing absorption of this hyperplasia
by massage. The duration of each sitting was from eight
to ten minutes, and the massage was repeated da^y.
Massage of the pendulous portion of the urethra presents
no difficulties, but that of the membranous and prostatic
portions is possible only through the rectum. Internal
massage by means of the repeated introduction and with-
drawal of a sound, as recommended by Bardinet, does
not commend itself to the author. It is only possible in
those cases in which the stricture is already permeable,
while V. An tar s method is of especial value precisely in
those cases in which the urethra will not admit of the
passage of a bougie. Further than this, internal massage
acts only upon the thin layer of tissue immediately sur-
rounding the urethra, while the external method causes
the entire hyperplasia to disappear. The author thinks
that in many cases massage will be used in preference to
urethrotomy.
Rabies in Birds. — M. L. Gibier has succeeded in in-
oculating hens with the virus of hydrophobia and the;i
reinoculating rats with cerebral matter taken from these
diseased birds. The rats so treated presented all the
characteristic symptoms ot rabies ; microscopic exami-
nation of the brains of the inoculated hens showed the
presence of the specific micrococcus. — Centralblatt fOr
Chirurgie^ June 7, 1884.
July 26, 1884.J
THE MEDICAL RECORD.
97
Death following the Extraction of a Tooth. —
Pr. Zakharevitch relates two instances of young men,
both physicians, dying from the results of the extraction
of a molar tooth. One died ten days after the operation
fiK)iD osteomyelitis, and the other six days after from
osteitis of the inferior maxilla and septicaemia. It was
found that the dentist had not been careful in cleaning
the forceps used by him. The author, moved by these
accidents, recommends the employment of antiseptic
tooth-pulh'ng. He advises washing the inside of the
checks with soap and water, and then with a two per cent,
solution of carbolic acid. After the tooth has been ex-
tracted the mouth should be again washed with the car-
boiic solution and the tooth cavity filled with a wad of
cotton charged with iodoform powder. — Raccoglitore
Medico, June 20, 1884.
Treatment of Slight Burns. — Dr. Cramer treats
sl^bt degrees of burns by means of compression. He
applies a layer of wadding and over this an elastic band-
age, so as to make firm and even pressure over the whole
of die injured surface. By this means the subcutaneous
capillaries are emptied in a measure of their blood, and
iD^ammation and exudation of serum are prevented.
The compression is to be maintained from three to fifteen
hours, according to the intensity of the bum, and then a
less degree of pressure kept up until new epidermis has
ixxm^.'-Memoriibilien, May 14, 1884.
Treatment of Sweating of the Feet. — The follow-
ing method of treatment for this unpleasant condition is
endorsed by Dr. G. Cramer in Memarabilien of May 14,
1884. The patient must wash his feet thoroughly in a two
to five per cent solution of carbolic acid, at first twice a
day, then once a day, and finally two or three times a
veek. After the bath he is to put on clean stockings,
sprinkled inside and outside with a powder composed of
two parts benzoin, three parts salicylic acid, and ninety-five
parts magnesia. The shoes must also be sprinkled inside
with the powder. The stockings, when Uken off, should
be allowed to soak for twelve hours in carbolized water,
then dipped in lye, and washed. In this way the bac-
teria which cause the skin affection and the consequent
atnormal secretion of sweat are destroyed Without
thb thorough disinfection. Dr. Cramer maintains, a cure
of the affection is impossible.
The Apyretic Form of Typhoid Fever. — Dr.
Brothier has collected several observations, which show
that in certain cases the characteristic lesions of typhoid
fever may be found in patients whose temperature has
always remained normal. In spite of the apparent mild-
ness of the disease, hemorrhages, perforation, and other
comfdications are liable to occur. The symptoms are
those of the ordinary form, with the exception that they
are less marked, and that the temperature does not rise
above the normal standard. It is very important to
keep the patient in bed, and the diet must be carefully
legolated.— y^^^r. de M/d. €t de Chir. Prat
Reunion of Divided Nerves. — Nerve-suture is often
aosuccessful, especially in those cases in which a portion
of die nerve has been excised, the tension causing the
wtures to cut their way out. For this reason Dr. A. L.
l^s^^]L\eS{C€ntraidlattfiir Chirurgie, June 7, 1884),
has discarded this method, and instead simply brings the
<firided ends of the nerve so that they overlap, and then
tes diem together. He has found by experiments upon
more than a hundred animals that the conductive power
<if the nerve is perfectly restored. After exposing the
Bcrve-sheath, an^ before dividing it, he passes two catgut
hgatures beneath it, and ties them tightly enough to pre-
vent slipping. The nerve is then divided, ana the two
«ds, after flexing the limb so that they may overlap, are
W together, ^er the expiration of from six to twenty
ooDdis, experiments were made to test the conductivity
of the nerves, and in every case the muscles responded
readily to central irritation of the nerves. In some cases
he divided two nerves and reunited them in crossed
fashion, so that the peripheral end of one nerve was at-
tached to the central extremity of the other. Then, after
allowing sufficient time to elapse for union to occur, he
found that central irritation of one nerve was followed
by a response in the muscles attached to the peripheral
extremity of the other nerve with which the first had been
united. This was conclusive proof that union between
the two divided nerves was perfect The author believes
that his method will be found of especial utility in those
cases of gunshot wounds and the like in which there has
been a considerable loss of nerve-substance, and which
are precisely the cases where suture of the divided ends
is impracticable. In operations also in which a number
of nerves or a plexus has been divided, the various ends
may be tied together without regard to preserving their
separate identity, in the expectation that the functions of
all the wounded nerves will be restored.
Miliary Aneurisms of the Mucous Membrane of
the Stomach. — Dr. Gallard reports {^Gaz, Hebdoma-
daire) the case of a man, forty-eight years of age, who
was admitted into the hospital in a state of extreme
prostration, caused by repeated hemorrhages from the
stomach. There was anorexia, and pain in the epigastric
region, but no local or general disease could be made
out The patient died after a few hours, and at the post-
mortem examination an aneurism of the size of a bean,
situated near the cardia, was found to have given way.
Gallard has observed two other cases of the same affec-
tion, and thinks that the so-called essential hsematemesis
is generally caused by the rupture of a small gastric
aneurism.
Left Inguinal Colotomy for Imperforate Rec-
tum.— Dr. W. H. Haynes, of New York, records in the
July number of The American Journal of the MediccU
Sciences a case of inguinal colotomy. One procedure in
the treatment we do not find discussed elsewhere in
detail, namely, that of opening up a passage at the
natural site for the canal, either simultaneously or sub-
sequent to the operation of opening the gut When the
two operations are to be performed at the same time,
the first or inguinal opening would be in the nature of
an exploratory operation, and should be made small so
as to admit of immediate closure, and return to the
peritoneal cavity after a passage had been secured 2^ the
natural site. If this latter be not secured, then the
opening could be enlarged and made to serve the pur-
pose of an artificial anus in the abdominal wall. The
advisability of this procedure, however, is at present in
such a doubtful state that only the experience of a
number of operators can determine it Of the few cases
so far undertaken in this manner that Dr. Ha^^nes can
find recorded, his own is the only one that survived the
second operation. Dr. Haynes' single experience, though
successful, does not lead him to advise this procedure,
since the object of it will, during the early years of its
life, be dependent on the exceedingly diligent and con-
stant attentions of others whose affections and services,
though the closest, are not to be depended on, as was
demonstrated in his case. If the second operation be
subsequent to the first, the patient will have a double
annoyance, or be under the necessity of having a third
operation performed for the closure of the opening first
made, which is not unattended by danger to life or of
doubts as to the result; and perhaps be under the
necessity of having to have it reopened, owing to neglect
in the proper after-treatment of the new canal in the
natural site. Whereas if one is satisfied with having
saved life in a manner which numerous cases testify is
not unenjoyable or full of discomfort, as used to be
maintained, all dangerous risks of subsequent operations
are avoided, there will be no more dependence on others'
services than is natural, and many sources of distress
will be obviated.
98
THE MEDICAL RECORD.
[July 26, 1884.
The Medical Record:
A Weekly Journal of Medicine and Surgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD &. Co., Nos. 56 and 58 Lafayette Place.
New York, July 26, 1884.
CHOLERA AND THE CABINET.
The approach of cholera along the great routes of Euro-
pean emigration to the Northern ports, and the ever-
threatening presence of yellow fever along the lines of
commercial intercourse between tropical countries and
the Southern ports, places the United States this season in
a peculiarly dangerous position with reference to those
foreign pestilential diseases. So eminent an authority as
Koch is reported to have stated, after personal exami-
nation of cases at Toulon, that the disease is genuine
Asiatic cholera, and of the most unmanageable type, and
that it would spread everywhere. This statement is in
Accordance with our own convictions, as stated in a
previous article, in which we took occasion to urge our
health authorities, and especially those of the large sea-
port towns whither emigration tends, to take immediate
steps both to effect thorough sanitation and to vigilantly
watch the current diarrhoeal affections. As to yellow
fever, no predictions can be made ; it is a summer
pestilence which is ever at our doors, and only awaits
favoring conditions to invade our Southern seaboard
cities. Of this, however, we are reasonably certainy
viz. : that the United States is threatened with two
foreign foes, the most fotal to public health and national
prosperity of any known, both of which it is in the power
of a properly organized and equipped sanitary service to
prevent The progress of cholera since our last article
confirms our prediction that we are imminently threat-
ened with an outbreak of this Oriental plague, and we
urgently advise all local boards of health to organize
their methods and forces as if in the very presence of the
epidemic. We repeat what we then said, and with added
emphasis, that no intelligent health authority will rely on
our present quarantines to prevent the introduction of
the germs of that disease into this country. If the epi-
demic is rendered in any sense harmless, and is brought
under any proper control, it will be by the vigorous and
vigilant action of local boards of health. We are grati-
fied to notice that the New York State Board has issued
the excellent memoranda prepared by its late Secretary,
Dr. Elisha Harris, and that other State Boards have
taken similar action.
In this approaching conflict with a foreign foe, more
dangerous to the health and prosperity of the people than
a European army, it is pertinent to inquire what is the
attitude of our Government toward this national scourge ?
With the first rumor of cholera in Toulon, the Govern-
ments of Europe summoned their Boards of Healdi to
prepare regulations and to take immediate measures to
prevent an invasion of the epidemic. Among those
brought into the service of their respective States, we no-
tice the names of the eminent sanitarians Koch and Pas-
teur, of Brouardel and Prouse, of Buchanan and Car-
penter. But what action has our Government taken to
protect the country now on the eve of invasion by two
of the most terrible scourges known to the human £unily ?
Though it has in its service a National Board of Health,
composed of experienced physicians and sanitary experts,
the duty of which is, according to the statute, " to obtain
information upon all matters affecting the public health,
to advise the several departments of the Government
. . . on all questions submitted by them," we cannot
learn that the advice of this Board has been sought in
this great and pressing emergency, on any question relat-
ing to the approaching epidemics, by any department of
Government. It appears that the Cabinet had a meet-
ing ;on Saturday, and '*it was decided to take prompt
measures to prevent the introduction of cholera into the
United States ; the State and Treasury Departments will
act in conjunction in enforcing the regulations to be pre-
pared." What member of the Cabinet is sufficiently
familiar with the latest discoveries of science and the
teachings of experience in the control of cholera to pre-
pare these "regulations," does not appear. In the Cab-
inets of Europe no one has been found competent to
prepare " regulations " to meet the demands of modem
science in Uie prevention of cholera, and hence those
Governments at once called to their aid their several
National Boards of Health, and submitted to them all
questions relating to the prevention of the epidemic.
But with an assurance peculiar to the Yankee nation, our
Cabinet ignores the branch of the public service consti-
tuted by law its adviser on all matters pertaining to the
public health, and single-handed grapples with and setties,
to its own satisfaction, questions of science which the
foremost medical men approach with special care and
caution. If we may judge of the character of the " regu-
lations" in course of preparation by the daily bulletins
from the Capitol, or from the President's Proclamation,
we should infer that the Cabinet had consulted some an-
tiquated authority — a resident of Venice in the fifteenth
century. As yet the Government has proposed no
measure at all adequate to the emergency, and is evi-
dently entirely unaware of its duties and its obligations.
Its reliance seems to be on daily bulletins issued to the
Associated Press and a proclamation by the President
Well-meaning as undoubtedly these efforts of the
Cabinet are, we venture to suggest that they are alto-
gether unworthy the age and the occasion. If no better
counsels prevail in the Cabinet, cholera will invade our
shores and spread far and wide, except as it is stamped
out in localities by energetic and enlightened boards of
health, and the money appropriated by Congress will
melt away, leaving no record of great achievements in
the prevention of the epidemic.
We make these remarks in no captious or cavilling
spirit, but with a painful consciousness that in the strug-
gle among nations to combat this common foe of the
human race, our Government lags far behind. It enters
upon a warfare discarding the very arm of the public
July 26, 1884.]
THE MEDICAL RECORD.
99
service created for the occasion, and fully qualified to
give k the highest degree of success in the field of con-
flict Much as we lament the occurrence of a great
epidemic, which leaves only misery, ruin, and death in
its path, we still recognize the fact that every such de-
vastation brings us nearer to the golden era when no
contagious or infectious disease will be allowed to travel
along the highways of commerce and human intercourse.
The yellow fever epidemic of 1878 was a national calam-
ity, but it did more to organize a system of sanitary ser-
vice in this country than would a century of agitation
by simple agreements and appeals. Six years of free-
dom from epidemics has created an indifference to health
oiganizations which has, in many instances, ripened into
actual hostility to their existence. It requires other
great epidemics to restore these organizations to the
public confidence and perfect their methods of work.
That these epidemics will come, as great public educa-
tors, at proper intervals, until our system of sanitary
government is perfected, we need not doubt. We look
hopefully forward to the time when sanitary science,
thoroughly and intelligently applied by national. State,
and municipal governments, will eliminate from our
mortality records the names of all contagious and infec-
tious diseases.
THE TREATMENT OF DIARRHCEA.
A CONSIDSRATION of thc commonest diseases acquires a
special interest at different times. At present as we
arc in the midst of the heated season, with cholera just
on the edge of the horizon, it.may be of interest to dis-
cuss such a fiamihar subject as the treatment of diar-
ihoea. AU recognize that a diarrhoea is simply an ex-
pression of a certain derangement of the gastro-intestinal
tract To interpret and remove [the cause should be
the first rational effort of treatment Now as the vast
majority of gastro-intestinal disturbances are produced
by indigestible food, a diarrhoea is very frequently at the
start a conservative process induced by nature to get rid
of such an offending mass. In the efforts to achieve this
object a catarrhal inflammation is often set up. The
idea of treatment should be to so expedite the removal
of the foreign substance as to save the intense irritation
inTolved in nature's unaided efforts to accomplish this
end In these days, lobsters and green apples, clams
and cucumbers, are among us. Their digestion is fre-
quently assisted by ice-cream ; nearly always by large
quantities of ice-water. Just as the unfortunate stomach
is trying to get warmed up to its difficult task, its tem-
perature is suddenly and gready lowered by a deluge of
ice-water. This is repeated so frequently that finally
the injured viscus gives up in despair and passes the
mcfaanged material along to the intestine to get rid of
it as best it may. It is fortunate for the patient if the
doctor, m his zeal to check the naturally induced pxurg-
ing, does not suddenly lock up the bowel, and in it the
offending master that is causing all the trouble. There
is a popular idea that a diarrhoea should not be stopped
too saddenly. As there is nearly always a grain of truth
someiHiere to be found underlyin^^ a popular delusion,
10 this idea doubtless rests upon the fact that an intes-
ttBal discharge due to irritating masses of food, suddenly
^faeded by a heroic dose of opium, may be followed by
inflammation of the bowels and peritonitis. When such
a source of irritation has been removed, a diarrhoea can-
not be checked too quickly. Indeed, fxurther treatment
is frequently unnecessary. The elimination of indigest-'
ible substances can be accomplished by various agents.
All irritating laxatives must be avoided A few grains
of calomel finely triturated with a litde bicarbonate of
soda and sugar of milk often does very well. A small
dose of calomel if triturated finely enough, will answer all
the purposes of a large amount. Many physicians prefer
castor-oil or some of the preparations of rhubarb for
cleaning out the bowel. The secondary astringent effects
of these drugs are beneficial It is well to combine with
them a small quantity of one of the preparations of
opium. After the irritating cause of a diarrhoea has
been removed, the different astringents can be used,
according to the preference of the practitioner. Out of
a very large number from which to choose, the sub-nitrate
of bismuth in large doses is probably the least harmful
and most effectual. It checks any acid fermentation,
and soothes and constringes the mucous membrane.
While improper food is a preponderating element
in the diarrhoea of summer, impure water and foul air
introduce into the system noxious ingredients that are
frequently irritating to the bowel. It is a common ex-
perience of medical students to contract a diarrhoea from
staying in the dissecting-room, which ceases when they
stop working upon the cadaver. A conservative process
of elimination is here instituted that probably saves them
a fever. Animal and vegetable refuse matter in the
streets, wakened into active fermentadon by the hot sun
of summer, may act the same upon the layman as the
dissecting-room does upon the students. Some persons
seem to be peculiarly susceptible to this form of poison,
and correspondingly quick to throw it off by a diarrhcear
The treatment of this form of intestinal derangement is
obviously to remove the patient from exposure to the
foul air, .when recovery will readily take place. Mild
astringents may be needed to hasten this result. Occa-
sionally persons in debilitated condition, in consequence
of the heat and impurity of air so frequently found in the
city in summer, seek to relieve a continual irritation of
the bowels by a change to the purer air of the country.
But if the air is purer, unfortunately often as much can*
not be said of country water. In fact, many people
leaving town in a sound condition fall victims to diarrhoea
before many days' sojourn in the country. The uncom-
fortable proximity of the cess-pool to the well, and the
defective means of ridding the premises of sewage,
destroy the good effects of many a rural visit The
sanitary condition of numbers of farm-houses and country
hotels is far from what it should be. If the visitor does
no more than contract a diarrhoea in many of these
places he will be fortunate. Of course a simple change
in the character of drinking water often produces a slight
diarrhoea, aside from any animal or excess of vegetable
matter it may contain. If a looseness of the bowels per-
sists, however, after treatment by ordinary astringents,
the patient had better quickly change his place of sum-
mer recreation. The valuable account of the sanitary
condition of health resorts, appearing in the report of
the National Board of Health for 1882, affords interest-
ing reading on this subject.
lOO
THE MEDICAL RECORD.
[July 26, 1884.
We have thus seen that a diarrhoea is primarily a conser-
vative process of nature indicating its eflforts to eliminate
some disturbing element in the economy, and that during
the present season; indigestible food, bad air, and impure
water, under the debilitating influences of high tempera-
ture, are most frequent causes in its production. Any
looseness of the bowels must always be treated directly
in reference to the agent producing such condition.
In an article on another page of this number Dr. Chapin
has called especial attention to the fatal effects of great
heat in largely increasing the mortality from infantile diar-
rhoea. As shown by his statistics, susceptibility to a high
temperature is much greater in early life than in adults.
In conclusion, the laity should have impressed upon them
the great importance of attending at once to any loose-
ness of the bowels at this time. A diarrhoeal condition
of the intestine is a favorite developing place for the
comma-shaped bacillus that Dr. Koch is just now finding
in the bowels and dejections of cholera patients. Every
possible means should be taken to avoid affording a
favorable soil for this bacillus, in case it finds its way to
our shores. It is certain that it will not stay long if it
finds a limited field for its development. The possibility
of such an invasion is suggested by the fact that a ship
has lately arrived in lower quarantine from Marseilles,
laden with a cargo of wool.
MEDICAL CHARITY IN THE SOUTH.
We publish elsewhere a communication from Dr. Shear-
down, of Knoxville, Tenn., in which he goes over the fa-
miliar ground of the abuses of medical charity. It is inter-
esting as showiqg the state of things in the smaller cities
throughout the West and South ; and also because the
author makes some suggestions as to remedies.
Dr. Sheardown is a trifle one-sided in his description
of the status of medical charity. It is to be remembered
that a Urge amount of medical service is tendered for
the sake of learning or teaching. Medical students and
young practitioners must be educated and must learn
their art practically. They are, therefore, glad to work in
hospitab and dispensaries for nothmg. In smaller cities
and towns, to be sure, where medical colleges do not ex-
ist, this factor does not come in to so great an extent.
We think that it would be better also that the profes-
fiion earn less money, rather than gain the reputation of
being hard-fisted, and always demanding the quid pro
quo. We say this while fully aware that Dr. Sheardown
has in the main presented the question correctly.
SOME PRACTICAL FACTS REGARDING ASIATIC
CHOLERA.
As to Us nature and mode of prevention, — Asiatic cholera
requires for its development, first, a specific germ of poi-
son ; second, a proper soil for the poison to grow in. We
may not be able to keep away the germ by quarantine,
but we can destroy the soil by disinfectants.
"Excrement-sodden earth, excrement-reeking air, ex-
crement-tainted water," these are for Americans the
causes of cholera.l
Cholera attacks the most insalubrious places in a city
in succession. Hence every man can choose whether
I'e will live in a nidus for the disease or not.*
The poison of cholera exists in water, and wet soil
chiefly, also in food, and in the air near infected spots
only. It has a very short reach. It is infectious and
portable, but not contagious in the ordinary sense.
Hospital attendants, nurses, and doctors, if careful, are
but little more liable to the disease than others living in
the same locality.
Koch's cholera bacillus, if really a pathogenic agent
(which has not yet been proved), is only one of the factors
necessary to develop cholera.
Maritime quarantine is of use in preventing cholera.
Inland quarantine and sanitary cordons are of no value.
To keep clean is the best internal quarantine.
The best disinfectants for cholera are carbolic acid,
the zinc and copper salts, and corrosive sublimate.
There are no specifics against the attacks of cholera,
except perfect domestic and personal cleanliness, tern-
perate living, and leaving the infected spot.
The French have an old "preventive of cholera"
which runs as follows :
** Tiens tes pattes au chaud,
Tiens vides tea boyaux,
Ne vois pas Marguerite,
Du chol6ra tu seras quitte."
The prevalence of typhoid fever furnishes a fair indi-
cation of the extent to which cholera would spread if it
reached a city. Such is the conclusion of English ob-
servers. There is y^ry little typhoid in New York City
now.
Persons living in low-lying parts of a city or town are
the most liable to cholera. The inhabitants of high flats,
properly plumbed, are safe.
Panics over cholera, such as occurred at Toulon and
Marseilles, show ignorance as well as cowardice. Mod-
ern sanitation can hold cholera in check.
The mortality from cholera docs not average over fifty
per cent. It is generally less toward the close of an
epidemic. The mortality is less in those treated in hos-
pitals (in England). The mortality rate varies somewhat
with each epidemic.
The duration of a cholera epidemic in a given com-
munity is several months, unless it is " stamped "out by
sanitary measures. It may go away and return again
the next year. In any limited locality it expends its
force in two to three weeks.
Of individual cases, the duration, if fatal, is about two
and one-half days, if non-fatal, about nine days. The
period of incubation of cholera is from two days to a
week.
Diagnostic points, — Painless, profiise diarrhoea should
excite suspicion. A case showing such symptoms as
non-feculent, very copious, watery stools, of a rice-water
character, early cramps, quick exhaustion, low tempera-
ture, pinched facies, should make the physician very
suspicious. If cholera were present in the locality his
diagnosis could be positive.
Points in treatment, — Epidemic cholera is generally
preceded by a painless diarrhoea. This, if attended to
at once, can be easily cured in ninety-nine per cent of
the cases. HypodeHiiic injections of morphine, and tiie
internal use of opium, aromatics, and astringents, are
indicated here. In the collapse stage of cholera give
ice-water and ice, but be careful in the use of stimulaats.
July 26, 18H]
THE MEDICAL RECORD.
lOI
Watch the pulse to see if they affect it Horner's anti-
cbolera mixture, recommended by Hartshorn and Bar-
tholow, may be used before or at the beginning of the
stage of collapse.
9. Chloroform,
TiDOt. opii,
Spts. camph.,
Spts. ammon. aromat && f 3 jss.
Creasote gtt. iij.
Olei cinnamomi gtt. vij.
Spts. vini gall f 3 ij.
M. Sig. — Gtt. X. to XX. in ice-water every five minutes.
A hypodermic injection of morphine is a most effective
remedy for the diarrhoea and cramps.
Cholera specifics do not exist. Oxygen, saline ven-
oas injections, chloride of sodium drinks, warm baths,
calomel, camphor, venesection, have all fiotiled.
TOHT CESSPOOLS, THEIR DANGERS AND REMEDIES.
We so frequently receive letters like the subjoined, that
we have concluded to answer once and for all, at least
for the present, in our pages :
Long Island, June 19, 1884.
Dear Sir : May I ask a favor at your hands? The
water-closets in my house discharge into a cesspool of
about two thousand gallons capacity. This is of brick,
well cemented, and supposed to be tight ; it is closed by
a stone slab and has no ventilation. Its contents are
poinped out and put upon the land as often as once a
month in the summer, and in winter, when full, say
ahout once in three months.
In my water-closets the bottled chlorides are freely
used, but I have come to suspect that the quantity used
is not sufficient to disinfect the cesspool. The arrange-
ment of the plumbing, soil-pipe, etc., I believe to be good.
Should this cesspool be treated with additional disin-
fectants ? If so, how often, and when ? When full, or
when just emptied, or more frequently ? Can you also
^ve me an idea what quantity of, sa^ a saturated solu-
tion of copperas, or anything else which you can recom-
mend as better, should be considered enough for one
application ? I mention the strong solution of copperas
becaose I am familiar with it, and always keep the solid
salt by the barrel on hand for frequent use about my
premises, stable, etc. . It is cheap and in' convenient
form for solution. Is there anything better ? How about
carbolic acid, quicklime, sulphur, etc. ?
Yours very truly, G. T. L.
The readers of The Record need scarcely be told that
tig^t and unventilated cesspools, with no outlet for their
gases except into the bath-tubs, water-closets, wash-basins,
and kitchen-sinks, which empty into them, must rank
among the most dangerous of all "modern conveniences'*
tiiat can be devised by the perverse ingenuity of man.
They are far more dangerous than open privies, open
cesspools, and more or less ventilated sewers. The
gases which are formed, and the germs which are bred,
in darkness and heat, with little or no oxidation or re-
newal of air, are annong the most concentrated and viru-
lent ; far more injurious and destructive than ordinary
seter gases, which always have so many outlets to the
open ur. A closely sealed cesspool is a many multiply-
iag fool air-chamber or foul gas-retort. Apart from the
wdinary unsavory and harmful products of the decom-
positioD of vegetable and animal matters which takes
place there, all the discharges from pauents sick with
measles, scarlet fever, diphtheria, summer diarrhoea, dys-
entery, or typhoid or intermittent fever, if there happens
to come any, also become more virulent Yet just such
cesspools are among the most common additions to the
largest and finest country houses, and are regarded as
the nicest things for country hotels and summer board-
ing-houses. They are very numerous in the most fash-
ionable watering places. It is not uncommon, in some
half-primitive and half-civilized places, to find out-door
privies for the male boarders and up-stair water-closets for
females, the pipes from which empty into a tight cesspool.
In order to save a few hundred feet of drain-pipe these
cesspools are generally placed very near the houses.
Every observant person has seen them within ten feet,
more or less, of parlor or bed-room windows, with huge
and even splendid flower-pots put over their covers, in
order to hide any trace of their existence. Of course,
these hotel and boarding-house cesspools cannot be
emptied during the summer season, when the gases and
germs in them become abundant and virulent, and have
no escape except into the rooms from which the materials
for their growth and composition came. When con-
sulted about such matters it is well to advise that a new
cesspool be built far away from the house. It should
have a large man-hole, which should always be left open
for free ventilation ; then such great quantities of fresh
earth should be thrown into it from time to time, that not
only all fluids and moisture should be neutralized and
absorbed, but all its foul contents should be covered by
at least six inches of fresh absorbent earth. In short,
the cesspool should be converted into a great and whole-
some earth-pit. Thus not only will the whole contents
be kept odorless and healthy, but all the waste materials
of the house will be changed into an excellent and in-
offensive fertilizer, which can be used in gardens as well
as fields. Every open out-door privy can be changed, in
the same simple and inexpensive way, into an outdoor
earth-closet by throwing in, if necessary, one or several
or many cart loads of fresh earth, until a dry surface of
earth alone is visible, and all offence to the eye and nose
is obviated. Then fresh earth should be thrown in every
day, sufficient to hide and disinfect the daily deposits.
We are sure that this earth treatment of cesspools and
privies would pay in the greatly increased quantity of
excellent and inodorous fertilizers which would be gained ;
for earth permeated with the fluids and gases of decom-
position is almost as rich as garden mould.
It requires no stretch of imagination to suppose tiiat
it would pay to have earth thrown from time to time in
every horse-manure pit, and over the contents of every
stable- and barn-yard. Horse, cow, and cattle manure
would thus be ripened and mellowed. The great waste of
good material by evaporation from the heat of the sun
in the hot months, and by the washing and soakage of
rain in wet times, would be largely prevented. An en-
thusiastic hygienist says, every country bam- and stable-
yard could be converted into a wholesome and cleanly
earth-yard, where every one could almost always walk
with comfort and decency. The nasty smells of stable-
men, and cow and cattle herdsmen would also be largely
done away with. Many of the diseases which arise from
the discharges of sick men, horses, and cattle would be pre-
I02
THE MEDICAL RECORD.
[July 26, 1884,
vented ; the occupations of stable and cattle men, and
even sweet milkmaids, would become much more cleanly
and wholesome. The amount of good and savory fer-
tilizers that would be gained would be almost incalcul-
able. The air of every country house, village, and small
town would be greatly improved. Places naturally
wholesome, but polluted by thoughtless man's filthy
habits, would regain their primitive healthfulness. We
have heard of pleasant and productive farm-yards which
were hollowed and graded toward the centre to prevent
all fluids from running off to waste. The bottoms were
stamped down hard to make an impervious base, over
this about six inches of loose earth was thrown, and
above this the first layer of the droppings of horses or
cattle or both were thrown, also to the depth of six or
more inches ; then a fresh layer of earth, say three inches,
and so on successively, layer by layer of earth and manure.
Such farmers always had much more and better fer-
tilizers than their neighbors. Their barn and stable
yards were always pleasant and wholesome, their stable
jand cattle men and women were always more tidy, sweet
smelling, and cleanly. The milk and butter was better,
and spoiled less readily; almost all infectious human,
horse, and cattle diseases were prevented or quickly
stamped out, and that without other scientific or chemi-
cal aid.
f — I
The Greely Arctic Expedition. — The reports from
this expedition show that Americans can live for two
years in perfect health in the arctic region, and that the
use of brackish water does not produce scurvy.
A New Insane Asylum for Iowa. — A new asylum
for the insane is to be built at Clarinda, Iowa. The sum
of $50,000 has been appropriated for beginning the
work.
Journalistic Changes. — Dr. T. F. Rumbold has
given up the editorship of the 5/. Louis Medical and
Surgical JournaL Dr. Le G. Atwood becomes editor
in his place.
Dr. R. B. Stover has retired from the editorship of the
Atlantic Journal of Medicine^ leaving it in charge of
Dr. Henry G. Houston.
Dr. Wesley C. Norwood, a prominent physician of
South Carolina, and a medical writer of note, died at
Cokesburg, S. C, June 17th, at the age of seventy-eight.
Out of a handsome competence he gave magnificent gifts
of money to Woflford College, South Carolina, and Adger
College, South Carolina.
Dr. Kirkbride's Successor. — Dr. John Bassett
Chapin, Superintendent of the Willard Asylum for the
Insane, at Willard, N. Y., has been unanimously elected
by the Board of Managers of the Pennsylvania Hospital
for the Insane to succeed Dr. Thomas S. Kirk bride, de-
ceased, as Physician-in-Chief and Superintendent of that
Institution. The Board is fortunate in having secured so
able and accomplished a physician as Dr. Chapin.
The Yellow-fever Germ not Discovered. — Some
months since considerable interest was excited by the
announcement that Dr. Freire, of Rio Janeiro, had de-
tected the presence of the organism causing yellow-fever
in soil taken from graves of persons who had died from
the fever, and that he had succeeded in communicating
the disease to rabbits and guinea-pigs. But [Medical
Press and Circular) in a communication since forwarded
to the English Government from the island of Barbados
an account is given of the results of a number of control
experiments made with soil taken from the graves of per-
sons who died of yellow-fever in the epidemic of 1881,
and from open fields on which no manure had been used.
Previously sterilized chicken-soup impregnated with any
of these moulds and kept at the ordinary temperature
usually became turbid in a few hours, and by the second
day had assumed a bright yellow color. Summing up
their results, Messrs. Moxly and Harrison say that they
can discover no difference between a micrococcus from
a grave and one from a garden.
The Legality of Cremation. — One of the English
courts has just decided that it is illegal to cremate a
body on which a coroner had determined to hold an m-
quest. The body in question was that of an illegitimate
infant, and the decision seems an eminently natural and
proper one.
A Grand Fair in Aid of the London Hospitals is,
it is said, to be undertaken under the auspices of the
Health Exhibition. The hospitals in question are, many
of them, in great need of pecuniary help.
A Medical Drama. — A drama, called " Sister Grace,"
written by a doctor, and played for the benefit of the
East London Hospital for Children, has just been pre-
sented at the Avenue Theatre, London. The play in«
troduces hospital life and incidents. The binaural steth-
oscope made its first appearance on the stage.
The Death of Dr. Moreau, the celebrated alienist,
at Paris, in the eighty-first year of his age, is announced.
He was a pupil of Esquirol, and had been attached to
Bicdtre and La Salp^tri^re.
The Epidemic of Small-Pox, which has for some
time been prevalent at Liverpool, has now attained
alarming dimensions. Traffic, except for residents, is in
certain streets suspended, and the public institutions for
the reception of small-pox patients are full to overflow-
ing. It is stated that the Local Government Board have
severely censured the local authorities, and have called
upon them to immediately provide suitable hospital ac-
commodation for infectious cases. Small-pox is also
still very prevalent in London, there having been over a
thousand cases in the hospitals.
Excessive Child Mortality in New York City. —
The Lancet estimates that the mortality rate among chil-
dren under five years of age in New York City is 90.3
per 1,000 living children, while in London it is onl)
65.1 per 1,000, a diflference of thirty-nine per cent.
The Yellow Fever Germ. — The Panama physiciai
who claims to have discovered the yellow fever germ, t<
have cultivated and inoculated it, passed through thi
city last week on his way to Paris. He was interviewee
by a member of the daily press, who procured a picturi
of the hypothetical germs and produced them before tht
admiring laity. As shown in wood-cuts, they certainl;
look like very ordinary forms of fungus.
July 26, 1884.]
THE MEDICAL RECORD.
103
Dr. Octave Pavy, Late Surgeon to the Greely
I ExpfiDinoNy was a man of curious character, and had
led a varied career. He was born in Havre, France,
! where he was educated, and where much of his youth
was spent. Early in life he accompanied a French ex-
I pedition to Lady Franklin Bay, and spent several years
in the polar regions. He fought in the Franco-Prussian
war. At its close he came to America, where he resorted
to various expedients for a living. He finally studied
medicine, and began practice in 1877. He was a mem-
ber of the Howgate expedition, and when this failed he
remained at Disco Island, off the coast of Greenland,
oDtil he joined the Greely party.
Dr. William Fruitnight, one of the medical staff
^Bellevue Hospital, died suddenly, July 21st, at the
residence of his brother. Dr. J. Henry Fruitnight, from
thrombosis of the brain. The deceased was but twenty-
five years of age. He was graduated from the Bellevue
Hospital Medical College in 1880, and since that time
bsiA been attached to the medical staff at the hospital.
Professor Virchow has begun a series of popular
articles on cholera in Die Nation^ a weekly political jour-
nal of Berlin. He condemns the French for careless-
ness, and takes a conservative view as to the real signifi-
cance of the cholera bacillus.
Medical Novelists. — Dr. William A. Hammond an-
nounces that he has four novels written, and intends
hereafter to publish two a year. He states that he would
lather be a novelist than a doctor, and thinks that it is
time medical oien, in a literary way, give some results of
their rich and peculiar experience with human nature.
The Illinois State Board of Health held its quar-
terly session on July 2d The Secretary in his report says :
"There have been fewer complaints made direct to the
Board, of unprofessional conduct, and fewer cases of this
tind otherwise coming under observation, during this
qaarter than ever before in the history of the Board/'
Taking up the subject of public health, the Secretary
refers to the prevalence of small-pox in England, and the
probability that it will become more prevalent in this
country. He advises the printing and distribution of the
school vaccination order.
Pasteur's Experiments on the Prevention of
Rabiks. — Further experiments have been made by M.
Pasteur on the prevention of hydrophobia by inoculation.
Jie has experimented upon 57 dogs, 19 of which were
mad, and 38 bitten by them under uniform conditions.
Out of these 2^^^ half had been previously inoculated.
Those not inoculated died of unmistakable hydrophobia,
^risereas the 19 others are apparently in the possession
of perfect health.
Death of Dr. CiSSAR Henry Hawkins. — Dr. Caesar
Henry Hawkins, the well-known English surgeon, who
lad been Sergeant Surgeon to her Majesty Queen Vic-
toiiafor a number of years, died in London, July 21st,
>t an advanced age. Dr. Hawkins was bom near the
<iosc of the last century. After having served for a few
Tears as Lecturer on Anatomy at the school in Great
WiBdmiU Street, London, he was appointed surgeon to
^ George's Hospital, where he lectured on surgery, and
^ipidly became known as one of the most learned prac.
titioners of Great Britain. He held this position for
thirty-two years, in the meantime becoming a Trustee of
the hospital, until 1861, when he resigned and was ap-
pointed consulting surgeon, a post which he filled until
his death. He was also for several years an Examiner
in Surgery at the University of London and a member of
the Court of Examiners of the Royal College of Surgeons,
of which he was twice elected President. He served at
different times as President of the Royal Medical Society
of England, the Royal Chirurgical, and the Royal Patho-
logical Societies. On the death of Sir Benjamin Collins
Brodie, Sergeant Surgeon to Her Majesty, Dr. Hawkins
was appointed to fill the vacancy in the Queen's house-
hold. He was the author of a series of lectures on tu-
mors, and furnished a number of other valuable contri-
butions to medical journals.
Some Advanced Views on the Subject of Medical
Education. — The Chicago Medical Society, says the
Medical Age, has lately been devoting considerable of its
attention to the subject of the regulation of medical
practice in the State of Illinois, and a committee, re-
cently appointed to place the matter in shape for con-
sideration, has just made its report. The committee
hold that no degree of the doctor of medicine should be
deemed valid if conferred by any medical college on any
one who shall not have been previously examined, as to
his general education, by a committee of the school of
practice which said student proposes to follow. They
believe also that no medical college should hereafter be
incorporated unless it have an endowment fund of not
less than $150,000 free of all claims. They further be-
lieve that no person should be permitted to enter upon
the practice of medicine unless he has been previously
examined by a board of seven examiners on anatomy,
physiology, chemistry, obstetrics, gynecology, surgery,
practice of medicine, hygiene, State medicine, psychiatry,
therapeutics, materia medica, and pharmacy. This board
of examiners should be chosen from the various schools
of medicine, in proportion to the number of practitioners
of each schooL
Cholera in the Unfted States. — There have, been
five importations of Asiatic cholera into this country,
viz., in 1832, 1848-49, 1854, 1865-66, 1873.
A Veritable Electrical Girl. — A propos of the
Lulu Hurst nonsense, which has lately been amusing
New Yorkers, Dr. Ch. F6r6 publishes editorially in the
Progres Midical of July 5th the account of a genuine
"electrical girl." He describes the case as one of the
"electric neurosis." The patient, a woman twenty-nine
years of age, had been under observation for three years.
She was thin, anaemic, had a very dry skin, and suffered
from nervous anorexia and ovarian tenderness. She ap-
peared to be charged more or less with ^.positive elec-
tricity. Her hair when stroked would crepitate, and
sparks could be produced. With her fingers she could
repel light (electro-positive) objects and attract others
(electro-negative). She was in fine, in the condition of
one who has been slightly charged with electricity. This
evolution of electricity was much greater when her emo-
tions were excited, and M. F6r6 appears to think that the
force is evolved by Mme, X , and not that it accu-
mulates through friction in locomotion. In damp weather,
I04
THE MEDICAL RECORD.
Duly 26, 1884.
the phenomena are much less prominent, and when this
is the case, the patient experiences lassitude and malaise.
Static electricity given at this time makes her feel much
better. M. F6re considers the condition the result of
some neuropathic disturbance. He cites several some-
what similar cases reported by Drs. Girard, Mussy, Hos-
fbrd, Floquin, and others.
Some of the Work which Cholera has Done. — In
187 1 there were 300,000 deaths from cholera in Russia;
in 1873 there were 16,000 deaths in Poland; iri 1872-73
there were 140,000 deaths in Hungary; in 1872-73 there
were nearly 27,000 deaths in Prussia; in 1865-67 there
were 143,000 deaths in Italy. In Paris the mortality
from cholera has been as follows : in 1832, 18,654 deaths ;
in 1849, 191^^4; ^^ 1^53-5493,096; in 1865-66, 12,082;
in 1873, ^^5' ^^ England, in 1849, the deaths from
cholera were 70,000. In 181 7 the army of the Marquis
of Hastings in India lost 9,000 men in twelve days from
Asiatic cholera.
Progress of the Cholera in Europe. — At date of
writing the cholera is continuing its ravages at Toulon
and Marseilles with unabated violence^ The deaths
at the former place average daily between 20 and 30 ;
at the latter between 50 and 60. The number of cases
in the hospitals at Toulon averages about 200. The
record for July 21st at the St. Mandrier Hospital was :
admissions, 14; deaths, 2; under treatment, 122. We
may infer that the epidemic is not a specially virulent one.
Cases of Asiatic cholera are reported at Aries, at Nismes,
and at Vienna. Deaths from ** cholerine " are reported
at Lyons. Deaths from sporadic cholera have been
reported at Paris, but it is doubtful as yet if genuine
cholera has reached that city. The French authorities
have wisely decided not to undertake any inland quaran-
tine against the disease, but to employ suitable inspec-
tion. Quarantine at the frontiers of Italy and Spain
appears to have been carried out with a ridiculous, if not
absolutely harmful stringency. Koch has presented to
the mayor of Toulon a memorandum regarding the meth-
ods for preventing cholera. The substance of it is as fol-
lows : I, cholera is propagated l^ people, and is gener-
ally communicated by contact with human beings or
clothes ; 2, lead a very temperate life, in eating as well as
drinking ; 3, see that your food comes from no infected
locality — cook it well ; 4, see that the water for drink-
ing and washing is pure, boil it if need be ; 5, avoid
large gatherings, fairs, etc. ; 6, disinfect choleraic evac-
uations with carbolic acid ; 7, the apartments of cholera
patients should be left uninhabited for six days ; 8, per-
sons who have been in contact with cholera cases should
wash their hands^ in soap and water and carbolic acid ;
9, laundresses should not take the linen of patients till
after its disinfection ; 10, the .clothes of patients should
not be transported until after disinfection; 11, funerals
should be as plain as possible.
The French Government has decorated Koch with the
cross of the Legion of Honor.
The National Dental Association held its fourth
annual session in Washington, beginning July 2 2d. The
President, Dr. R. B. Winder, of Baltimore, presided.
We would suggest for future discussion the question,
Why dentists always convene in hot weather? |
The Importation of Rags into this Country from
infected ports in Europe has been forbidden by the
Government.
Suicide of Dr. William M. Dorran. — Early on the
morning of July 2 2d Dr. William M. Dorran, of Mount
Vernon, N. Y., shot himself in the head. He was dead
when discovered. Dr. Dorran was bom in Ireland, and
was fifty-two years old. He graduated from the Univer-
sity Medical College in 1863. He left nothing telling
why he had taken his life, but it is supposed that he be-
came despondent over continued ill-health from, a disease
which he contracted in the army, while stationed at Fort
Scott, Arkansas.
New Crematories. — Companies have been organized
in Pittsburgh Pa., and Buffalo, N. Y., for the purpose of
building crematories. They will conduct cremation on
a business basis, and doubtless will find enough '* cranks"
to keep their furnaces supplied.
Peptonizing Milk — A Correction. — In Dr. Smithes
letter on " The Feeding of Infants," etc.. Medical Reg-
ORD, July 19th, p. 80, second column, it should read:
" Mix a powder consisting of five grains of, etc.," instead
of five grammes.
Final Decision Regardino the United States
Medical College. — ^The Court of Appeals has declared
that, according to the intent of our legislation, the words
"literary or scientific college "in the amended general
statute do not cover medical colleges, respecting the
organization and management of which there is a special
statute. The legal defect under which the "United
States Medical College of the City of New York" labored
fi-om its birth not having been cured by the nicely planned
legislation of 1882, that institution, says the TlnteSj has
returned to the nothingness out of which it sprang.
Is IT True ? — It is generally considered better not to
wash in public the linen that is encumbered with adven-
titious, sordid, and germ-breeding products. Alleged
peculiarities in the social habits of the American Medicaji
Association doctors, however, have lately been receiving
not only a national but a European laundressing. We
clip the following from the Medical Press and Circular ;
Lack of Refinement in the American Medical i
Association. — A resident of Washington writes to thti
New York Medical Journal as follows : " The usual disJ
graceful performances took place at the receptions. Mrsu
L generously opened her beautiful house, and prQ
vided as fine a table as Demenet could serve. She wa
rewarded by having men stalk in (hats on their heads
from the front room to the dining-room, where thq
fought like wolves for places at the tables, overturaiq
piles of plates, breaking her expensive ornaments, an
soiling her rugs with pools of tobacco-juice."
We are very confident that the description thus given isi
gross exaggeration. We have met a number of gentlemei
who attended the Washington receptions and heard a
such reports. We can refer also to the authority of th
Texas Courier-Record that the members in question we^
a " grand, grave body of men," whose lives gave proofs
the immortality of the soul, and suggested nothing i
prandial rapacity and ill-timed expectoration. WasbinJ
ton correspondents should be a little more careful i|
criticising their medical colleagues.
July 26, 1884.]
THE MEDICAL RECORD.
105
Reports ot ^ocUtUs.
AMERICAN OTOLOGICAL SOCIETY,
SivenUenih Annual Session^ held at Grand Hotels Cats-
kill Mountains^ JV. Y.yjuly 15, 1884.
The American Otological Society held its seventeenth
annual meeting at the Grand Hotel, Catskill Mountains,
Tuesday, July 15, 1884.
Morning Session.
Id the absence of the President, Dr. C. H. Burnett,
Vice-President Dr. J. S. Prout called the Society to
<ffder.
The first business was the appointment of a Business
Committee, consisting of Drs. F. B. Loring, £. W. Bart-
Jett, and A. Alt.
Dr. Andrews, of Philadelphia, was invited to a seat
in die Society.
Dr. H. Knapp, of New York, read a paper
m THE indications for opening the mastoid pro-
cess, BASKD on some RECENT OBSERVATIONS.
In it he described three cases, which were cited as
dlostrations of some of the conditions in which this oper-
ation was of value. The first case was one of acute
tympano-mastoiditis, in which paracentesis of the tym-
panic membrane had been tried without afifording any re-
Iie£ The mastoid process was trephined, a large amount
ofpus removed, and this was followed by rapid recovery.
The second case was one of chronic suppurative tym-
pmo-mastoiditis, in which there was severe half-sided
headache. In this case relief followed the operation.
The third class of cases, of which an illustration was
dted, was sclerosing mastoiditis. In this case the tym-
panic membrane was intact, there was constant severe
headache. Complete relief was afforded by the opera-
tiOD.
The operation, as performed by Dr. Knapp, consists
in making an incision one centimetre behind the inser-
tion of the auricle, the point of election for perforating
the bone being the pit of Dessarenne. Chisels alone are
tued in making the perforation. The direction of the
openmg should be parallel to the course of the external
meam& Especial stress was laid on the use of sponges
in die cleansing of such wounds. The advantage being
that no fibres are left in the part.
In acute suppurative otitis the immediate removal of
the pus is sometimes sufficient to cause a cure. Syring-
ing is not employed unless there is old suppuration or
profuse suppuration sets in a few days after the opera-
tion. Where it is wished to have union by first inten-
tion, the edges of the wound are brought together with
tiie continuous suture. This is intended after operations
ior merely congestive sclerosing processes, or when in
WMKsnppurating otitis, the cranium has been opened.
For washing the wound, weak solutions of chloride of
«dtam or boradc acid are employed.
Before taking up the discussion of this paper, the
paper of Dr. J. A. Lippincott, of Pittsburgh, Pa., was
Rad, entitled,
i CASE OF mastoiditis INTERNA CHRONICA WITH SCLS*
ROSIS — ^TREPHINING — RECOVERY.
A young lady nineteen years old was first seen March
X5i 1883, at which time siie complained of moderately
terere pain from which she had suffered several months.
Her previous health had been good. Tlie watch could
be heard when placed against the ear. A quantity of
vax was removed fi^m the canal and the tympanic niem-
Inae found to be red and irritated. The removal of the
VOL did not cause much improvement in hearing, which
ns one-diirtieth in the right ear. The left ear was nor-
BaL Sli^t catarrh of the naso-pharynx was found. A
solution of boric acid and borax was ordered to be in-
stilled ; this caused some relief. But five weeks later,
the suffering greatly increased and the pain y(dA referred
to the region of the middle ear and to the mastoid pro*
cess. It was also felt in the whole side of the head. '
There was a great deal of swelling over the process and
below it. Examination of the ear showed that the mem-
brane was not congested, but the typical light-cone was
absent and the anterior two-thirds of the membrane
showed a silvery lustre. The Eustachian tube was per-
vious. There was slight elevation of temperature.
Leeching and poultices were applied extemsdly, and
calomel and a febrifuge administered internally. This
caused rapid improvement
The note of the case made April 28th was as follows :
Continuous dull pain in the ear and mastoid process.
The swelling has entirely disappeared. Hearing two-
thirtieths. Tunbg-fork on vertex heard best on the af-
fected side.
During the following months the pain continued to in-
crease in severity and was especially felt in the mastoid
region. Hearing steadily diminished. There was no
swelling, and cerebral symptoms were absent. The
treatment consisted in the use of blisters, and other ap-
plications, incisions and anti-neuralgic and alterative
remedies internally.
On March 20, 1884, an incision was made behind the
auricle under ether, and an opening, seventeen millime-
tres in depth, was made with Buck's drill. The osseous
tissue was hard and ivory-like. A carbolized tent was
inserted and a poultice applied.
After the operation, the pain was greatly relieved and
entirely disappeared in a few weeks. Shortly after the
operation, a return of the pain was produced by expos-
ure, but this was at once relieved by the application of
an ointment of the yellow oxide of mercury and bella-
donna.
On July 8, 1884, the patient was entirely free firom
pain and the hearing was six-thirtieths.
Dr. a. H. Buck, of New York, thought that it was
not desirable to attempt to obtain union by first inten-
tion. He had always believed that the good results of
the operation were largely dependent on the irritation
and drain which it produced.
Dr. Knapp said that the only ease in which he had
tried to secure healing by first intention was in one in
which the lateral sinus had been opened.
Dr« Charles J. Kipp, of Newark, N. J., had come
across a number of cases in which, while there was no
external evidence of disease, carious bone was found
after separating the periosteum, and cited an illustrative
case.
Dr. Samuel Theobald, of Baltimore, Md, considered
the administration of constitutional remedies a very im-
portant part of the treatment, often obviating the neces-
sity for operation. He had obtained excellent results
firom the use particularly of iodide of potassium and the
biniodide of mercury. With these he had used inunc-
tions of mercurial ointment and the oleate of mercury.
Dr. Sexton, of New York, exhibited a number of phQto-
graphs and briefly described the cases which they illus-
trated. He differed from Dr. Knapp in the conclusions
which he had drawn. He did not think that pain alone
was a sufficient ground on which to base a diagnosis of
involvement of the mastoid process.
Dr. J. A. Andrews stated that one of the indications
by which he was guided in opening the mastoid cells was
the occurrence of swelling of the optic disk or optic neu-
ritis. When this appeared in a case in which there was
restlessness, and pain, he performed the operation.
Dr. a. Mathewson, of Brooklyn, stated that in many
of the fatal cases of aural disease, post-mortem examina-
tions failed to reveal any evidences of mastoid disease.
Dr. a. H. Buck described the method which he pur-
sued in these cases. They can be divided into two
classes: in one the mastoid disease develops in a well
106
THE MEDICAL RECORD.
[July 26, 1884,
Dr. J. J. B. Vermyne, of New Bedford, Mass., read
the next paper, which was entitled
DISEASE OF THE ETHMOID, THE CONSEQUENCE of
CHRONIC CATARRH OF THE NASO-PHARYNX— EXOPH-
THALMOS,
in which was described the case of a young lady of six-
teen, who consulted the author on account of a slight
protrusion of the right eye. The protrusion was forward
and downward and had existed for some time. The eyt-
lids were not cedematous. There was no dilatation of
the veins, the conjunctivae were normal and pam was
absent. Ophthalmoscopic examination showed that the
optic disk was slightly elevated and that the vessels of
the retina were dSstended. There was slight hyperme-
tropia on the right side, but vision was normal on both
sides. Headache had been noticed for a few days be-
fore she came under observation. The general health
was good with the exception of a chronic naso-pharyngeal
catarrh, which had existed for eleven years and which
had followed a severe attack of scarlet fever. This was
particularly marked on the right side. The movements
of the right eyeball were not interferred with. There
was slight diplopia on awakening in the morning, but
this continued only for a short time. A neoplasm in or
around the nerve was suspected and the treatment di-
rected accordingly. In a short time the patient entirely
recovered with Sie exception of the protrusion of the eye.
A further consideration of the case led the author to
think that possibly the symptoms might be explained on
another supposition than that of a neoplasm. A careful
examination was again made, and a hard inunovable
nodular tumor, extending from the upper internal corner
of the eye to the internal canthus, and which evidently
was connected with or originated from the os planum,
was 'found. The symptoms were then referred to the
naso-pharyngeal catarrh and suitable treatment insti-
tuted. The case was considered to be one of retention
tumor, similar to one which was reported by Dr. Knapp,
in 1876, to the International Ophthalmologicai Congress.
This opinion was largely based upon the fact that there
had been frequently observed a peculiar appearance of
the eye, which was compared to a lobster eye. The
speaker referred to the fact that Dr. Knapp's case had
been successfully operated on by the chisel : a plan of
treatment which Dr. Knapp had advised in all cases of
this kind whether of exostosis or of retention tumors.
Another case of Dr. Knapp's, reported in the April
number of the Archives of Otohgyy was referred to. The
above operation was performed, but the patient died from
traumatic meningitis. Disease of the osseous walls oJ
the frontal sinus was found after death. In reviewing the
conclusions drawn by Dr. Knapp from the last case, th(
speaker though it proper to ask what constitutes a com-
paratively healthy pneumatic, and whether some participa
tion of the bone in the neighborhood of the tumor can no
with reason be suspected ? And also, considering the le^
danger which might attend simple mechanical distentioi
of the bone, whether an explorative puncture with :
trocar would not become imperative, instead of beiqi
unnecessary, as stated by Dr. Knapp, and whether ii
tmmors of this kind, when not endangering the eye am
not of inconvenient size, it would not be better to Ic
them alone as has been advised by other authorities ? .
' Dr. Vermyne also read a paper on \
MYXOFIBROMA AT THE BASIS CRANII, CAUSING BLINDNESS
AND SEVEN YEARS LATER, COMPLETE DEAFNESS BY Dl
STRUCTION OF THE LABYRINTH.
The patient was first seen in the early part of i87<
dimness of vision and fatigue of the eye being coi
plained of. Vision = ^ There was slight congestion \
the optic disk and of the retinal vessels. Three monll
later, severe headache and optic neuritis appear^
Under the use of the artificial leech and the adouniM
tion of large doses of bromide and iodide of potassin
person ; in the other it develops in one who has had
for some time a purulent discharge from the ear. If the
disease supervenes in an old case of ear trouble, tender-
ness, redness, and swelling of the glands will probably be
absent, although serious disease of the mastoid process is
present The next question is whether or not there is
adequate provision for the discharge of matter. If there
is not the operation should be performed. In the acute
cases he considered it good surgery to operate on the
mastoid process.
The paper was discussed further by Drs. Jones, Seely,
Pooley, Mathewson, and Fryer.
Dr. a. H. Buck, of New York, in a paper
ON THE USE OF LARGE DOSES OF IODIDE OF POTASSIUM
AND IODIDE OF SODIUM IN THE TREATMENT OF CASES
OF RAPID LOSS OF HEARING
supposed to be due to syphilitic disease, reported several
cases which he had collected in studying the literature of
the subject. In two of these, benefit had followed anti-
syphilitic treatment He added to this a detailed account
of a number of cases treated by himself with large doses
of the iodides, in none of which had a cure been effected
and in only one or two had temporary benefit been ob-
tained. He had given the iodide in doses as large as
five hundred and twenty-five grains per diem, without
any beneficial effects. He thought that this was prob-
ably due to the fact that the disease had destroyed the
organs essential to the perception of sound, and although
the source of pressure which had caused this injury might
be removed, the destruction had been such that the organ
did not regain its functions.
Dr. Seely stated that his experience had led him to
the conclusion that if benefit did not follow moderate
doses of anti-syphilitic remedies it was not to^be ex-
pected.
Dr. Buck had reached the same conclusion.
Drs. Mathewson, Jones, Knapp, and Andrews also
took part in the discussion, and reported cases similar
to those described by Dr. Buck in which the results
of treatment had been negative.
Adjourned.
Evening Session.
The first paper read at the evening session was by Dr.
Seely, of Cincinnati, O., on
THE TREATMENT OF SUPPURATHTE OTITIS MEDIA WITH
JEQUIRITY.
After referring to the failure of the various plans of treat-
ment in this affection, he stated that in oider. to obtain
the best results, it was necessary to fulfil the following
conditions : first, cleanliness ; second, rendering and keep-
ing; the Eustachian tube patulous ; and third putting the
naso-pharynx into a healthy state. This last point is
frequently entirely ignored. The mucous membrane of
the cavity of the tympanum frequently passes into such
a condition that it can only be relieved by changing it
into cicatrical tissue ; a condition similar to that found in
tracheomatous inflanunation of the conjunctiva.
This latter affection has recently been treated by indu-
cing a violent inflammation by means of the infusion of
jequirity. For the past year or two Dr. Seely has been
treating certain cases of long-standing suppurative otitis
media, by inducing inflammation with the solution of
jequirity which has been used in the treatment of similar
diseases of the eye, and he considers this plan of treat-
ment of value under certain conditions, which he formu-
lated as follows : i, where there is extensive destruction of
the membrana tympani ; 2, where there is a great amount
of thickening of the mucous membrane, thus rendering
other plans of treatment futile or tedious ; and 3, where
there is a patulous Eustachian tube, a condition for regu-
lating the inflammation.
July 26, 1884.]
THE MEDICAL RECORD.
107
the patient improved The patient passed from under
observation on account of the statement to the patient's
parents that there was probably a cerebral tumor, and
that the improvement was likely to be only temporary.
Five years later the patient was again seen, and sec-
ondary atrophy of both optic disks was found. In 1873
she became deaf ; but six weeks' later she could hear
almost as well as before. After this the hearing gradu-
ally disappeared. The patient died in May, 1874, ^ig^t
and a-haJf years after the first observation.
At the autopsy, a tumor measuring six centimetres in
lei^9 four centimetres in width, and two centimetres in
thickness was found occupying the left inferior occipital
fossa. The left half of the cerebellum had been com-
pif^ed to one-third of its normal size. The consbtence
of the cerebellum was increased, and both it and the
cerebrum were anaemic. A considerable amount of fluid
vas found in the ventricles. The tumor in its growth
bad impinged upon the petrous portion of the temporal
bone of the left side, and had caused the entire destruc-
tion of that portion of it between the posterior wall and
the tympanic cavity, which had been opened.
The speaker considered that the first symptoms of the
ttsDor were those referred to the eye ; that in all prob-
ability the tumor originated from the dura mater, and that
the e£fect upon sight and hearing was to be attributed
entirely to interference with the circulation from mechani-
cal pressure.
Dk. Charlks Kipp reported two cases of a similar
nature, m one of which the frontal sinus, the ethmoidal
ceQs^ and the sphenoidal cells, were filled with innumer-
able polypL
A CASE OF EPITHELIOAiA OF THE AURICLE
was reported by Dr. Charles J. Kipp, of Newark. The
grovth developed in a young man aged nineteen, and
had been growing for one year. It involved the concha
and closely resembled a mass of granulation tissue, but
it was harder than this, and this condition led to the
diagnosis of granuloma. It was removed, the wound
healed, and the case passed from under observation, so
that its subsequent history could not be obtained The
miaoscope showed the growth to be made up to a great
extent of epithelial cylinders, imbedded in a very vascu-
lar, fine fibrillar tissue.
Dr. Kipp also exhibited a cavernous fibro-lipoma which
be bad removed by excision from the auricle of a man
thirty-one years of age.
Dr. L. Howe rea!d a paper entitled
IL£MAT0MA AURIS — ITS TREATMENT WITH ERGOT.
The condition had occurred in a sane woman aged
tvcDty-eight, without apparent cause. Hypodermic in-
jections of ergot were tried with the effect of greatly di-
BunishiDg the size of the auricle.
Dr. Samuel Sexton read a paper on
THE influence OF DENTAL IRRFTATION ON THE EAR.
A nomber of plaster casts were exhibited, showing the
condition of the teeth in cases in which the ear symp-
toms were found to be due to the caries or other trouble
vi& the teeth, and in which relief was only obtained
«i^ these difficulties were corrected.
The following papers were read by title : Dr. Todd's,
of St. Louis, Mo., entitled, " Necrosis of the Right Laby-
mth; Total Facial Paralysis on the same Side ; Partial
lecovcry;" Dr. Burnett's, of Philadelphia, Pa., on
'^Iteflex Aural Phenomena from Naso-Pharyngeal Ca-
toik ; Objective Noises in and from the Ear ; " and Dr.
H. N. Spencer's, entitled, " A Simple Device for the
li'atiiient of Nasal and Post-nasal Inflammations, and
a the Importance which Attaches to such Conditions
tf iBflammation as they are Related to the Ear.**
Pkopkssor F. E. Clarke read a paper in which he
s^ for a reliable test for hearing, by which the differ-
t&cc between hearing and feeling might be determined ;
for a method by which the hearing might be developed
or improved, and whether injury might be done in these
cases by loud noises, etc.
The paper was referred to a committee of three, of
which the President of the Society was to be chairman.
The Society then went into executive session.
The new members elected were : Dr. E. D. Spear, Jr.,.
Boston ; Dr. John Vanduyn, Syracuse, and Dr. S. O.
Richey, Washington.
officers for the ensuing year.
President— Dr. C. H. Burnett, Philadelphia ;: ^^'^-
President— Dr. J. S. Prout, Brooklyn ; Secretary and
Treasurer— Dr. J. J. B. Vermyne, New Bedford, Mass. ;
Committee on Publication — Dr. J. J. B. Vermyne, Dr. C
J. Blake, Dr. O. J. Green ; Committee on Membership —
Dr. John Green, Dr. H. G. Muller, Dr. H. O. Moyes.
The next meeting to be held at the same place as the
American Ophthalmological, and on the day preceding
its meeting.
The Society then adjourned.
THE PARIS ACADEMY OF MEDICINE^
I Stated Meetings June 24, 1884.
M. Alphonse Gu^rin, President, in the Chair.
(Spccui Report for Thb Mbucal Rbcord.)
The Academy having been called to order, M. Fauvel^
at the request of several of the members, made a short
report upon
the cholera in toulon.
He had already had occasion, before the Consulting
Committee on Hygiene of France, to express the opinion
which he held that the present epidemic was not Asiatic
cholera. All the (acts in connection with the case go to
prove that the disease is of local origin, and is due to the
herding together of a considerable number of troops
placed under defective hygienic conditions. These same
conditions have before now, notably in England, caused
outbreaks of epidemics, attended with great mortality.
Such epidemics are ephemeral, continuing and subsiding
along with the conditions which have ^ven occasion to>
them. The mode of origin of the epidemic in Toulou,.
and its subsequent course, have nothing in common with,
our ideas of Asiatic cholera. Whenever this dreaded
disease visits a large community, it strikes with great fury
and advances with extreme rapidity, so that it reaches its.
maximum of intensity within a few days, having then at-
tacked all those who are susceptible to its influence.
M. J. Gu^RiN asked that M. Fauvel might be a
little more explicit in his report, so that the Academy
might not be dependent upon the daily papers for infor-
mation concerning the Toulon epidemic.
M. Fauvel regretted that he would not be able to
give any more detailed information until the next meet-^
mg. He could state, however, positively, that the epi-
demic was declining.
M. Boulev announced that MM. Roux and Straus
had left for Toulon, and would bring back some valuable
documents bearing upon the origin and nature of the
disease there prevailmg. These documents would be-
laid before the Academy when the question of thecholera
epidemic came up for discussion.
M. BucQUOY then related a case of
FARCY,
occurring in a coachman, nineteen years of age. The
patient, who had been ill for a fortnight, presented all
the symptoms of typhoid fever, except that there were
no rose-colored spots nor any gurgling on pressure in
the right iliac fossa. A little later, M. Bucquoy noticed
a small round ulcer on the external suriace of the ri^t
leg, and an abscess a little higher up on the limb. With^
io8
THE MEDICAL RECORD.
[July 26, 1884.
in a short time the patient had a severe chill, and this
was followed by swelling and redness about the right
ankle. Suppuration soon appeared within the joint.
Several of the other articulations became similarly
aififected, the patient rapidly lost strength, and finally
died. Just before death the body was nearly covered with
an eruption of bullae. The author inoculated an ass
with fluid taken from the body of this patient, and the
animal sickened with farcy, thus showing conclusively the
nature of the disease from which the young man had
suffered. It was ascertained afterward that the patient
had slept in a stable in which was a horse affected with
glanders.
A communication to the Academy from Madame Pa-
quereau, regarding the interests of
MIDWIVES IN ALGERIA,
was then reported upon by M. de Villiers. He declared
himself in favor of recognizing the midwives practising
in that colony.
The Academy then adjourned.
THE BIOLOGICAL SOCIETY OF PARIS.
Stated Meetings June 21, 1884.
M. Paul Bert, President, in the Chair.
(Special Report for THb Mbdical Rjbcokd.)
The Society having been called to order by the Presi-
dent, M. BocHEFONTAiNE read a communication on the
ACTION OF salicylic ACID UPON RESPIRATION.
He had observed the effects of the drug upon healthy
individuals and those suffering from typhoid fever. The
respiratory movements became more regular under its
influence, probably by reason of its action upon the me-
dulla oblongata.
M. DlsjERiNE had recently been studying the
PERIPHERAL NERVE-LESIONS IN LOCOMOTOR ATAXIA,
and presented a report of his investigations to the So-
ciety. The man, a patient in M. Vulpian's service, had
a sclerosis of the posterior and lateral columns. There
was complete anaesthesia of both lower extremities, with
the exception of a small area on the inner surface of the
right knee, where sensation was preserved. M. D^jerine
found marked changes in all the peripheral nerves except
those suppl3dng the area of preserved sensation. The
lesions were less marked in the cord than in the nerves.
The author insisted upon the importance of this localized
beuritis in the symptomatology of ataxia.
M. DuMONTPALLiER related a case of
INDUCED BILATERAL HALLUCINATIONS.
The subject was an hysterical female who had been
h3rpnotized. While in the somnambulistic state, a card
was placed perpendicularly between the eyes so as to
divide the field of vision into two parts. A pleasant
image being presented to one eye and a disagreeable one
to the other, the impressions thus conveyed to the hemi-
spheres were reflected back to the corresponding halves
of the patient's countenance. These impressions per-
sisted even after the patient was awakened, the two sides
of the face expressing the opposite sentiments of joy and
grief. M. Dumontpallier believed that he was the first
to produce these suggestions to the brain by influencing
the retina alone.
M. Glsy had endeavored to repeat the experiments of
M. Aphanasieff in the
TRANSFUSION OF PEPTONIZED BLOOD.
He had at first made use of peptones of German manu-
facture, but had found them too impure for this purpose.
He had, however, succeeded in arresting coagulation by
means of a liquid obtained by the washing and macera-
tion of a pig's stomach.
M. Beauregard described the
HEART OF THE SPERMACETI WHALE,
which he had recently had an opportunity to examine.
It measured nearly three feet in length by a foot and a
half in width, and was of an oval shape. The right auri-
culo-ventricular valve had three segments, the lefk had
four. The sigmoid valves were without any nodules.
The bone of the heart was absent The heart of the
spermaceti whale would thus appear to be intermediate
between that of the ordinary whale (balaena) and the
dolphin. AiiLOther point worthy of mention was that
the walls of the left heart were no thicker than those of
the right.
M. P. Bert remarked, regarding the equality in thick-
ness in the walls of the two sides of the heart, that this
was as it should be physiologicalljr, since in the whale
the blood was to be propelled horizontally and not up-
ward. One could easily understand that it would re-
quire a stronger heart to pump the blood upward into
the head of a giraffe than forward into a whale's head.
M. Okorovitz then read a note upon
ideoplasty,
or the physiological realization of ideas.
This was followed by some further remarks by M.
Bert upon
ANiESTHESIA FROM DILUTED CHLOROFORM VAPOR.
He agreed with M. Aubean, who had read a commu-
nication upon the same subject at the preceding meet-
ing of the Society, that the best mixture was one of eight
parts of chloroform to a hundred parts of air. This
mixture caused death in a dog in three hours ; but if the
strength was reduced to six per cent, the fatal termina-
tion was delayed for nearly seven hours. Although man
bears chloroform better than the dog, M. Bert thought it
advisible, nevertheless, after anaesthesia had been pro-
duced by the eight per cent, mixture, to reduce the
strength somewhat The author stated further that when
an animal had once fallen into the most profound an»»-
thesia, it would absorb no more chloroform until the
aneesthesia had begun to diminish.
M. Brown-S^quard related a case of
CHLOROFORM NARCOSIS MAINTAINED FOR EIGHT DAYS.
The patient was an epileptic who had sustained a
fi-aciure of the arm, and it was consequently of para-
mount importance to prevent the convulsions for a time.
Two of his assistants, medical men, were his authority
for the assertion that the sleep had not been interrupted
during the whole of this time. Simpson has recorded two
cases in which chloroform narcosis was prolonged for three
days.
After the election of a new member the Society ad-
journed.
Mr. Gamgee's Sponge.— Mr. Sampson Gamgee has re-
cently shown his new absorbent sponge before the Soci6te
de Chirurgie. The description of it is as follows : "A
small capsule, containing eucalyptus or other antiseptic,
was enclosed in absorbent cotton ; outside of this was a
layer of cocoanut fibre, and outside of this more ab-
sorbent cotton-wool ; the whole being enclosed in gauze.
When about to be used the capsule could be broken by
a blow of the fist, and the absorbent cotton become per-
meated with the antiseptic. He said these sponges could
be made at a very ^nfling cost, and hoped they would
come into use as a cheap substitute for ordinary sponges ;
they possessed this great advantage, that when required
for use they were certain — however long they might have
been kept— to be antiseptic : and, being so cheap, they
might always be destroyed after being used."
July J6, 1884.]
THE MEDICAL RECORD.
109
(SmxtsponAmce,
THE QUESTION OF THE FLORIDA CLIMATE.
To THE EnTOR or Thk Mbdicax. Rkcosd.
Sir : The nnmber of phthisical cases visiting Florida dur-
ing the winter of 1 883-^4, physicians and landlords assured
the writer during a stay of some months there, was greater
than ever before. Gainesville may have been an ex-
ception, but certainly not if scarcity of suitable food
and accommodations are a criterion. Approaching
Gainesville from the direction of Palatka the country is
almost an unbroken level, as it is in leaving Gainesville
and proceeding toward the Gulf coast ; this topographical
characteristic has probably been observed by thousands
fhohave visited Gainesville, as well as myself. There is
therefore no natural fall nor inclination of streams toward
any great river nor the Gulf of Mexico, no basis for
oatoral drainage. The construction of artificial drains
would, owing to the level surface, involve great expense.
The Alachua Sbk, a few miles distant, would from a
sanitary standpoint be considered rather as a source
from which the germs of malarial disease might be dis-
seminated during the spring and autumn months, than
otherwise. Practically, the throat leading to it is choked
up with debris and the surrounding country overflowed
by a vast and virtually stagnant pool of fresh water, into
which the element of vegetable decomposition must of
necessity enter, aided by absence of outlet and the flat
configuration of the land. The calcareous deposits and
in places marshy soil account for the inferior quality of
the drinking-water in those parts.
With reference to the large number of deaths, a clergy-
man well known and high in the church, one who has
spent many winters in Florida, and one certainly not
Qiely to make such an assertion unless founded upon the
finty rock of fact, affirms that during his visit in Gaines-
riDe deaths from phthisis occurred nearly every day or
two, and that cadavers were frequently removed by ni|rht
km the hotels by the back door, in order that depressmg
iafloences might not be exerted upon patients, non-
phthisical or otherwise. Darkness cannot conceal the
eold. white face, and the little world in the " Land of
flowers ** knows that another is gone to his or her long
kme.
One word about Cedar Key, or Cedar Keys as it is
written in not a few books and maps and so called by in-
habitants. During a sojourn there the prettiness of the
fole place, with its row of bearing orange-trees on either
ide of the street, impressed itself upon my mind. There
I a certain balminess in the air not noticeable on the
itiantic side. The approaches are perfectly flat, and
ftere is no obstruction to the mild zephyrs coming over
ie placid waters of the Gulf or across the numerous
Ettle keys studded with palms and cedars. It is a typical
ipot to which Tampa, although much farther south, bears
resemblance, and if phthisical cases ought to be
RDt to Florida at all, which is extremely doubtful, they
iQold certainly derive more benefit anywhere on the
lestero coast than along the borders of the Atlantic
kean. There is naturally considerable jealousy be-
rival towns eager to secure the greatest number of
■tors, and doctors differ as widely in their views about
biida as a health resort as about anything else,
pnions founded logically upon reason and individual
tion are not likely to be changed, and further argu-
t upon the subject would not only be futile but would
be trespassing idly upon the valuable pages of The
)ICAL Rkcord. Yours very truly,
G. Halsted Bovland, M.D.
jKra,s8a4.
Thk White of an Egg must no longer be looked
IM as a simple albuminous body. Leboute, Goumoens,
, and recently Dr. E. T. Reichert have found that
exists in it a globulin and a peptone.
THE ABUSE OF MEDICAL CHARITY IN THE
SOUTH.*
To THK Editok op Thb Msdical Rboobo.
Sir : I desire to direct your attention to the evils of charity
practice as conducted in our city, and in fact not only
in Knoxville, but also throughout the country at large,
wishing to place myself on record as opposed to the
present custom. I will also endeavor, with a few brief
remarks, to suggest a more satisfactory mode of practice^
both to the practitioner and to the worthy poor.
I take it, we all, every one of us, are practising our
profession for our bread and butter, however much we
may speak of the honor and glory attendant upon the
practice of our truly progressive science. When we are
called to a patient we expect and certainly ought to re-,
ceive compensation for our services, and yet how many
are there among us who have not scores upon scores of
pauper patients upon their account books, and who is
there among us who does not go, always go, time after
time, to the same pauper patients, knowing beforehand
that we will never receive any pay for our services ? I
am speaking now of pauper patients as a whole, includ-
ing all classes — all who are recipients of gratuitous
practice. It is a thankless practice, whether we treat a
miserable dead-beat or a deserving pauper. To the busy
practitioner the attendance on the pauper class directly
takes money from his pocket, consuming valuable time,
time which could otherwise be given to the better classes
of his clientele. As it now is, the busy active doctor
will often attend before, and give more attention to a
poor patient than to a well-to-do patient, for the simple
reason that he is afraid it will hurt his reputation if he
fails to find time to wait upon the poor who call upon
him. He is afraid some one will say, ''Oh ! Dr. So-and-
so will not call and see me because I am poor." He
does not attend the poor from a feeling of duty, for
honor, glory, or fame, but simply out of policy. Policy
is a fine scheme. Leave policy out of consideration,
and I think a number of reputed benevolent, warm-
hearted physicians would be shorn and bereft of their lau-
rels. Mind, I do not say all. I only say a number. I
know there are hundreds who are really deserving of
their reputation for warm-heartedness, benevolence, and
philanthropic measures ; but ^fter all is said and done,
we are but human, we doctors, and we practise for dol-
lars and cents.
Another feature is the character of treatment we render
to the poor. And right here I will say I expect 1 will
receive censure for saying that I think die majority of us
neglect the poor. I do not think we are as careful and
painstaking with them as we ought to be. While here
and there we may find a conscientious practitioner, one
who will give as much attention to a pauper as to first-*
class pay patients, I am free to say I do not believe that
the majority of us give them the care and attention wc
ought and that they deserve. For I hold that no man,
in any business whatever, not even the profession of med-.
icine, will give without a quid pro quo^ the same care,
energy, thought, and attention that he would bestow for
a consideration.
Perhaps before continuing further it would be weU
to make a division or separation into classes of those
who are called charity patients. I divide them inta
simply two classes : first, dead-beats ; second, the wor-
thy poor. There is no need of further subdivision.
These two classes include the whole mass of charity pa*
tients. Of the truly worthy and needy poor, I have this
to say : it is the duty of every man, in whatever walk of
life he may move, to help, relieve, and succor a poor^
distressed, and afflicted brother, he being worthy. It
is the bounden duty and becomes the solemn obliga-
tion of every village and county to take care of their
worthy poor ; but because it is right and just that the
' This letter is the substance of an address delivered before the Knox County
Section of the East Tennessee Medical Society, May 09, 1884.
no
THE MEDICAL RECORD.
[July 26, 1834.
worthy poor should be taken care of^ it is not right, nor
is it just, that the care, labor, attention, and in many
•cases expenses also, necessary for their assistance and
relief should be saddled upon a few only of the commu-
nity, simply because they always have shouldered the
burden and carried it, not only without compensation but
without murmur or grumbling. To be sure, ours is a lib-
eral profession (in more senses than one) and in all ages
and all time we have ever been ready and willing to re-
spond to the call of charity, not only with money itself
but with the knowledge, skill, and understanding of treat-
ment our professional attainments should be composed
of. This is a very mistaken idea. This is all wrong.
Because we have heretofore, do now, and probably will
hereafter do these things is no reason why we should be
imposed upon. A free horse should not be ridden to his
death. Yet it is our own fault, all our own fault ; the
remedy lies in our own hands. We can stop this wrong
system of practice if we only will do it.
I have talked with numbers of our profession, both here
and elsewhere, and I have yet to find the first man who
does not condemn and deplore the present system of
practice, and yet all, not one exception, but express
themselves as ready to attend the needy poor. To dis-
tinguish always between the worthy and unworthy poor
is not easy. The dead-beats we all know (after we get
through with them) ; those who run up a bill and employ
you as long as they dare, and then apply to some one
else, because, perhaps, they don't wish to lay themselves
liable to be refused your services ; perhaps because they
are ashamed to call you in after they have made large
bills. They are the ones who dodge you on the street
corner, iv^ho would rather go squares around than pass
your office or house. In this way they go the rounds,
and every new doctor is sure to be overrun with these
patients, who owe every doctor in the neighborhood, and
in this way get their entire professional services free, as
it takes them their lifetime to make the rounds of every
physician in a city of this size. Some of them, it is true,
die before they get clear around. Sad, is it not ! Then,
too, there is a singular peculiarity about these miserable
dead-beats ; it is this, they more frequently call you out
at night for trifling ailments. If a farmer living in the
country, he cannot spare a horse or man from the field
to send after you in the day-time, but must needs wait
until night, after the day's work is done, and thus entail
double duty on man and beast, for he never goes himself,
but sends a neighbor.
There is another important feature with this class of
practice : nine-tenths of all the suits for malpractice one
has or may hear of, if one takes the trouble to look them
up, will be found to have been instituted by some misera-
ble scoundrel of a dead-beat. You find them all alike.
They are the men who find it cheaper to move than to
pay rent, and as they move back and forth through the
•city leave their bills at drug stores, at the grocer's and at
the butcher's unpaid. You recognize the man. You all
know him. These are plain, unvarnished truths.
Perhaps I have drawn out and spread over too much
paper my conception of the evils of the present sys-
tem of charity practice. In treating of the remedy,
which I claim lies in our own hands, I will try and be
more brief, and at the same time give a clear outline
of what I conceive to be the best way out of the
dilemma. Let me preface by saying that, did this prob-
lem lie before any other class of men than physicians it
would be quickly and readily solved. But physicians
are proverbially unbusinesslike. As one of the first
steps toward reform in this direction let us make out,
and keep up and compare full and complete black-lists,
not merely talk of it and once in several years exchange
a hasty memoranda of delinquents, but regularly every
quarter, say, revise the old black-lists carefully and make
such additions and alterations as is necessary, bring your
new list to your medical society, each man hand his
list to the secretary, and have the secretary make out a
complete list and furnish one to each member of the
society, have them in printed form if desired. By doing
this in earnest, not making a farce of it, we will accom-
plish a great deal. We will create more of an mterest in
our society. We will bind ourselves more closely to-
gether, and will naturally work more harmoniously to-
gether, and be in* better shape to secure the accomplish-
ment of our desires whatever they may be.
We should not only have one city physician, but we all
should be city physicians^ and receive pay in proportion
to the amount of work we do. Another thing, in regard
to the city hospital Under the present regime the
hospital practice is in the hands of a select few. If any
outsider has an interesting case, which of a necessity is
obliged to avail himself of hospital privileges and accom-
modations, he is obliged to turn over his patient to the
select few. In Stillwater, Minn., a city of fifteen thou-
sand population, where I practised some little time be-
fore removing to Knoxville, any physician in the city was
privileged to take a patient to the city hospital and
wait upon him himself. The system worked well, and is
in vogue to-day in Stillwater, giving excellent satisfac-
tion.
In several parts of the old country, in Germany, which
I recall in particular, where an individual is sick, or
members of his family are sick and need professional
care and is unable to pay for same, he makes applica-
tion to one of the town officials for aid. The official
gives him an order to a physician (the applicant select-
ing his ph3rsician) to wait upon him, and also gives him
an order to the apothecary for necessary medicines,
which order must be countersigned by the physician.
Then the physician and apothecary present their orders
to the treasurer or proper official and are paid their
bills. A certain schedule of prices being authorized by
law at a certain per cent, discount from the regular fee-
bilL
In some parts of Michigan, also in Lancaster, O., a
similar law prevails. Other places that have this system
I cannot now recall. In our own city, perhaps, the best
way is, when a pauper requires medical attention let him
apply to the alderman of his ward — aldermen are usually
pretty well acquainted with the people of their wards (at
least immediately preceding a municipal election) — and
let the alderman be empowered to give an order to any
physician the applicant prefers ; at the same time giving
an order to the apothecary for the necessary medicines,
this order to be countersigned by the physician to be of
any value.
If this work is considered by the aldermen as derog-
atory to their official dignity and position as city fathers,
let the proper power be conveyed to the assessor and his
deputies. If their duty is already too arduous, let there
be constituted an additional Board of Poor Commis-
sioners, one or more to each ward, with a nominal
salary. But to whosoever this power be relegated, make
it obligatory upon them to personally familiarize them-
selves, either before or immediately after giving the
order, with the worldly condition and financial standing
of the applicant in order to guard against imposture, and
also make it obligatory upon them to keep a full record
of all orders drawn, giving name of applicant and mem-
bers of family, his and their occupation, and the amount
of money earned by the family ; by this means ascertain-
ing whether they are worthy recipients of charity or not
Let them also keep a record of the date of application,
and names of physician and apothecary whom orders are
drawn upon. Make it also a duty of the physician to
render a full report of each case to the Board of Poor
Commissioners, all proper blanks being furnished by the
city. Then let us physicians adopt a charity fee-bill ;
either a new one designed for this class of practice or
make a certain per cent, discount from our regular fee-
bill.
These are my ideas on the evils of charity practice and
of the proper course of treatment indicated. If this treat-
July 26, i884>]
THE MEDICAL RECORD.
Ill
nent is adopted and adhered to, I think the prognosis
cxtremelf fevorable. Bat the profession must be united
in its emleavors. In union there is strength. United we
irill make a success of it ; divided we will ignominiousiy
T. W. Sheardown, M.D.
jiBHtvnix, TtaiH., May 29, 1884.
MORPHOLOGICAL STATUS OF THE CERE-
BELLUM.
To THB Edttok or Thb Mbdicai. Rbcord.
Sir: I have read with considerable interest the elaborate
lectures' delivered under the provisions of the Cartwright
bequest by Professor Wilder. Having given attention to
tbe matters with which that distinguished anatomist deals,
pennit me to offer some suggestions regarding a single
proposition made by him which cannot, I think, be sus-
tained The lecturer follows the lead of a number of
comparative anatomists in regarding the cerebellum as a
distinct segment of the primitive group, under the name
of meUncephalon. He goes further than they in creating,
as it were, a new ventricular subdivision, in order to
render this classification consistent This is the anterior
portion of what all authorities have agreed in regarding
as the fourth ventricle, according to Wilder the epkalia.
Practically we all recognize that the cerebellum is an
mportant segment of the adult brain ; indeed, the clas-
sification of the parts of the adult brain, useful for med-
ical students and for the localizationalist, can scarcely be
made to correspond to morphological or embryological
reqoirements.* I need but refer to the case of the thala-
mus, which is an outgrowth of the embryonic thalamen-
tfihalon^ and really one of the finest representatives of
an embryonic segment which could be cited. In man
and higher aninoals, however, so intimate has become its
secondary fusion with the medullary centre of the hemi-
spheres, that it assumes the position of an intracerebral
ganglion, comparable to the lenticular nucleus and the
caudate mass of the corpus striatum. So absolute is the
dominion of the cerebrsd hemisphere over the thalamus,
dat die ventricular cavity of the former, in man and apes
It least, encroaches on the dorsum of the thalamus a
^rt distance beyond the caudo-thalamic groove, as if
to falsify the embryonic relations of the derivative cere-
bral vesicle to its parent thalamic vesicle. I cite this
case to show that the embryonic importance of a segment
is not a proper gauge of its importance to the physiolo-
gist and physician and that therefore conversely the im-
portance of a segment — ^like the cerebellum — to the physi-
dogist and physician is not an indication that it occupies
a correspondingly important place in the embryologist's
olcolations. To a certain extent the aims of morpho-
logical and physiological anatomy are distinct. To the
comparative anatomist the pituitar)* body and pineal
gland are of much more fundamental importance than
»hc pyramid tract, while the physiologist discards the
fcnncr and attaches the greatest value to an accurate
bowledge of the latter, just as the surgeon is more in-
tttttted in understanding the mechanism of the atlanto-
occipital articulation than in being told by the morpholo-
pst that the ligamentum suspensorium denii epistrophei
ODteins a notochordal relic. I say this with a full ap-
pRciation of the high biological importance of even un-
pnctical facts» which, if I could attest in no other way,
I needed but to refer to a few original discoveries which
I have been fortunate enough to stumble across while
undertaking researches in this field.
The reasons why I cannot agree in regardbg the cere-
beDom as a primary segment, nor the epicalia as a pri-
oaij ventricular subdivision, are the following :
I. Primarily, the cerebellum is only the dorsal part of
^ "Sum. MBDIC4L Rkoko, April to Jiim, 1884.
' Ceretmin, cerebellum, and axis (or Udimui).
' Dieaocphalon (Wilder), dentencephalon.
the wall surrounding the anterior part of the cavity of
the hind brain (fourth ventricle).
2. The ventral part of this wall is morphologically
continuous with and inseparable from the posterior
" open " part * of the fourth ventricle.
3. The cephalic portion of the fourth ventricle is dis-
tinguished from the caudal portion only by the fact that
in the former the roof — and the roof alone — undergoes
hypertrophy, while in the latter it — and it alone — under-
goes atrophy. If this fact is to constitute a discrimina-
tion between two cerebral segments, then the closed,
portion of the oblongata should be separated firom the
open portion.
4. There is at no time an indication of a boundaiy (of
the kind found with other ventricular cavities in all higher
forms) between the epicalia and metaccelia. The procag'
iia are separated from the diacoslia by a constriction, the
p&rta Monroi; the diacoelia and fourth ventricle are de-
marcated firom the mesocoelia by a sudden narrowing,'
but where is the boundary between the two divisions
which Wilder makes of our old familiar fourth ventricle ?
It happens to widen out at the (imaginary) boundary.
5. Dr. Wilder recognizes the necessity of finding a
ventral part of his epencephalic segment, and believes
to have found it in the pons. The term " pons " in one
sense indicates an arbitrary division ; in another it is used
to designate only the (apparently) transverse fibre mass
which is thrown across the brain-axis like a belt This
is not a commissural mass, however. Nearly all its
fibres pass to the crura cerebri, either with or without
ganglionic intervention, according to the testimony of
Gratiolet, Me)mert, Vemicke, and Flechsig. Morpho-
logically they are heralded in lower animals by arciform
fibres which are continuations of the zonal fibre system
common to the entire myelencephalon of reptiles and
birds. There is henc^ no support to be derived from
the existence of this apparent basilar commissure for
Wilder's designation. This objection is strengthened by
the next
6. There is not even an approximate uniformity in the
boundary of the epencepkalon. If the extent of the cere-
bellum be taken as the gauge, it is almost nil in meno-
bronchus and extremely large in man. Homologous
parts of the ventricular floor fall within the epicoilia in
man and without in reptiles. If the extent of the pons
be taken as a guide, then this segment is absent in rep-
tiles and birds, it is a narrow belt in the opossum,
twice as wide in the rabbit, thrice as great in the dog,
five times as great in the ape, and six times as wide
(cephalo-caudad) in man.
The only indication of a coelian monopoly on the part
of the cerebellum is the tent-like projection of the fourth
ventricle into the fasiigium. Indeed, in birds — like the
ostrich — ^it is a closed pond, communicating with the
fourth ventricle by a narrow slitv But this is not a ven-
tricular segment, hvX a diverticulum^ Wke the primitive
cavity of the hypophysis (pituitary body) or the conarium
{epiphysis or pineal gland). I think this comparison
suggests the true morphological x/tf/«x of the cerebellum.
Respectfully,
E. C. SprrzKA.
Treatment OF Phlyctenular Ophthalmia. — Dr. H.
Power recommends as a local remedy in cases of phlyc-
tenular ophthalmia an ointment commonly called Pagen-
stecher's, which is a combination of vaseline with bin-
oxide of mercury, in proportions var}'ing from one to
ten, or even fifteen, grains to the ounce. This forms a
yellow ointment, whidi in the milder forms gives scarcely
any pain, but in the stronger proves sharply irritating to
the eye, inducing firee lachrymation. Dr. Power thinks
that this preparation may be regarded as a specific for
corneal ulcers. — Louisville Medical News.
^ Whera die roof loseajits nervous character and becomes membranoos.
* Even in reptileB.
112
THE MEDICAL RECORD.
[July 26, 1884
^vmvi ^jmns.
Official List qf Changes in the Stations and DuiUs cf Officers
serving in the Medical Departmsni^ United States Army,
from July 13 to July 19, 1884.
Wright, J. P., Major and Surgeon. Assigned to duty
as Post Surgeon, San Antonio, Texas. S. O. 87, par. 4,
Headquarters Department of Texas, July 14, 1884.
McElderry, Henry, Captain and Assistant Surgeon.
From Department of the Platte to Department of the
East S. O. 165, par. 12, A. G. O., July 16, 1884.
EwEN, Clarence, Captain and Assistant Surgeon.
Assigned to duty as Post Surgeon, Fort Sidney, Nebras-
ka. S. O. 58, par. 8, Headquarters Department of
Platte, July 11, 1884.
Elbrey, F. W., Captain and Assistant Surgeon. Leave
of absence still further extended six months on surgeon's
certificate of disability. S. O. 161, par. 6, A. G. O.,
July 12, 1884.
Wakeman, Wm. J., First Lieutenant and Assistant
Surgeon. Relieved from duty at Fort D. A. Russell,
Wyo., and assigned to duty as Post Surgeon, Fort Wash-
akie, Wyo., relieving Assistant Surgeon Norton Strong.
S, O. 58, par. 9, Headquarters Department of Platte,
July II, 1884.
Ewing, Charles B., appointed to be Assistant Sur-
geon, with the rank of First Lieutenant, July 5, 1884,
vice Middleton, promoted. Memorandum, A. G. O.,
July 14, 1884.
W^t&ivxX Itjems,
CoMTAGious Diseases — ^Weekly Statement. — ^Re-
port of cases and deaths from contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the week ending July 19, 1884 :
Week Ending
Gutff.
July 12, 1884 . .
July 19, 1884. . .
Deaiks.
July 12, 1884. .
July 19, 1884. .
4
3
I
187
167
The Amorphous Borate of Quinine is a prepara-
tion highly recommended by Finkler and Prior, who
have used it in the clinic at Bonn. Its advantages are
that it does not irritate the stomach, and that it has a
more powerful antiseptic action in the digestive tube. It
is used in about the same doses as the sulphate.
Cerebral An£miants and Hyper^miants. — Curci,
experimenting upon dogs by trepanning and attaching a
uranometer, finds that chloral, chloroform, ether, paral-
dehyde, and quinine, produce cerebral anasmia; mor-
phine and nitrite of amyl, hyperaemia. Atropine in
small doses has little effect ; in larger doses it is rather
an an6miant.
Chloroform in the Treatment of Tape-worm. —
Dr. J. G. Brooks writes to the Medical and Surgical
Reporter : " I have had within the last three years sev-
erad cases of tape-worm to treat, and, finding such strong
objection to the large draught of medicines in ordinary
use, I prescribed the following: $• Chloroform, ex.
male fern, aa f 3 j.; emul. ol. ricini (50 per cent.), f | tij.
M. Sig. — All to be taken at once after twenty-four hours'
fast In every case the medicine was well borne and
the worm expelled entire. In two cases I omitted the
male fern, and the result was the same as when the latter
drug was in combination. My object in reporting this
treatment is to induce others of the profession to try the
chloroform and report results. I claim for this agent a
specific and rational action as an adjuvant in the expul-
sion of the worm. It anaesthetizes or suspends vitality,
and any active purge during anaesthesia of the taenia is
all that is requisite to expel it. I earnestly ask those
who have cases to try the chloroform, or chloroform and
male fern, as above prescribed, and report results."
In the Treatment of Sprains, Dr. Brinton, in the
College and Clinical Record^ recommends that the limb
is to be put into a vessel of ver)' hot water immediately,
boiling water being added as it can be borne, and kept
immersed for twenty minutes, or until the pain ceases.
Then put on a pretty tight bandage and order rest.
Sometimes the joint can be used in twelve hours. If
the trouble is more chronic, apply a silicate of sodium
dressing, and let the patient walk with a cane, if the
ankle be the joint affected.
The Question of the Feeding of Infants has
been recently discussed in the British Medical Journal
by Drs. Beatty and Davies. Thtf latter gentleman gives
the following presentation of his view of the matter. He
sa^s : ^* Now, as the food we are at variance about is
milk in its usual state from the cow, or condensed, let us
see how we stand. Dr. Beatty recommends one part of
milk to three of water, I recommend two parts of milk
to one of water. Now let us take the composition of
milk, and then judge as to which approximates nearest in
strength to the mother's.
Woman. Cow. Abi.
Casein (cheesy matter) and insolu-
ble salts Z'ZS 4-55 1-70
Fatty matter 3.34 3.70 1.40
Sugar of milk and soluble salts. . . 3.77 5.35 6.40
Water 89.54 86.40 90.50
100.00 100.00 100.00
From this analysis it will be seen at once that Dr.
Beatty's is much too weak. It is estimated that a healthy
woman gives three pints of milk in the twenty-four hours;
therefore an infant should have at least a quart of cow's
milk a day, as mudi must of necessity be wasted by giv-
ing it by the bottle, and I know of no reason, nor have I
ever read of any, which shows that a woman's milk is
weaker at first than it is in four or five months after par-
turition. Now, with regard to condensed milk, ^the
First Swiss Brand,' that is, the unsweetened milk (the
only kind that should be used), is four times as strong as
ordinary milk from the cow ; therefore, a tin would be
equivalent to a quart of milk. I say a tin a day is about
what should be given, diluted with five times its bulk of
water. Dr. Beatty says he orders a teaspoonful (!) to a
quarter of a pint of water, at first, and says infants thrive
on it ; that may be his experience, I regret to say it is
not mine/*
Sodium Iodide instead of Potassium Iodide. —
Dr. Jno. D. Mulhane, of Steubenville, O., writes, refering
to the article on " Sodium Iodide," of Dr. Beig (Medi-
GAL Record, vol xxv., p. 542) : " During the past year,
while physician to Gould's Tunnel Panhandle Railway,
I had under my care four hundred men, white and
colored. In this class of fellows you find syphilis in all
its forms. At first I used potassium iodide, but noticing
that the late lamented Gross, in * Surgery ' (voL i., p. 338,
1872) was y^ry partial to sodium iodide, I used it in one
hundred anid seven cases, and in not one did it produce
that dryness of air-passages which follows potassium
when pushed. I heartily agree with Dr. Beig. No
gastro-intestinal irritation in a single case."
The Medical Record
A Weekly yournal of Medicine and Surgery
Vol. 26, No. 5
New York, August 2, 1884
Whole No. 717
©riflitml ^rticljes.
ADDRESS ON PHYSIOLOGY,
Dblivbred at the Annual Meeting of the Brit-
ish Medical Association, July 29, 1884.
By PETER REDFERN, M.D. Lon., F.R.C.S.L.,
rSOnSSOR of anatomy and physiology XN QURKN's COLLBCB, BHX.FAST.
(Special for Thb Mbdical Rbcord.)
Ur, President and Gentlemen of the British Medical
Amdation : I value very much the honor of having
been selected to give the address on physiology and I
thank you warmly for the mark of your confidence which
it^implies.
The great problems of life have in all time had a pro-
iband influence upon the heart and mind of man. What-
ever concerns the prolongation of life, or the increase of
the capadty for enjoying it, the prevention or cure of
tiwse modified vital actions which we know as disease
has always interested the mass of mankind. Hence the
mission of medical men — ^as extensive as humanity,
whatever form it takes — uninfluenced by age, or sex, or
ountiy — succoring alike the orphan, the criminal, the
ratuous, the poor, and the rich. The medical man is
die true fiiend of all within his reach ; he advises, in-
stnicts, befriends all alike.
There is no one to whom accurate and ikicessant ob-
serration is so essential. His first step is to observe and
record all the healthy phenomena of life ; it is his con-
stant care to secure the most fitting conditions for their
Bercise; and his last effort is to note how certainly
ieir continued action brings about their own extinction,
and how often they are suddenly arrested in their course
hf disease.
The delicate adjustments of vital operations and the
unstable physical and • chemical equilibrium of living
structures present such difficulties to the physiologist
{hat thousands of years of the world's history had passed
before we had learned a single fundamental doctrine ap-
plicable to all life on the globe. Yet I doubt if as great
progress has been made in any science as in physiology
dnimg the past fifty years, or if such an amount of labor
-has been expended in the same time on any subject as
has been devoted to the study of physiology in the last
fiarter oi a century. Still all we now know may appear
very insignificant in the estimation of our successors of
the next generation.
Every step in physiology concerns life and health;
teefore each must be made as secure as possible. 1
tfunk nothing has given as great confidence and security
& die advance of physiology as the demonstration that
d living matter has been derived from previously living
Htter of its own kind, and that all living beings and
tissues have originated from fragments of previously
beings or tissues, which, when detached, carried
properties of their parents with them.
It is quite true that living bodies are continually in-
fcenced and altered by external conditions ; but it is
tin true that conditions at least as potent tend to their
Kton to their original state. The changes which a par-
fadar mode of life may effect in the highest type of
in&g beings may be such as to require three generations
iDnuLke a glass-blower ; but it is not probable that his
children would care to preserve the advantages which
they had derived by inheritance from their parent's father
and grandfather.
The formed materials of our tissues differ widely from
the original protoplasm to which they owe their origin ;
but some of that protoplasm remains in each, and still
possesses powers of reproduction, which, in many in-
stances, are no less startling because of the character
than of the quantity of the tissue produced in a given
time. The colossal increase in size, no less than the
increase in number, of the muscular fibres of the uterus
required to raise the standard weight of the adult organ
from one and a half ounces to three pounds, is only par-
alleled by the still more rapid reduction in two or three
weeks of the same organ from three pounds in weight to
three ounces. This happens in an organ which is often
more or less dormant for years together ; but in the con-
tinually acting diaphragm, the presence of an unusual
number of protoplasmic corpuscles in each fibre points
to the greater and more persistent activity of the change
which takes place there. Observe, in comparison with
its cause, the vastness of the change produced in the
mode of nutrition of the uterus, when an ovum only
y^th of an inch in size has come into contact with a
still smaller spermatozoon ; and the not less remarkable
change when this ovum leaves the uterus. The estab-
lishment of different physiological relations has been at-
tended in the first instance by deposition and formation
of tissue ; in the other, by its disintegration and removal.
Changes of external conditions produce as remarkable
results. Mr. Ward found ill-fed plants of the common
centaury (Erythrc3ea Centaurium) only half an inch high,
with one flower, at no great distance from better fed ones
four or five feet high, covered with hundreds of flowers.
Without other difference than greater looseness of the
texture of the soil I had plants of the common rape
(Brassica napus) between five and six feet high, freely
branched everywhere, and carrying leaves as large as
ordinary dishes, as contrasted with others close by, only
fifteen inches high, but little branched, and having few
linear leaves only about an inch long. And everyone is
familiar with the marvellous change wrought upon the
hive bee when, from being fed on royal jelly instead of an
ordinary bee-bread, it becomes a queen. Yet these
naked-eye evidences of the influence upon vital activity
of a change in surrounding circumstances are insignificant
in importance when compared with those of which the
results are witnessed daily in medical practice.
Dr. Williams showed that when a drop of weak solu-
tion of capsicum is applied to the web of a frog's foot,,
dilatation of the arteries and capillaries takes place and
more blood circulates through the spot in a given time
than before, and that from this condition recovery may
take place, and the experiment be repeated time after
time on the same part But if the solution be stronger
recovery will not occur, and the increased rapidity of
circulation will give place to slowing and stagnation. In
the first instance the life of the vessels was affected and
their contractility impaired transitorily, but the stronger
solution destroyed their contractility more completely
and produced the phenomena of inflammation, conges-
tion, exudation, and stasis. No matter by what external
means the life of the vessel is affected, the same result
follows. And if the injury be inflicted firom within by
adding some irritant to the circulating fluid the effect is
still the same.
114
THE MEDICAL RECORD.
[August 2, 1884.
Mr. Lister demonstrated, in a series of beautifully-con-
trived experiments, the delicacy of the relations between
the walls of the blood-vessels and the circulating blood —
that injury of the wall of a vessel causes arrest of the
white corpuscles on the injured part, with coagulation of
the blood ; and if the injury be considerable, it will cause
complete obstruction to the circulation. Disintegration
of the white corpuscles takes place, and acts as an effici-
ent cause of the coagulation and stoppage.
On the maintenance of this nice balance of the rela-
tions between the blood and the tissue over which it
flows depends the issue whether the blood shall continue
to flow or not.
The rupture of the internal coat of a vessel, or the al-
teration of the lining endothelium by endocarditis, causes
arrest and disintegration of white corpuscles at the spot.
. Consequently, depositions of fibrin or the formation of
thrombi on the valves of the heart are attendant phe-
nomena on inflammation of the endocardium.
And Cohnheim found that stopping the circulation for
from thirty-six to sixty hours, through particular vessels
in a frog, and then allowing the circulation to go on
again, was attended by such exudation as occurs in in-
flammation. The walls of the vessels had suffered in-
jury from the temporary arrest of the circulation, their
elements seemed to have been loosened, and exudation
of certain of their contents took place.
It is important to note that this is not a mere passive
transudation, it is attended with an active movement of
the living corpuscles through the injured wall, a move-
ment which does not happen in the instance of the mes-
entery to which solution of sodium chloride of double
the normal strength, which stops the amoeboid move-
ments of these corpuscles out of the body, has been ap-
plied. An inflammatory exudation is readily distinguish-
able from the transudation of mere engorgement by
being richer in albumen and corpuscles than it, and by
coagulating more readily.
Dr. Burdon-Sanderson, in his admirable statement of
the results of his own observations and in reviewing our
present knowledge of inflammation, has called attention
to the great accuracy of Sir William Bowman's early ob-
servations on keratitis, and has pointed out that not only
do corpuscular elements migrate into injured spots of
the cornea, but that they accumulate upon and within
pieces of dead membrane or other tissue inserted into
the peritoneal cavity. And Dr. J. Hamilton found that
they so completely fill the cavities of pieces of prepared
and engrafted sponge that it soon ceases to be visible.
Dr. Sanderson has expressed the difficulty of maintain-
ing that the migration of corpuscles is in such instances
due to an increased attraction between them and the
tissues, and he concludes that we are coming back to the
notions of John Hunter, who accounted for the inflam-
matory blush by referring it to the action of the vessels.
On the other hand, it may be suggested that the
changed conditions have diminished the restraining in-
fluence of the walls of the vessels and stimulated the cor-
puscles to more active migration than ordinary.
The interest and importance of the relations of the
circulating fluids to the elements of the animal tissues
demands a further consideration of them.
The structure and action of the supply vessels of any
part are doubtless very important, but they can scarcely
equal in importance the relations of the tissue and blood
elements where these lie quietly in contact, and mutually
influence each other.
One can scarcely exaggerate the importance of the
observation that the pressure impelling the secreted fluid
outward in a salivary duct is twice as great as that pro-
pelling the blood in the carotid artery, from which that
gland is supplied, and that a large amount of secretion
is discharged by a salivary gland, on stimulation of its
nerve, after the circulation of blood has been altogether
cut off from it. In like manner, at the instance of a
nervous impulse, a muscle similarly withdrawn from the
circulating current contracts and gives out cafbonic
acid and sarcolactic acid, neither of which was free in
it before the contraction took place. And in the gastric
glands, the pancreas, and possibly in all secreting glands,
the constituents of the secretions are slowly abstracted
from the blood and stored in some form of zymogen
until a nervous impulse suddenly causes their transfor-
mation into the active principles of the secretion and its
discharge.
Thus we localize the real laboratory of the organism—
the place where the work of the body is done — the spot
whence nervous impulses emanate — where motion re-
sults from chemical and vital changes — where the powers
operate which regulate and produce secretions, excre-
tions, nutrition, regeneration, and reproduction.
It will be admitted that the simplest mass of proto-
plasm, whether plant or animal, selects all it needs for
the varied purposes of its life from the more or less fluid
matters within its reach ; and, in exactly the same way,
the tissues of our bodies select what they need from the
fluid plasma in which they are continually bathed. The
vessels supply a larger or smaller quantity of this fluid
as the demands of the tissues are greater or less at one
time than at another ; but it is the business of each tissue
to select, both as to character and amount, all it re-
quires, and in this selection, no less than in the use
it makes of the materials it has selected, the tissue can
only be very indirectly aided by the blood-vessels.
The anatomical relations of the tissue elements to the
lymph spaces, by means of which they are continually
bathed in lymph, are very interesting, and have been ad-
mirably described and illustrated by Dr. Klein in his
"Anatomy of the Lymphatic System" and "Adas of
Histology.'* Dr. Curnow has given an excellent account
of the history of the acquisition of our knowledge of the
lymphatic system in the Gulstonian Lectures for 1879,
published in The Lancet Von Recklinghausen led the
way, and so many accurate observers in different coun-
tries have followed him that we now stand on very safe
ground.
The result has shown that the acini, or the tubes of
glands, the bundles of fibres of tendons, the layers of the
cornea, fasciculi of muscles, and funiculi of nerves, are
in relation with lymph spaces, or vessels more or less
completely lined by endothelial cells, and occupied by
lymph containing amoeboid corpuscles in variable num-
bers. These Dr. Klein has shown to belong to the same
system as the spaces between the fibres and bundles of
fibres of areolar tissue, which contain here and there
flattened and branched endothelial or connective tissue
cells folded over the bundles, which are themselves con-
tinually bathed in lymph containing amoeboid corpuscles.
Similar spaces under the mucous membrane of the ali-
mentary canal or air-passages are continuous with the
cement substance between the epithelial cells, where
also branched connective-tissue cells occur, together with
occasional amoeboid corpuscles. All such spaces com-
municate directly with large lymph canals, immediately
succeeded by irregularly dilated lymphatic vessels fur-
nished with valves.
The immediate effect of medicines introduced ender-
mically is abundant proof of the rapid and free com-
munication of the lymph of the spaces of areolar tissue
with the current of the blood, while, if Dr. Creighton's
observations on the absorption of fat from the intestines
be confirmed, we shall have learned that the emulsified
fat of chyle passes through the cement spaces of the
intestinal epithelium into the lacteal and mesenteric
glands, the epithelium itself discharging the function of
secretion.
But there are much larger reservoirs of lymph than the
spaces of connective tissue, tendon, and cornea. The
great lymphatic sac of the frog, the serous and synovial
cavities, and the sheaths of tendons of mammals and man
are similar spaces. Von Recklinghausen was the firs^
to witness the passage of milk and other fluids contain-
August 2, 1884.]
THE MEDICAL RECORD.
115
in£ visible particles through the stomata of the peri-
toneum covering the tendon of the diaphragm into the
hniphatic vessels, and the disappearance of fluids from
tiie peritoneal sac by this means. You will all call to
mind many instances of rapid disappearance of recent
pleuritic and peritoneal effusions ; others, where such
efiiisions have remained undiminished in amount for
weeks and months, and some in which the effused fluid
ifia a time assumed all the characters of pus. Coagu-
lated blood does not disappear from the peritoneal
canty, but defibrinated blood is absorbed and its corpus-
cles continue to live in the circulating blood.
Ladwig and Schweigger-Seidel have pointed out that
the respiratory movements are the chief cause of the en-
trance of fluids into the lymphatic spaces through the
stomata of the peritoneum, and that during the descent
of the diaphragm l)rmph is drawn into the spaces between
the tendon bundles by their expansion, and pressed on
at the same time in the pleural lymphatics furnished
with valves, while during the ascent of the diaphragm,
exactly the opposite action takes place, the diaphragm
thus playing the part of a pump.
The pleura of the intercostal spaces is also provided
with stomata and is similarly related to lymphatic vessels,
and as there is an arrangement of a similar kind on the
sariaces and in the substance of all fasciae and tendon
^aths, it is not improbable that the connections of a
jvge number of muscles with fasciae rather than bones
jBfvcs the same purpose. How much of the pleasure
derived from muscular exertion depends upon the pro-
motion of the circulation of lymph about all these parts,
ind upon their consequent invigoration, we may never
le able to estimate, but no one can question the impor-
iBce even in the limbs of a free circulation of lymph.
Let us now return to the contents of these spaces,
lebear in mind that epithelial cells are masses of proto-
ibsm variously modified for secretion, protection, or for
itering into the construction of the terminal organs of
k nerves of special sense, and that between epithelial
^ whether on the skin, the cornea, or on mucous
lembranes, there are spaces occupied by semi-fluid
ment, with branched connective-tissue coipuscles, and
ioeboid or white blood-cells. We trace these cement
Bces onward and And them continuous with the con-
Ktive-tissue spaces under their respective membranes
nd with lymphatic vessels. In the different spaces the
Dotained corpuscles vary greatly in number, but a food-
ipply is always afforded them by l^ood- vessels in pro-
ortion to their number.
Under extensive tracts of the mucous membrane of the
imentary canal and respiratory organs, very notably in
be sabstance of villi and around Lieberkuhnian follicles
the intestine, the spaces are crowded with amoeboid
lymph corpuscles forming adenoid tissue, or when
Bsscs of such tissue accumulate in more or less spheri-
ll or pear-shaped blocks they constitute solitary glands
the glands of the patches of Peyer. All such parts
! supplied very freely with capillary blood-vessels, and
Riicke demonstrated many years ago, their spaces
Rctly communicate with unusually large and numerous
iphatic or lacteal vessels. The lacteals become al-
st inunediately connected with the largest group of
Bphatic glands in the body. The muscular and fibrous
ill of the vessel opens out, and becoming greatly in-
ttsed m amount fonus the capsule and trabeculae,
"e the cell elements of the connective tissue forms
framework of the adenoid mass we call lymphatic
kL The substance is composed of lymphoid cor-
Bdes multiplying with a rapidity which is measured by
food-supply from capillary blood-vessels and the
ig stream of chyle ; while their detachment is in
^portion to the amount of distention by passing chyle.
^greater the amount of chyle, the greater is the num-
of corpuscles added to it as it passes, each corpuscle
Ig derived both in substance and properties from a
**'*<asting one, or, as in the original development,
from the differentiated protoplasm of the endothelial
cells.
Dr. Klein has described small cells which bound the
stomata of serous -membranes, cover the surface near the
stomata, and often extend along considerable tracts of
their surface. These are smaller than the ordinary endo-
thelial cells and germinate freely under ordinary healthy
conditions, but in such unhealthy states as are induced
by the presence of pieces of gutta-percha or irritating
substances injected into the peritoneal cavity, they
germinate with great rapidity and form large villous pro-
jections on the surface of the membrane, the newly-pro-
duced cells falling into the cavity or presenting themselves
in large numbers in the adjacent lymphatic vessels.
Thus, in the same way as in lymphatic and other blood-
forming glands, white corpuscles of the blood are con-
tinually formed and thrown off into the stream of chyle
or lymph, so under both normal and abnormal circum-
stances the cells bordering the stomata and covering
parts of the surfaces of serous membranes multiply
rapidly, while in inflammation not only these lymphoid
cells, but the branched cells of the matrix also undergo
very active proliferation. The natural food-supply of
such cells is derived from the blood, the amount and
rapidity of circulation of which is largely increased in
some stages of inflammation.
I now ask your attention to the structural relations of
the walls of blood-vessels to the tissue elements. The
most cursory examination of blood-glands, such for in-
stance as the spleen and the red marrow of bones, shows
an important adaptation of these parts to each other.
Ordinary capillaries, which are really little more than
spaces between the elements of tissues lined by endo-
thelial cells loosely cemented together at their edges,
have frequently sinuous, spindle-shaped, or angular dila-
tations upon them, while their walls have projecting pro-
cesses directly continuous with the branched connective-
tissue corpuscles of the adjacent parts, a connection which
shows the close similarity of the lumen of the vessel to
the spaces of areolar tissue, while the endothelial cells
of the vessel correspond to the less numerous but simi-
larly flattened endothelial cells of the spaces, and to
tendon and corneal corpuscles, which cover in an equally
sparing manner their respective tendon or corneal spaces.
Indeed, the whole lymphatic system, with its lymph cana-
licular spaces and its more definitely walled vessels, is
neither a new nor an added system, but a part, and a
most important part, of the general vascular system of
the body.
If we trace a small artery in the spleen, we see the
tissue of its wall opened out into spaces occupied by
lymphoid cells, a veritable mass of adenoid tissue involv-
ing the whole or part of the circumference of the vessel,
and when at length the vessel ends, it empties its blood
into the spaces of the pulp bounded and supported by
the flattened, branched, endothelial elements of the walls
the commencing veins. Where the adenoid masses, the
Malpighian corpuscles of the walls of the arteries abut
upon the pulp tissue there is no separation, the elements
of the adenoid reticulum and those of the walls of the
sinuses being continuous, while the lymphoid cells of the
adenoid tissue are free to mix with the venous blood in
the sinuses. Here, as in the case of the lymphatic glands,
the organ is subjected to great distention after the ab-
sorption of food, which not only leads to the formation
and separation of large numbers of new lymphoid ele-
ments, but at the same time the cellular protoplasmic
elements of the venous sinuses become very active, take
up old colored corpuscles, break them down, and set free
their variously oxidated remains into the blood stream.
The vascular arrangements of the spleen, at the same
time as they tend to retard the flow of the blood, are no
doubt highly advantageous for the completion of the
changes which the blood undergoes in the organ, while
the necessarily tardy flow of the blood is no doubt com-
pensated by the large size of both the artery and the
Il6
THE MEDICAL RECORD.
[August 2, 1884.
vein, and the loss of force by the rhythmical contractions
of the organ so beautifully demonstrated by Dr. C. S.
Roy. Lymphatic glands also have a muscular capsule
and muscular trabeculse, but as yet we have no evidence
of their having rhythmical contractions.
I cannot pass without mention the largest living mass
of protoplasm in the body — the liver — at one period
employed in the. production of blood-corpuscles, and
then half the weight of the body. Originally formed
upon the vitelline veins, and subsequently transferred to
the umbilical, and then to the portal vein, as each in
turn becomes the recipient of the food supplies, there can
be no doubt that while its function is mainly to make
and to maintain the blood, its methods of action still in-
volve great physiological secrets.
From the preceding considerations it is plain that at
certain parts of the circulating system for lymph and
blood, lymphoid or white blood-corpuscles are produced
in adenoid tissue from pre-existing corpuscles at a defi-
nite rate. If Quincke be correct in his supposition, that
the duration of the functional activity of red blood-cor-
puscles is not longer than two or three weeks, we have
in this a measure of the required productive capacity,
for in healthy conditions a balance of the absolute and
relative numbers of the corpuscles is very accurately
maintained.
But this does not always happen. My late esteemed
teacher and friend, Dr. Hughes Bennett, in his original
description of leucocythemia, pointed out that an amaz-
ing relative increase of white in relation to the red cor-
puscles of the blood occurs in connection with enlarge-
ment of various of the blood-forming organs, and the
disease is now universally recognized. In the second
case, which came under the notice of Dr. Bennett, I had
the pleasure of making the examination, and of record-
ing and sketching the microscopical characters of the
blood in the Pathological Reports of the Royal Infirmary
of Edinburgh. • In that case the spleen, liver, and intes-
tinal glands were all enlarged.
In this disease there is a greatly increased production
of lymphoid cells in situations where there is abundance
of nutritive material, and this increased formation of cor-
puscles is possibly attended by a conversion of fewer
white into red blood-corpuscles than ordinary, thus
greatly increasing their numerical disproportion.
As lymphoid cells can also be produced in large num-
bers in and near the stomata, and on the surface of se-
rous membranes, it is probably from such sources that
the pus corpuscles of empyema and peritoneal effusions
arise. And it may be asked whether the amoeboid cells,
which migrate through the walls of the blood-vessels on
the onset of inflammation, possess the power of multiply-
ing on surfaces which are now supplied with a largely
increased amount of blood.
This is improbable for many reasons. Actual obser-
vation of such multiplication has not yet been satisfac-
torily obtained. Dr. J. Hamilton, in the record of his
very interesting observations on the healing of ulcers
and sponge-grafting, says that he has carefully watched
the exuded leucocytes, and has never seen them get
larger, either by over-nutrition or coalescence. Ranvier,
who thinks it probable that lymph cells are connective
tissue cells set free from adenoid tissue, believes that
they will neither move nor multiply, except when freely
supplied with oxygen ; that the free supply of oxygen-
ated blood by the capillaries of lymphatic and other
blood glands, is the means of their multiplication, and
that the absence of oxygen in the lymphatic vessels
stops it. He sees in the rapidity of the circulation of
blood an explanation of their migrating in small num-
bers only in health, while on the slowing or arrest of the
circulation in inflammation they migrate in large num-
bers, and getting beyond the reach of the supply of oxy-
gen disintegrate and cause coagulation of the plasma.
He points to the experiment of introducing fragments of
phosphorus under the skin, without arousing inflamma-
tion and migration of leucocytes, as indicating that the
phosphorus has taken up all the oxygen present, and de-
stroyed the amoeboid movement necessary for migration,
and thinks that the effect of cold in checking exudation
is due to a similar action. Whatever the mfluence of
oxygen on the manifestation of the vital movement of
lymphoid corpuscles, it is certain that lymph differs
widely from blood in containing a mere trace of oxygen.
In the formation of an acute abscess, the part is hot,
painful, and swelled, exudation and coagulation of the
exuded matter occur with migration of leucocytes
through the vascular walls ; the pain becomes more se-
vere and throbbing, and the heat greater than before ;
next day there is mdistinct fluctuation from the formation
of pus, and from this time the pain and heat lessen, and
the matter makes its way by softening and degeneration
to the surface. The greater heat and pain preceding
the formation of pus indicate greater distention of the
vessels, and greatly increased exudation ; or that the
larger supply of blood which increased the pain and ten-
sion had furnished the food for the more rapid generation
of l)anphoid corpuscles.
When in diffuse phlegmon punctures are made one
day and discharge thin serous fluid, and the next day the
whole areolar tissue is distended with pus, there is little
room for doubt that a rapid generation of lymphoid cor-
puscles has taken place at that very part and produced
the pus. If this happen in one instance, it is probable
that in other cases, too, pus is either formed by rapid
proliferation of connective-tissue corpuscles, or that it
is the result of rapid generation of corpuscles from those
which first migrated, and that the primary cause of this
is an increase of the normal attraction of the tissue for
the nutritive matters of the blood, whereby the lymph
stream flows more slowly and the corpuscles drag lazfly
along the wall, then penetrate it and escape with the
plasma in large amount at a time when the cement be-
tween the endothelial cells has softened, and the spaces
occupied by it have become widened.
But whatever be the cause, let us not lose sight of the
main phenomena : millions of lymphoid corpuscles have
been rapidly produced somewhere, and they have been
produced from pre-existing corpuscles of the same kind.
It will scarcely be suggested, without evidence, that the
whole circulating blood has taken on either an entirely
new, or, certainly, an unwonted action, in order to sup-
ply more lymphoid corpuscles than ordinary to the par-
ticular part where we find them accumulate ; and it is
little less difficult to maintain that, because of some local
injury, a multitude of lymphatic or other blood-glands at
a distance have produced a greatly increased quantity of
corpuscles to migrate into the injured spot. We know
that the period when the corpuscles of blood-glands mul-
tiply rapidly, and fall off in large numbers into the cir-
culating current, is the period of tension and turgescence
of such glands — a tension and turgescence produced by
an extraordinary afflux either of blood, or of both blood
and chyle. We cannot dissociate, either here or any-
where else, increased activity from increased supply of
nutritive material, and we have no ground for supposmg
that there is an increased supply of nutritive material to
the blood-glands because of a distant local injury. What
remains ? The admission is now as full and complete
as I could wish in the instance of cartilage, that what-
ever changes take place in it are the results of the exer-
cise of its own and of no borrowed power, and though
some of the old leaven clings to the accounts we get
now and then of the living actions of bone and tooth, 1
have no doubt that what is true of a living tissue, easily
made the subject of observation, is true also of more
complex ones, with whose elements other accessory tis-
sues are mingled
In the seats of formation of pus we have been con-
sidering, the corpuscular and formed tissue elements are
ordinarily bathed in lymph transuding through the c^
ment spaces of the endothelium of their vessels, ana
August 2, 1884.J
THE MEDICAL RECORD.
117
having amongst it, here and there, amoeboid corpuscles ;
Dov, a greater amount of blood than ordinary circulates
through the vessels, these are dilated, the cement be-
tveen their endothelial cells is of greater bulk and softer
than ordinary ; the fluid plasma and lymphoid corpuscles
of the blood pass out into the tissue, which becoming
tease and having its vitality impaired, acts as foreign
natter to the effused fluid, and leads to the disintegra-
tioD of some of its corpuscles and coagulation. Mean-
time the supply of nutritive material increases, the red-
ness, heat, and throbbing become more intense, the
part becomes firm and brawny with its increasing mass
of corpuscles ; and then, the violence of the action
heing over, and the vitality of the central part of the
mass lessened by the tension, pallor and oedema, with
great relief from pain, succeed ; softening, degeneration,
and solution of both tissue and exudation occur, and the
flnid mass approaches the surface and points.
If it seem strange that the same process should pro-
dace necrosis at one part and rapid growth and multi-
plication of corpuscles at another, let us recollect what
happens in the healing of ulcers. The surface is no
longer supported by firm skin, therefore its vessels dilate
and exudation occurs freely. Stimulated to unwonted
acdvity, the connective-tissue corpuscles multiply rapidly ;
dier first form rounded, then spindle-shaped cells, and
iltimately the fibres, corpuscles, and ground substance
«f the new connective tissue of the cicatrix, while the
exudation and the migrated corpuscles it contains dis-
iotegrate and soften into pus, which escapes on the sur-
ke. As the healing proceeds, the epithelial cells at the
c^ of the ulcer divide and produce others like them-
idves, which gradually extend over the surface and cover
ie newly formed connective tissue corium with an
^oally new epithelial layer, both having been derived
BO similar pre-existing tissue. The newly formed cica-
bidal tissue scarcely equals the old in bulk ; therefore
le surface is genersdly below the surrounding level, the
icer healing down, not up, as Dr. J. Hamilton has ex-
Rssedit, in his admirable demonstration of the changes
lendant on the healing of an ulcer, in the Journal of
wiimy and Physiology for July, 1879, from which I
Bt freely extracted these details.
Let us turn for a moment -to the peritoneal surface, on
Kch such a proliferation of cells as we have been con-
iering has been going on for some time, and we shall
Ire no difficulty in understanding that, while effusions
wi be absorbed by it with great rapidity as long as its
nxnata are healthy, when these are obstructed or ob-
^ed by masses of proliferating corpuscles, the dia-
bgm, pump as it may, becomes entirely powerless to
■pty die sac of its fluid contents.
A very interesting case occurred to Dr. Whitla, of
lb town, in which obstruction and rupture of the tho-
dc duct led to the passage of the whole chyle into the
idofflinal cavity for several months. The surface of the
tritoneum was everywhere' studded with tubercles, and
consequence absorption of the fluid could not take
. It was removed by tapping at intervals in quan-
of twenty pints or more.
The importance of the physiological arrangement by
^' ii the lung is irritated by lymph from the pleural to
vesicular and bronchial surfaces has, I think, not
a sufficiently appreciated. The application of cold
Ac surface of the body produces general congestion
the lung, taking the form of pneumonia, pleuritis, or
ndutis, in different persons, according to their respec-
Pliabilities to these diseases. But the addition of one
these diseases to another which has been primarily
•dnced is not as easy to explain by reference to their
^t\j different capillary blood-vessels as by the great
Kdom of communication of their lymph-passages.
Jilirary secretion discharged after stimulation of the
^ da tympani of a salivary gland deprived of circulat-
^biood is no doubt derived from lymph previously
•*cd in the gland itself; but under normal conditions
this exalted action of the gland tissue is attended by
the circulation of a greatly increased quantity of blood
through it, a notable instance of afflux of blood attend-
ant on increased vital activity of a tissue. The case of
muscular tissue is exactly similar. I presume there can
be no doubt that the increased activity of the circula-
tion leads to increased transudation of lymph, which,
however, does not coagulate, because the healthy limit
has not been passed. But if the lymph had transuded
into tissue which had been previously damaged, or dam-
aged by the exudation itself, it would have coagulated
as the veritable exudation of inflammation does.
When we call to mind that the cellular elements of
capillary walls are continuous with the framework of
lymph spaces, which themselves communicate through
the endothelial cement with the lumen of the capillary
tube, the continuity seems to reduce the question, whether
the phenomena of inflammation depend on increased
vital attraction of the tissue for blood or on some altered
vital action of the vessels, to one mainly of words.
Yet the separation which is effected by the endothelial
cement between the circulation of red blood-corpuscles
in capillary vessels and that of lymph and white cor-
puscles only in lymphatic spaces is a real separation — a
separation by a living colloidal septum of great liability
to change. It suggests the necessity of a supply of
oxygen and red corpuscles to some tissues, while others,
such as cornea, have all their vital needs supplied by
fluid plasma and white corpuscles.
If I have occupied much of your time on matters
which I conceive to involve fundamental principles of
physiology and its twin-sister pathology, and made free
use of vital action,. of which we cannot hope to learn
more than the manifestations, let me plead the powerful
influence of early impressions gathered from a most
revered and philosophical teacher, the late Dr. Alison,
who held that the essential peculiarity of inflammation is
a peculiar perversion of nutrition or of secretion.
In the very pleasant exammation of the border-ground
of physiology and pathology, which the writing of this ad
dress suggested, nothing has been more forcibly brought
before me than the clear insight which the painstaking
and accurate investigations, and the genius of Sir James
Paget gave him, long years ago, into many vital phe-
nomena which seemed startling when they were spoken
of individually. Thus, in his lectures at the College of
Surgeons, from 1847 to 1852, he demonstrated many of
the conditions under which exudations coagulate, or are
restrained from coagulating, conditions which Mr. Lister's
subsequent careful experiments have more fully elucidated
in connection with the conversion of lymph corpuscle^
into granule cells, inflammatory globules of Gluge, a
change first demonstrated by Reinhardt, and indepen-
dently by Sir Andrew Clark. He pointed out that it is
impaired nutrition, fatty degeneration, not death, which
leads to absorption ; he described most graphically the
hardening of the wall of an abscess by coagulation of
plasma, which neither the exuded corpuscles nor the fluid
plasma alone could effect, and followed this by a clear ac-
count of the subsequent liquefaction of the hardened mass
by what he styled " liquefaction degeneration," a great
feature in Dr. Ziegler's more modern description and de-
monstration of what happens in the formation of a blister
from a burn, and in the disappearance of clots of blood.
And in the same lectures Sir James pointed out that
granulations and clots of blood hinder the healing of
wounds, leaving it for Dr. J. Hamilton, only quite re-
cently, to prove this by irresistible microscopical evidence.
Knowledge derived from experience is never more in-
teresting than when confirmed by scientific examination.
Dr. Hamilton's paper on sponge-grafting recalled some
of the earliest lessons of my professional life under a very
able surgeon, the late Mr. R. C. Botham, of Chesterfield.
He taught me to treat foul ulcers of the leg in working-
men by scrupulous cleanliness, a pad of lint steeped in
solution of chloride of lime on the ulcer, then oiled silk
Ii8
THE MEDICAL RECORD.
[August 2, 1884
and a constantly applied bandage, making equal pressure
from the toes upward, and kept wet with solution of chlo-
ride of lime. The success of this treatment was most
marked, and I now see that, beginning with an absolutely
clean surface, the dressings acted antiseptically ; they
prevented the contact of the atmosphere, and afforded
the support which Dr. Hamilton has shown to be so es^
sential for healing wherever the restraining pressure dP
the skin has been removed.
■ Dr. Cor/s unfortunate success in vaccinating himself
with matter taken from the cow-pox pustule of a syphilitic
child, will lead to a reconsideration of the respective
powers of development of the different constituents of
the blood, and to the relations of its white nucleated to
its colored non-nucleated constituents.
At the last meeting of the British Medical Association,
Dr. Schafer called attention very pointedly to the func-
tion of reproduction as belonging to the nucleus of a cell,
and it is long since Dr. Beale showed the great power of
the germinal matter as compared with that of the formed
material of tissues. Yet for years the startling propo-
sition has been maintained that syphilis is alone commu-
nicable- in vaccination by the colored non-nucleated
formed constituents of the blood. Every medical man
knows the potency of the lymph taken early from a vac-
cine vesicle as compared with that obtained in the later
stages when the lymph-corpuscles have degenerated into
pus. And the previous considerations which I have
urged upon you show that these lymph-corpuscles accu-
mulated in the vaccine vesicle have been produced in
this local inflammation either by migration and subse-
quent multiplication of the white corpuscles of the blood
or by active proliferation of the connective-tissue cor-
puscles of the part ; in either case from germinal matter,
active, living protoplasm, if not by the direct agency of
the nuclei of such matter.
Recalling Mr. Goodsill's happy demonstration, that the
cells of lymphatic glands are developments of the epi-
thelium of lymphatic vessels, and Dr. Klein's beauti-
ful tracing of endothelium and the corpuscles of connec-
tive tissue at the fenestras of omenta and in other situa-
tions, we recognize the family relationship between the
lymph-corpuscles which, when detached, constitute white
corpuscles of the blood — the endothelium of serous
membranes so often found germmating abundantly — and
the connective-tissue corpuscles, which Dr. Hamilton
has figured and described as multiplying with great rapid*-
ity when stimulated by the agents causing inflammation
and unduly fed by a largely increased afflux of blood.
If it be asked why syphilis does not more frequently
follow vaccination, the reply is simple, that the greatest
care is taken to select none but perfectly healthy chil-
dren for the collection of lymph, and that it is possible
that when lymph has been collected where syphilis,
though present, was not recognized, the results may not
always have been referred to their proper causes.
This leads me to mention the most difflcult, exciting,
and important problem of the day : whether other dis
eases than small-pox can be deprived of their virulence
by vaccination.
You are aware with what ardor M. Pasteur has es-
poused the affirmative side of this question, and it was
very natural that, having had a certain amount of evi-
dence that infectious diseases of animals may be de-
prived of their fatal effects by previous vaccination, he
should have been led to hope that what is true of one is
true of all, and that in this way even hydrophobia may
be deprived of its horrors.
The exceedingly careful researches of Dr. Klein, de-
scribed with such accuracy of detail that they may be
followed by any one, have shown that there are numei-
ous pitfalls in the way of such inquiries, and that we are
yet very far from being able to foresee the end of them.
Yet the progress made gives great hope for the future,
for careful experiments by Drs. Klein and Roy, and by
Dr. Burdon-Sanderson and Mr. Duguid, have clearly
shown that sheep inoculated with anthrax blood of the
white mouse, cattle inoculated with anthrax blood of the
guinea-pig, and cattle inoculated with anthrax blood of
the South American bisachas are, for a time at least,
insusceptible of a fatal attack of the malady.
Dr. Klein has found that the virus which communi-
cates swine disease is a form of bacillus which he has
been able to cultivate out of the body in various ways,
and which is capable of forming spores when exposed to
the air. But though the organs of a dead animal swarm
with the bacilli, these soon degenerate and become
harmless, without forming spores, if the body be not cut,
and this happens equally whether the body be interred
or not.
From long experience I am satisfied that the bodies
of persons who die of small-pox, or of puerperal or
other fevers, may be dissected without harm if properly
prepared.
Dr. Burdon-Sanderson has suggested the possibility of
the determination of the morbid process in contagious
diseases by an action similar to the spontaneous arrest
of septic fermentations by the development of members
of the aromatic group of chemical compounds destruc-
tive of any further manifestation of the vital activity of
septic microphytes, and he has undertaken to direct a
series of researches on this subject.
On the one hand, what can be more alarming than
that, under certain conditions, living organisms of the
utmost minuteness enter the body and multiply with a
rapidity with which fungi alone can multiply, corrupting
the blood, causing local coagulations, obstructions of
vessels, abscesses, and death ? and, on the other hand,
what can be more comforting than Dr. Sanderson's happy
reference to the manner in which salivary, gastric, or
pancreatic digestions furnish the means of their own
arrest, and to the similar manner in which the organisms
containifig the virus of contagious diseases prepare the
means of their own destruction ?
Surely the day will come when it will be seen that
gratitude and reverence are due to such men as Pasteur
and Koch and Sanderson and Klein, rather than that
they should be assailed with insult and hindered by mis-
chievous legislation, as if they were criminals rather than
benefactors of the whole human and animal races.
Let me mention certain t:ircumstances which I think
indicate that we are on the eve of great simplification
and extension of our knowledge. It was a great step
when the late Master of the Mint taught us the difference
between crystalloids and colloids, and many of the laws
of diffusion and osmosis. It led the way in an intelli-
gent investigation as to how, in the process of digestion,
colloidal starch and albumen are fitted to pass through
the membranous walls of the alimentary canal. We
have found that contact with a mere trace of saliva
or pancreatic or intestinal secretion suddenly converts
starch into sugar, and that a large number of other or-
ganic matters produce a similar result Bernard showed,
by experiment, how different* cane, grape, hepatic, and
diabetic sugars are in their relation to the economy; that
starch and sugar are converted into fat by the liver ; and
that by an insignificant lesion of the medulla oblongata
temporary diabetes can be produced. And we know,
further, that during the conversion of starch into sugar
there are many almost insensible stages. The process
is influenced by numerous conditions which require in-
vestigation at every step to enable us to trace these sub-
stances at their entrance into the economy, in the re-
gions where they contribute to the production of heat
and motion, and until their final deposition or discharge
in some more oxidated form.
Similarly I would suggest the most careful observation
— not by one person, but by every one in his own sphere
— of the conditions under which albuminoid matters are
changed, whether after their entrance into the upper or
lower end of the alimentary canal ; of those under which
they pass into the blood, circulate, and become tissue ;
August 2, 1884.]
THE MEDICAL RECORD.
119
also of the forms under which they reappear in their
variouslj oxidated conditions in the urinary excretion in
health and disease.
The marvellous differences between albumen of the
egg and serum and albumen washed free from salts, or
when changed into acid or alkali albumen ; the modes
of production of peptone and its varieties ; the diflfer-
ences in the conditions and results of the action of the
gastric, pancreatic, and intestinal secretions ; and very
specially the appearance in the urine, in disordered or
diseased conditions, of albuminoid substances yielding
reactions, showing that the variety of forms in which
these substances appear are no less numerous or closely
related than those of the varieties of sugar and starch,
all point to the necessity of rigorous investigation, and
to the possibility of presenting these substances and
their various alternations in a light far more simple than
has as yet been suspected.
It is unfortunately the custom in this country- to leave
such investigations to be undertaken by private individu-
als, very few of whom have the necessary physiological
and chemical knowledge, and fewer still have the requi-
site time and means at their disposal. That we have
men admirably fitted to direct and aid or to conduct
sQch inquiries is plain from the researches of Simpson
and Thudichum and the aid rendered by Gamgee,
Ralfe, and T. C. Charles. And I am not without hope
that the public spirit of this great country may yet be
aroused by the expressed opinion of the President of
the Royal Society and others as to the duties of the
state in such matters, and that something worthy of the
nation may yet be done to aid the teaching of science
and to promote scientific inquiry.
PRACTICAL OBSERVATIONS ON THE HUMAN
EAR AND ITS DISEASES, WITH ILLUSTRA-
TIVE CASES.
By SAMUEL SEXTON, M.D.,
AUBAL S17RCBON TO THB NBW YOKK BYB AND BAR INF1RMAKY.
I. — ^The External Ear.
(Continued firom No. 713, p. 7.)
HiGMATOMA AURIS — SYMPTOMS.
The affection may begin in either ear, but most frequently
attacks the left ; both ears are sometimes attacked about
the same time, the left, however, being usually, it is al-
lied, the first to exhibit symptoms of invasion. The
exadation always takes place, as far as my own experience
goes, on the outer surface of the pinna, and seldom
affects the inner surface at any period of the disease.
The swelling in most cases begins near the superior
border of the pinna, but it may show itself on any por-
tion of the exterior surface, including the concha. The
bbule is never directly affected, since it contains no
anilage, and the cartilaginous portion of the external
loditoiy canal is seldom involved. The tragus seems to
(iijoy entire immunity from attacks.
This selection of the outer surface of the auricle seems
to be owing to the greater vascularity of this region, upon
liuch the branches of the anterior and posterior auricu-
lar arteries ramify and anastomose, and to the fact that
^ almost invariably receives the impact, when the auricle
tf struck, with greatest force. Where there is an inflam-
Biitory movement in the parts, the connective tissue on
tk inner suriiace of the pinna may become the seat of
suppurative action and an abscess may form ; or, should
perforation of the cartilage take place, the contents of
ti»« tumor may pass through from the anterior cyst, sepa-
titing the perichondrium from the cartilage on the inner
wface, and escape into the connective tissue even.
^Tieo the invasion takes place the affected region
ssoall? presents a hyperjeraic appearance ; frequently
^^ is in lunatics a very decided flow of blood toward
the head, producing great capillary turgescence of the
face, ears, and eyes ; in some instances an effusion of
blood beneath the conjunctiva of the eye has been
known to occur simultaneously with the appearance of
the othaematoma. In the more severe cases, where the
characteristic effusion takes place rapidly with inflamma-
tory action, there is often an elevation of temperature ;
and in nearly all instances the integument assumes a
bluish or purplish hue. The affected organ is seldom
very painful, even where the tumor is greatly distended
or roughly handled, especially in boxers and lunatics,
where the parts have been subject to rough treatment
from repeated contusions ; in the latter, however, the
ears are wanting in sensibility at all times. The writer
has, however, frequently observed that sensibility is very
much exalted in some cases occurring in sane persons.
The progress of the tumor varies very much ; it may rise
to a considerable size in the course of a few hours, and
when first seen may be as large as an almond or a walnut.
Sometimes the distention continues to progress rapidly,
the walls becoming thinner in consequence of the stretch-
ing, until, finally, in the worst cases, they undergo spon-
taneous rupture unless relieved by an operation. In
asylum cases it is not unusual to allow the cyst to burst
in this manner ; thus of the twenty-four cases reported
by Hun fifteen niptured spontaneously ; in one of them
the lefl ear burst on the twelfth day at the upper part
of the concha, while the patient was sitting in a chair, and
the contents ** were thrown to the ceiling, a distance of
twelve feet, so as to stain the plaster."
These tumors are, however, frequently without some
of the symptoms of inflammatory action, passing through
all of the stages of the disease without either heat or
pain being experienced by the patient. This variety
manifests a disposition to develop slowly, and has a
tendency to spread itself laterally rather than in thick-
ness. The following case is one of this description :
Case I. — W. W , an Englishman, forty-three years
of age, by occupation a negro minstrel ; health good, and
he claims to have no bad habits ; never had any aural dis-
ease before ; came to the New York Eye and Ear In-
FlG. T.
firmary May 4, 1880. States that two weeks ago,
while washing the burnt cork from his face, he felt a
slight soreness on the top of the right auricle. On ex-
amination he found a small tumor on the outer aspect
of the auricle, which afterward gradually increased in
size until it was larger in diameter than a twenty-five
cent piece ; it then obliterated the antihelix, and finally
became about one-half an inch in thickness. On shak-
I20
THE MEDICAL RECORD.
[August 2, 1884.
ing his head the patient could '' feel the contents of the
tumor rattle."
Dr. Henry D. Joy, to whose kindness I am indebted
for the case, had painted the tumor with the tincture of
iodine for the first few days, and it had decreased some-
what in size. When the iodine stains disappeared the
color of the tumor was found to be but little more red
than normal, but its walls were thickened. Under the
expectant plan the fluid continued to be reabsorbed
quite rapidly, and later on the contents had a doughy feel.
June 4th. — The patient himself has occasionally painted
the ear with tincture of iodine, and for the past two
weeks it has diminished notably in size. Thickening
and immobility of the integument,* however, remain.
There is no shrivelling of the cartilage, and but little
deformity from the remaining induration of the parts. It
is the belief of the patient that the auricle, previous to
the beginning of the swelling, had been struck a slight
blow by a papier-mach6 stove, which he had to throw
upon his shoulder during a play.
Fig. I represents the appearance of the ear imme-
diately after the tumor had commenced to subside.
In some instances, however, cases like the above, after
remaining, ifi statu quo for a variable period of time,
suffer an exasperation from repeated contusions, and an
othaematoma of very considerable size may be developed.
Such an aggravation may also be brought about by in-
judicious operative procedures, or probably by an ex-
acerbation of cerebral symptoms, giving rise to increased
activity of the general circulation about the head and
ears.
In the beginning of an attack, and during its progress,
the patient sometimes experiences a feeling of heat in
the affected organ, like the extreme congestion due to
flushing ; in the insane, however, precursory signs are
not likely to be reported.
Generally the outlines of the outer surface of the
pinna, formed by the foldings of the cartilage, are more
or less obliterated, according to the extent of the tumor;
where there were ridges and depressions before, the sur-
face will be smooth — usually convex even.
The contents of the tumor ^ in the beginning, may con-
sist of blood and serum, or of the latter principally ;
even when at first serous, the fluid usually becomes sero-
sanguinolent sooner or later. In some instances, how-
ever, the serous character continues throughout. In
most cases an early formation of coagula takes place in
the tumor, which, not being reabsorbed, increases en-
suing deformity. In the milder form of the affection,
sometimes described as ** cedematous," but little fibrous
tissue remains, reabsorption being more complete ; such
cases seem to pass through all of the stages with but
moderate inflammatory action.
The wound which affords an outlet for the contents
of these cysts, when they require any, whether from punc-
ture or due to spontaneous rupture, has no tendency to
remain open, and the cavity, therefore, sometimes re-
fills in the course of a few hours ; on the other hand, in
certain cases the cyst pours out fluid so rapidly that a
discharge constantly trickles down from the opening, thus
preventing the wound from closing.
The duration of othczmatoma will of course vary greatly,
depending as it does on the severity of the case, the ra-
pidity of reabsorption, and the habits of the patient ;
thus in lunatics, inebriates, and boxers the organ is liable
to repeated contusions, giving rise to aggravations which
may retard the cure. Sometimes reabsorption comes to
a stand-still, and a considerable tumor remains for an
indefinite period of time.
The writer has seen a case of this kind which is given
below :
Case II. — Charlotte K , aged thirty-nine, was
admitted to the New York City Lunatic Asylum in May,
1880, when suffering from her first attack of acute melan-
cholia. She had delusions of persecution and suicidal ten-
dencies, was subject to exacerbations of excitement, dur-
ing which she was violent and destructive until quieted by
large doses of sedatives. In June, 1883, haematoraa
commenced in the left ear, which ran its course in two
months without any particular treatment, leaving much
deformity. On September 12, 1883, othaematoma com-
menced in the right ear : at first it was intensely red, but
finally became purplish in appearance. No treatment
October 31st. — The patient was examined by the writer
and a considerable collection oC fluctuating fluid was de-
tected in a cyst, over an inch in length, on the outer sur-
face of the right auricle. It was recommended that the
fluid be evacuated by a rather free incision, the walls of
the cyst painted with Churchill's solution of iodine, and
the auricle bandaged to the head so as to cause a moder-
ate amount of pressure. This was done by Dr. L. C.
Toney, though through some misunderstanding three
successive applications of the iodine were made. By
November 3d the walls were adherent, and on Novem-
ber 9th the wound was found healing by granulation.
When the writer last saw the ear, on November 23d,
it was found that the sac was entirely obliterated. The
cicatrix was slightly stained from the excessive use made
of the iodine solution. There was scarcely any deformity.
In some instances a sinus remains, aflbrding a serous
discharge which may continue for an indefinite period
The following is a case of this kind :
Case III. — Annie M , aged thirty-five, was ad-
mitted to the New York City Lunatic Asylum, March,
1879, with acute mania. Soon afterward, on refusing
food, was forcibly fed — the process consisting in placing
the head of the patient under the left arm of the operator,
while with his left hand a wedge is held in the patient's
mouth, and with the right hand the feeding-tube is in-
serted. Subsequently haematoma developed in the left
ear. Although it seems probable that the ear was bruised
during the forcible feeding, yet the patient was frequently
engaged in fights with other patients at this time, when
she was liable to receive blows upon the ear. There
was no treatment, and the tumor passed into a chronic
stage, which escaped observation until September, 1883,
when serum was observed to ooze from an opening in
the outer surface of the auricle just above the condia.
This opening was enlarged and the cavity syringed out
with a solution of carbolic acid with no result. On
^ October 19th the writer examined the case and
"j determined to obliterate the sac by an operation.
The sac was laid freely open, cleansed of the co-
pious flow of blood and other contents, and the
walls were then thoroughly painted with Church-
ill's solution of iodine. Notwithstanding the em-
ployment of such pressure as was found to be
practicable, the parts healed up again, leaving a
small sinus as before. Subsequently the opera-
tion was tried three different times by Dr. Dent,
the assistant superintendent, without avail.
November 23d. — ^The writer finding a slight
sero-sanguinolent discharge remaining, concluded
to try to obliterate the tumor by scraping its walls
with a cutting-scraper. It was found, however,
1 that the walls of the sac, which proved to be very
large, consisted of broken-up and shrivelled car-
tilage, presenting rough and uneven surfaces. A
partly detached plate of cartilage was found lying
on the outer wall, and the edge of the superior
portion of the heUx could be felt. There was a
deficiency in the cartilage composing the inner
I wall of the sac. It was evident that the irregu-
larities of the walls had prevented adhesion of
the surfaces from taking place.
Operation, — With scraper (Fig. 2) every portion
of the secreting surface was destroyed, considera-
FiG. a. 5ie broken-down tissue being brought away by the
instrument, which had to be cleaned several times. The
oozing of blood was quite profuse for a time. The parts
were thoroughly cleansed with hot water, and pressure es-
tablished by bandaging the padded ear firmly to the side
\
August 2, 1 884,]
THE MEDICAL RECORD.
121
of the bead. It was noted that throughout the operation
the patient seemed to experience no pain whatever. No
aoxstfaetic was employed. The parts healed kindly, pres-
sure was maintained for some time afterward. After the
first week there seemed to be some improvement, but
when 1 saw the patient, on December 2 2d, the cure was
incomplete. It is very evident that union can only be
obtained between the walls of the sac in this case by
dissecting out the irregular and detached masses of carti-
lage whidi prevent them coming together.
in a very considerable number of cases the disease
will terminate spontaneously in from four to eight weeks,
depending somewhat on the extent of perichondrium
afected and the quantity of the effusion ; othaeniatoma,
however, cannot be ^aid to have any regular course
vhere it occurs in irresponsible or uncontrollable pa-
tients.
Subjective symptoms, — ^These usually are present where
occlusion of the external auditory meatus is produced by
swelling of the concha ; they consist in deafness — due to
dosureof the canal — and tinnitus aurium — from increased
tension of the membrana tympani. The extent of these
symptoms in lunatics cannot with accuracy be determined.
CompluaHons. — The retroactive consequences of this
local trouble in the insane need not be considered here,
yet it is worthy of note that the posterior auricular artery,
tbroogfa one of its branches — the stylo-mastoid — com-
municates with the middle meningeal by anastomosis,
thus establishing a significant and important relationship
between the ear and the meninges of the brain. In the
mentally sane this becomes a factor of serious import, and
sboold not be overlooked \ besides, more or less general
nervous sympathy may exist in sane patients.
Parts contiguous to the ear are sometimes implicated
in an extension of the inflammatory process ; neuralgia
maj be kindled into action, and general febrile action
flttj supervene. Whilst othaematoma may be produced
b]r disease or wounding of the cartilage of the external
auditoiy canal, it seldom extends itself to these parts
from the pinna ; and the middle ear, so far as is known to
the writer at least, has never been invaded by an exten-
sve inroad of the inflammatory process.
DIAGNOSIS OF OTHiGMATOMA.
The " Asyluna Ear" was, by all observers half a cen-
huy ago, regarded as a curiosity simply, and even at the
present time it seems to very often escape attention
entirely, or to be merely entered in asylum case-books
IS a nondescript phenomenon. It is to be hoped that a
nnt of knowledge in this respect will not long prevail
ibcrc the disease is liable to occur, and where treatment
may do much to ameliorate the condition of the patient.
In fact, the want of adequate knowledge in regard to
othematoma seems scarcely any longer excusable when
we consider the light that has been thrown upon the
sobject during the past twenty years by various authors.
In distinguishing this afiection from erysipelas, phleg-
Dionous inflammation, frost-bite, burns, eczema, tuber-
oikr syphilis, and other cutaneous affections one almost
consUnt causative agency should be first sought for,
aamdjr, trauma. Whether predisposing conditions are
[CMent or not, the history will give unmistakable evi-
dences oi this factor. There may often be reasons for
Bipyressing the truth; persons may desire to conceal
it £iets of blows having been administered, or they may
i»rc been so slight as to have escaped attention, never-
fcless where othaematoma is suspected, inquiries in this
fcction should be diligently pressed.
The essential nature of the afiection depending on a
pexkhondritis of the cartilage of the auricle, its exist-
cQce may be readily detected by examining the con-
sents of the tumor, which will be found to be serous or
iMD^sanguinolent These tumors are usually of rapid
fonriation, and speedily refill again on being evacuated.
I* *iU be found that they have well-defined and resisting
'^j a fact which may be determined by exploring the
walls of the tumor with a probe after it has been incised
or ruptured.
Abscesses or blood extravasations rarely develop in
the scanty connective tissue of the auricle, and they are
much more limited in dimensions than othaematoma ;
their walls, moreover, give way to moderate distention,
and their progress will be found to be less protracted than
the tumors under consideration. The serous or sero-
sanfi;uinolent discharge which characterizes othaematoma,
could not have its origin in a cavity formed by the break-
ing down of the connective tissue by effused blood, but
must arise from a secreting surface.
Suppurative perichondritis has been alluded to by
writers, but it is difiicult to see how pus could be se-
creted by these cysts ; extravasated blood may, however,
become putrescent, or a perforation of the walls of the
cyst may afibrd a communication with an abscess behind
the cartilage of the auricle, or with the deeper parts
about its attachment to the temporal bone.
Abscesses, however, may develop in the post-auricular
connective tissue during the progress of cases of marked
inflammator>' tendency or as a result of contusions. In
such cases, or where swelling occurs without niahj
an asymmetrical prominence of the auricle ^
Fig. 3.
The following case is in point. Fig. 3 is an excellent
likeness of the patient, and Fig. 4 is a view of the post-
aural abscess, natural size.
Case IV. — Michael Y , thirty-five years of age ;
married ; intemperate ; entered New York City Asylum
for the Insane, with dementia, 1872. Is morose and
stupid. In 1878 found to imagine that he had a woman
in him. In 1882, delusions of dead bodies in his head.
April, 1883, extravagant delusions, as head filled with
articles of food. The eyebrows have almost disappeared
from constant rubbing, tries to rub his eyes out. No-
vember 24, 1883, haematomaof the right pinna observed.
Continually rubs side of head with stones and beats him-
self. November 25th, the tumor on inner surface of
auricle was incised. . . .
I saw this patient on November 27 th, and the follow-
ing is an abstract of the notes taken by Dr. Robert Bar-
clay, who assisted me : The right auricle is thickened,
the outlines of the outer surface being almost obliterated.
The whole organ is red and tender, although sensibility is
much lowered. A large fluctuating abscess occupies the
lower half of the inner surface of the pinna, and extends
downward, spreading out over the mastoid process and
involving the lobule. There is a slight indentation where
incision was made on the 25 th, It has been treated by
122
THE MEDICAL RECORD.
[August 2, 1884.
applications of iced water. The writer made an inci-
sion, about half an inch long, into the lower part of the
abscess, evacuating about a fluid ounce of pus. The
teeth of this patient were very carious, quite so on the
right j side,]| and were all of them enveloped in much
Fig. 4'
tartar. It would seem that the post-aural abscess, al-
though consecutive to the othaematoma, was due to the
constant bruising of the parts by the patient himselC
The othaeroatomatous tumor on the exterior surface of
the auricle probably gave rise to unusual vascularity in the
whole organ, and there may have been an opening in the
cartilage permitting the passage of the contents of the cyst
into the connective tissue behind the ear, but there was
no evidence of any separation of the perichondrium from
the cartilage on its inner surface, and the contents of the
abscess apparently contained no serum. There was no
history as to the exact duration of the othaematoma.
In many cases of othaematoma the auricle does
not stand off from the head, the disease bein^ limited
to the wing of the ear throughout. Parts contiguous to
the auricle are always the last to be affected, if invaded
at all. The trouble may be distinguished from erysipelas,
for which it was formerly sometimes taken, by its well-
defined sacculated appearance and the absence of super-^
ficial changes common in erysipelas. Eczema and ery-
sipelas, unlike othaematoma, are liable to extend into the
external auditory canal, while the latter, at most, usually,
occludes the meatus by the encroachment of its sac
The cutaneous affections mentioned above, moreover,
frequently invade the neighboring parts, especially the
inner surface of the auricle ; none of them, however,
leave the deformity which characterizes othaematoma.
Naevi may resemble othaematoma very closely in some
instances. Dr. Gorham Bacon showed the writer a case
of this kind occurring in a woman where a large portion
of the auricle was involved. The marked pulsation and
absence of fluctuation in such a case would serve to
distinguish it from othaematoma. The age of the patient
should be considered in arriving at a diagnosis ; thus
eczema is most frequent in infancy and childhood, whilst
othaematoma is more particularly a disease of adult life.
Cases of othaematoma, it is true, have been reported as
occurring in children ; one of them, it is stated, occurred
*'idiopathically" in a child one year and three months
old, where an otorrhoea and eczema of the external
auditory canal preceded the attack.* The writer has
never seen a case of this kind, and is convinced that
their occurrence is extremely infrequent.
(To be continued.)
> Dr. Weil, Stuttean : Beiixag aur Casuistik der Otfaamatome— Moaataduift ftr
Ohrenhdlkuade, May, 1883.
ON RESPIRATORY MEDICAMENTS.
By Professor GERMAIN S^E,
MEMBER OF THE ACADEMY OF MBDIONE, AND OP THE FACL'LTV OP MlDICIllBf
PAKIS, FRANCE.
Pneumotherapy constitutes an artificial respiratory
method, calculated to facilitate respiration as well as the
central and peripheral circulation. It comprises the
fixed respiratory apparatuses, known for many years, but
whose effects on the heart and circulatbn have less en-
gaged the attention of observers than the action of these
artificial atmospheres on respiration and nutrition.
Pneumotherapy, in its more modem development, is
practised by the aid of portable apparatuses, invented by
Waldenburg, with more precise aifd special applications
to diseases of the heart and blood-vessels.
EFFECTS OF NORMAL INSPIRATION AND EXPIRATION ON
THE THORACIC ORGANS.
Respiration in free air exercises a marked influence on
the circulation.
Inspiration, — The pulmonary air is in a state of diffu-
sion, and thereby exercises an aspiration or suction on
the vascular system in such a manner that during inspira-
tion the venous blood arrives with greater facility and
speed from the head and trunk to the thorax and heart ;
the latter dilates easily to the inflowing current During
this period, nevertheless, the expulsion of blood fix)m the
heart takes place with less energy, and for this reason
vascular tension diminishes during the inspiratory act
It is only at the end of inspiration that the pressure of
the pulmonary air becomes equal to that of the atmo-
sphere, and then the modifications in the circulation,
dfected by inspiration, end.
Expiration.— Here ever3rthin^ is reversed ; the tho-
racic parietes sink in, compressing the air in the lungs
which undergoes condensation ; there results at the same
time a pressure on the heart and great vessels. The
venous blood flows with diflSculty into the thoracic cavity
and heart, the veins of the body swell ; the contractions of
the heart take place with more energy^ but without power
to force a great deal of blood into the arterial tubes.
EFFECTS OF INSPIRATION OF COMPRESSED AIR.
Mechanical effects on the lungs, — ^The inspiration of
compressed air determines at first a sensation of plen-
itude and distention in the thorax, resulting fi-om the ex-
pansion of the lungs and the entire thoracic cavity, an
expansion which is more marked than that which follows
the most powerful voluntary inspiration, although the in-
spiratory muscles do not in this case put forth any sensible
effort. The compressed air which penetrates the lungs
begins by diffusing itself with the residual air in the
lungs, and it is not till the end of inspiration that it
reaches the degree of pressure which it had in the appa-
ratus. The quantity of air introduced into the lungs and
then eliminated during these inspirations of compressed
air amounts to one thousand cubic centimetres, according
to Waldenburg, and according to Speck, to seven, eight,
and even ten thousand cubic centimetres each minute ; this
explains the thoracic enlargement, which may exceed the
normal by four centimetres. The lungs become thor-
oughly permeated with air, and clear themselves of bron-
chial mucus. Still later, both inspiratory and expiratoiy
force is increased, and this, not only during the pneu-
matic treatment, but for some time after.
The same may be said of that increase of vital capacity
which results from treatment by compressed air, it lasts
for a considerable time. The condition of success is not
to exceed -^ of the atmosphere pressure, for if this con-
dition be not observed serious accidents may occur, such
as loss of elasticity of the pulmonary tissue, pulmonary
emphysema, and hemorrhages from rupture of blood-ves-
sels, if the lung-tissue be at all altered.
Effects of inspiration of compressed air on the heart
and circulation. — [The entire subject of the ph3rsiological
August 2, 1884.]
THE MEDICAL RECORD.
123
^ts of inspiration of compressed air demands revision
and restatement No one has acknowledged this more
plainlj than Professor S6e himself, when, after a long
and interesting statement of Waldenberg's theory, he
confesses that it has been overthrown by recent sphygmo-
graphic explorations. This being the case, I have taken
die liberty to omit this portion oiProfessor S6e's lecture,
for however reasonable any theory may be, if it will not
stand the test of facts it is worth nothing.
Waldenberg established the following laws : Inspira-
tions of compressed-air augment the pressure in the en-
tire arterial system ; expirations in rarefied air diminish
the pressure in the aortic system. Lambert, Ducrocq^
Riegel, Franck, Zuntz, and others, by a carefully con-
ducted series of experiments, arrived at opposite results.
Dujardin-Beaumetz, m summing up the results of ex-
perimentation, thinks that compressed air has often a very
bvorable effect on the respiration, producing a current
of air through the air-passages which clears them of
macosities, and gives to the pulmonary parenchyma a
new elasticity. The vital capacity is augmented, 2ls is
shown by the spirometer. On this point, Waldenburg is
in harmony with all other experimenters. As for the
effect of compressed air on the circulation, the opinions
are so contradictory that nothing very reliable can yet be
determined ; it is by no means demonstrated that this
therapeutic method is of any efficacy in diseases of the
heart, while its utility as a respiratory medicament in '
chronic bronchitis, asthn^ emphysema and phthisis is
anquestioned. — ^Tit.]
Experiments on animals by most painstaking observers,
such as Einbrodt, Hering, Drosdorf, Lambert, Zuntz,
have cast great doubt on the theory of Waldenburg,
seemingly so reasonable. Clinical observations, aided
by tracmgs of the pulse, have confirmed the conclusions
derived from physiological experimentation. These ex-
periflcienters msule use of the kygnaogiuph, a sort of
manometer, introduced into the arteries in animals. In
al] the conditions which to Waldenburg indicate an
augmentation of arterial pressure, they constantly found
a lowering of vascular tension. Where a diminution of
pressure had been noted experimentation showed an ex-
cess of pressure. Waldenburg sought to explain this
discordance by saying that the tension of the vessels and
mtiavascular pressure are not correlative terms, and
that sometimes the tension of the arterial walls augments
while the blood-pressure diminishes. He sought to make
this demonstration by means of an instrument designed
to measure the degree of arterial tension, and which he
called a " pulse-shower " {montre du pouls). The down-
&11 of the theory was nevertheless complete.
Clinical and sphygmographical observations. — Clini-
cal observations have conclusively confirmed the results
of experimentation. Riegel and Franck distinguish two
opposite periods, the one of the initial phenomena, the
other a final period, which is the most important. Their
results agree with those of Ducrocq, Drosdorf, and Zuntz.
Omitting the somewhat tedious details of sphygmographic
tradngs (for which I refer you to my work on ** Anoma*
ioQS Forms of Heart Disease '') these careful observers
are unanimons in affirming that the first effect of inhalar
dons of compressed air is to produce a diminution of
intravascular tension, with dimmution of the frequency
of the pulse ; as soon as the atmospheric pressure on the
longs, the heart, and blood-vessels diminishes, the blood-
pressure rises.
It results from these observations that, while Walden-
burg taught that compressed air was a means of fortifying
the heart, by a sort of regular gymnastic exercise, the
observers cited above, and especially Oertel and Schnitz-
Icr, have never noted such effects, especially in the appli-
cation of pneumotherapy to diseases of the heart.
Dynamic effects. — ^According to Sommerbrodt and
fiiedert, the intra-alveolar air, by the exaggerated press-
Bie which it exerts on the respiratory mucous membrane,
produces on the sensory nerves of the lungs an impres-
sion which, by reflex action, excites the vaso-dilator
nerves, in this way diminishes the vascular tonicity, di-
lates the blood-vessels, and lowers the pressure. On the
other hand, the inhibitory nerves of the heart are en-
feebled, and there is quickening of the heart's action and
of the peripheral circulation ; the intra-alveolar pressure
thus becomes the regulator of the velocity of the circu-
lation. "
Chemical effects, — Every change of pressure in the
inspired air or in the expired air determines increase of
activity in the respiratory process ; but the elimination of
carbonic acid is always more marked than the absorption
of oxygen, so that more oxygen is eliminated than was in-
troduced previously. The action of inspired or expired
air, then, resembles the voluntary augmentation of ordi-
nary respiration, and the modifications ou^ht not to be
considered as the result of more energetic oxidations,
but only as the consequence of a more complete diffusion
of ^as, abstraction being made of the muscular action
(which is of little significance) during this more active
respiration. These facts were long ago pointed out by
Paul Bert.
RAREFIED AIR.
Expiration in rarefied air. — Expiration in rarefied
air produces a y^xy distinct sensation of retraction of the
thorax. The abdominal viscera and diaphra^ are drawn
upward into the thorax by a sort of aspu-ation. The
lungs vare very thoroughly emptied of their atmospheric
contents ; even large quantities of residual air are elimi-
nated, from five hundred to two thousand, cubic inches,
and even three thousand in the emphysematous.
It is easy to understand that by reason of this elimina-
tion the volume of the lungs is reduced. The expelled
iiir issues in greater volume and the inspired air pene-
trates with greater facility ; the inspiratory muscles are
little taxed.
The contraction of the pulmonary area is shown bjr
the cyrtometer, and amounts to from one to two centi-
metres of circumferential measurement. The retraction
of the efMgastrium, and especially the elevation of the
diaphrasm, recognizable by percussion, are, moreover, a
proof of this narrowing of the field of respiration.
By lonf^ continuance in the practice of expiration in
rarefied air an increasing augmentation of vital capacity is
noted ; this may, in the emphysematous, amount to five
hundred, and even one thousand cubic centimetres. It
is easy to detect, by the pneumatometer, an increase in
the force of both inspiration and expiration— the latter
by virtue of the less resistance which the elasticity of the
pulmonary tissue and the muscles of expiration have to
overcome.
Effects on the circulation of expiration in rarefied
air. — These are similar to those of inspiration in free
air. The venous blood more readily returns to the
thorax. and heart, the veins are emptied while the tho-
racic viscera are filled. The work of the heart becomes
more difficult and the ventricular systole is weaker, pres-
sure in the arterial system falls and the arteries are less
tense and more compressible, the pulse is small and soft,
and while the lesser circulation is overcharged, the greater
circulation is poor in blood.
The nervous system is more irritated and reflex vaso-
motor action is more marked than when compressed air
is breathed.
Inspiration of rarefied air. — This ought to act on the
circulation like inspiration in free air, and like expira-
tion in rarefied air, but with more intensity. It is
readily understood that more effort is required on the
part of the muscles of inspiration to introduce the neces-
sary quantity of air than when ordinary air is breathed;
hence the respiratory muscles become strengthened by
a sort of regular gymnastic exercise. The ventilation of
the lungs, according to Waldenburg, is diminished ; ac-
cording to Speck it is augmented.
l^xpiration in compressed air. — By expiration in com-
124
THE MEDICAL RECORD.
[August 2, 1884.
pressed air the expulsion of air from the lungs is ren-
dered more difficult. Here the muscles of expiration
are called upon for more work. According to Speck,
pulmonary ventilation is augmented, as it is by inspira-
tion of compressed air, for although an obstacle to free
respiration exists, this is overcome by the enhanced ac-
tion of the breathing muscles, and air enters in great
abundance. The organs of circulation are modified, as
by inspiration of compressed air.
APPLICATIONS OF PNEUMOTHERAPY TO DISEASES OF THE
HEART.
Waldenbur^, Henich, etc., recommend inspirations of
compressed air in certain cases, directing from fifty to
one hundred inspirations, of yf^ to -^ above the atmos-
pheric pressure. The utility of these inspirations in any
form of heart disease is doubtful. When you have a
case of mitral disease with perfect compensation, com-
pressed air is not necessary. On the other hand, if
compensatory hyyjertrophy has not commenced, or if it
is insufficient, compressed air removes the besoin de
respirer, the dyspnoea, the congestions of the lesser
circulation, the palpitations, and the cyanosis. This
effect may be far more lasting than the period of in-
spiration. During the inspirations of com|>res8ed air the
excess of pressure on the part of the air drawn into the
lungs causes expulsion of the blood from the pulmonary
vessels, and a clearing of the lesser circulation. Com-
pressed air is then useful {a) to augment the systole and
the arterial pressure, (b) to facilitate the passage of blood
from the heart, {c) to render more difficult the access of
blood from the great veins to the heart, and thus to
free the lungs.
In these cases, says Oertel, it is preferable to expire
in rarefied air, for then the vascular pressure and the
tension of the arterial walls are augmented during the
entire expiration, and stases in the peripheral veins are
prevented, while the heart's energy is promoted by a
more easy diastole. All this is uncertain and theoretical,
the result, it must be confessed, of rather hazardous as-
sertions, based on two successful cases reported by
Henich and Schnitzler.
Aortic insufficiency and constriction. — In both aortic
insufficiency and aortic constriction (according to Wal-
denburg) the dyspnoea is diminished because the intra-
pulmonary pres:ure clears the blood-vessels of the lungs,
before engorged ; but the facts cited by Waldenburg
have no value.
Fenoglio, in fact, denies the utility of compressed air
in these afifections ; he thus formulates the application
of pneumotherapy : In aortic insufficiency with ex-
cessive activity of the left ventricle we have an indica-
tion for expiration in rarefied air. We hope in this way,
he says, to diminish the exaggerated compensation, and
he cites three cases in support of this method of treat-
ment. Under the influence of these expirations* in rare-
fied air he has seen tension enfeebled and the arterial
engorgement lessened ; at the end of the expiration the
sphygmographic elevation of the blood-wave was dimin-
ished, the line of descent became less vertical, and
dicrotism was less marked Little by little the palpita-
tions diminished also, as well as the painful arterial pulsa-
tions and the feeling of anxiety and precordial distress.
Fatty degeneration. — Several cases treated by Wal-
denburg were benefited by compressed air.
Pulmonary cardiac hypercemia^ with hamoptysis. — De-
spite the theory which indicates the employment of in-
halations of compressed air, the facts are opposed to
the treatment, and hiemoptyses are certainly to be feared.
Resume. — ^There is no precise indication, and there
are everywhere contra-indications respecting the applica-
tion of aerotherapy to diseases of the heart. It is a
question yet to be decided, despite the rigor of the
sphygmographic explorations of Franck and Riegel in
their researches concerning the physiological effects of
this respiratory method.
HEPATIC ALBUMINURIA.
By C. C. THAYER, M.D.,
CLIFTON SPKINGS, N. V.
Albuminous urine always signifies a patholo^cal con-
dition. That pathological condition may be either with-
in or without the kidneys ; it may be entirely local,'or
may be general, and even in parts far remote from the
kidneys. It may be inflammatory or mechanical, nervous,
organic, or functional.
Traces of albumen in the urine are far from being a
strange phenomenon. In fact, it is much easier to
discover albumen in the urine, than accurately to define
its pathological condition, or to declare its significance
when found.
In the year 1827, when Dr. Richard Bright published
his "Medical Reports" on albuminuria, the popular
mind naturally drifted, as it was led thereby, to consider
albumen in the urine to indicate definite pathological
changes in the kidneys ; and while we cannot justly say
that this distinguished physician unequivocally declared
that albumen in the urine was an infailibie s\ga of renal
disease, yet in his enthusiasm he pressed this feature, not
too far, but to the exclusion in a great degree of other
and equally legitimate phases of the same phenomenon.
These researches and reports rekindled and intensi-
fied a deep and wide-spread investigation into the signifi^
cance of albuminous urine.
Christison, Osborn, and othbrs indorsed, and further
elaborated, the theories of Dr. Bright. Fourget reported
albuminuria as dependent upon hypertrophy of the
heart. Solon reported albuminuria as dependent on
••obstruction of the circulation, peritonitis, crises of
fevers, cutaneous affections, pregnancy, and pneumonia."
Graves reported albuminuria as dependent on " chronic
inflammation of the liver, phthisis, and diabetes " (Con-
tributions to the Physiology and Pathology of the Circu-
lation of the Blood," by George Robinson. London, 1857).
The same author ^ves this proposition : " That the pres-
ence of albumen m the urine is produced by, and its
proportional quantity is in direct ratio to, the degree of
congestion of the capillaries of the kidneys, from what-
eve: cause that congestion may arise " TMoreland).
Braun, Frische, Litzmann, reported albuminuria as
dependent upon " mechanical pressure ; " Rayer, Bee-
quet, on "typhoid fever;" Copeland, on «* powerful
blood changes;" West, on ** exanthemata ; " Virchow,
on ** erysipelas." ** It is known that the urine may be-
come temporarily albuminous in consequence of an ex-
cess of albumen in the blood" (Dickinson, Wood's Li-
brary).
** These different views are not reconciled even at the
present time ; whije many physicians today read die
term albuminuria as an equivalent for kidney disease,
there are others who attribute some, if not all, such
cases to an altered condition of the blood " (Ziemssen's
"Cyclopaedia," vol. xv.).
As all renal diseases do not produce albuminous urine,
so albuminous urine is not, per se, an evidence of renal
disease. Among the varied pathological conditions out-
side the kidneys that give rise to albuminuria, my atten-
tion has been called of late to two cases, where daily
examinations, careful investigations, and varied tests
seemed to prove that the albuminuria (in said cases) was
not produced by, or dependent on, any pathological
changes in the kidneys themselves, but upon some gas-
tric or hepatic disorders.
Case I. — Mr. K , merchant, aged twenty-four;
nervous, bilious temperament, mentally depressed, con-
stipated, voracious appetite, palpitation, throbbing of
arteries, with daily excretions of albumen in the urine.
He was treated as follows : Hepatic stimulants, Turk-
ish, salt, and electrothermal baths ; electricity applied
to the hepatic region produced considerable pain. After
one week's treatment, some specimens of urine exhibited a
diminished amount of albumen ; others remained the same.
August 2, 1SS4.]
THE MEDICAL RECORD.
125
After two weeks some specimens contained none, yet
vithin twelve hours the usual amount would reappear.
He was still eating enough for two well men. Diet was
DOW cut down one-half, when a marked change in the
orine appeared. Urea increased ; lithates and albumen
dJiQioished. Afler two months, albumen could no longer
be detected.
Case II. — Mr. K , aged thirty-five, of bilious tem-
pcraraent; yellowish, lead-colored, rough, and dry skin;
poor appetite, constant bad taste in mouth ; flatulence,
and constipated from youth. For months has had no
movements save by the use of extraneous means, and
often goes a week without being able to secure a move-
ment from the bowels. Great tenderness over the liver
and epigastrium ; subject to chills and often night-
sweats, with much muscular parn, nervous prostration,
and mental depression ; urine scanty, high colored, of
big;h specific gravity, and loaded with lithates ; albuncteo 1
constant and clearly marked. He gave up his business
last October, aind consulted Professor Timothy F. Allen,
of New York, who treated him one month.
He then consulted Professor E. L. Keyes, who took
duufge of his case.
Was brought here in March following, with the above
^ptoms. He was put upon a relaxing and depletory
treatment, Turkish and electro-chemical baths, alkaline
salts, and amylaceous food, with colocynth and hydrargy-
rum pills sufficient to secure a movement from the bowels
once in two days, with stimulating packs over stomach,
bowels, and liver. In two weeks his skin and color be-
gan to dear up, and in three weeks there was not a trace
of albumen in the urine; had gained several pounds of
flesh, and walked around very well.
Now, while there has been constant and considerable
albumen in the urine since October ist — ^seven months —
and we know not how long before, we have been unable
to discover the slightest evidence of any structural
changes in any of the renal organs. Where, then, must
we look for the source of the albumen ? Not in the
oervoQs system, for they presented neither of the ner-
lOfis conditions known to give rise to albuminous urine ;
DOt in any organic lesion of the heart, for they had none ;
Dot in any febrile condition that sometimes for a limited
season produces albuminous urine ; but we may look for
ft in line with their prominent and harmonious symptoms
of gastric and hepatic disorders. We may search for the
caufe of Mix symptom where we look for the cause of
tiieir other symptoms. That the albumen is associated
with, and dependent upon, hepatic and gastric disorders
is incontrovertibly substantiated by the positive relief
afforded by the hepatic and gastric treatment employed.
Tins line of reasoning is abundantly established by Prout,
Cohnheim, etc Exactly ^ow albuminous urine is pro-
doced in these cases is not yet clear, but the fact is au-
thorized by Carpenter, Bennett, Dal ton, and others. The
same may be said of chyluria and glycosuria. ** There
are also reasons for believing that albuminous urine may
be induced by hepatic derangements, independent of
structural disease of the kidneys. I have met with sev-
eral instances of hepatic colic, but where there was no
jaundice, and the paroxysm was followed by a temporary
increase of lithates and albuminous urine" (Murchison).
Dr. Parices ('* On the Composition of the Urine ") thinks,
throagh s<Hne failure in the preparation, either by the
stomach or liver, crude albumen is introduced into the
drcnlation and excreted by the kidneys. Claude Ber-
nard found that crude albumen injected into the jugular
Tdn produced temporary albuminuria. "It is well
known that if two or three raw eggs are eaten at once,
attmmen makes its appearance in the urine " (Fothergill).
This last quotation is in line with the above reasoning,
bat must be limited to cases of gastric and hepatic dis-
ofders ; as experiments show that in such cases, and such
only, does the eating of raw eggs produce albuminous
mat. To test this truth I ate at one meal six rare-
oooked e^s, and made a careful test of the urine at four
and eight hours afterward. Then I ate at one meal
twelve hard-boiled eggs, and tested as before. Then I
ate at one meal six raw eggs — in all, twenty-four eggs in
twenty-four hours, but not the slightest trace of albumen
could be found. After repeated tests of this kind upon
myself, and similar oi^es on others, I assume that albu-
minous urine cannot be produced where there is a healthy
state of digestion with a free portal circulation ; and had
Claude Bernard injected crude albumen into the circula-
tion on the other side of a healthy liver he would not
have found it in the urine. Claude Bernard's experiment
is valuable in the discussion of this subject, in that it
shows that crude albumen may be excreted in the urine.
And thus we are brought one step nearer to the solu-
tion of this question, namely : Mo/ albuminoids passing
through the digestive process^ in excess of the pouters of
the liver to deal with them, may produce albuminous urine.
As an excess of lithates in the urine may indicate defec-
tive powers of the liver, instead of defective metamor-
phosis of tissue (for they have never been tissue), so albu-
men in the urine may indicate not a degeneration of
tissue (for it never was tissue), but defective metabolism
in " liver indigestion," and both are aborted proteids,
wrecked on their way by defective digestion and assimi-
lation.
A pertinent question here arises. What is the charac-
ter of the albumen in hepatic albuminuria ? Is it egg
albumen (Fothergill)? is it globulin (Lehmenn)? is it
a peptone (Lander-Brunton) ? If it were egg albumen,
it could be positively distinguished by the use of ether in
the test For while this secretion of the fowl's oviduct
resembles albumen in the blood-serum, and while its
action under heat and nitric acid is virtually the same,
yet egg albumen is precipitated by ether, while the albu-
men of the blood-serum is not. If it were globulin, or
"latent mine albumen," it could be shown by the use of
alcohol in the test, but not by boiling or by nitric acid.
If it were peptones, it would not be coagulated by heat
or nitric acid in the test.
Traces of albumen in the urine are often unnoticed,
because of imperfect examinations.
1. The test-tubes should be perfectly clean, else both
the character and appearance of the urine may be changed.
2. The urine should always be rendered slightly acid
by the addition of a few drops of dilute acetic acid, as
albumen is held in solution in alkaline urine, notwith-
standing the application of heat.
3. A few drops only of nitric acid should be used, as
an excess of it redissolves albumen. Egg albumen is not
redissolved, except in part, by an excess of acid.
4. Latent albumen (Gerhardt) is not discovered by
heat or nitric acid, but is precipitated by alcohol.
5. Albuminose in the urine is not coagulated by ether,
heat, or nitric acid, but only by the metallic salts and
alcohol in excess.
6. Albumen in the urine, first rendered slightly acid, is
readily discovered by the addition of a few drops of a
solution of potassium ferrocyanide, one of the most deli-
cate of tests.
From the above clinical cases, statistics, and consid-
erations, we draw the following conclusions :
First, — Crude albumen in the circulation may be ex-
creted as such by healthy kidneys.
Second. — Crude albumen in the circulation may arise
from a retrograde metamorphosis of albuminoids in the
process of digestion and assimilation from liver disease.
Third, — Crude albumen in the circulation may arise
from a luxus consumption of albuminoids in excess of the
capabilities of a healthy liver.
Fourth, — Crude albumen in the urine denotes that albu-
minose, in its hidden course to its legitimate and ulti-
mate end, viz., fat and urea, has escaped its proper des-
tiny as an aborted proteid.
Fifth, —Crude albumen in the circulation denotes not a
defective metamorphosis of tissue, for it has never been
tissue, but a defective metabolism in tissue construction.
126
THE MEDICAL RECORD.
[August 2, 1884.
The Medical Record-.
A Weekly yournal of Medicine and Surgery,
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD &. Co., Nos. 56 and 58 Lafayette Place.
New York, August 2, 18^4.
THE BRITISH MEDICAL ASSOCIATION.
The meeting of the British Medical Association this week,
a cabled report of which we present in this issue, was
a remarkably successful one, not only as to attendance,
but as to the subjects of scientific interest which were
discussed. In point of numbers and representative char-
acter, there is probably no scientific association in the
world that is its equal. Its organization is so simple and
withal so perfect that its membership embraces the lead-
ing and working men throughout the kingdom, and gives
it a proportionate influence for good, not only with the
medical profession, but the public at large. This latter
effect is in no small degree due to definite and concerted
action in all matters not only pertaining to advance-
ment in medicine, but to everything scientific and sanitary
which effects medical legislation. Hence the profes-
sion of that country naturally look to the Association
for such expressions of opinion as shall be forcibly direct
as well as widely representative.
It is a matter of great congratulation with its many
friends that the Association is prospering from year to
year, and that its actual membership reaches into the
thousands. One reason for the latter is possibly that
there is no other organization in the country which can
claim to compete with it, and that it combines in its
general branches every element for effective work, and
focuses the united energies of the most progressive medi-
cal and surgical minds. The addresses — of which Dr.
Redfem's, in the present issue, is a type — are, as a rule,
models of their kind, showing much study, patient re-
search, and wide grasp of the subjects treated. This is
no more than could be expected considering the care
with which the orators are selected, and the necessary
incentive for the best efforts on the part of the gentle-
men so honored. The section work is also carefully
looked after, and not only are the topics for discussion
systematically advertised in advance, but the proper
men are duly selected to present them. This gives
ample opportunity for due preparation, and naturally
invests the scientific proceedings of the Association with
proper interest. The addition of a new section, on thera-
peutics and pharmacology, is a notable feature of im-
provement, and gives an earnest of the intention of the
members to devote themselves to the study of a branch
of our science which has of late been too much neglected
by progressive investigators. There is already promise
of much good work in these branches, and the impor-
tance of the same in its general bearing upon the future
progress of medicine was properly enforced by the re-
marks of the learned president of the Association in his
annual address.
Probably nothing has shown the influence and power
of such an Association more than its practical demon-
stration of the utility of systematizing a collective inves-
tigation of disease. By means of its extensive machinery
and its perfect system of organization, it can command
the means to an end which cannot be equalled by any
similar body. The work already done has been highly
satisfactory, and we opine that each successive year the
elaborate report of the committee on the collective in-
vestigation will grow .in importance, and increase in
interest accordingly. At least, so far, it shows what
can be done in a proper direction, and should encourage
similar committees to surmount what are, after all, only
ordinary obstacles.
In thus reviewing the work and influence of the
British Medical Association, it behooves us to utilize, in
behalf of our own National Association, the lessons which
it teaches. In a general way this can be done with great
profit to us. There are certain drawbacks, in regard to
organization and representative character, which will
however be next to impossible to surmount. Great
Britain is, comparatively speaking, a small country,
and concentration of medical talent within a reason-
able area is not impossible. On the other hand, thou-
sands of miles separate the members of the American
Medical Association. There are here certain elements
that militate against continuous annual attendance upon
the meetings, which are very serious ones to consider.
Hence it follows that a new set of members make up
the majority of those in attendance at each session.
Some attempt has been made to overcome this ten-
dency by the biennial meeting at Washington, but even
this latter city is by no means central in location, and
cannot be reached by the larger number of delegates in
the West and Far West without great expense and with-
out serious loss of time. Again, the incentive whicR ob-
tains with our British brethren, within their easy travelling
distances, of being called in consultation, does not exist
with the larger number of the best men so widely scat-
tered over our vast territory. Hence the tendency is
for the leading men in different parts to do their best
work in their district societies, and as a rule leave the
so-called parent association to take care of itself in its
own way.
It can hardly be necessary, in view of the example set
us by our cousins, to urge the necessity for a better pro-
gramme for section work. It has become too much the
fashion with chairmen of sections here to seek papers
from such as may find it convenient to come, rather than
from such as should feel it their duty to come and con-
tribute what they can to the interests of the sessions.
There was an exception to this rule in some of the sec-
tions which met this year in Washington, notably in that
of the Section on Medicine, but not enough, generally,
to give us very sanguine hopes for desirably radical de-
partures.
But from all this it must be understood that our best
men are not backward in doing their work to suit their own
purposes. Their local and State societies absorb a great
deal of this, but their best efforts are expressed in contribu
August 2, 1884.]
THE MEDICAL RECORD.
127
tioDS to our leading medical jonrnals, which are very
properly recognized as the best media for rapid and ex-
tended communication with all the leading centres^ and
with large circles of appreciative readers. In respect to
thus utilizing information from widely scattered regions,
we certainly excel our cousins, and m no small degree
offset the necessity of a national association for the dis-
tribution of intelligence such as they possess.
But, after all, how to practically overcome the pecu-
liarly inherent difficulties in the organization and work of
oar own association is not an easy matter. The British
example cannot be followed throughout, for reasons al-
ready suggested. Interpreting the signs of the times, we
may say that the tendency in this country is toward State
rather than National society work.
THE SCIENTIFIC GRANTS REPORTS OF THE BRITISH
MEDICAL ASSOCIATION.
The series of reports from committees to which sums
of money had been granted by the British Medical As-
sociation begins this present year with the report of Mr.
G. F. Dowdeswell, on the " Intimate Nature of Con-
tagium in Certain Acute Infective Diseases." Mr.
Dowdeswell prefaces his report with a review of the pres-
ent status of scientific opinion as to the relations of
micro-organisms and infective diseases.
There are now two distinct schools of schizomycolo-
ffsAs : one, represented by Cohn, Koch, and others, up-
bold the doctrine that a difference of either form or
fonction is sufficient to establish a distinct species, and
ihat these different species are constant, and do not
meige into each other. The other school, represented
bjrVon Nagcli, Billroth, Lankester, and indirectly by
Pasteur, contend that these different morphological and
]^ysiological forms are merely developmental phases of
the varieties, brought about by external condition of a
very few distinct species.
Mr. Dowdeswell's investigations relate largely to the
above points. He examined experimentally into the re^
ladons of micro-organisms to Davaine's septicaemia, and
Pasteur's so-called septicaemia, or infective peritonitis
(also known as Koch's *' malignant oedema''). We
wooki remind our readers that the specific septicaemia
of Davaine is that produced by the injection of putrid
Uood into the subcutaneous tissue of healthy animals.
Mr. Dowdeswell's experiments showed that this infection
is the result of the presence of a special pathogenic or-
g^mism, resembling d. subtiiis^ that the disease is unques-
tionably a specific septicaemia, not a septic intoxication,
and that by successive inoculations of the blood of one
(fiseased animal into another, the viruUnce of the blood
is mi irureased. This is in opposition to the views of
Coze and Feltz, and of Davaine, and so far as it goes
tends to show that micro-organisms do not change in
physiological function.
Pasteur's septicaemia, or *' infective peritonitis,'' is a
disease produced by injecting putrid matter into the ab-
dominal cavity. An inflammatory exudation results, con*
taining numerous micro-organisms, and this exudation
vben inoculated in other animals produces serous effu*
sion, sepdc intoxication, and death. Mr. Dowdeswell
(oand as had Sanderson and Klein, that the injec*
tion of a germ-free chemical irritant into the abdominal
cavity also excited similar infective peritonitis. The
microorganism developing in these cases had already
been described by Koch, who called it the " bacillus
oedematis," and states that it is to be found on wet soils
and is a conomon saprophyte, appearing where decom--
position takes place, like kacterwm termo.
Mr. Dowdeswell's conclusion regarding infective peri-
tonitis is that it is not a specific septicaemia, but rather
a septic toxaemia in which the micro-organisms play a
subordinate and probably mechanical part There is no
increase of virulence here either in successive inocula-
tions.
It is difficult in the short space at our disposal to give
any fuller account of the report. It contains much else
that is instructive and suggestive, and shows its author to
be a careful and judicious investigator. It is only to be
regretted that the work was not pushed a little farther in
the lines wherein it was begun.
The second report is that of Dr. George Thin, upon
<' Leprous Infiltration of the Epiglottis, and its Depend-
ence on the Bacillus Leprae." It can be disposed o^
very briefly. Dr. Thin believes, if we understand him
correctly, that the bacillus leprae is the pathogenetic
agent of leprosy. He relates the history of a case, jand
shows specimens illustrative of the mode in which this
parasite acts. Its special home is the lymph or white-
blood corpuscles. It migrates with these, modifies their
activity, causing absorption of fibrous tissue, production
of tubercles, and a low grade of inflammation. We can
hardly agree with Dr. Thin that sufficient data yet exist
to enable us to say that the bacillus is the cause of lep-
rosy. His contribution to this subject is, however, a
most important one.
Dr. W. North makes a report upon the '* Influence ol
Bodily Labor upon the Excretion of Nitrogen." His
conclusions have already been published. They in the
main corroborate those of Dr. Parkes, and disprove
again the crude investigations of Flint, Jr., in the same
direction. We must say of Dr. North, however, that
his work is very blindly and unintelligibly reported in
the British Medical Journal.
THE PATHOLOGY OF THE CERVICAL SYMPATHETIC.
Dr. Paul Julius Mobius has written an elaborate
monograph (published serially in the Berliner Klinischt
Wochenschriff) upon the pathology of the cervical sym-
pathetic. This interesting but mysterious part of human
anatomy has received a great deal of attention of late
years, yet its exact relations and functions are still far
from being satisfactorily made out. Dr. MObius, besides
giving a critical review of previous contributions, furnishes
something new in the shape of a unique case of paralysis
of the cervical sympathetic produced by a knife-stab.
The sharp blade entered the right side of the neck just
below the angle of the jaw, and apparently cut the sym-
pathetic cord entirely in two. There was very little
bleeding and the wound rapidly healed, but the patient
soon discovered that there were various disturbances of
function upon the right half of his face.
His right eye tired easily, and became sufiiised with
tears ; the pupil was smaller ; the lid-fissure narrower ;
the ocular skin-reflex on the right side (/.^., the widening
128
THE MEDICAL RECORD,
[August 2, 1884.
of the pupil on strong irritation of the skin oi the neck)
was absent, the right eye was more moist and more easily
injected. The face was no redder or more congested or
moist apparently upon the right side than upon the left ;
but slight irritations easily produced right-sided flushings
and sweating. The temperature in the right external
auditory meatus was higher than that in the left (36.5**
C. to 35.6°).
The right muse risor. Santor. and platysma were a lit-
tle paretic, and the right angle of the mouth hung lower
than the left. The heart's action appeared normal and
the patient did not sufifer from vertigo, tinnitus, headache,
or sleeplessness. He did have at times a disagreeable
«ense of feeling the t)eating of his heart. Applications
of electricity to the neck produced no change in any of
these symptoms.
We have related the history of this case because it
shows very typically most of the phenomena which oc^
cur in one-sided paralysis of the cervical sympathetic.
Slightly different symptoms, or a difference in predomi-
nance of special symptoms, naturally'occur according to
the location of the lesion. We may, however, sum up
those symptoms which have been found in the cases
reported by Seelifi:mailer, Nicati, Eulenburg, Mitchell,
and others, as follows : i. Myosis is always present in
the eye of the affected side. The pupil may be one-half
or twO'thirds smaller than that of the other eye. It re-
sponds to light and to acconmiodation, but its motion
may be slower than normal. 2. Narrowing of the pal-
pebral fissure through paralysis of the muscle of Muller
is almost always observed, /.^., in thirty-five out of thir-
ty-nine cases. 3. Sinking in of the bulb occurs more
rarely and is a later symptom. It is due to absorption
of orbital fat, and to paralysis of Mailer's nmscle. The
tension of the bulb sometimes becomes less and the
cornea flattened. 4. There is, quite uniformly, an in-
creased temperature and redness on the affected side
of the face. Sometimes the affected half simply flushes
very easily on the application of slight stimuli. A few
cases have been reported by Nicati in which the
blanched face and lowered temperature have occurred
along with the eye-symptoms of paralysis. 5. A de-
creased sweating of the affected side often occurs.
•6. Slight trophic changes may occur, the subcutaneous
fat becoming absorbed, but it is doubtful if true atrophy
ever takes place. In paralysis of the cervical sympa-
thetic on one side the heart's action is not slowed, the
thyroid gland is not enlarged, and there are no distinctive
cerebral symptoms, such as might be expected to oc-
cur in a vaso-motor paralysis of those intracranial ves-
sels supplied by the sympathetic.
Dr. Mobius confines his attention chiefly to the subject
of sympathetic paralysis, and seems inclined to think that
this includes most of the pathological disturbances of the
nervous strands in question. Only thirteen cases of true
-sympathetic irritation are cited. In these there was
widening of the pupil, moderate exophthalmus, and ac-
<:ommodation paresis, coolness of the face on the dis*
cased side, and increased heart's action. Seeligmiiller
noted a flattening of the cheek and dilatation of the pupil
in two cases.
Mobius Ycry correctly excludes from the category of
cervical sympathetic diseases, migraine, Basedow's dis-
ease, angina pectoris, and progressive unilateral atrophy
of the face. It is to be hoped that our teachers and text-
book writers will soon become sufficiently advanced in
nervous pathology to follow Mobius' example.
THE INFLUEItCE OF THE CHOLERA EPIDEMIC.
No one can doubt that the present epidemic of cholera
will have, and indeed has already had, an immense in-
fluence for good in the sanitary education of the people.
There is no one thing about which doctors disagree less
than that of the relation of filth to cholera. And every-
thing in the history of the present epidemic has tended
to enforce the lesson of the great need of municipal and
individual cleanliness. Without filth no cholera, is the
motto which has been learned from the past, and which
has for the last six weeks been steadily inculcated by
medical authorities.
The result is that throughout Europe and the United
States there has been an amount of municipal scrubbing
which is quite unprecedented in summer history. For,
since the cholera epidemic of 1866 and 1873, sanitary
organizations have increased in number and effectiveness,
while the people have been educated to a more intel-
ligent idea of their functions and usefulness. There is
no doubt that the extra cleanliness produced by the
cholera scare will effect a saving of life from other filth
diseases far in excess of the mortality from the cholera
itself, unless indeed it should spread beyond all expecta-
tion.
There is no paradox, therefore, in saying that the
cholera in France has a beneficent side, and will event-
ually save more lives than it destroys. We might even
assert that cholera is a disease which the people cannot
spare quite yet from the world. It is needed as an edu-
cator and as a prophylactic against typhoid, diphtheria,
and the other diseases that proceed from municipal
fllthiness.
THE BATH IN MISSOURL
«
Dr. W. E. Scott relates {Sf. Louis Courier of Medicine)
the case of an old Missourian *' who hadn't been wet all
over since '63." Following up with inquiries this
alarming suggestion of uncleanliness. Dr. Scott reaches
the conclusion that there is not one-third of the people
of Missouri who average one bath per month, and agaun
'* there are at least fifty per cent, who do not take a full
bath from October till the month of May ! " This con-
dition of things is not, says Dr. Scott, peculiar to Mis-
souri. In these days of " health hints," hygienic hand-
books, and sanitary propagandism, it is rather startling to
learn that in the very home of " Listerine " half the
people do not bathe from fisill to spring, v^ile a certain
limited number have not been wet all over since 1863 1
Suicide of an Epileptic. — Medical men can appre-
ciate the state of mind which had been reached by the
young man who shot himself in this city last week. For
a number of years he had suffered from epilepsy. He
had been treated by several prominent physicians, but
had got no better. He found himself, on the eve of mar-
riage, a confirmed epileptic with no hope of improve-
ment held out and so he killed himself.
August 2, 1884.]
THE MEDICAL RECORD,
129
^ews of thz ySSitsik.
Yellow Fevsr is said to be increasing at Panama.
It has also appeared at Sonora, Mexico, and is spreading
rapidly.
Ah Honor to Dr. Hust£d. — At the Annual Com-
mencement recently held at the Syracuse University, the
honorary degree of LL.D. was conferred upon Dr. N.
C. Hasted, a well-known and esteemed physician of
New York City.
Dr. E. W. Jenks was the recipient of a cordial recep-
tion by his medical brethren on the occasion of his return
to Detroit. This high compliment was well deserved,
and the profession of that city did itself credit in tender-
ing it
The Illinois State Board of Health is now en
gaged in revising the " Register 01 Physicians," prepara-
tory to publication. Any changes or corrections should
be promply sent to the Secretary. Lists of the officers
of the medical societies in the State are also requested.
Annual Meeting of the National Board of
Hkalth. — The National Board of Health held its annual
meeting on July 30th, and elected officers for the ensu-
ing year as follows : President — Dr. James L. Cabell, of
Virginia; Vice-President — Dr. Stephen Smith, of New
York ; Secretary — George E. Waring, Jr., of Rhode Isl-
and \ additional members of the Executive Committee —
the Hon. Thomas Simons, Department of Justice ; Dr.
Charles Smarts United States Army, and Dr. T^ S. Verdi,
of Washington. A resolution was adopted that in view
of the possible invasion of the country by cholera, and of
die existence of epidemics of other diseases, and in view
of the duty imposed upon the Board by law to obtain in-
formation on all matters affecting the public health, the
Executive Committee is directed to put on duty such
members of the Board as in its judgment may be neces-
sary. At its subsequent meeting the Executive Com-
mittee directed that the members of the Board be placed
on daty for the investigation of all matters which, in fheir
jadgment, have a direct bearing on the question of chol-
en as a present menace to the public health, and epe-
demic of other diseases existing in the country. Con-
gress having failed to make appropriation for the purpose,
it is understood that such duty is to be done without
compensation.
Texas Fever among Western Caitle. — A con-
signment of cattle from Indian Territory was received
It Kansas City and kept in the stock yards in that city
!or some days. They were then shipped, part to Man-
hattan, part to Chicago. Of 200 sent to the former place
over 30 died of what seems to be Texas fever. Of 500
sent to Chicago, a large number were attacked with the
same disease, and the whole herd has been isolated and
killed.
New Facts as to the Cause of Death by Chix>-
KOPORif. — Professor K. Winogradow has reported to
Wratsch the discovery of peculiar changes in the ner-
voQs ganglia of the heart in a person who died from the
cfects of chloroform. He believes that they throw a
Kw light upon the cause of death in these cases.
Honors to Medical Men. — Professor Le Fort and
Dr. Dumontpallier, of Paris, and Professor Tourdes, of
Nancy, have been given the cross of the Legion of Honor.
Dr.. Paul Flechsig has been made ordinary professor of
Mental Diseases at Leipzig. Professor Longmore, of Net>
ley, has just been elected corresponding member of the
Acad6mie de Mddecine.
The most Unique Medical Journal at present pub»
lished is probably Le Journal Medical Quotidien, It is
published daily, as its name implies, at Paris. All the
matter is written out in excellent script, and this is then
lithographed. The journal is autographic, therefore.
The International Otological Congress. — We
have received a copy of the programme of the Third
International Otological Congress, which meets at Mle^
Switzerland, on September ist to 4th, 1884. Dr. Alb.
Burckhardt-Merian, President, is also chairman of the
organization committee. A list of thirty-nine promised
communications is given. We observe that no Americans
and only one Englishman are among the contributors.
The Late [Guiteau. — Dr. Michael J. Madigan has
been attempting the fresh and always interesting task of
proving Guiteau insane. Dr. Madigan announces him*
self to be a cerebro-physiologist, and is doubtless very
competent to tell, all too briefly, what is the truth about
Guiteau. We venture to suggest to him, however, that
he has a singular ignorance of certain well-established
logical methods, and that, for instance, he can never
prove Guiteau insane by showing that the editor of this
journal is "only a surgeon." For the rest, the single
sensation, aside from weariness, which this young man's
polemic excites is a wonder that at this late date the
Guiteau question cannot be discussed without person-
alities and passion.
The Death of Professor Jager, the distinguished
ophthalmic surgeon, of Vienna, is announced.
The Treatment of Cholera at Marseilles and
Toulon is about the same, according to the Times cor-
respondent. In the first stage, twenty drops of lauda-
num are given with three grammes of ether, and ice in
the mouth to stop the vomiting. In the second stage,
from ten to fifteen grammes of acetate of ammonia, the
same quantity of alcohol, and injections of morphia are
given. If the patient has embarrassed breathing, oxy-
gen is inhaled and the limbs are rubbed with turpentine.
The third stage is the cofiin.
Progress of the Cholera. — There seems to be no
doubt that the violence of the cholera is abating at Mar-
seilles and Toulon. The deaths, according to Consul
Mason, have fallen at Marseilles from an average of
sixty, previous to July 2 2d, to between twenty and thirty
on July 30th. At Toulon the daily average has fallen
from forty to fifteen. On the other hand, the epidemic
has spread to numerous small places, about two thousand
in all, in the country about Toulon and Marseilles, and
has appeared in an active form at Aix-les-Bains and at
Aries. The disease has also crossed the Italian boundary
and appeared in several small towns and villages. Up to
the present time there have been about two thousand three
hundred deaths in France from cholera, according to an
estimate of Mr. Harold Frederic, the Nexv York Times
I30
THE MEDICAL RECORD.
[August 2, 1884
correspondent. This same correspondent has furnished
4L very clear and instructive account of the state of
affairs in the cholera-stricken cities, and shows very
clearly the intimate relation between cholera and filth.
Of Toulon, he writes : " The city itself is situated on a
dat plain, four feet only above the level of a tideless sea.
The consequences arising from imperfect drainage, with
a natural want of slope, are that the sewers have only a
fall of eighteen inches, so, with a sluggish movement,
the filth of the town drops into an almost stagnant sea.
What is worse is that at the points where these drains
flow they are only covered with plank, and the filth,
disgusting to the nose, impresses itself on the eyes.
Vou not only then smell, but you see, the garbage of
Toulon. Just fancy people living in this city, of quite
eighty thousand inhabitants, without the faintest glim-
mer of common sense in regard to public hygiene !
Toulon must be inhabited by people who utterly ignore
«very precaution which health requires. Their habits,
both in their houses and in the public streets, are in-
describably filthy. Toulon has always been a breeding-
place of disease. Small-pox when it broke out in Tou-
lon was always of a malignant type, and more difficult
to stamp out than elsewhere."
The patients at the hospitals in Marseilles and Toulon
are nearly all from the lower classes. At first nineteen-
twentieths of the patients died ; later, the mortality be-
came less frightful.
Dr. Koch's Report to the German Government
on the cholera epidemic in France was made July 5th.
The disease, he says, is undoubtedly of Asiatic origin,
and the milder form of the malady, spoken of by Toulon
medical men, is nothing but severe cases of diarrhoea.
But, in reality, writes Dr. Koch, the disease is of a very
violent form, and is making rapid progress. In examin-
ing the bodies of some patients, he found the cholera-
bacillus. The fact that hitherto the plague has not
spread extensively in the neighborhood of Toulon is due,
he thinks, to the hilly character of the region, which was
also less rapidly and severely infected on the occasion
of previous cholera epidemics there. Finally, Dr. Koch
expresses his conviction, based on past experience, that
the Asiatic cholera now raging in the South of France,
will also extend itself to the Continent of Europe. Im-
mediately on the arrival of the report at Berlin the
various Federal Governments were requested to take the
necessary preventive measures against the spread of the
•disease to Germany.
Dr. Koch's Lecture on Cholera at Lyons. — At
the request of the Lyons authorities. Dr. Koch while in
that city gave a free lecture on cholera. He showed
specimens of the bacilli. They were, he said, favored in
.growth by alkalies and killed by acidity or dryness.
Three hours of dryness he thought mortal to them.
They were inoffensive in the lungs, and to be baleful
should be carried into the stomach. Opium he thought
the best for early treatment. A strong stimulant might
be useful later, but he was not, he said, able to indicate
one. Chloride of zinc, sulphate of iron, and even mer-
cury, were not efficacious, but he thought carbolic acid
was. Nevertheless, he often washed his hands in Van
Sweiten's fluid, which contained a thousandth part of
bichloride of mercury. When it was observed to him
that the past immunity of Lyons from cholera was at
variance with his theory of dryness, the climate being
damp and the city on a tongue of land where the Rhdne
and Sadne meet, he ventured to think that freedom from
epidemic was probably due to the excellence of the
sewers. At the same time he feared that Lyons was too
near by rail to Marseilles and Toulon to be spared this
time. Cholera rarely attacked those the coatings of
whose stomach and intestines were healthy. There was
no greater predisposing cause among the healthy than
fear, which at once affected these organs. Scouring
floors and furniture was not nearly so good a preservative
as polishing and frequent dry rubbing.
A Hygienic Institute in Berlin. — It is proposed to
found a Hygienic Institute in Berlin, in connection with
the Berlin University. Professor Koch will be placed
at its head.
The University of Heidelberg is about to celebrate
its five hundredth anniversary. The Baden Parliament
has voted $40,000 to meet the expenses of the occasion.
Cholera Curbs. — Naturally, the appearance of the
cholera in Europe has led to the revival of various spe-
cifics or specific methods for curing cholera. The first
to be brought to notice was the use of oxygen by inhala-
tion. It was speedily shown, however, that this agent
did little or no good. M. Paul Bert has revived the
claims as to the utility of copper as a prophylactic and
curative agent. He has adduced fresh evidence, as he
thinks, of its value. But with the memory of the deadi
of M. Thuillier still fresh in mind, it will be hard to ex.
cite any confidence in the prophylactic value of this metal
Prof. S. Samuel, of Kdnigsberg, Prussia, calls attention,
in the Berliner Klinischer Wochenschrift^ to a treatment
of cholera recommended by him a year ago, viz., the
subcutaneous injection of warm saline solutions. He
admits that the circulatory apparatus in cholera is like a
sieve, and that injections directly into the veins are soon
lost : but by injections into the subcutaneous tissue of
the arms and chest he claims to have obtained excellent
results. He cites a case in which seven ounces of water,
and subsequently four and a half ounces, were thus in-
jected with success. The treatment by applying ice-
bags to the spine, in order to stimulate (or relax) the
ganglionic centres, has also been again brought up for
discussion. No certain conclusions regarding this method
have yet been reached. Among other " cholera cures '•
that are of more or less historic interest, are : the injec-
tion of quinine into the veins ; the plugging of the anus ;
the actual cautery over the kidneys ; and the administra^
tion of large doses of sugar (to affect endosmotic changes
in the intestines); asafoetida, capsicuni, calabar bean,
quassite, berberine, naphtha, phosphorus, sulphur, and
various antiseptics have been at different times recom-
mended as useful in cholera. Finally, Dr. W. C. Seaman
has recently advocated in The Lancet a return to the
use of calomel in gr. x to gr. xx doses, with cold affusions
and subsequent friction.
Dr. Kidd's Address on Obstetric M kdicike, de-
livered before the British Medical Association, is unavoid-
ably crowded out of the present issue, and will appear in
our next.
August 2, 1884.]
THE MEDICAL RECORD
lax
FIFTY-SECOND ANNUAL MEETING,
Held in Belfast^ Ireland, Tuesday, Wednesday, Thursday,
and Friday, July 2f), 30, ^1^ and August 1, 1884.
(BY DIRECT CABLE TO THE MEDICAL RECORD.)
Tuesday, July 29TH — First Day.
The Council met at 2 p.m. The first general meeting
was held at 3 p.m., the retiring president, Dr. A. T. H.
Waters, of Liverpool, in the Chair.
The minutes of the previous meeting were next read,
as aLready published, and confirmed.
RSPORT OF COUNCIL.
Mr. C. G. Whselhouse, of Leeds, Chairman of the
Council, spoke of the increase of membership during the
past year, which was over one thousand. The total
nmnber was now nearly
TWELVE THOUSAND MEMBERS.
Veiy few members had died during the past year. The
Association vras now in a prosperous condition with
A SURPLUS IN THE TREASURY,
aod was increasing in influence and in representative
character. The report after some discussion was
adopted
Mr. C. NCacNamara, of London, was then elected
Treasurer of the Association ; vice Mr. W. F, Wade,
of Birmingham. Mr. Wade was thereupon elected Vice-
President for life.
Dr. McVail made a motion to the effect that the
txaveUing expenses of members of the Council be paid
\fj the Association. A long discussion ensued in regard
to the propriety of such a measure. It was contended
that as each branch association now sends a member to
the Council that the aggregate tax upon the Association
would be large ; especially would this be the case with
members from the more distant parts of the kingdom.
The pay system would be no extra inducement for at-
tendance. The motion was finally lost.
First Day — Tuesday — Evening Session.
The Association was called to order in pursuance of
previous adjournment.
ADDRESS OF RETIRING PRESIDENT.
The retiring President, Dr. A. T. H. Waters, of
Liverpool, made a brief address. He spoke of ihe
dianges that had been made in the character of the
Council, so that it had become more representative.
He believed that this would tend to increase the pros-
perity of the Society. He congratulated the Association
upon its continued growth and present flourishing condi-
tion. He referred briefly to the subject of the medical
bin which had been before Parliament during its present
sesaon, and had been the subject of much sharp dis-
cossion. He lamented the fact that it had been with-
drawn, and that the prospects for medical reform were
again postponed. In conclusion, he thanked the Asso-
ciation for the honor it had paid him in electing him to
the presidency.
A vote of thanks was then tendered the retiring pres-
ident, carried unanimously, and Dr. Waters was elected
Vice-President for life.
Dr. Waters then resigned the chair in favor of Dr.
Cuming, President-elect, who delivered his
PRESIDENTIAL ADDRESS.
Dr. Cuming gave a cordial welcome to the visiting
members on behalf of the profession at Belfast He
expressed his thanks also for the honor paid in electing
him to the presidency. He ^hen said that the present
epidemic of cholera in France naturally brought up the
subject of the sanitation of cities, and of Belfast in par-
ticular. The sanitary condition of Belfast was excellent
except that the sewage polluted the harbor to a some-
what dangerous extent.
The subject of
MICRO-ORGANISMS
and their relation to disease was next considered.
Dr. Cuming contended that minute organisms under-
went changes in character as do other animal forms,
and in that way very likely determined the character and
extent of epidemics. The old term, *' epidemic consti-
tution," could be explained on this theory of the modi-
fied life of micro-organisps. But in addition to the influ-
ence of micro-organisms there is something in the human
body which modifies vital phenomena, whether normal
or abnormal, and this was the diathesis. That there was
this peculiar modification of vital activity was abundantly
shown, and the recent studies in scrofula and phthisis
had still more strongly confirmed it.
The President then dwelt upon the advantages to be
expected from the newly created
SECTION ON pharmacology AND THERAPEUTICS.
Much progress was now being made in these branches,
and much more could be expected. Medicine could
never be cultivated in the same lines with the physical
sciences. There are too many elements of uncertainty
or too many complex factors. But in the great art of
relieving and preventing suffering more and more was
being accomplished, and the medical profession was
every year becoming one of more dignity and usefulness.
At the close of the address various proposed amend-
ments to the by-laws were discussed, but no important
motion was carried.
The Association then adjourned for social reunion.
Wednesday, July 30TH — Second Day.
The meeting of the Council was held at 9.30 a.m.
Dr. Balthazar Foster was elected President of the
Council, vice Mr. Wheelhouse. The latter gendeman
was elected Vice-President of the Association for life.
The second general meeting was held at 1 1 a.m.
Dr. Lewis A. Sayre, of New York, gave a demonstra-
tion of the application of the
plaster jacket
in diseases of the spinal column. Dr. Sayre showed the
1^2
THE MEDICAL RECORD.
[August 2, 1884
methods of applying the jacket, and asserted the ad-
vantages of it over later so-called improvements.
Dr. William M. Ord, of London, delivered the
Address on Medif ine. His subject was
SOME PERVERSIONS OF NUTRITION CAUSED BY THE
NERVOUS SYSTEM.
Many observers of late years had been contributing evi-
dence to show that the nervous centres have a remark-
able power over the processes of nutrition. Charcot,
Weber, and others had suggested that chronic rheumatic
arthritis was a nervous disease. That the arthropathies
in tabes dorsalis were produced by nervous influence
there could be no doubt. The speaker suggested that
in these cases there was probably some lesion in or near
the anterior cornua. He related the history of a very
interesting case of progressive muscular atrophy in
which there was a joint lesion.
Dr. Ord referred to the changes in opinion which had
taken place by reason of observations like the foregoing
and a closer study of the nervous system. When Sir
James Paget's book first appeared it was laid down that
all general diseases were of blood origin. Now it could
not be denied that this view must be greatly modified.
He had noticed many illustrations of the reflex and direct
influence of the nervous system upon nutrition. He
had seen uterine congestion produce, reflexly, irritation
of joints, and even rheumatic inflammation. On treat-
ing the womb these symptoftis disappeared. The
speaker also instanced cases of
URINARY PARAPLEGIA,
in which paralysis was produced reflexly by disease of the
urinary organs. The influence of the nervous system
upon secretion was undoubtedly a very marked one and
showed itself in a variety of ways. Fetid breath might
be the result of a secretory dystrophy or nutrition per-
version. The influence which mental disturbances have
upon the secretion of milk is familiar to every one. The
nervous system regulated the destruction of sugar in the
body, and not infrequently exhausted or perverted con-
ditions of this system resulted in temporary '* non-dia-
betic '* glycosuria. As this often occurred in persons of
a gouty tendency. Dr. Ord suggested the term
GOUT OF THE LIVER.
The speaker discussed the subject of the relations of
myxoedema to the nervous system, and the probability
that this too was a nervous disease. He referred to
Kocher's views on the subject.
Dr. Ord made the original suggestion that the thyroid
gland was a trophic organ, and, perhaps, ruled the nutri-
tion of the nervous system in a measure.
He referred in graceful terms to the debt which was
owed to Dr. Weir Mitchell, of Philadelphia, for his con-
tributions to the subject of the nervous system and nu-
trition.
At the conclusion of the address. Dr. A. T. H.
Waters moved that a vote of thanks be tendered the
speaker.
The motion was seconded by Dr. Gairdner and
unanimously carried.
After the transaction of some miscellaneous business
the meeting adjourned for the day.
REPORTS OF SECTIONS.
SECTION ON SURGERY.
Wednesday, July 30TH — Second Day.
The Section on Surgery was called to order at 2 p.m.
by Sir William MacCormac, President, who delivered
an address
ON ABDOMINAL SURGERY,
in which he reviewed the advances made in that depart-
ment during the past few years. Every part of heretofore
forbidden ground had been boldly and successfully at-
tacked by the surgeon, and visceral surgery had enlarged
its domain of applicability beyond the most sanguine ex-
pectations of the most progressive of our forefathers.
He particularly referred to gastrostomy as an operation
which had for itself a brilliant future in properly selected
cases. The radical cure of hernia was another topic
dwelt upon by the speaker, who cursorily considered the
different operations and the indications for their per-
formances. The removal of the thyroid gland also claimed
attention as a feasible operation in many cases hereto-
fore allowed to drift along unrelieved.
Following the address was the discussion on
THE PLASTER-OF-PARIS JACKET IN THE TREATMENT OF
SPINAL DISEASES,
opened by Dr. L. A. Sayrb, of New York. The speaker
demonstrated the principles upon which the jacket was
applied, and referred in a general way to its superiority
over other methods of fixation. Several additional points
as to detail of application, were brought out in a general
discussion which followed. His remarks were well re-
ceived and becomingly appreciated.
SECTION ON MEDICINE.
Wednesday, July 30TH — Second Day,
The Section was called to order by the President, Dr. ].
W. T. Smith, of Belfast, who delivered an address.
The subject for discussion was
albuminuria, its causes, consequences, diagnosis,
AND treatment,
which was opened by Dr. George Johnson, of London.
He reviewed the subject in an exhaustive manner, noting
all the more recent advances made in its study, particu- .
larly those referring to diagnosis and treatment.
In the discussion which followed, a letter was presented
from Sir Andrew Clark, of I^ndon, calling attention to
the importance of recognizing the non-functional fonus
of albuminuria. These he thought should be divided
into four varieties, hepatic, oxaluric, gouty, and nervous.
ADDRESSES BEFORE THE SECTIONS.
The other addresses before the Sections this afternoon
were respectively as follows : *' Obstetric Medicine," by
Dr. Clement Godson, of London ; " Ophthalmology,"
by Dr. W. A. McKeon, of Belfast ; ** Physiology and
Pathology," by Dr. W. S. Greenfield, of Edinburgh;
"Pharmacology and Therapeutics,'* by Dr. Thomas J,
M aclagan, of London.
In the evening a conversazione was given to the mem-
bers of the Association in Queen's College by the Presi-
dent and Executive Committee. This was largely at-
tended.
(To be continued)
August 2, 1884.]
THE MEDICAL RECORD,
133
THE MEDICAL SOCIETY OF BERLIN.
Stated Meetings June 25, 1884.
Herr Senator, President, in the Chair.
(Special Report for Thb Mkdical Record.)
The Society having been called to order, Herr
ScHOLER exhibited a case of
marked retraction of the conjunctiva.
The patient, a woman, sixty-nine years of age, had been
in excellent health up to within about three years. Since
1881 she had had two attacks of pneumonia, and it was
at one time feared that she was developing a pulmonary
tuberculosis, but this danger was now past. In February
d this year she had what appeared to be a simple catar-
rhal conjunctivitis, for the relief of which ordinary astrin-
gent lotions were employed. The swelling and redness
did not subside, however, and in May the patient applied
to Herr Scholer. He found the conjunctiva in both eyes
evenly suffused, with here and there little specks of
thickened secretion. There was, further, a very marked
contraction of the fold where the conjunctiva is reflected
from the ball of the eye to the lids. At that time the
contraction of the superior fold was not so great but that
the upper lid could be everted, but now it was as far ad-
vanced as at the inferior fold. Cicatrix-like bands
could be seen, but there were no adhesions.
The patient gave no history of any former affection of
the conjunctiva, and there was no disease of the eye it-
self The cornea was perfectly normal. The speaker
said that there were but two recognized conditions in
which such an extensive retraction of the conjunctiva
could occur. The first of these was granulation. But
when this process has advanced far enough to cause such
an atrophy of the conjunctiva, we always find corneal
opacities. The second was pemphigus ; but here, also,
the cornea is always involved. But one similar case has
been recorded, the account of which was published by
Alfred Graefe*s assistant in Halle. Graefe gave to the
affection the name of essential retraction of the con-
jnnctiva.
Herr Kobner then presented a patient suffering from
lichen ruber planus,
affecting not only the skin but also the mucous mem-
brane of the mouth and tongue. The patient, a woman,
sixty years of age, had had a hard chancre three years
before, but had never exhibited any secondary symptoms.
Two months ago the patient noticed a number of little
pmples, looking like gnat-bites, on both hands. These
itched and burned considerably, and soon spread to the
extensor surfaces of the lower part of the forearms. At
the same time it was stated that her tongue was coated.
The eruption now was thickly spread over the extensor
surfaces of both hands and forearms, with isolated nod-
ules on the soles of the feet, the shoulders, and the palm
of one hand. * On both sides of the anterior portion of
the back of the tongue was a row of dirty white, irregu-
larly oval, roundish, or polygonal specks. • There were a
few very small nodules here and there, arranged in semi-
circular groups. On the inside of the right cheek there
were numerous whitish specks, arranged in the form of a
network, and some similar growths on the red border of
the lower lip. The patient had taken about half an
ounce of iodide of potassium without effect, but had ap-
peared to improve somewhat since the administration of*
small doses of arsenic.
Herr Virchow read a paper entitled
syphilitic joint diseases.
He said his communication occupied nearly the same
ground which was gone over by Herr Giiterbock in his
paper read at the meeting held on June nth, but that he
should not confine himself to the hereditary fonn. Syph-
ilitic joint disease bore no slight resemblance to arthritis
sicca, but in the syphilitic affection there was always an
increase in the amount of the synovial fluid. The seat
of the lesions is the same as it is in arthritis deformans.
The principal changes take place in the cartilage, and
consist in a gradual destruction of this tissue, sometimes
advancing so far that the cartilage is entirely absent in
certain portions. On the other hand, however, there is
this difference between the two diseases, namely, that
while in arthritis deformans the cartilage disappears and
exposes the bone, in syphilitic arthritis the loss of sub-
stance in the cartilage is replaced by a coincident forma-
tion of connective tissue. In addition to this cicatrix-
like development of connective dssue there is, in the worst
cases, a villous growth, springing from the borders of
these ulcers in the cartilage, and floating free in the fluid
of the joint. One cannot help treating these lesions as
though they were inflammatory, although they appear to
be atrophic. The new growth of connective tissue at
the bottom of the erosions in the cartilage recalls tlie
cicatricial contractions of syphilitic lesions in other parts
of the body. The author had never had the opportunity
to examine a case in the early stage of this disease, but
he thought it not improbable that there were in the be-i
ginning gummy processes at the points where the above-
described lesions were found. In looking at the articu-
lar surfaces one would almost believe that pieces of the
cartilage had sprung loose, so sharply defined are the
edges of the ulcerations. They are found usually in
the central parts of the joint and not, as in arthritis de-
formans, around the outer surface. Any of the joints may
be thus affected, and undoubtedly the chsease may in cer-
tain cases progress so far that the whole of the articular
cartilage may be destroyed. The author exhibited a
number of specimens showing the changes described,
and related briefly the histories of the cases from which,
they had been taken. And he concluded from a study
of these cases that there existed a
CHRONIC ARTICULAR CHONDRITIS
of a syphilitic nature. This disease resembled most
closely arthritis deformans, yet differed from it in some
important points. In the latter there is a new growth of
cartilage tissue about the edges of the bones, but no
such change takes place in the syphilitic affection. The
disease runs its course without suppuration, in which it
differs from the other fonn of syphilitic arthritis, some-
times met with in adults, which is accompanied by sup-
puration and carries off the osseous structure.
Herr A. Baginsky related a case of the hereditary
syphilitic joint affection, described by Giiterbock at a
previous meeting of the Society, which he had observed
in a child thirteen weeks old. In addition to the arthri-
tis the child had also a skin eruption and pseudo-
paralysis of the arm. This
pseudo-paralysis
is not a very rare condition. The speaker met with two
or three such cases on an average every year. At first
sight there appears to be a true paralysis, for the affected
limbs hang perfectly motionless ; but a more carefiil
examination reveals the fact that we have to do with a
very different affectiota. Both the diaphyses and epi-
physes of the bones are thickened, and any movements
of the affected articulations cause severe pain. The
joints are swollen, and suppuration sometimes takes place.
Not infrequently the articular extremities of the bones
are destroyed, and a wobbly joint remains.
There is still another form of joint disease in young
children, in which there is nothing to indicate that it is
of a syphilitic nature, and which the speaker thought was
to be explained on the theory of a late appearing
puerperal infection.
The affection is seen in children three or four weeks
old. There is first infiltration and swelling about the
joint, later suppuration in the joint itself,*and finally per-
134
THE MEDICAL RECORD,
[August 2, 1884,
foration. Particles of bone and cartilage may even be
extended through the opening, and yet the subsequent
progress of the disease is favorable. In one such case
that he had observed there was perfect restoration of
joint motion, so that the child, after it had begun to walk,
had not the slightest limp. As regards the
TREATMENT OF SYPHILITIC JOINT DISEASES,
he had for years made use of corrosive-sublimate baths,
to the exclusion of all other therapeutic measures. He
used seven and a half grains of bichloride of mercury for
each bath, and gave a bath every day or every other day.
Twenty such baths suffice to bring about a substantial
improvement, or even a complete cure, in some of the
most severe forms of infantile syphilis. There is no
necessity for giving calomel or any other remedy in-
ternally, thus saving the stomach from possible injury, a
matter of no small importance for syphilitic children.
Herr Henoch said that the director of the children's
clinic in Naples had recently sent him his work on the
joint diseases in hereditary syphilis, in which he found six
cases of the affection described by Giiterbock. It seemed
to him, however, that there might be some doubt as to
the syphilitic nature of all the cases there given. It was
possible for other joint diseases to occur in syphilitic in-
dividuals. He could not understand how it was, if these
affections were so common, that there was so little oppor-
tunity to observe them in Berlin. Of the immense num-
ber of children treated by him for hereditary syphilis, he
had never yet seen one with syphilitic joint disease. It
was true that he had had one patient who had at the same
time arthritis of the elbow and syphilis; but while the
other symptoms disappeared during a course of specific
treatment, the joint disease steadily progressed. He
therefore thought it fair to assume that the arthritis was
non-specific in character.
Herr Hirschberg asserted that he had oflen seen
the joint affection of hereditary syphilis. At the same
time with the characteristic deformity of the teeth, there
was hydrarthrus of the knee. This was regarded, not only
by the Germans but also by English authors, as a specific
affection.
Herr Henoch maintained that this malformation of
the teeth was no indication of syphilis, for it was often
observed in healthy children, and was as frequently ab-
sent in those who were undoubtedly syphilitic.
Herr Hirschberg had convinced himself that Hut-
chinson's assertion on this point was correct. All syphilitic
children might not have misshapen teeth, yet when the
dental deformity existed, it was a certain indication of
hereditary syphilis.
Herr G. Lewin agreed with Herr Henoch. He
thought the malformation of the teeth was due to nutri-
tive disturbances rather than to syphilis. Referring to
Herr Virchow's paper, he asked if the lesions there de-
scribed were not the same as those occurring in caries
sicca. He was inclined to believe that they were. The
speaker then related some cases, occurring in his prac-
tice, of syphilitic arthritis in both adults and children.
Herr Scholer held to the views advanced by Herr
Hirschberg. He related an instance of joint disease in
a child which had yielded readily to specific treatment.
Herr Sonnenburg was in accord with Herr Henoch
in the opinion that syphilitic arthritis was a very rare af-
fection. He had met with but two cases in his clinic in
a number of years. He considered it exceedingly diffi-
cult to diagnose these affections, since there were no
characteristic symptoms. He had seen a number of cases
of joint disease in syphilitic children, but they resisted
all specific treatment, and he had his doubts as to their
syphilitic nature.
On motion it was resolved to postpone further dis-
cussion until the next meeting, and the Society then ad-
journed.
Sugar- CURED is the epithet applied by Puck to the
successful results of homoeopathic medication.
THE HOSPITALS MEDICAL SOCIETY OF
PARIS.
Stated Meeting, June 27, 1884.
M. BucQUOV, President, in the Chair.
(Special Report for The Medical Rbcokd.)
The Society having been called to order, the President
announced the death of M. Moreau, of Tours, at the age
of eighty-one years.
A somewhat heated discussion, participated in by a
number of the members, then followed upon the questioa
of establishing a
STANDING COMMITTEE ON EPIDEMICS.
It was finally decided to create such a committee, and
the President appointed MM. Vallin, Bucquoy, Danlos,
Du Castel, Labric, Laveran, and Tapret.
M. Cadet de Gassicourt presented the third volume
of his
TREATISE ON THE DISEASES OF CHILDREN.
He desired to call the attention of the menibers especially
to the chapters on meningitis and diphtheria, two subjects
to which he had devoted considerable study. He had
been able, by the study of ten thousand cases seen by
himself, to correct certain statements made by different
authors concerning diphtheria.
M. Tenneson then exhibited a
PORTE-OUATE,
or cotton-holder, for making local applications to the
cavity of the uterus. It consisted of a sound which
could be bent in any desired curve, the end of which
was provided with a little wad of cotton. The cotton
could then be dipped in any medicinal substance and
carried into the uterine cavity without necessitating a
previous dilatation of the os.
By means of this instrument M. Tenneson had ob-
tained good results in the
TREATMENT OF CHRONIC METRITIS.
The local treatment of this disease, he maintained, should
not consist merely in the cauterization of that part of the
uterus which could be reached through a speculum, for
cervical metritis is a very rare condition. Intra-uterine
injections may cause death, and the introduction of a
suppository, to be left in the cavity of the uterus, is very
apt to give rise to an excruciating colic. The speaker
thought his method of making applicarions was su-
perior to all others. He used an ointment of sulphate
of copper (five to eight parts in thirty) or of white pre-
cipitate (two parts in thirty) in preference to tincture of
iodine, nitric acid, or chloride of iron. There were two
contra-indications to this mode of treatment of chronic
metritis. The first of these was perimetritis. In the
case of peri-uterine inflammation there was danger of
exciting suppuration in cauterizing the mucous mem-
brane. It was also necessary to omit the intrauterine
applications during the periods of acute ^ exacerbation
which occur so frequently in the course of chronic metri-
tis. Emollients are called for during such attacks, and
the caustic applications should not be resumed until the
hypogastric tenderness has entirely disappeared, and the
uterus is freely movable without pain.
M. Martineau thought there was one fatal defect in
M. Tenneson's instrument — a defect common to all sim-
ilar appliances— and that was that the cotton on the end
of the sound was not covered. In its passage through the
^internal os, the ointment would almost surely be rubbed
off, and thus the attempt to cauterize the raucous mem-
brane of the body of the uterus would miscarry. He had
devised a porte-caustique, somewhat similar to Lalleroanf s
instrument, by which the medicated cotton was retained
within a canula until it was fairly within the internal os.
As regarded the treatment of metritis advanced by M.
Tenneson, he thought it was very incomplete. He had
seen four or five thousand cases of metritis in the past
August 2, 1884.]
THE MEDICAL RECORD.
135
six years, and he thought he knew something about the
disease. The lymphatic spaces of the mucous mem-
brane and parenchyma are the seat of inflammation.
There are two lymphatic plexuses in the posterior part
of the uterus, and it is there that the affection begins
vbich is called perimetritis, or pelvic peritonitis, but
which the speaker preferred to designate as
POSTERIOR ADENO-LYMPHANGITIS.
There is a deeply seated induration in this disease
which no superficial applications can reach, but which
can be removed only by stimulating the circulation in
the part, and thus promoting the absorption of the exu-
dation. Finally, it should be remembered that uterine
inflammation is often dependent upon a diathesis, which
latter is amenable to general treatment.
*M. Tenneson preferred the term perimetritis as one
DOt indicating a possibly erroneous pathological concep-
tion. He was prepared to admit, however, that the lym- .
phatics played an important r6le in the production of
the diseases, as M. Lucas-Championni^re had pointed
out The speaker had not asserted that local treatment
was suflScient, biit had spoken of the general therapeu-
tic management simply because that was not included
in the scope of his communication. But he desired to
protest against the idea of a diathesis. Diatheses were
words, and nothing but words, used merely as a cloak for
ignorance. He repudiated the term and the conception
which was sought to be expressed by it.
M. Martineau claimed that he was the first to de-
monstrate the part played by the lymphatics in perime-
tnds.
M. BuCQTJOY thought the credit of priority was justly
due M. Lucas-Championnidre.
M. Martineau admitted that others had spoken of
lymphangitis in this connection, but he maintained that
he had studied the subject more carefully than they.
M. Du Caste L exhibited a specimen of
TUBERCULAR MENINGITIS
limited to the paracentral lobule. This was now the
third case of this kind that he had seen, and he believed
that this was the usual seat of localized tubercular men-
ingitis in the adult.
M. BucQUOY showed a patient who had suffered from
an
HYDATID CYST AT THE BASE OF THE BRAIN.
He had related the history of this case at a former
meeting of the Society, and some discussion had been
aroused at the lime. The patient was now perfectly well.
The Society, on motion, then adjourned.
^awzspon&enct.
A Medico-I^egal Note. — A decision interesting to
physicians, says the Philadelphia Medical Times^ was re-
cently rendered in the courts of one of the Western
States. Two surgeons had been employed in a certain
case, but in different ways and for different compensa-
tions. The patient did not seem satisfied with the treat-
ment, and refused to pay either of the bills rendered. As
a result, suit was shortly brought by one of the surgeons,
and defended on the ground that the services were of no
value. The court held, however, in favor of the surgeon,
and judgment was given for him. This result was so un-
satisfactory to the patient that he thereupon began a
suit for malpractice, and one of the defences interposed
was that this question had been, in effect, adjudicated in
the previous suit and could not be again raised. This
defence the court held to be a good one, deciding that
the former suit was a bar to the second one. This de-
cision is only one of several in the various States holding
the same way, so that a physician or surgeon need not
fear a direct suit for damages from malpractice if the
value of his services have been acknowledged in a suit
to recover the amount of hi? bill.
OUR LONDON LETTER.
(From our Spedal Coirespondent.}
MR. HUTCHINSON'S LECTURES AT THE LONDON HOSPITAL
— EARLY SYMPTOMS OF CANCER — MEDICAL MEN AND
THE TEMPERANCE CONGRESS — DR. RICHARDSON ON
PAINLESS SLAUGHTERING — THE NORTH LONDON CON-
SUMPTION HOSPITAL — CHOLERA AND PRECAUTIONS
AGAINST IT — THEORIES OF THE DISEASE — SMALL-POX.
London, July xa, X884.
As Emeritus Professor, Professor of Clinical Surgery Mr.
Hutchinson is now delivering his second annual course
of lectures at the London Hospital. This course was
instituted last year on the occasion of Mr. Hutchinson's
retirement from the acting surgical staff, when he was
appointed consulting surgeon. It was considered desir-
able to retain him as a teacher in connection with the
Medical College, so he was made Emeritus Professor,
and undertook to deliver six lectures annually on some
subject connected with surgery.
The lectures for the present year are perhaps a greater
success than those given last summer, and being wholly
delivered extempore appeal more directly to the minds
of the auditors. It goes without saying that Mr. Hutch-
inson gives no mere summary of ordinary text-book opin-
ions, but lays before his hearers, in plain and unmistakable
terms, the results of his own clinical experience.
On Wednesday, July 2d, a good audience assem-
bled to hear the lecture on " The Early Recognition
of Cancer.'* The term "cancer" was used in its clinical
sense and as including sarcoma, and not in its limited an-
atomical sense applying solely to carcinomatous growths.
The importance of its early recognition was obvious.
Mr. Hutchinson said that before the actual presence of
cancer was what might be termed the pre-cancerous
stage, and this was essentially a condition manifested
by signs of local inflammation. An interesting case was
narrated in support of this view. It was that of an old
gentleman whom Mr. Hutchinson saw in consultation
some years ago. One testicle had enlarged and was
slowly increasing in size. The surgeons who saw the
case agreed that it was probably not malignant and
recommended non-interference. It continued to grow,
however, and was at last removed solely by request of
the patient, who had all along been anxious about it lest
it should be' cancerous. It was examined microscopically
and was found to be simply in a condition of inflamma-
tory hyperplasia, and no signs whatever of malignancy
were discoverable. The patient recovered from the
operation, no further trouble manifested itself, and his
medical attendants came to the conclusion that his tes-
ticle had been really unnecessarily removed. Two years
elapsed. The remaining testicle then began to enlarge
in the same way in which the other had done. Remem-
bering the result of the previous operation, the surgeons
strongly advised the patient against operation. As be-
fore, it continued to enlarge until finally it reached a con-
siderable size. At last even the surgeon began to be
alarmed and the patient's anxiety was extreme. The
testicle was finally removed at the urgent request of the
patient. It was examined and proved to contain a well-
marked sarcomatous growth. The inference was that
the one first removed would, if allowed to remain, have
also acquired a sarcomatous structure, and that the inflam-
matory hyperplasia found was a condition leading up to
that of actual malignancy.
Eczema of the nipple preceding cancer was an illustra-
tion. Mr. Hutchinson remarked that cancer attacked parts
that were functionally dead, as the breast in women late
in life. Among animals it attacked the cat, the dog,
and the horse, but not the sheep. The two former ani-
mals led a lazy life and were allowed to drag out their
136
THE MEDICAL RECORD.
[August 2, 1884.
existence to old age. Sheep were usually killed before
they were old enough to develop cancer.
The practical conclusion Mr. Hutchinson drew from
his view was to treat as cancer all those cases where you
suspected it — to adopt active measures at once and not
wait for '>iore decided symptoms until it might be too late.
The recent Temperance Congress at Liverpool had
what may be termed its medical side. Several medical
men took part in it and read papers and delivered
speeches. Dr. Ridge, of Enfield, made some rather
startling statements, which may prove of importance
should further research confirm them. Dr. Ridge said
he had been able to sliow by experiment that alcohol was
injurious to the health of growing cells in direct pro-
portion to the quantity to which the cells were exposed,
and that even a single drop of alcohol in a quart of water
was able to affect them injuriously under suitable condi-
tions. He now announced that he had found that
alcohol, while we knew it to be an antiseptic in large
quantities, was really a septic agent in very small ones,
and that it promoted decomposition of animal and
vegetable matter with bacterian effects. The accompani-
mentSyif not the causes, of its decomposition flourished and
were propagated to a greater extent when minute quan-
tities of alcohol were present than when the decomposi-
tion was going on entirely in its absence. Below one
per cent, the amount of alcohol present affected in pro-
portion to its amount the degree of decomposition. Dr.
Ridge deduced from these facts an argument against
moderate drinking.
At the annual meeting of the Society for the Preven-
tion of Cruelty to Animals on Monday, July 7th, Dr.
Richardson gave an interesting account of the researches
he had made to discover the best method of slaughtering
animals without pain. He said that he had come to the
conclusion that the electric shock could not safely be
made use of by those who have to put animals to death.
He had made experiments with various anaesthetics, and
had chiefly employed carbonic oxide gas charged with
the vapor of chloroform. Dr. Richardson has been able
to make experiments on a large scale at the Dogs' Home,
Battersea. Several hundred dogs have been painlessly
put to death under anaesthesia, and sheep have been also
killed in the same manner. Dr. Richardson suggests
that the method should be employed in the killing of
animals used as food. Painless slaughtering has been ad-
vocated by him for years, and now that an easy method
is withui reach we may hope for its adoption.
Another inquiry into hospital management is now tak-
ing place. This time it is the North London Consump-
tion Hospital. This hospital is a most useful institution,
and has had a good many good men on its stafil It is
satisfactory to find that the errors of the past are likely
to be redeemed in the future.
It is reported that a case of cholera is on board a ship
now expected at the port of Cardiff. The authorities are
quite prepared, and will not, of couse, allow any case to
be landed. At every port the sanitary authorities are on
the look-out. The various hospital authorities are be-
stirring themselves. In view of the fact that the stress
of the last severe epidemic fell upon the East End, and
that thus the London Hospital received within its walls
a large number of cholera patients, a meeting of the staff
of that hospital is to be held at once to consider what
arrangements should be made in case of another epi-
demic.
Considering the probability of an invasion of cholera,
it seems a pity it was not put down as a subject for dis-
cussion at the approaching International Congress.
Even if no definite rules as to treatment had been agreed
upon, we might have acquired some more distinct notion
of its nature from hearing the views of investigators of
various countries. The water-carriage theory is mainly
held in England, but few of our clinical teachers have
had the opportunity of practically studying the disease.
In India, on the other hand, where most of our medical
officers have had cholera cases to deal with, a large num-
ber of them decry the water theory altogether. The
opinions held here are mainly the result of the teachmg
of the late Dr. Farr. He was an ardent advocate of the
water theory, and all facts supporting it were pushed for-
ward in the Reports of the Registrar-General, then edited
by him. Opposed facts received at least scant courtesy,
and many accused him of systematically suppressing
them. The opinion of the Indian observers seems at
least to merit a better hearing than it has yet obtained.
Small-pox is still increasing. Some of the hospitals
have, in consequence of the prevalence of the disease in
their neighborhoods, forbidden in-patients from receiving
visitors as usual.
OUR PARIS LETTER.
(From our Special Correspondent)
ANiESTHESIA IN CHILDREN — GERMAIN ON THE GERM
THEORY — HIS OPPOSITION TO THE SAYRE PLASTER-OF-
PARIS JACKET — A STRANGE CIRCUMSTANCE CONNECTED
WITH AN EPIDEMIC OF MEASLES AT BOURG ARGENTAL
— A WORM IN THE EAR — CHOLERA AT TOULON.
Paxis, July 9, X884.
In a work just brought out by Dr. de Saint-Germain, he
resumes his clinical lectures of the last twelve years on
different points of infantile surgery which came under
his observation at the. Children *s Hospital in Paris, of
which he is surgeon. In his first lecture the author
treats of surgical anaesthesia, in which he shows that
children possess no greater immunity against chloroform
than adults, although the idea is entertained by some
writers, the risk being the same in both cases. Never-
theless, M. de Saint-Germain never hesitates to employ
chloroform in a great number of cases, even when it
appears useless, as in keratitis. He prefers general to
local anaesthesia, even when the latter would appear to
be indicated, as, for instance, in opening abscesses, in
operations for ingrowing of nails, etc., the local anaes-
thesia being as painful as the operation itself. More-
over, in the case of children one would have to fear the
reaction after the application of cold. He employs
chloroform alone ; and in more than ten thousand cases
in which he practised chloroformization he never had a
single death. During the administration of chloroform
M. de Saint-Germain attends exclusively to the respira-
tory rhythm and neglects the pulse, which, he says, gives
indications too late to be of any value. The heart, it is
known, dies the last.
M. de Saint-Germain often employs the Ijsterian
method of dressing wounds, but without the least en-
thusiasm, and he expresses himself to the effect that the
great lesson given by Lister to surgeons was to teach
them how they were to wash their hands. He has no
faith in the germ theory as far as the dressing of wounds
is concerned, the ancient methods appearing to him suf-
ficient in the great majority of cases.
According to M. de Saint-Germain, children do not
enjoy immunity even against cancer. This is more fre-
quent in boys than in girls, from the fact that cancer of
the testicle is met with rather frequently, whereas cancer
of the ovary is very rare. The forms most frequently ob-
served in children were : the encephaloid and the fungus
haematodes, then in the order of frequency the scirrhous
form, epithelioma, and finally myosarcoma. The organ
most frequently affected with cancer is the eye, and the
encephaloid form is the most frequent. It is primarily
intra-ocular and begins either in the choroid or in the
retina. The treatment consists in the extirpation of the
eye as soon as the diagnosis is established ; it is the only
chance in favor of the patient, and yet, .unfortunately,
relapses are not rare. I may here mention that Dr. de
Saint-Germain is vehemently opposed to Dr. Sayre's
system of treatment of spinal deformities, the plaster
jackets as recommended by that surgeon being, he con-
August 2, 1884.]
THE MEDICAL RECORD.
iZ7
siders, not only useless in these cases, but positively in-
jurious, particularly in Pott's disease.
Dr. Paul Dagand has just published a report of a strange
circumstance connected with an epidemic of measles which
prevailed at Bourg Argental, in the department of the
Loire, a short time ago. He detected the presence of a
large quantity of round worms which had been expelled
from the stomach and bowels, sometimes numbering as
many as fifty. In one case a worm made its exit through
the ear. A case occurred in a child aged seven years,
who was affected with the measles. The child had been
complaining of severe pain in the ear. On examination
the physician noticed something which to him looked
like the remains of a worm, in which he was not mistaken,
as on trying to extract the object, to his surprise he found
after its removal that it was a worm. The worm meas-
ured about twelve centimetres in length and two milli-
metres in diameter. The child had passed five or six
of these helminths by the mouth a few days previously,
which were slightly thicker than that which was removed
from the ear. According to Dr. Dagand, the worm
pix)bably passed up through the Eustachian tube and
perforated the tympanum. The child, who was seen
again a fortnight after the occurrence, was quite well,
with only a slight diminution of hearing of the right ear,
which was the one affected. In getting the child to blow
with its nose closed, no communication was perceptible
between it and the ear. The otorrhoea which existed
tor 2l few days after the expulsion of the worm had dis-
appeared. This case was brought to the notice of the
Medical Society as a curiosity by Dr. Championni^re, who
remarked that though the case was very interesting, yet it
was not without precedents. In the article " Lombric,' ' in
the "Dictionnaire des Sciences Medicales," Dr.Davaine
reports that Winslow discovered a worm in the Eusta-
chian tube of a little girl on whom he had a post-mortem
examination. One extremity of the worm was in the
pharynx, while the other was entangled among the bones
of the tympanum. Bruneau, of Amboise, reports another
case in which the subject was a young woman, from whose
ear he removed an entire worm. He reports also that
other observers had detected worms in other parts of the
body. For instance, Rodriguez and Vrayet each relates
a case of worms having been extracted from the inner
angle of the eye. Apropos of these cases. Dr. Champion-
ni6:e observes that the migratory worms should not be
confounded with the larvae of insects which have some-
times been discovered under the eyelids, in the frontal
sinuses, in the ear, and in the nostnls, and which might
have been taken for entozoa.
The cholera at Toulon, which, as you are aware, broke
oat about three weeks ago, is still raging with varying in-
tensity in that town, and although at first the local medical
men were undecided as to the true nature of the epidemic,
they are now agreed that the malady is indubitably of the
Asiatic type. Dr. Rochard, Inspector-General of the
Naval Department, and Drs. Brouardel and Proust,
members of the Council of Hygiene, were deputed to
report on the nature of the epidemic. These gentlemen
gave it as their opinion that the disease, whether im-
ported or not, is unmistakably the Asiatic cholera, though
in a Yery attenuated form. Dr. Fauvel, however, the
President of the Consultative Council under the Minister
of Commerce, and who never went to Toulon since the
outbreak, is singular in his opinion that the disease is of
the sporadic type. This opinion he expressed officially,
not only in his report, but before the Academy of Medi-
cine at the outbreak of the epidemic, and to which he
stil] adheres, on the grounds that it is not nearly so viru-
lent or fatal as the Asiatic cholera. Moreover, it is
more localized, has no tendency to spread, and was pro-
duced by purely local conditions, which are of the most
anti-hygienic character that could be imagined. How-
ever, the epidemic has spread to Marseilles, but Dr.
Fauvel thinks that it will go no further. May his predic-
tion be realized. Meanwhile the whole country is in a
state of panic, and the process of disinfection of men and
thin^ and other sanitary measures are being actively
carried out
RATTLESNAKE POISONING IN NEW YORK.
To THE Editor or Ths Medical Record.
Sir : The somewhat unusual occunence in New York City
of a case of rattlesnake poisoning, and its unfortunate
fatal termination having furnished a popular theme for
the daily papers, it may not be uninteresting from a
medical standpoint to recite the history of another
metropolitan case which occurred just two 'years ago,
the full history of which was never published. At that
time it was impressed upon me that there had been no
cases in New York City for eighteen years previously,
the victim then being, as were also the two recent cases,
a showman. The occurrence of two cases in two years
is hardly sufficient to make us apprehend an epidemic
of snake-bites in New York, or, on the other hand, are
the cases frequent enough to destroy interest in tiiem as
novelties in metropolitan practice. The history of the
case I have to report is as follows : E. W , aged
thirty-two, a showman, entered Ward 9, Bellevue Hos-
pital, July 10, 1882. As the proprietor of a menagerie
and museum then exhibiting in the Bowery it was his
custom every evening to study the habits of a collection
of a dozen rattlesnakes he had confined in a cage.
Being careless in the handling of one of the larger ones,
it struck at his hand, severely wounding his thumb in
several places. The wounds were deep and the fangs
had full opportunity to exert their influence. He imme-
mediately commenced to suck the wound, and sent for
whiskey. Before it arrived evidences of constitutional
infection were apparent. He complained of fulness in
the head, vertigo, impairment of vision, and great pros-
tration. He drank copiously of the whiskey and con-
tinued to suck the wound. On entering the hospital,
the hand and arm presented to us, who had never before
seen a snake-bite, a most peculiar appearance. They
were greatly swollen, hard and tense and had a strange
mottled discoloration extending to the shoulder. The
color was a yellowish green, and figured in a manner
best described by the term mottled. He was delirious,
undoubtedly in part due to the whiskey, the tongue was
dry and brown, and he suffered greatly from thirst. He
was in marked shock, verging on collapse, and for twenty-
four hours it was doubtful if he would survive, but to the
vigorous treatment employed I think his recovery can
undoubtedly be ascribed. Moderately free incisions
enlarged the wounds, and to these firee applications were
made of strong aqua ammonia, and into the hand, fore-
arm, and arm a solution of carbonate of ammonium was
injected. This was given for both its local and its con-
stitutional effect. Poultices of flaxseed and charcoal,
enveloping the entire limb were applied and frequently
changed. Diaphoretic and diuretic mixtures were given,
together with the joint administration of carbonate of
anunonium and phenic acid, then under trial in the hos-
pital. Just how much resulted from the use of the latter
cannot with accuracy be estimated, but to the ammonium
the major part of the credit is given. After a very criti-
cal stage of twenty-four hours he began to improve, and,
barring a tedious convalescence, did well.
Gangrene of the thumb supervened, rendering neces-
sary amputation. The mottled look of the limb remained
for some weeks.
Another example of novelties in city practice are
tarantula-bites, of which I have had two cases, both
occurring in men engaged in unloading bananas from
West India fruiters. The symptoms were similar in
character to snake-bites, but much less severe in degree.
Eraser C. Fuller, M.D.
234 West Fifty-ninth Street,
July X5, X884.
** Small Fevers Thankfully Received " is a motto
suggested to a young physician by Dr. Holmes.
138
THE MEDICAL RECORD.
[August 2, 1884.
THE USE OF PEPTONIZED MILK, AND HOW
TO MAKE IT.
To THE Editor op The Medical Record.
Sir : A formula for a food, as well as for a medicine, will
certainly disappoint one who wishes to try it, and it may
do much harm, if it be wrongly stated. In my note to
you on peptonizing milk, the word grains has in three
places been printed grams or grammes, thus making the
quantities fifteen times too much. The sentence, " Mix
a powder consisting of five grammes of Fairchild's ex-
tractum pancreatis," etc., should be, **Mix a powder
consisting of five grains," etc. In the letter from Pro-
fessor Leeds/ ^ i^ grams of extractum pancreatis and 4
grammes of sodium bicarbonate," should read, " i^ grains
of extractum pancreatis and ^ 4 grains of sodium bicar-
bonate." In justice to Professor Leeds as well as myself,
please publish these corrections.
Yours truly, J. Lewis Smith, M.D.
New York, July ai, 1884.
A PROBLEM, ETHICAL AND MEDICO-LEGAL.
To THE Editor op The Medical Record.
Sir: An unmarried woman, about forty-five years o
age, of spare frame and delicate nervous organization,
is now suffering, as she has formerly done after various
intervals in her life, with hysteria, accompanied by some
emotional and mental aberration, and exhibiting a ten-
dency under her present management to confirmed in-
sanity. Without medical advice or direction, her family
have locked this poor woman up in a small room, have
put strong and gloomy looking oak bars across the win-
dows, have left her much of the time alone in the room,
without a bed, chair, carpet, or show of comfort, having
only an angular and uncomfortable lounge to lie on, and
have provided her with no regular attendant, medicines,
or physician. She has been sleepless, almost without
appetite, and having a pulse of feverish and excited
character. It is doubtful whether she has been provided
with suitable and sufficient food. She has been treated
to a strait-jacket several times, and the amateur direct-
ors of her case have sought diligently among the physi-
cians of the town to have her bled freely, but none would
do the job. In none of these attacks has she ever ap-
peared dangerous, her most offensive freak (except some
harsh talk about her relatives) consisting of a break for
liberty, at night, perhaps not too well clad, and this not
recently, but at one or two former periods, before this
present demon-baiting system was adopted. The friends
of this poor woman think themselves intelligent, liberal-
minded, even benevolent They are financially able to
procure comforts and help for their afflicted relative.
Now for the
Problem. — What is the social and ethical duty and
legal power of remedy in the above case, possessed by a
neighbor and physician who knows and can prove facts
as stated ? Can it legally be that such neglect of skilled
advice and treatment, and such an active course of medi-
eval or barbarous management be adopted and pur-
sued upon the mere whim and guidance of unmedical
and relentless friends (?) of the invalid ? Has the edu-
cated and humane onlooker no power to interfere in the
defence of outraged personal rights and for the correc-
tion of abused nature and health of mind and body? An
early answer will oblige Humanity.
-, Pennsylvania, July Z9,'x884.
[The law of Pennsylvania is that insane persons may
be placed in a hospital : " On statement in writing of
any respectable person that a certain person is insane
and requires restraint, the judge shall appoint at once a
commission to inquire into and report upon the case.
This commission shall be composed of three persons, of
whom one at least shall be a physician and another a
lawyer. If after hearing the evidence they think it a
suitable case for confinement, the judge shall issue his
warrant for such disposition of the insane person as the
circumstances of the case require. If any insane person
is manifestly suffering from want oi proper care, any law
judge shall order him to be placed in some hospital for
the insane. In such cases, however, notices must be
served and a hearing given."
There seems to be a sufficient remedy indicated in the
above. — Ed.]
Official List of Changts in the Stations and Duties of Officers
serving in the Medical Department^ United States Army,
from July 20 to July 26, 1884.
Wright, J. P., Major and Surgeon. Granted leave
of absence for one month on surgeon's certificate of dis-
ability. S. O. 89, par. 3, Headquarters Department of
Texas, July 17, 1884.
Hartsuff, Albert, Major and Surgeon. Leave of
absence extended one month. S. O. 79, Headquarters
Division of the Missouri, July 18, 1884. ^
Reed, Walter, Captain and Assistant Surgeon. Re-
lieved from duty at Fort Sidney, Neb., and ordered for
duty as Post Surgeon, Fort Robinson, Neb., relieving
Assistant Surgeon Henry McEIderry, U. S. A. S. O. 62,
par. 2, Headquarters Department of Platte, July 22, 1884.
Benham, R. B., First Lieutenant and Assistant Sur-
geon. Assigned to duty at Fort Brown, Texas. S. 0.
90, par. I, Headquarters Department of Texas, July 19,
1884.
Strong, Norton, First Lieutenant and Assistant Sur-
geon. Granted leave of absence for two months, to take
effect when relieved from duty in Department of the
Platte. S. O. 68, par. 2, Headquarters Division of the
Missouri, June 27, 1884.
Official List of Changes in the Medical Corps of the U. S.
Navy, during the week ending July 19, 1884.
GiHON, A. L., Medical Director. Ordered as Member
of Board of Inspection.
Persons, R C, Passed Assistant Surgeon. Ordered
to U. S. S. Saratoga.
Seigfried, C. a.. Passed Assistant Surgeon. Detached
from U. S. S. Saratoga; ordered to Naval Hospital,
Brooklyn.
Sayre, J. S., Assistant Surgeon. Ordered to U. S. S.
Independence.
ijacdicaX %ltms.
Contagious Diseases — ^Wsskly Statkmknt. — ^Re-
port of cases and deaths from contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the week ending July 19, 1884 :
Week Ending
Casgs,
July 19, 1884 . .
July 12, 1884..,
Deaiks.
July 19, 1884. .
July 12, 1884..
I
167
187
I
Tubercle Bacilli in the Non-tuberculous. — Dr.
George Zahn records at length a case in which tubercle
bacilli were found in the sputa, but in which after death
no tuberculous process'at all was found in the lungs.
August 2, 1884.]
THE MEDICAL RECORD.
139
Alum coagulates the albumen of the saliva and mucus
of the mouth into membrane>like flakes. It causes con-
traction of the capillaries, blanching of the mucous mem-
brane, and subsequent diminution of secretion. Not-
withstanding its power to coagulate albumen it is absorbed
into the blood, and Or61a found it in the liver and urine.
Circulating in the blood it contracts the capillaries, pre-
vents the emigration of leucocytes and red corpuscles,
and arrests secretion and hemorrhage. May it not also
arrest cell-growth, and may not this harmless and not un-
pleasant remedy be tried against sarcomas, and even can-
cers of internal organs which cannot be reached by the
surgeon's knife ?
AcETUM Opii is made from opium, § v. ; nutmeg, § j . ;
sugar, I viij. ; dilute acetic acid, O ij. This is the
strongest liquid preparation of op\um, viz., 75 grs. to | j.
or 6J minims to gr. j. It is nearly free from the sickening
smell of opium, and less apt to nauseate. The nutmeg
helps to prevent nausea and there is almost complete
absence of narcotine, the most irritating ingredient of
opium to the stomach ; in this acetate equals deodorized
opium. Dose 5 to 10 minims. It may also be given in
aromatic vinegar, to make it still more pleasant and
efficacious.
Apomorphia was discovered in 1869, by Gee. It
results from the action of hydrochloric acid on morphia,
which extracts one molecule of water. Codeia and
hydrochloric acid makes chlorocodia, which splits into
chloride of methyl and apomorphia ; sulphate of morphia
with excess of sulphuric acid makes sulph-morphia and
sulphate of apomorphia. Apomorphia is soluble in
water, ether, benzol, or chloroform. Two grains injected
into a dog causes vomiting, and coursing around the
room in a curiously persistent and methodical manner.
Cats do the same, and also turn summersaults in the air.
Two grains more caused epileptiform convulsions ; and
two more perfect relaxation and death. On man, one-fifth
grain caused in twenty minutes headache, dizziness, op-
pression, and qualmishness ; face pale, free salivation ;
pulse infrequent, small and feeble, and free vomiting in
ten to twenty minutes. It is a cerebral emetic. Some-
times there is retching, at others free vomiting without
effort It is chiefly used h)q)odermically in cases of great
emergency when it is necessary to cause vomiting. The
dose is one-fiftieth to one-tenth grain. It has been used in
some disorders of coordination, in sick headaches, dis-
orders of the cerebellum, and in the early stages of cerebral
meningitis. It is a dangerous remedy, and comparatively
rarely used, although . the homoeopathists advertise it
widely as a remedy against sea-sickness.
.^MONii Phosphas. — Phosphate of ammonia is made
from dilute phosphoric acid, 5 xx. ; aqua ammon. fort., q. s.
It has a cooling, sharply saline taste, is insoluble in
alcohol, but soluble in four parts of cold water. Dose,
ten to twenty grains three times a day in water, or barley-
water. It is supposed to make more soluble salts with
uric add than those of soda and lime, and to be usefulin
gouty concretions, gout, and rheumatic gout. In uric acid
gravel it is more than rivalled by borax, the utility of
which is very great. It enters the urine from the kidneys
almost unchanged, attacks the uric acid, which it decom-
poses, forming a soluble urate of sodium. Dose five to
thirty grains.
AiCMONii Boras, or borate of ammonium, is made from
one part of boracic acid in three parts of warm ammonia
fater. It has a strong ammoniacal odor, and dissolves
in twelve parts of cold water. It is used for urinary dis-
orders with an excess of acid or earthy phosphates, and
in irritability of the bladder. It has fallen into disuse, but
is nearly as useful as borate of sodium. Dose ten to
twenty grains largely diluted. It of course is one of the
remedies for lithaemia, and has been used in low fevers
in the place of the carbonate of ammonia, especially when
there is ulceration of the bowels.
Sugar as Food. — The Deuisch-Amerikanische Apo*
theker Zeitung (December i, 1883), gives a note by Dr.
Phipson, on sugar as a regular article of diet. Dr. Phip-
son opposes the general prejudice ajgainst sugar. He
declares that he has, during forty years, eaten very largely
of it, at least a quarter of a pound daily, not counting
sugar-forming substances taken at the same time. Dur-
ing all this time he has not been under the necessity of
taking medicine, and has not suffered from any com-
plaint, except brief attacks which could be traced to
irregularities in eating or in dress. He declares that the
condition of men would be much improved if the use of
sugar should substitute that of alcohol.
An Antirachitic Mixture. — Dr. Von Leser rec-
ommended, in a paper read before the Leipzig Medical
Society, the following mixture in the treatment of
rachitis :
51. Tinct. rhei vinos 20 parts.
Solut. potas. acetici 10 **
Vini stibiati 5 "
M.
The beginning dose is five to ten drops three times
daily. This is increased three drops every three days
until twenty to thirty drops is reached. The maximum
dose is continued three or four weeks. Improvement
sets in so rapidly that this is then rapidly decreased-
The Cause of Objective Quacking Sounds in the
Ear. — Dr. William S. Parker, of Piqua, O., recounts the
following case and asks for a diagnosis : " Miss D ,
aged thirty, about the last of October, 1883, ^^.d a slight
fainting spell, not amounting to unconsciousness, accom-
panied with nausea and thickness of speech, so much
so that she was unable to articulate. This lasted but
an hour and a half, and was the only attack she ever
had. I may mention that for several years she has
been subject to very slight attacks of vertigo, which, but
for the present state of affairs, would pass unnoticed.
Since the attack in October she had constant ringing in
the ears until January i, 1884, at which time she noticed
that the sound became interrupted in a manner hereafter
described. I observe that she is in perfect health in every
particular, and never had any serious illness. The ears
are perfect, as is also their function. Upon examination
at this date (June 12, 1884), I find by placing my ear
against that of the patient, a distinct sound, precisely like
that of the quacking of a mallard duck in the far-off dis-
tance (which she says exactly describes the sound as it
seems to her). This sound is synchronous with each beat
of the heart, and is heard very distinctly in the left ear,
and only slightly less so in the right by myself, although
the patient can only perceive it in the left ear. Press-
ure upon the carotids makes no difference in the sound.
Inflition of the Eustachian tube also has no effect. Ly-
ing upon the left ear intensifies the sound very largely,
says * it is like the roaring of a saw-mill.' This condi-
tion has obtained since January ist last, when it was first
observed."
Removal of Benign Mammary Tumors without
Mutilation. — Dr. N. E. Oliver, of Thornton, 111.,
sends us the following : ** In yoiu: issue of July 5 th (Vol.
xxvi., No. i), on page 12, is an excerpt from TTie Ar-
chives Med, BelgeSy in which M. Moli^re claims origi-
nality for the (therein described) operation for the re-
moval of (benign) mammary tumors without mutilation.
Professor T. Gaillard Thomas, in a communication (read
before the New York Obstetrical Society, February 21,
1882) to The New York Medical Journal and Obstetrical
Review for April, 1882, describes the above operation as
applicable to all benign tumors of medium size. It would
seem that American medical literature scarcely receives
appropriate recognition from our irascible French breth-
ren, otherwise so distinguished a gentleman would not be
guilty of so palpable a * medical plagiarism,' or at any
rate he would not be two years behind the times."
I40
THE MEDICAL RECORD,
[August 2, 1884.
Trichinosis in Massachusetts. — Dr. Averill, of
Campello, Mass., sends us the notes of several cases of
trichinosis recently occurring in his practice. He writes :
"On March 27, 1884, I was asked to visit a Swedish
family consisting of husband, wife, and four children. I
found husband and wife and eldest child (a son about
eight eight years of age) all sick in bed, and learned
that they all took to their beds about the same time
some three or four days before calling for me. All had
felt tired and languid for several days before taking to
the bed. All were cedematous about the face and eyes,
and the wife was markedly so all over her body. They
complained of pains all through their bodies, headache,
lassitude, muscles were sore and painful when touched
or moved, limbs generally flexed, and extension caused
extreme pain. The husband complained especially of
pains across his thorax. Temperature about 102^°, pulse
about 125." Dr. Averill learned that about a week be-
fore the sickness the family bought half a smoked ham,
and all had been eating it raw except the three younger
children, who ^^ere not attacked. Another family in the
same house bought the other half of the ham. The hus-
band alone ate some of it raw, and he alone was taken
sick, but recovered. The three sick members of the
first family gradually recovered, but it was about five
weeks before the symptoms had disappeared.
The Lack of Progress of Cremation. — With refer-
ence to our recent editorial upon this subject, Dr. F.
Hoffmann, editor of the Pharmac cutis che Rundschau^
calls our attention to an article by himself in the March
number of that journal. He there shows by statistics
the very slight progress that cremation as a mode of
burial is making, and takes the ground that it is an un-
called-for and dangerous mortuary rite.
The Psvcho-pathologv of an Application for In-
crease OF Pension. — A pension surgeon at Washington
sends us the copy of a very ingenious medical certificate
which was sent to his office a few days ago with an ap-
plication for an increase of pension. " Affiants discover
upon the right instep of the applicant a soft and mova«
ble cicatrix, as if the integuments had been ploughed up
by a bullet. We find no deformity or displacement of
the tarsal or metatarsal bones, and no erythema or hy-
peraesthesia of the surface of the wounded region. Affi-
ants also discover that the applicant's disability is greatly
increased at times by the reaction of the above described
cicatrix on the higher nervous centres. We believe that
a sensory impression, conveyed from the cicatrix through
the second pair of cranial nerves, is intensified in the
cerebrum by certain processes of intellection, one of
which is known as expectant attention. The impression
so intensified and modified is then refiected to the region
where the trauma was sustained, and the applicant's suf-
ferings are increased many fold. Under such circum-
stances, and at the time when these reflex nervous phe-
nomena are manifested, we believe that the applicant's
disability is extreme, and that an increase is urgently
indicated as a therapeutic measure. , M.D., ^
M.D."
The Therapeutic Value of the Iron Albumi-
nate in ANiEMiA. — Dr. Allan McLane Hamilton writes :
" I have been in the habit for several years past of giving
iron in combination with albumen to nervous patients
whose powers of assimilation were so enfeebled that they
were unable to take any of the preparations in ordinary
use, even the most bland and non-irritating. Anaemic
and hysterical women and those with idiosyncrasies often
declare their unwillingness or inability to continue the
iron, even in minute doses, and in such patients something
must be found to take its place. In the year 187 1 Diehl
announced the discovery of the albuminate of iron, but
so far as I can discover, no one has yet employed the
combination in medicine. Miahle has held that 'the
albuminate of the peroxide of iron is formed in the blood
and that this is the basis of the red globules,' and it has
been shown that the presence of an alkali favois the
catalytic change. Some iron salts are absolutely inert as
remedies and pass unaltered from the body. Among
these are the ferro and ferricyanides of potassium and
other double salts which are not precipitated by the alka-
lies (Headland). The combination of iron and albumen
with an alkali seems to be at once a measure likely to
be of value from a therapeutic point of view, and so 1
have found it. Mr. Theodore Angelo, of New York, has
made for me a dry preparation of the iron albuminate, and
he has combined with this chocolate and moulded this
into small lozenges, each of which contains ten grains of
the salt. I have given the iron albuminate a thorough
trial in a large number of cases of all kinds where a
haematic was needed, and am convinced that there is no
form of iron now in use that acts as rapidly or is so
well borne by the stomach as that of which I write."
A Question of Maternal Impression. — Dr. C. H.
French, of Waterbury, Conn., writes : " I was engaged to
attend Mrs. T during her confinement. Soon after
conception a young man, whose right arm just above
the elbow had been amputated some years ago, came to
board in the family. Mrs. T felt very sorry for the
young man, showing her sympathy by frequently washing
and dressing the arm. She says that that young man's
arm was seldom out of her mind, and that any person
she saw who was similarly affected (she had seen several)
sent a thrill of horror, followed by one of intense sympathy,
through her. I delivered her, on June 5 th, of twins.
One of the children had the right arm just below the
elbow missing. Whether this was merely a coincidence
or the result of the mother's mind over the foetal devel-
opment I am not prepared to state. In view of the fact
that cases of this nature, taken collectively, may be of
value, I send you this.**
Some Delusions in Medical Chemistry. — That
colorless tincture of iodine has the chemical and medical
properties of the tincture of iodine. That serum albumen
is the only albuminous body to be tested for in the urine.
That potassium chlorate yields oxygen to the blood
(some recent experiments have made this not so improb-
able). That corrosive sublimate or potassium perman-
ganate can be given with vegetable preparations.
Identity of Friedlander's Pneumonia Cocci with
THE Organisms of Salivary SEPTiCiEMiA. — Dr. George
M. Sternberg, U. S. A., sends us the following important
communication : " I am induced by yoiu" remarks upon
* Micrococci under the Floor ' (The Medical Record,
June 28), to call your attention to the apparent morpho-
logical identity of Friedlander's micrococci of pneumonia
and the micrococci from the blood of a rabbit inoculated
with human saliva, shown in Fig. i of the plate which
illustrates my paper on * A Fatal Form of Septicaemia in
the Rabbit,* etc. (published in 1881), a copy of which I
send you by mail to-day. This morphological identity
was recognized at once by Dr. Wm, Welch, of New
York, when I called his attention to this figure, upon his
visiting the biological laboratory at Johns Hopkins Uni-
versity not long since. As Dr. Welch has personally
demonstrated the presence of Friedlander's (?) micrococ-
cus in pneumonic sputum, his recognition of this mor-
phological identity at once confirmed my own suspicions.
I have not myself had an opportunity to examine pneu-
monic sputum since the announcement of Friedlander's
discovery (?)."
Urinary Test Papers. — Messrs. Parke Davis & Co.,
of Detroit, have manufactured a very neat and con-
venient pocket case containing the various test papers
for urinary analysis recommended by Dr. G. Oliver, of
Harrowgate, Eng. {Lancety February 3, 1884), and Dr.
C. W. Purdy, of Chicago {Jour. Amer. Med. Assoc.^
January 19, 1884). It is also supplied with test tubes,
and dropper making the whole a very useful pocket
companion for the general practitioner.
The Medical Record
A Weekly yournal of Medicine and Surgery
Vol. 26, No. 6
New York, August 9, 1884
Whole No. 718
(^viQimd ^tMcUs.
PUERPERAL FEVER,
Being an Address on Obstetric Medicine,
Delivered at the Fifty^second Annual Meeting of the
British Medical Association, held in Belfast, 1884,
By GEORGE H. KIDD, M.D. Ed. ; M.A.O., Hon. Causa,
Duel.
nUOV AND KX-PnSlDKNT ROYAL COLLBGK OP 8URGBOM8, ISKLAND ; HONOHARY
mXOW LONDON AND BUNBURGH OBSTBTSICAL SOCIBTIBS ; CORRRSPOND-
nC MIMBBR OP THE GYNRCOLOGICAL SOCIXTIBS OP BBRUN AND BOSTON ;
OORSPLTART AND BX-MASTSR OP IHB COOMBS LYING-IN HOSPITAL.* CON-
scLTUfC oBsrrrRic surgbon to thb hospitals op the housb op in-
DOSTKV; PRBSIOBNT OP THB OBSTBTRIC 5BCTION OP THB IRISH ACADSIIY
or XBDICINB.
(Special for THb Mbdical Rbcorix)
xUsETiNGS such as those of the great Association under
whose auspices we are here assembled have always ap-
I)eared to me as having their most useful function in
presenting opportunities for reviewing the work we have
bees doing ; estimating the value of the results attained ;
elimioating, so far as may be, the erroneous or defec-
tive; and so getting plainly before us certain stand-
points from which further advances may be made. I
propose, then, in endeavoring to accomplish the duty
imposed on me by your Council when they selected
me for the high and honorable office of delivering an
address on obstetric medicine, to take Puerperal Fever
as my subject, and to treat it in accordance with these
piinciples. In selecting this subject I have been in-
flaenced not only by its importance — its vital importance
-to one and all of us, but also by the great advances
that have recently been made in our knowledge of its
pathology, and in some measure perhaps by the feeling
that in our enthusiastic pursuit of the new paths that
have been opened to us we are in danger of losing the
due that is to lead us out of the labyrmth in which we
have so long been wandering. I shaJl ask you to con-
ader the disease mainly from a clinical point of view,
refemng to the laboratory experiments of scientists and
pathologists to illustrate and explain the facts observed
at the bedside, where alone disease can be studied. In
(kang this I shall not attempt to present any new or
ongina] doctrines. My task must be the more humble
one of stating, with what clearness I may, the questions
at issue, and the facts on which their solution must be
founded, endeavoring to arrange and balance the evi-
dence, so that its true value may be more fully appre-
hended.
Much of the difficulty that has always attended the
study of this disease arises from the similarity of the
symptoms during life and of the pathological appearances
^Dond after death in its various forms. Its dependence
on the great act of childbirth, and the peculiar condition
of the patient's system at this period, sufficiently account
for this similarity. The enlarged and highly organized
uterus suddenly emptied of its contents after violent
muscular exertion, and becoming a mass of efifete mate«
lial, whose constituent elements have to be absorbed
into the blood as a preliminary to their being eliminated
from the system ; the exposed state of its vessels ; the
torn and contused tissues ; the great current of blood
Verted from the course it has so long been pursuing ;
the altered condition of the fluid itself; and the highly
stnmed nerve-tension — all tend to concentrate the dis-
eased action of one set of organs, and to impress on it
this similarity of development The attempts, conse-
quently, that have from the earliest times been made to
differentiate the various forms of the disease, founded on
its morbid anatomy and its symptoms, have failed to
simplify its study or in any great degree elucidate its na^
ture. A classification founded on the conditions under
which the disease arises, and the nature of the exciting
cause adopted by some writers, as by Barnes in modem
times, has proved more useful and done more to pro-
mote accuracy. One founded on this principle will
probably best serve the requirements of the present
occasion.
A writer of the last century, Kirkland, upbraids his
contemporaries with including ^' a thousand disorders '*
under the one head of puerperal fever. It requires but
a very elementary knowledge of the subject to see that
a large proportion of these disorders arise from traumatic
causes. These, then, will constitute the first group I
will ask you to consider, and perhaps not the least im-
portant, seeing that so much can be done for their pre-
vention.
In tedious and difficult labors, more especially in first
labors, the soft parts of the mother are liable to be in-
jured at every stage — the cervix may be lacerated, the
lips may be caught between the head of the child and
the side of the pelvis and contused, the vaginal walls
may be compressed till sloughing be induced, so as to
lay open the bladder or the rectum, or both ; the
perineum may be torn, or some of the blood-vessels may
be lacerated, and blood be effused into all the surround-
ing tissues, giving rise to hematoceles, more or less ex-
tensive ; and yet, formidable as the enumeration seems,
we all know that in the great majority of cases the reac-
tion is moderate, the inflammation set up is localized, if
the damage done be not excessive it is repaired, and the
patient recovers. But if the patient be in an unhealthy
condition, or if her surroundings be unwholesome, then
a new train of symptoms may arise, not necessarily de-
'^nding on the extent or gravity of the wounds, but
influenced by them. The inflammation, instead of being
normal in character, becomes abnormal ; it may extend
to surrounding parts, and peritonitis or pelvic cellulitis
may be set up ; or more distant parts may be affected,
and the disease will manifest itself in the pleura or the
serous membranes of the heart or of the joints ; or the
blood in the veins may be coagulated, giving rise to
thrombi and emboli, and subsequently pyaemia.
We have now to inquire what is the nature of this
change. The researches of modem pathologists and
scientists have proved that it is due to the introduction
of a poison into the system, and that certain vegetable
organisms (bacteria) are essential agents in the produc-
tion and dissemination of this poison. They are^not
agreed, however, as to the exact part played by these
organisms. Some hold that the most severe injuries may
be inflicted without producing inflammation, and that
when inflammation takes its origin from a wound, all that
the wound does is to play the part of the door of en-
trance for the real noxa — ^water germ, air germ, or germ
which sticks to the surface of the weapon or missile which
inflicts the injury. They assert that in the genesis of
every inflammation, however definite may be the relation
between the antecedent damage and consequent reaction,
this relation is after all merely secondary. The tme
cause is the introduction into the damaged tissue from
142
THE MEDICAL RECORD-
[August 9, 1884.
the atmosphere of invisible germs. Where there are no
germs, there is no possibility of inflammation. Others,
as Dr. J. Burdon-Sanderson, to whom we are indebted
for most of our exact knowledge on the subject, teach
that inflammation is the direct physiological effect of in-
jury, and that the only inflammations to which minute
organisms stand in relation are those which from their
proved dependence on previously existing inflammation
may properly be termed secondary or infective, and that
consequently the organisms in question were in all prob-
ability not so much mischief-makers as mischief-spreaders
— that is to say, although an inflammation may come
into existence without their aid, their presence communi-
cates to it, after it has come into existence, the power
of reproducing itself in previously healthy tissues, whether
by extension or dissemination. During the ten years
which have elapsed since 1872 (when he first taught this),
Dr. Sanderson says the question of the intervention of
micrococci, which was then strange even to professed
pathologists, has become familiar to everyone, and now
the tendency exists to believe that germs explain everyn
thing ; so that whereas formerly one had to vindicate
the very existence of such things as parts of pathological
processes, it has now become a part of one's business to
protest with all needful vehemence- against the attribu-
tion to them of functions they do not possess.*
In support of his theory he proves a series of proposi-
tions on an experimental basis that seem to leave no
room for rational doubt. He shows that the introduction
into the circulating blood of a relatively large quantity
of exudation, which is the most important effect of a con-
siderable local inflammation, does not produce second-
ary inflammation elsewhere, and is not attended with
any serious constitutional disturbance. He further shows
that no organisms endowed with inflammation-producing
phlogogenic particles exist in the atmosphere or in the
ordinary aqueous liquids with which our bodies come
into contact.
It had been proved by Hiller that bacteria collected
from fluids in an advanced state of putrefaction might,
when washed and purifled, be introduced into the circu-
lating blood without producing any injurious efi'ect,
though proved to be as lively and capable of develop-
ment as ever. Hiller* even inoculated himself with
them. Dr. Wegner* showed that the subcutaneous tissue
of a rabbit may be kept distended for days by frequently
renewed injections of unpurified air without producing
inflammation, and that the effect was not more serious
if the same tissue were ventilated for a number of hours
by a continuous current of air, even when that air was
derived from a post-mortem theatre. When water charged
with septic bacteria was injected into the peritoneum of
a rabbit, in quantity less than two ounces, it produced
no effect whatever. When the animal was killed, the
fluid had been absorbed and the lymphatics of the
diaphragm were full of bacteria, but neither in them nor
in the peritoneum were there any signs of inflammation.
Similarly it was found, that when a current of the fluid
was passed through the peritoneum for many hours, so
that the membrane was exposed for a long time to what-
ever phlogogenic influences the liquid conveyed, no
effect whatever was produced. These experiments with
watery liquids are even more conclusive than those with
air, for we have here to deal with media, in every particle
of which we can very readily prove the actual existence
of germs in such a state of viability as to only require a
suitable soil to insure their development.
Having thus proved that the exudation of a normal
inflammation is not infective, and that no organisms
endowed with inflammation-producing phlogogenic par-
ticles exist in the atmosphere or in the ordinary aqueous
liquids with which our bodies come into contact, Dr.
ilLiunldAn Lectures on Inflammadoa. Deiivored before the Royal College of
Physicuuis. By J. Burdon-Sanderaon, M.D., etc. Brit. Med. Journal, Aiml 8,
x88a, p. 40J.
> Brit. Med. Jour., January 5, 1878, p. a. * Ibid., April 15, x88s, p. 597.
Sanderson proceeds to show that whenever an inflamma-
tion becomes infective it owes that property to a chemi-
cal change in the exudation liquid, of which the presence
of microzymes is a necessary condition, and that con.
versely septic organisms, which are infectious, owe their
infectiveness to the exudation soil in which they have
grown. He refers to experiments he made a dozen
years ago, which showed that in rodent animals peri-
tonitis induced by the injection of irritant liquids is
always infective, notwithstanding that the irritant (tinc-
ture of iodine) was not only free from germs, but de-
structive of them. This was, he says, understood to
mean that the flrst effect of the iodine was the effusion
of liquid into the peritoneal cavity ; the second the in-
fection of this liquid by formed ferments which found
their way into it, not from the atmosphere or from ex-
ternal media of any kind, but from the alimentary canal.
In another experiment, water which had been boiled so
as to remove all germs that might have been in it, was,
when cool, injected, with antiseptic precautions, in so
large a quantity that it could not be rapidly absorbed.
When thus accumulated in the serous cavity it charged
itself by diffusion, first with the salts, subsequently in
increasing proportion with the proteids of the blood, and
thus became a most favorable soil for the development
of septic organisms, whicli in their turn acted infectively
or phlogogenically on the blood-vessels and living tissues
with which they came in contact. A septic peritonitis
ensued, which killed the animal by septicemia in twenty-
four or thirty-six hours. It is thus shown that though
the seed is indispensable to the coming into existence
of the infective process, the question whether that seed
becomes morbific or not depends not on the seed itself,
but on the soil. Other experiments prove the same
thing, and the whole result is to establish that the pres-
ence of septic organisms (provided that they have not
been bred inside the organism) is not necessarily at-
tended with any danger, but that they become sources
of danger at once when they are brought into relation
either with devitalized organs or with extravasated serous
fluids of any kind, and particularly with inflammatory
exudation.
The sum of our knowledge of these organisms seems
to be this : They are found everywhere — in the air, in
water, in the soil ; in the bodies of the most healthy ani-
mals, on the surface where most exposed to the air ; in
the entrances to the alimentary and air passages ; in the
stomach and upper portions of the alimentary canal, but
not frequently here, for acid secretions kill them ; in the
lower portions of the canal frequently ; possibly also in
the tissues of solid organs, as in the pancreas, liver, kid-
ney, muscle, but this is still a disputed question. In the
circulating blood of healthy animals they are never found.
They enter the system by the absorbents of the mucous
membrane of the small intestines, the lacteals, by the
pulmonary mucous membrane, by recent wounds, by the
uterine surface after delivery. They exist in the animal
body without interfering with health. If they meet with
a proper soil, such as exudation liquid, or dead tissue,
they set up putrefaction, and in the process of putrefac-
tion a poison is produced which, mingling with the blood,
poisons it and gives rise to septicaemia. This poison they
carry into the system, but the bacteria themselves are
not poisonous.
Thus, then, we must have two factors for the produc-
tion of the poison — (i) The material capable of putre-
faction ; and (2) bacteria to effect putrefaction.
Now, how are we to apply this to our subject ? It is
well known, as Billroth remarks, that in most open
wounds, especially in contused wounds, shreds of con-
nective tissue die, and in many spontaneous inflamma-
tions the circulation ceases in some parts of the Inflamed
tissues and they die. Here, then, we have the material
from which the poison is to be elaborated, and the infer-
ence is plain that the first step to be taken to avoid this
form of puerperal fever is to so conduct the labor as to
August 9, 1 884,]
THE MEDICAL RECORD.
143
lessen the amount of injury done, to be careful that the
membranes be not ruptured too soon, and that the head
be not allowed to press so long on the soft parts as to
injure them, and above all that no violence be used.
In the second place, to cut off so far as possible the
access of bacteria to the injured parts, by cleanliness, by
yentilation, by disinfection ; but the experiments of
Cbanveau and of Kocher, of Berne and of Sanderson,
prove that even where all access of orp;anisms from with-
out is cut off they will pass from the mtestinal canal or
other sources to the point where dead or dying tissue
exists, and there set up putrefaction and the elaboration
of the septic poison, and consequently a third indication
remains of equal, if not greater, importance than the
others — that is, to remove the products of decomposition
as quickly as possible. Cleanliness, the adage says, is
next to godliness. Mr. Simon has modified this, and
tells us that of all our present removable causes of dis-
ease uncleanliness is the most deadly; and Burdon-
Sanderson tells us that the only scientific definition of
filth is that it consists of the products of bacterial evolu-
tion. If the septic poison be not introduced too quickly,
too frequently, or in too large a quantity, the living
blood and tissues will decompose and neutralize it They
are the best colytics. All collections of blood and
liquids must be prevented. Liston did this by leaving
the wounds after his operations exposed to the air for five
or six hours, or covered with lint dipped in water till all
oozing had ceased and the surfaces were glazed over, and
then brought them into apposition. This was before the
days of antiseptic surgery, yet the wounds were not
poisoned by atmospheric germs. Lister leaves drainage-
tabes in the wound to carry off the fluids as formed. In
obstetric practice we must depend on the natural drainage
and on frequent washings by the syringe. Billroth says
that in ordinary wounds the secretion poured out within
the first forty-eight hours is especially active, and that
the stinking products of tissue decomposition are possibly
the least noxious. This does not seem to me to hold
good of the discharges after delivery, but let it be so or
not we must ever bear in mind that uncleanliness must
be reckoned as the deadliest of our present removable
auses of disease.
The next group we have to consider is so closely con-
nected with the former that it will not be necessary to
direll on it at any length. Since the days of Hippocrates
it has been known that portions of the placenta, or mem-
branes, or clots, retained within the uterus will cause
fever. As in the laboratory, infusions made of fragments
of organic matter, animal or vegetable, afford the material
on which bacteria may work and elaborate septic poison,
so will organic substances retained in the uterus afford
the conditions for the formation of septic poison, which,
when it gets into the system, will set up fever. Harvey,
of whom it has been said that if he had not been a great
phjsiolc^st, he would have been a .great obstetrician,
washed out the uterus under these circumstances ; but it
is to Dr. Braxton Hicks we are indebted for formally
recommending the practice. The rapidity with which
die fever subsides when this is sufficiently done proves
that the fever depends on the absorption of the poison.
Closely connected with these groups is another set of
cases where the disease takes its origin in varicose veins,
which inflame, and in which thrombi form, giving rise to
emboli and pyaemia with metastatic abscesses. Bacteria
make their way into these thrombi, from within the
system, and cause them to disinte^ate and break into
fragments, which, being carried off iri the current of the
blood, get arrested at certain points and give rise to
secondary inflammations and metastatic abscesses.
The foregoing groups belong to the class Dr. Barnes ^
calls autogenetic. Autogenetic they are so far as the *
primary factor for their production is concerned, but for
their development they require the presence of organ-
oms to carry on the manufacture of the posion — that is,
the active agent in their production. The cases we have
next to consider present a different clinical history, and
seem to depend on entirely different causes. Those we
have been considering occur only after labor, and have
their origin in conditions caused by labor. They occur
in isolated cases, are not infectious, and do not spread
through whole communities. In the cases we have now
to consider the disease may manifest itself before labor
has set in. It seizes great numbers at the same time ; it
observes cycles of development and decline, sometimes
disappearing altogether for long or short periods ; at its
onset it proves fatal to almost all who are attacked by
it. as it declines it becomes more mild in its char-
acter, and many of those attacked recover. In all these
respects these cases resemble diseases specific in their
nature, and dependent for their development on the ac-
tion of a specific epidemic influence.
The occurrence of fever before labor, which rapidly
develops after delivery into puerperal fever of a very fatal
character, has been noted and described by many ob-
servers. In the following cases all the facts seem to be
so fully verified as to leave no room for doubt ; A lady,
mother of several children, residing in a healthy situa-
tion, in a large and well-kept house, when expecting her
confinement, had one of her children under the care of
Mr. Wheeler for club-foot. Not feeling very well she
spoke to Mr. Wheeler about herself, and he prescribed
a diaphoretic mixture. Next day Mr. Wheeler finding
the fever increasing, and knowing that she was in hourly
expectation of her confinement, advised her to send for
her accoucheur. Dr. WilUam Smyly now saw her, on
April 14, 1882. He found her skin dry and hot ; her
pulse, 120 ; her temperature, 104° F. The fever con-
tinued to increase till the morning of the 15 th, when
perspiration occurred, and labor set in. The child was
bom at 1.30 P.M. on the 15th — a healthy child, still
living. The fever continued; though the temperature
never again reached 103**, the pulse was abnormally and
increasingly fast. The lochial discharge became fetid
and the abdomen tympanitic. During the night of the
1 8th violent diarrhcea set in, with great pain. I saw her
the following morning ; she had then a very rapid and
small pulse, the abdomen was tympanitic, the breasts
flaccid, the skin relaxed, and she was gulping up
mouthfiils of coffee-ground fluid, and was apparently
dying, but rallied a little, and lived till the next day — the
sixth after her confinement. There was no history of
exposure to any zymotic disease. Her infant was born
alive and healthy, and continued healthy. There was no
disease in the house or family. The child under treat-
ment for club foot was wearing a boot, and running
about in perfect health. The fever manifested itseS
before either accoucheur or nurse was in attendance or
labor had set in, and ran its fatal course with all the
characters of puerperal fever.
Epidemics of puerperal fever have been so frequently
snd so fully described that it is almost unnecessary to
more than refer to them. But there is one epidemic on
record whose whole history can be so clearly traced that
it is exceptionally worthy of attention. It occurred in
Rotunda Lying-in Hospital in 1854 and 1855, and has
been described by the late Dr. McClintock* with all the
faithfulness, accuracy, and vividness of detail character-
istic of him. Unfortunately time will not admit of my
giving more than a brief outline of the history. It was
the second epidemic Dr. McClintock had witnessed in
the hospital — the first being in 1845, when he was assist-
ant under Dr. Charles Johnson, and this one in 1854-55
when he was himself Master.
The epidemic unequivocally declared itself in the first
week of December, 1854, but not unexpectedly. Dr.
McClintock says, for there had been twelve or fourteen
cases of puerperal peritonitis and phlebitis, together with
a few isolated cases of scarlatina and typhus, in the house
during the preceding nine months.
1 Proceedings of DuUin Obstetrical Society, Dublin Qnarterty Journal of
Medical Science, vol. xix., p. 456.
144
THE MEDICAL RECORD.
[August 9, 1884
From the beginning of December to the 14th of Feb-
ruary, 182 vfromen were confined — not half the average,
as admissions, except in extreme cases, were stopped in
the end of December, and all January.
Of the 182, 38 or I in 5 were unequivocally affected,
and of the 38, 17 recovered and 21 died — making the
proportion of fatalities i in 8 of all admitted, more than
tenfold the average of the hospital. In three of these
cases the puerperal disease was complicated with scar-
latina ; of these two died. One woman, who was slowly
recovering from scarlatina, which came on soon after de-
livery, was seized with symptoms of peritonitis on the
tenth day, under which she rapidly sank.
"It rarely happens," Dr. McClintock says, **that
puerperal fever breaks out in the hospital without its
contemporary appearance in private practice ; and it
never happens, I believe, that it prevails to any extent
outside the hospital without appearing among the patients
within its walls. On the late occasion I had reason to
know that several deaths had occurred from the disease
among women confined at their own homes, and lacking
neither comfort nor attention, before it visited the hos-
pital. Nor since then were its ravages confined to the
poor inmates of our wards, for many women among even
the upper classes of society were carried off under its
fatal influence. During the months of December and
January no less then twelve of such deaths, in and about
Dublin, came to my own knowledge, and I have heard
of four or five more in the beginning of last month "
(February, 1855).
On the outset of the fever in the hospital it displayed
uncommon virulence, and the first seven patients who
were attacked fell victims to its malignity.
The progress of the epidemic is shown by the number
attacked on different successive days. Thus, on each
of the following days — viz., the ist, 3d, 4th, 6th, 9th,
loth, nth, and 12th December, there was one woman
seized with the disorder, three on the 13th, and three on
the 15 th, and on no subsequent days of this month was
there more than one, and on many days not one was at-
tacked ; but in Febniary two were attacked on the 8th,
two oh the 9th, and two on the loth.
With respect to the period after delivery at which the
patient was seized the following are the general results :
— 2 were attacked in three hours from-the completion of
labor, I in four hours, i in twelve, 1 in fourteen, i in
seventeen, and i in twenty-two hours. Each of these
seven cases terminated fatally. One was seized in
twenty-two hours after delivery, and i in twenty-three —
the former recovered, and the latter died. Thus we see,
of 9 patients in whom the complaint manifested itself
on the first day of childbed 8 died ; 12 were affected on
the second day, 6 of whom died ; 10 were attacked on
the third day, and of this number the complaint proved
fatal to three.
Here, then, is a disease which approaches gradually,
which suddenly acquires such force as to make the mor-
tality of a hospital nearly tenfold, which at its onset
caused the death of all who were attacked by it, which
affected the city at large, which manifested itself some-
times within three hours of the patient's delivery, and
which gradually exhausted its violence and ceased. Is
not this the history of an epidemic ? Does it not re-
mind one of the history of cholera, or of small-pox,
epidemics of which are also characterized by their gradual
approach, marked by sporadic cases, their furious on-
slaught and their gradual subsidence indicated by di-
minished violence and the increased number of re-
coveries ?
Epidemic diseases vary as to the mode of their com-
mencement. Generally their advent is heralded by the
occurrence of isolat«d cases at varying intervals. It was
thus in the epidemic of 1854-5, of which we have been
speaking, and in that of 1826, described by Dr. Collins.
In the epidemic of 1845, also described by Dr. M'Clin-
tock, there were no indications of its approach. Its in-
vasion was sudden and unexpected. It sometimes dis^
appears abruptly, as in that described by Dr. Collins :
"In the year preceding my appointment as Master,*' be
says, "which took place in November, 1826, puerperal
fever prevailed in the hospital to an alarming extent.
In the succeeding year, 1827, the mortality from this
disease was slight Typhus fever was, during these
periods, very prevalent in Dublin, and many cases of it
appeared in hospital. In 1828 the attack of puerperal
fever was much more severe, proving fatal to twenty-onc
women. It continued to increase in violence con-
siderably in the months of January, February, and March,
after which it disappeared, and for the four remaining
years of my Mastership we did not lose a single patient
firom this disease."
During these four years 10,785 patients were de-
livered in the hospital, of whom only 58 died, which
is nearly in the proportion of i in 186, or 0.54 per
cent. — the lowest mortality on record — in an equal
number of a similar class of patients, as Dr. CoUms,
writing in 1836, remarks, and now, in 1884, the same
remark, I believe, holds good. The mortality of lying-
in hospitals may be taken as depending on the extent to
which puerperal fever prevails. For short periods,
when fever is absent, the average is low, but when the
observation extends over a longer term the average is
equalized.
The whole mortality of the Rotunda Hospital, from
its opening in 1757 to the close of Dr. Shekieton's
Mastership in 1854, nearly one hundred years, was at
the rate of 1.21 per cent As we have just seen, dur-
ing the four years after the epidemic of 1826 it fell to
0.54, but during the whole seven years of Dr. Collins'
Mastership it was 0.96. During the seven years of Dr.
Evory's Mastership, 1 794-1800, it was lower, o. 75. From
1 78 1 to 1786 under Dr. Rock, it was 0.76, and in the re-
port just published for the year 1883 it was 0.55.
Epidemics of other diseases, small-pox for example,
subside as completely as did that of puerperal fever in
1826, but they more frequently linger on, the epidemic
influence getting less and less active till a new wave ap-
proaches, and overlaps that which was disappearing.
This seems to have been the case in the epidemics of
1845 and 1854. The report of the hospital published by
Johnston and Sinclair of the seven years preceding Dr.
M'Clintock's Mastership, enables us to trace it. Un-
fortunately we have no details for 1846, but in 1847,
when Dr. Charles Johnson's Mastership terminated and
Dr. Shekleton*s began, the disease was still prevalent, or
probably there had been a recrudescence of the epidemic.
During the months of November and December of that
year, with which the report commences, the total monal-
ity was at the rate of 7.02 per cent In the following
year it fell to 1.81 and continued to fall till 1852, when
it reached the minimun} of 0.56. The new wave now
manifested itself. . In 1853 the mortality was 0.88 ; m
the beginning of 1854 it was 1.13; and in the latter
months of that year the epidemic, as we have already
seen, was in full force, and the mortality reached xi.53
per cent
The following tables, calculated from Johnston and
Sinclair's report, show the total mortality and the mor-
tality from puerperal fever :
Tablb I.— Total Mortality.
Nov. & Dec. [ • '7 in 24a deliveries = 7. ca percent., or i in 14,23
1848 33 •* 1.823 *• =1.81 - I', cca
1849 37 " 2,063 •• ==1.79 •« X" 55.7:
1850 17 •' 1.98a •• =0.85 *• X .« iIi.o
1851 14 •• a.070 '• ZZO.67 •• z'*Z478
1853 II •• 1,963 •• = 0.56 '• 1 '^lyao
1853 17 " 1.926 •* =a88 •• I •' H3.3
1854 19 •• 1,679 •* =1.13 •• I •• 88.3
Total ... 165*
> An error of a. owing to a misprint in the Report. Total mortality izom all
causes was only 163 = 1.85 per cent.
August 9, 1 884. J
THE MEDICAL RECORD.
145
Table U.^Pturperal Fevtr,
1847
Nor. & Dec.
1848....
1849....
1850....
1851
1852
1853....
1854....
> • 10 cases of puerperal fever, 9 died, = 90 percent
43
IS
10
I
23 •
= 53-48 •
19 •
= 65.55
a '
= 13.33
5 •
= 50
3 '
=z66
s •
= 6a.s
10 '
= 90.9
In Dr. M'Clintock's report of the epidemic of 1854-5
it appears the hospital was closed in the latter part of
December and all January. It is not directly so stated,
but it would appear that it was opened again inlFebruary,
but the disease showed itself among the new set of pa-
tients— two were attacked on February 8th, two on the
9th, and two on the loth. We had a similar experience
in the Coombe Hospital in the early part of 1880. The
hospital was completely rebuilt and newly furnished three
years before. Fever manifested itself m the early part
of the year, and in March the hospital was closed. The
whole house was cleaned, the walls and ceiling scraped
and whitened, the floors saturated with wax and turpen-
tine, and everything thoroughly cleaned. It was re-opened
in April, every alternate bed being left unoccupied ; again
the fever showed itself, and again the house was closed.
The hospital consists of two buildings, about twentv yards
apart from one another. The second building is used
for gynaecic cases. The patients were transposed — the
gynsecic cases were moved to the labor wards, and all
nevr labor cases were taken into the gynaecic wards ; but
again the fever manifested itself among the labor cases.
The other patients (transferred to what was supposed
to be an infected house) remained perfectly healthy. The
evidence here seems conclusive that the disease was not
tiie result of " Hospitalism.*'
Another feature of the disease of almost equal import-
ance manifested itself on this occasion, as showing its
tnie nature. As the epidemic subsided, and the patients
who were attacked began to recover, they got pelvic
cellulitis, and at the same time many cases of the same
kind came into the house from among the patients who
had been confined at their homes. At first, suppuration
and the formation of abscesses was the rule in these
cases, but after a little the majority got well by resolu-
tion. The epidemic had expended its force.
In many of the recorded epidemics the occurrence of
cases of tjrphus fever and of scarlatina at their beginning
is noted, and it might be said that they were epidemics of
these diseases and not puerperal fever at all.
The eighty-nine cases recorded by Dr. Braxton Hicks
in his paper on "Puerperal Diseases "* may lead some to
adopt this view, but a careful examination of his cases
will show that they prove only that scarlatina and other
(fiseases may, and frequently do, occur in the puerperal
state. They occur in a similar manner after surgical op-
eradons, and seriously influence the result, but do not
prove that puerperal is scarlatina fever, or the converse,
if you sow thistles you will grow thistles, and if you sow
scarlatina the crop will be scarlatina. One case men-
tioned by Dr. McClintock affords evidence, however, of
the clearest character that the disease was not scarlatina.
* A woman recovering from scarlatina, which attacked her
soon after delivery, was seized with symptoms of perito-
nitis (phrase often used by Dr. McClintock as synony-
mous with puerperal fever) on the tenth day, under which
she rapidly sank." It must be admitted that it is in the
highest degree improbable that if the epidemic disease
was scarlatina it would afiect a patient in this manner
who was only just recovering from the same disease. It
is worthy of remark that, though he makes special allu-
sion to the health of the children, and to the absence of
trismus and convulsions, which had been of frequent oc-
cun-ence in the epidemic of 1845, ^^* McClintock does
Dot describe a singe case of scarlatina as having occurred
among the children of the women attacked by puerperal
I TnnMctiont of Obstetrical Society of London, vol. xii.
fever. Nor can it be said the patients died too soon to
allow of the appearance of the characteristic eruption.
The eruption of scarlatina appears on the second day of
the fever. None of the patients died within this time ;
one died in 50 hours from the period of invasion, one in
60, and two in 72. These were the most rapid cases.
Four or five days was the average time that patients lived
after being seized with a fatal attack of the fever.
The foregoing evidence seems to me to prove irresist-
ibly the existence of a specific epidemic influence. Much
more might be adduced to the same effect. Dr. I^usk '
tells us that in the year 187 r the mortality from childbed
in New York was 399 ; in 1872, 503 ; in 1873, 43' 5 ^^
'874, 439 ; and in 1875, 42o« The excess in the deaths
for 1872, he says, was due wholly to an increase in the
cases of metria, those from ordinary accidents remaining
nearly the same as in the preceding years. The disease
certainly did not extend into the city from the hospitals
serving as foci, for the mortality at Bellevue Hospital
was scarcely more than half the usual average. There
was no especial mortality that year from either diphtheria,
erysipelas, or scarlatina, but the >^ggregate mortality was
the largest known in the history of the city.
Dr. Fordyce Barker, in the recent discussion at the
New York Academy of Medicine, alluded to the great
puerperal mortality of 1872, and attributed it to epidemic
influence. In five of the best wards of the city, he said,
- in which are the residences of a great proportion of those
of wealth, and few of the class of dwellings known as
tenement houses, with a population of 307,046, there
were eighty deaths from puerperal fever, while in the
remaining wards of the city, with a population of 605,-
245, there were but sixty-three deaths — that is, nearly
one-third less, in proportion to the population, than in
the best parts.
Epidemic disease is defined to be "a disease prev-
alent among a people or a community at a special time,
and produced by some special cause or causes not natu-
rally or generally present in the affected locality, as dis-
tinguished fi-om an endemic disease.' The facts now
mentioned seem to me to prove that there is a large
group of puerperal cases that come strictly within this
definition, and that the epidemic thus constituted is a
specific disease.
It is taught, however, by many that puerperal fever is
nothing else but poisoning with septic matter from the
genital organs.'
This theory seems to me to be defective, inasmuch as
it does not embrace the foregoing facts.
As stated by Schroeder, it involves the following prop-
ositions :
1. Puerperal fever is caused by the absorption of septic
matter from the genital organs. It is nothing but
poisoning with septic matter.
2. The infecting matter is found everywhere where
organic compounds decompose. It may be derived from
dead bodies, suppurating wounds, disintegrating neo-
plasms, and especially the secretions of diseased and
sometimes also of healthy puerperal women.
3. Fresh wounds are necessary for the absorption of
septic matter. Wounds in a state of granulation do not
absorb, but if the granulations be absorbed, or the sur-
face of the wound broken, then it becomes an absorbing
surface.
4. The septic matter is never absorbed through the
intact skin or mucous membrane, through the lungs or
intestinal canal.
5. The septic matter may be generated within the pa-
tient herself— self or auto-infection ; or be introduced
from without — external or hetero-infection.
6. Self or auto-infection is most likely to occur when
the wounds are fresh — that is, when at the birth of the
child there are already decomposed materials, as from a
» Science and Art of Midwifery. London : H. K. Lewis. 1884,
s New Sydenham Society* i Lexicon.
* A Manual of Midwifery. By Karl Schroeder.
146
THE MEDICAL RECORD.
{August 9, 1884.
decomposed foetus, gangrene of the soft parts established
before delivery, or when new growths, as carcinoma,
rapidly undergo decomposition. Retained membranes
and placentae are rarely the cause, because by the time
they begin to decompose the wounds have ceased to be
in an absorbing condition.
7. Hetero-infection, or infection from without, arises
from the direct application of septic matter to recent
wounds in the genital organs by means of the sponge or
linen used in cleaning the parts, by instruments, or by
the examining finger. It takes place most frequently
through lacerations in the cervix.
8. It may possibly be caused by septic matter floating
in the air, but there are no cogent reasons for such an
assumption.
9. The definition shows there is nothing specific in
puerperal fever. It is the same state which is frequently
observed in surgical wards, and designated as erysipelas,
pyaemia, ichoraemia, and septicaemia.
Such is the septicaemic theory as to the nature of puer-
peral fever. Those who hold it look on the disease as
preventable, and assert that its occurence is due either to
ignorance of the precautions necessary to prevent it, or
to failure in seeing that such precautions are rigorously
carried out. These precautions are of a very elaborate
character. They have been very fully set out in a paper
read before the New York Academy of Medicine in De-
cember last, by Dr. Gaillard Thomas. They are to be
put in force in private dwellings of aU classes as well as
in hospitals. When a confinement is expected the pa-
tient's room is to be carefully prepared, all curtains and
upholstery to be removed, the ceilings and floors are to
be washed with a solution of carbolic acid or bichloride
of mercury. The bedstead and mattress to be sponged
with the sanie solution. The nurses and physician are to
take care that all their clothing is free from septic infec-
tion. If they have been exposed to the effluvia of septic
diseases, such as typhus or erysipelas, their clothing is to
be changed and their bodies thoroughly sponged with a
saturated solution of boracic acid. As labor sets in the
nurse is to wash her hands, remove the dirt from under
her nails, and give the patient an antiseptic injection
every four hours. The physician is also to wash his
hands and attend to his nails ; and, after washing, both
doctor and nurse are to soak their hands for several min-
utes in a solution of bichloride of mercury. Labor being
complete, the third stage being carefully attended to, the
physician is to examine the vulva of the patient ; if the
perineum have been ruptured it is to be closed by suture;
if slight lacerations have occurred they are to be dressed
with a solution of carbolic acid and persulphate of iron,
and painted over with collodion. The patient is to take
ergot three times a day for a week, to have the vagina
syringed out with an antiseptic lotion every eight hours
— twice as often if the labor has been an instrumental or
difficult one — and, ailer each syringing, a pessary of
iodoform and cocoa-nut butter is to be introduced into
the vagina, the nurse being careful to disinfect her hands
before every approach to the genital tract of the woman.
In corroboration of their views, the advocates of the
theory appeal to the results which they have obtained by
adopting some such mode of preventive treatment as that
laid down by Dr. Thomas. But the history of great
hospitals, such as that of Dublin or Vienna, shows that
puerperal fever will prevail and cause sad mortality at
times, and disappear again, and that the conditions
governing its movements have not yet been discovered.
Dr. Collins' precautions, compared to those recommend-
ed by Dr. Thomas, were very simple indeed. " All the
beds in the hospital are composed/' he says, " of straw,
nor is any one used more than a second time without the
cover having been washed and the straw renewed. In
every instance where the patient dies this is at once done,
and, should the most remote symptom oi fever have been
present, every article connected with the bedding is in-
stantly scoured and stoved; the wood-work and floor
washed with the chloride of lime solution, and the entire
ward whitewashed."
To these precautions, along with strict attention to
ventilation, he attributes the complete disappearance of
puerperal fever, and the fact that his mortality during the
last four years of his Mastership was the lowest that had
ever been recorded. The gentleman who immediately
succeeded Dr. Collins in the Mastership was his near
relative, his pupil and assistant, and it may be fairly
assumed did not relax his attention to the means that had
been so successful with his predecessor ; yet we find that
the mortnlity during his Mastership was nearly double the
total mortality of Dr. Collins' Mastership, more than three
times that of Dr. Collins' fours years' exemption from
fever, and the highest recorded in the hospital during the
first hundred years of its existence.
The experience of the Vienna hospital is not less re-
markable. *' It is familiarly known," Dr. Lusk tells us,
"that after Semelweiss had introduced the practice
amon^ the physicians attending patients at the large
lying-m hospital at Vienna of washing the hands in a
solution of chloride of lime, there was a great diminution
in the mortality which prevailed, notwithstanding which
G. Brann reports, however, that in 1857, in the month of
July, in 245 deliveries there were 17 deaths. The fol-
lowing month Prof. Klein gave orders to suspend the use
of dismfectants. By chance in August there were only 6
deaths out of 250 confinements, and in September of 275
patients none died. From 1857 to i860 the mortality
was slight, though disinfectants were not used ; while
during the three following years, in spite of the system-
atic and persistent employment of those agents, the
death-rate once more assumed formidable proportions."
Such experiences are no doubt discouraging. The pre-
cautions of the present day are, however, much more
elaborate than those of Collins and of Semelweiss, and,
let us differ as to our theories as we may, we will all
unite in the earnest desire that they may prove, not only
still more efficient, but more permanent in their efiects.
CEREBRAL LOCALIZATION— THE
FOR VISION.
CENTRES
By PHILIP ZENNER, AM., M.D.,
CDiaNNATI, O.
The present theories of cerebral localization, which as-
sign to the various parts of the cortex distinct and differ-
ent functions, are of very recent origin. The teaching
of Flourens, that the removal of any portion of the hemi-
spheres will affect all the cerebral functions alike, and
that therefore every part of the cortex performs the same
functions, had complete sway in the medical world for
nearly half a century. The observations of Broca, that
certain disturbances of speech were apparently caused by
lesions in a limited part of the frontal lobes, were the
first to point to tne incorrectness of that teaching. Then
Meynert made his profound researches in the anatomy
of file brain, and with an acumen rarely equalled, com-
bining the results of anatomical investigations with clini-
cal and pathological observations, concluded that the an-
terior portion of the hemispheres possessed motor, the
posterior sensory functions. Hughlings-Jackson, also,
through pathological and clinical studies, arrived at simi-
lar results as to the motor areas. Lastly, a long series of
experiments in animals seemed to confirm previous re-
sults, and to map out with wonderful precision a new
cerebral topography.
These theories of localization, arrived at by so many
and independent methods, seem but a necessary corollaiy
of a deeper insight into the nature of psychical activity.
Nevertheless they have not yet found general, or, at least,
not universal acceptance. Some observations in man,
but especially the experiments of an eminent physiolo-
gist— Goltz, of Strassburg — have apparently afforded a
well-grounded doubt of the correctness of what had al-
August 9, 1884.]
THE MEDICAL RECORD.
147
most been accepted as ascertained facts. Goltz arrives
at coodasions very similar to those of Flourens.
In this state of uncertainty apparently existing, it may
ootbewithont definite results to examine the subject
bom a very limited standpoint ; and, taking in considera^
tion all the means of research, attempt to arrive at posi-
tive conclusions as to the localization of a single cerebral
I propose in these papers to thus investigate the sub-
ject, the cerebral centres for vision. It wiU be my effort
to bring to bear in that investigation all that has as yet
been contributed that is of value in its elucidation.
\Vhile I attempt to treat the subject as briefly and clearly
as possible, I wish to enter sufficiently into detail to en-
able each reader to draw his own conclusions from the
data given.*
To facilitate our investigations, we will examine the
sabject from three various standpoints, that is, the evi-
dence afforded by anatomical, physiological, and patho-
logical data.
ANATOMICAL DATA.
The optic nerves and their prolongations, the optic
tnu:ts, can be followed with little difficulty into some of
the large ganglionic masses at the base of the brain, that
is die optic thalami, the anterior cor|)ora quadrigemina,
and the external and internal geniculate bodies. The
fibres passing to the internal geniculate bodies, and
therefore these bodies themselves, are not connected
with the sense of vision. This knowledge is gained from
experimental and pathological observations, some of which
will be mentioned further on, but need not be considered
now. The other ganglia mentioned — the opric thalami,
or rather the nuclei of gray matter, in their posterior
portions termed pulvinar, the external geniculate bodies,
and the anterior corpora quadrigemina — may then properly
be termed the basal ganglia of vision. From these
masses of gray matter fibres pass in the corona radiata
to the cortex of the hemispheres. Such fibres were al-
ready clearly observed by Gratiolet and described as optic
radiations, and were, at a later period, more fully traced
oat by Meynert. These optic radiations were described
as passing from the ganglia at base to the cortex of the
occipital and temporal lobes ; but the fibres passing to
the latter are apparently those coming from the internal
geniculate bodies, and therefore are not connected with
vision. In the most recent systematic ^ork on the anat-
omy of the brain (Wernicke, i88f), the optic radiations
are described as passing only to the occipital lobes.
This anatomical exposition might be deemed sufficient
for the solution of our problem, and give us the requi-
site mformarion as to the part of the cortex in which is
sitaated the centre for vision. For the optic nerves,
whose functions are known, are distinctly followed into
one set of ganglia, and from the latter other fibres are
described as passing to a limited portion of the cerebral
cortex. And, in fact, these anatomical data would be
quite sufficient for our purposes if every part could be es-
Ublished beyond a doubt. But we are dealing with the
most intricate parts of the bodily organism, where facts
are largely inferred rather than clearly seen and proven.
It cannot be stated with certainty from the simple ana-
tomical investigations that the fibres passing to and from
the basal ganglia are either the immediate or mediate
continuations of one another, nor amidst that interminally
intricate network of the centrum ovale, that the so-called
optic radiations pass only to the occipital lobes. If both
these £acts be proven, we then have cause to admire the
success of those indefatigable anatomists who were first
to point out great physiolgical truths, but their researches
alone can scarcely be accepted as proving these contro-
^Wbea writing dm paper I wms not aware that the subject had been previously
trated in a unuXtx manner, but have since received a Mrork of Mauthner s (Gehim
■d Aiwe^ 1881) wherein be goc« over the same ground. But inasmuch as the
■HtnlnUe part of the material here collected together has been contributed
■Me llaotfanei'B book was published, I trust these papers will not be without
^■^ ia fWiM jiiiM knowledge of what has already been acquired on this subject
« RBorinf any doH^ Sormedy entertained.
verted points. But while such difficulties are encoun-
tered in tracing out, by ordinary methods, the course of
nervous strands amidst countless intermingling strands
of the same kind, we are often greatly assisted by the re-
sults of certain pathological changes. Thus degener-
ative changes may occur in a single system of nerve
fibres which will enable us to distinguish it fi-om the
surrounding healthy tissues and follow its whole course
from its inception to its termination. Such degenerated
tracts, subservient for anatomical and physiological
studies, are sometimes found after pathological lesions,
or may be directly obtained by experimental destruction
of tissues. Waller, an English physiologist, pointed out,
many years ago, the cause and course of these second-
ary degenerations in developed nervous tissues. The
principle proclaimed by him, and since termed the Wai-
lerian law, is that nervous tracts degenerate when separ-
ated firom their nervous centres. They degenerate in
the direction in which they convey impulses, those con-
veying centripetal impulses in a centripetal, those convey-
ing centrifugal impulses in a centrifugal direction, and
throughout their whole extent beyond the point of injury,
no matter whether they be fibres in a peripheral nerve or
in the central nervous system.
To what extent this Wallerian degeneration will assist
us in our present anatomical studies will appear further
on. But far more valuable in these investigations are
degenerative changes following destruction of different
parts at the earliest periods of extra-uterine life ; for here
there occurs, in addition to the secondary degenerations,
a lack of development in the tissues, and thus whole ner-
vous strands can be more distincUy mapped out. This
method was first methodicaHy instituted by von Gudden,
of Munich. He enucleated the eyes of new-born ani-
mals, also removed various parts of the brain, and when
the animals arrived at comparative maturity, noted the
changes resulting firom these early mutilations. He
states that, when under such circumstances a nervous
tract is severed, it will degenerate throughout its whole
extent. Also atrophy of nervous centres may follow
such injuries. Thus in case one centre is destroyed
which is a source of excitation to another, then the lat-
ter degenerates. This degeneration in the excited centre
will occur if only its connection with the exciting one is
severed. But an influence in the opposite direction, that
is, of the excited on the exciting centre is not found. It
is possible that this law of Gudden does not properly
represent all the facts in the case ; but, as we will see im-
mediately, it at least enables us to differentiate and fol-
low the course of separate anatomical tracts. It need
scarcely be mentioned that we will consider results thus
obtained only so far as they throw light on the centres of
sight
Course of the optic nerve, — ^The first experiments of
Gudden were performed for the purpose of determining
the course of the optic nerves in the optic chiasms. Since
the time of Isaac Newton it has been taught that in man
there is a semi-decussation of the optic nerves in the
chiasm, and only in recent times was that statement ques-
tioned, when, on the ground of anatomical investigations,
Mendelstamm, Michel, and others concluded that there
was complete decussation of the optic nerves in man.
I would not enter into this question here, were it not that
its answer throws light upon some of the final questions
with which we have to do, and that there is a prevalent
opinion that it has not yet been definitely settied.
As above stated, the doubt cast upon previous belief
of semi-decussation arose simply from anatomical inves-
tigations, and these are quite insufficient to decide this
matter.
Meynert, than whom there has been no abler researcher
into the cerebral structures, after a careful examination
of prepared sections, stated that he could not therefroin
determine whether there was complete crossing, or semi-
decussation of the nerves in the chiasm ; and Gudden, in
explanation of this difficulty, states that in addition to
148
THE MEDICAL RECORD.
[August 9, 1884,
the endless entanglement of the fibres, they pass from
higher to lower planes in their course, and therefore
could not possibly be followed throughout an anatomical
section. H. Mtiller* asserted as a law that in animals
with monocular vision there is complete crossing of the
optic nerves, and that as the axes of the eyes become
more nearly parallel, and therefore there is more complete
binocular vision, there is more nearly a semi-decussation of
the nerves in the optic chiasm. In fishes there is com-
plete crossing of the nerves. Here the crossing is very
evident, as the two nerves merely overlie one another in
crossing. Gudden at first believed that the same was
true of rabbits, until his experiments taught him that here
a small part of each optic nerve passes into the optic
tract of the same side, Gudden* s * experiments for the
purpose of determining the course of the optic nerves
were first performed on dogs and rabbits. He enucle-
ated either one or both eyes very soon after birth, and
when the animals had arrived at comparative maturity,
killed them and carefully examined the removed parts.
He found, in dogs, after enucleation of one eye, atrophy
of the corresponding optic nerves, and reduction in size
' of both optic tracts, that one being always the smaller
which was on the side opposite to the atrophied optic
nerve. Similar changes could be produced by destruc-
tion of the visual ganglia. When the left external geni-
culate body, anterior corpus quadrigeminum, and op-
tic thalamus had been destroyed, there was complete
atrophy of the left optic tract, and reduction in the size
of both optic nerves, the right being smaller than the
left. If both eyes were enucleated, atrophy of both
nerves and both tracts followed. These results of Gud-
den had been corroborated by various other experi-
menters, some of whom will be referred to farther on. If
after them there could be any doubt of the semi-decussa-
tion * of the optic nerves in the higher animals, this doubt
would be removed by the later experiments of Nicati,*
in which, after the median, antero-posterior section of
the chiasm in cats, the latter still retained their vision.
Similar experiments have since been made by Bechterow*
on dogs with like results. Atrophy of both optic tracts
in man, after blindness in one eye and atrophy of the
corresponding opric nerve, has been recorded by Gud-
den,* Adamiik,* Putscher," Marchand,' Deutschman,"
Burdach," and others, and we will have occasion to men-
tion at a later period cases in which with disease of one
optic tract blindness on the same side of each eye was
ob§9rved during life.
Relation of optic nerves to visual ganglia and cerebral
hemispheres, — We have thus been enabled to follow the
course of the optic nerves through the chiasm and optic
tracts, and must now attempt to follow the latter into the
cerebral ganglia and hemispheres. Their primary termina-
tion is very easily determined. After enucleation of the
eyes, by the method above mentioned, there is found
atrophy not only of the optic nerves and tracts, but also of
the anterior corpora quadrigemina, the external geniculate
bodies, and the posterior gray nucleus of the optic thala-
mus (pulvinar). The atrophy of these ganglia occurs so
uniformly that we need not hesitate in statmg that they
are immediately connected with the optic nerves, and
therefore directly related to the sense of vision." For the
sake of brevity I will hereafter speak of these ganglia con-
jointly as the primary visual centres. Our next object
must be to determine their relation to the hemispheres.
1 cited by von Gudden.
* Gudden's contributions on diis subject appear chiefly in Graefe's Archives
vols, xxi., XXV., and xxvi.
' Partial decussatbn would be %. more correct expression. I have here employed
the other^ and will continue to do so, as it is almost always used.
* Archtv. de Physiologic, 1878.
' Rlin. Monatsblatt Augenheilkunde, Bd. xxi., 1883. Q
* Archiv f. OphthaL, Bd. xxv., 1879.
^ Ibid., xxvi., 1880.
a Ibid.
* Ibid., Bd. xxviiL, 1882.
«o Ibid., Bd. xxix., 1883.
>Ubid.
IS In some of the instances mentioned, of atrophy of optic nerves in man bcins
followed by atrophy of both tracts, degenerative changes in these ganglia on both
ides was also observed.
With this object parts of the hemisphere were removed
in new-born animals, and after sufficient time had
elapsed the efforts of such mutilations were carefully ob-
served. Such experiments were made by Gudden* and
Ganser,' of Munich, and Monakow,* of St. Pirmins-
berg, Switzerland. The results of these experiments all
coincided in so far that removal of the posterior part
of a hemisphere was followed by a degree of atrophy of
the primary centres of the same side.
The most valuable experiments were those of Mona-
kow. He always succeeded in obtaining atrophy of the
primary visual centres in rabbits after removal of a very
limited portion in the occipital region, a part correspond-
ing to the area in the dog which Munk has termed the
visual area, of which we will soon have occasion to know
more. Monakow also found that removal of other parts
of the hemispheres, while followed by atrophy of other
subcortical centres, did not affect the primary visual
centres, so that the conclusion appeared logical that the
latter are anatomically connected with a limited area of
the cortex in the occipital region.
Nevertheless such conclusions might be too hastily
drawn. For in these experiments not only is the cortex
removed, but the underlying white brain matter neces-
sarily injured, and thereby fibres may be severed which
pass to other portions of the brain. To avoid this source
of error Monakow resorted to another series of very care-
ful and ingenious experiments (on rabbits). After re-
moval of the area in the occipital region already refened
to, he found not only atrophy of the primary visual
centres, but also atrophy of the fibres of the corona
radiata passing from this part of cortex to these centres.
He now severed these fibres in the midst of their course,
and subsequently observed the effects of their division.
(Operation, like the others, on new-bom animals, which
were then kept alive for weeks or months.) In such in-
stances there was subsequently found atrophy of the
severed fibres of the corona radiata both on the periph-
eral and central side of the section — the same changes
in the primary visual centres as after removal of the
hemispheres — and atrophy of the corresponding part of
the cortex. A microscopical examination of the latter
showed that only a part of the cortex was atrophied— the
third and fifth layers — those containing the large pyra-
midal cells.
This experiment was made many times, so as to secure
accuracy both as to the locality and nature of the changes,
and seems to leave no room for doubt that, in rabbits,
the primary visual centres are directly connected with a
limited area in the cerebral cortex.
The primary visual centres are, then, connected on
the one side with the cortex through fibres of the coroiia
radiata, on the other, with the retina through the optic
nerves. Each set of fibres probably terminates in these
ganglia, and, it will not be difficult to show, are mediately
or immediately connected with one another. The atro-
phied elements found in these ganglia after removal of
the eye or cortex are different according as the one or
other is the source of atrophy. Some layers uniformly
degenerate when the eye is removed, others when part of
the brain has been extirpated. Nevertheless there are
certain parts which atrophy alike from either cause, prov-
ing the relationship of the two systems of fibres.* But
this relationship can be more positively proven in another
way, that is, by the atrophy found in the optic nerves
subsequent to removal of those portions of the cortex
with which we are now concerned It is true, in rabbits,
after removal of the hemispheres degenerative changes
cannot be followed beyond the primary visual centres.
But in rabbits the hemispheres are so little developed
that their destruction does not appear to have a far-
> Loc. cit.
« Archiv f. Psychiarrie, Bd., xiii., zSSa.
» Ibid., Bd. XIV. 188^.
* It would lead too far to enter further into the subject here. I For the micro-
scopical structure of diese ganglia, and the changes takuig place in them in these ex-
perunents, I must refer to the original work.s of Ganscr and Monakow.
August 9, 1884.]
THE MEDICAL RECORD.
149
fgg^hing influence on the peripheral nerve structures.
But it is <l^te different in higher animals, where the
hemispheres are more fully developed. In a dog (Gud-
den)' and in cats (Ganser and Monakow) removal of a
hemisphere was followed not only by the usual changes
in the primary visual centres, but also by atrophy of the
corresponding optic tract, and in both optic nerves,
proving indubitably the direct relationship between the
hemispheres and optic nerves. The exact portion of
the hemispheres was not determined, though in all of
them the posterior part was removed. But Monakow
5^eves— inasmuch as he succeeded with small mutila-
doDS in the occipital region in producing these changes,
while the removal of large parts of the frontal lobes
caused no changes in the optic nerves — that the cortical
visual area is in the same part in cats and dogs as he
had already located it in rabbits.
Experiments have also been made in an opposite di-
rection, that is, to determine the effect of enucleation of
the eye on the cerebral cortex. Munk ' and Vulpian '
have observed atrophy in the occipital region as the re-
sult of such experiments (on dogs), but inasmuch as
others, Furstner * and Gudden * (on dogs), and Ganser *
and Monakow ^ (on cats), have obtained negative results,
we must leave this question as still open. But it is not
probable that much can be gained by such experiments,
both on account of the improbability of decided changes
occurring, and the difficulty of detecting them if any
exist
It is quite justifiable to draw from the above experi-
ments certain, though guarded, conclusions ab to the
aoatomical relations in man. But Monakow, to whom
we owe so much of the above researches, has also been
enabled to make some observations on human beings
which add to the force of such conclusions. He had
an opportunity to examine the brain of an eight-months'
fistus with a parencephalic defect in both hemispheres.
There was entire destruction of both occipital lobes, and
of the superior portion of the parietal lobes, and, as
a result (for everything pointed to its being secondary
to the former), atrophy of the primary visual centres and
both optic nerves and tracts. In another case, a man
seventy years of age, there was softenmg of the occipital
k)be of probably five years' standing, and also atrophy of
the corresponding primary visual centres, and optic tract,
and nerves. In both these instances, it is true, the dis-
ease involved also the white substance of the brain, so
that taken alone they do not prove that the affected por-
tion of the cortex is connected with the optic nerves.
But taken together with the facts, that, in these instances,
other subcortical centres, not in relation with the occi-
pital lobes remained normal, these cases add greatly to
the probability gained from the previous experiments
that the visual area in man is in the posterior portion of
the brain.
The only other observations with which I am ac-
quainted which point directly to such anatomical rela-
tions in man are two cases reported by Hugenin." In
these he found, subsequent to atrophy of the optic nerves,
atrophy of the " cortex of the occipital lobes, where the
occipiul fissure cuts into the margin of the convexity."
In the first case, a man fifty-six years of age, blind
three gr four ^earsin the left eye, he found these changes
in both occipital lobes, but more marked on the side op-
posite to the affected eye. In the second, a woman
forty-two years of age, nearly blind in both eyes from in-
faicy (result of variola), he found the same changes, but
alike on each side. When reported a microscopical
examination had not been made.
^ At die dme Goddca attributed the duwges in the nerves to accidentsd causes,
■t die resoles of sabse<]uent experiments leave little room for doubt diat there was
ktt a csasal irhtionrfiip.
« tr^tf ^ Fnctioaen der Grosshimrinde.
*GMb7Maiik.
*AidiiT£ Pi^cfaiatrie, 188a.
*IiOc;dL
*LflcdL
'LocdL
' CorrcspoDdenzbL f. Sdiweitxer Aerxte, 1878, No. as.
These observations of Hugenin stand alone. ^ For
this as well as for other reasons, partly already re-
ferred to, they cannot be accepted as more than doubt-
ful evidence m our present investigation. Herewith we
have completed the first part of our subject, the evidence
fiirnished by anatomical data of the locality of the
cerebral centres of vision. A brief summary of what has
been said will give us a clearer oversight of the subject
1. Simple anatomical researches teach us that the
optic nerves enter the primary visual centres, and that
fibres pass from these ganglia to the occipital lobes. On
account of the intrinsic difficulties of these investigations
they cannot be accepted as conclusive.
2. Experimental investigation has proven that in higher
animals the optic nerves do not entirely cross in the
optic chiasm. In man the same has been proven by
other means.
3. In rabbits experimental researches (Monakow) have
shown a close relationship between the retinae and a
limited area in the occipital region, the visual area of
Munk.
4. In higher animals (dogs and cats) similar experi-
ments have demonstrated a relationship between the
retinae and the posterior part of the hemispheres. The
exact area has not yet been definitely located, though it
is probably the so-called visual area.
5. Observations on a human foetus and pathological
changes in an adult brain (Monakow), together with the
former considerations, make it highly probable that the
same anatomical relations exist in man.
6. Further evidence for this relationship in man are
two instances (Hugenin) of atrophy of occipital lobes
* following atrophy of the optic nerves. But this evidence
must be accepted as of doubtful value.
PRACTICAL OBSERVATIONS ON THE HUMAN
EAR AND ITS DISEASES, WITH ILLUSTRA-
TIVE CASES.
By SAMUEL SEXTON, M.D.,
AUBAL StfSGBOM TO THB NSW YOMC SYB AMD BAK IMTIBMABV. *
I. — The External Ear.
(Contiaued from No. 7x7, p. xaa.)
It has been claimed that a distinction should be made
between othsematoma and " idiopathic " perichondritis of
the ear. They are thus considered as separate and dis-
tinct affections by Dr. H. Knapp,* who says that " the
majority of authors mention the inflammarion of the
perichondrium under the head of the much-discussed
othaematoma, with which, by Kramer and others, peri-
chondritis auriculae is used as a synonymous term.*^
Dr. Knapp presents a case of the latter disease firom
which it is alleged no blood at any time escaped after
the cyst was punctured, and that it was not, therefore, a
case of othaematoma. This statement, coming from so
reputable an authority, is certainly misleading, since it is
well known that in no case of othaematoma is perichon-
dritis absent, and that, moreover, the contents of the
tumor in ••othaematoma'* are firequently serous.
A peculiar variety of othaematoma remains to be
mentioned which is not always easily distinguishable from
hyperaemia, a condition that I have myself only met
with in the insane, where it is probably due to protracted
and violent rubbing of the auricle. Any portion of the
perichondrium may be involved, but it is usually limited
to a small space. Thickening is often scarcely observable,
and to the feel it is not ••doughy." The deep-seated
nature of the inflamed or congested region, however, may
be discovered by stretching out the auricle between the
observer's eye and a strong light. The effusion is not
> Mickel reported a case with extensiTe dianges in the cortex after bUndness of
probaUy twenty years* duration. In this instance not only are the duMftn very
dttose, but there is no eridence that they were secondary to the occular disease.
« Perichrondritis Auriculae, Archtv. Otology^ voL ix., p. 195 et seq., 1880.
I50
THE MEDICAL RECORD.
[August 9, 1884,
sufficient to form a tumor ; such cases seem to present
the characteristics of the first stage of othaematoma. The
following case is an example of this condition.
Case V. — Ignatius J , aged forty, was admitted
to the New York City Asylum for the Insane, August
18, 1883, ^^^^ dementia. Had to be fed with stomach-
tube; was a mere skeleton. He finally improved
very much mentally and physically, and on October
2 1 St was up and around and eating and sleeping
well. October 28th, slight hsematoma was observed to
be developing in left ear at inferior portion of concha, at
its junction with the meatus. My own examination,
on November 27, 1883, is thus recorded by Dr. Barclay:
The left auricle, whidi is very thin, is of a dusky red
color. The concha, which was naturally large, is much
thickened as far as the meatus, and especially is it nar-
rowed laterally by the thickening of its posterior and
inner wall ; it is, in fact, almost obliterated. No saccu-
lated fluid was ever discovered.
It is notable in this case that the haematoma came 00
at the stage of mitigation of chronic meningitis, and thai
it was confined to the concha. Its benign condition
rendered treatment unnecessary.
Termination, — It will be found that among any con-
siderable collection of lunatics or prize-fighters, a very
considerable number have their ears more or less de-
formed by previous attacks of othaematoma. The writer
has found this condition of things in several large asy-
lums for the insane ; and recently, in the vicinity of
Madison Square Garden, on the eve of a sparring exhi-
bition, he observed a number of persons with ears thus
deformed. In some lunatics, where well-marked deform-
ity presents itself in one auricle, the other will be found
so slightly deranged as to be liable to escape detection
altogether unless closely scrutinized, and in others
scarcely any observable thickening will be found in the
affected organ, the deeper coloring alone afifording evi-
dence to the eye, whilst the slight induration, thickening,
and immobili^ of the skin are not to be detected with-
out careful handling.
It seems exceedingly probable to the writer that in cer-
tain cases where the alienist is in doubt as to the sanity
of a patient, valuable confirmatory evidence of previous
mental trouble might be obtained by an examination of
the ears. Where 3ie deformity is great, in consequence
of an extensive area of cartilage having been ex-
posed by detachment of its perichondrium, the skin
on the outer surface will usually be found to be immov*
able, whilst that on the inner suiiis^qe remains unchanged.
In these cases the concha is liable to be much reduced in
dimensions, its posterior wall being often so much thick-
ened that a narrow vertical slit onl^ remains in front of the
meatus extemus, preventing the mtroduction of any but
a speculum of the smallest size. It is scarcely necessary
to add that the deformity arising firom othematoma is not
influenced by the mental condition of the patient.
The characteristic deformity resulting from othaematoma
is well shown in the following cases :
Case VI. — Joseph B , admitted to the New York
City Asylum for the Insane, May, 1883, was wild, mani-
acal, noisy, and violent ; made unprovoked attacks on his
fellow-patients ; was put on sedatives and became quieter,
but began tearing his clothes. About June 30th two ha&-
matomas of considerable size developed. He was then
excitable, destructive, and filthy. The left haematoma
ruptured about July 9th. July 30th, symptoms of excite-
ment, etc, unabated ; a slight discharge of blood from
the ruptured cyst. August 30th, the left ear began to
shrivel up with reabsorption of the effused fluid. Since
August 20th has given very little trouble, and is now
(February 4, 1884) quiet and well-behaved. Both haema-
tomas are quiet, and the ears have a shrivelled appearance.
Fig. 5 shows the deformity of one of the ears (the left).
Case VII. — Hugh S ^ aged forty-three, admitted to
New York City Asylum for the Insane, September, 1879,
Was demented for one year before admission ; is noisy
and excitable at times. Bodily condition not good, ^as
discharged in September, i88o» and readmitted March
I, 1881. Is incoherent ; prays a great deal — thinks he
Fig. 5.
is a great sinner. March loth, greatly^ excited, lau^^s,
talks and sings ; is filthy. Excitement increased during
the summer, and in autumn his physical condition im-
proved. He continued to have ludlucinations, was hard
to control, and tore his clothing, etc., up to the time
Fig. 6.
the writer saw him, in January, 1884. Fig. 6 shows the
condition of the left ear.* The history gives no account
of the time of its appearance or progress.
PATHOLOGY OF OTHiCMATOMA.
After what has been previously stated in respect to this
affection there remains but little to be said concerning its
pathology. Those interested in the early attempts to
clear up the subject will find the matter discussed by
M. Ferris, Franz Fischer, M. Foville, Virchow, and
others. There seems to be but little doubt of the ex-
istence in many lunatics and inebriates of incipient
1 The author is indebted to Dr. Tnutman for the excelleBt pholOKFiphs fion
which Figs. 3, 4» 5i and 6 were taken.
August 9, 1884.]
THE MEDICAL RECORD.
151
softening and disintegration in the tissues of the auri-
cle, which predispose to separation of the perichon-
drium from the cartilage; that this is always a fac-
tor of very great importance in the production of
othaematoma may well be doubted, since the disease
is scarcely ever known to occur in advanced life, when
such changes would be greatest, unless mechanical
agencies intervene. The extent to which softening of
the cartilage may proceed without any symptoms mani-
festing themselves is not, of course, known, but from the
foUowiog extract it is probably very considerable.
Referring to the pathological histology of the cartilaginous
framework of the ear/ Pollak shows that specimens
*' which were taken from the ears of individuals who had
not, so far as he could learn, been affected with any form
of mental disease," had *' in the cartilaginous portion of
the external meatus, and especially in the antihelix, small
nodules " varying in size ** from a mnstard-seed to a lentil."
These when cut open showed to the naked eye even a
departure from the normal condition of the reticulated
cartilage, and sections under the microscope were found
to be deprived of the fibrillated network in places, and
instead there was a structureless mass. In some peaces
the breaking-down process was even more marked.
Where an actual cavity was made out, it " lay wholly
within the mass of cartilage, and at no point was bounded
by the perichondrium^ which everywhere appeared to be
perfectly healthy."
From a recent examination of a very considerable
number of cases of othaematoma occurring in both men-
tally sane and insane subjects, and consisting of cases in
progress as well as where recovery had taken place, the
writer entertains no doubt in his own mind as to the
universal and immediate precedence of trauma in every
instance. That the pre-existence of the disintegration
spoken of above in the cartilage may influence the sub-
sequent course of the trouble must be admitted. Othse-
matoma occurring in pugilists differs in no respect from
that found in lunatics, its progress being influenced by
the general condition and habits of the patient in both
instances.
These tumors are formed of serum, or serum and blood,
which is efiiised, not under the skin, but under the peri-
chondrium detached from the cartilage ; the contents are
not ordinarily completely liquid, but are liable to con-
tain fibrous or gelatiniform clots, which if not evacuated
attach themselves to the internal surface of the sac dur-
ing the process of union between the two surfaces.
Union is believed to finiClly take place by means of an
exudation of plastic lymph. It was formerly believed
that the exudation produced a new formation of cartilage,
sometimes constituting a uniform layer, sometimes small
patches only, which was the cause of the thickening of
the ears. Virchow,' however, alleges that the cartilage so
commonly found in these cases consists of detached por-
tions of greater or less size,Vhich remain adherent to the
perichondrium, and are not of new formation.
In its r^ressive course the contents of the tumor are
gradually reabsorbed or a puncture gives them exit, the
sni&ces gradually come in contact, and the outlines of
the cartilage begm to reappear, but more or less altered
in distinctness. If obliteration of the cavity is accom-
plished by a moderate exudation of lymph uniting its walls
the deformity will be slight, especially if the tumor has
been but moderately distended by fluid. On the other
band, where the perichondrium has been greatly stretched
bj extreme distention of the sac, it contracts upon itself
as reabsorprion takes place, and adaptation to the car-
tilage as before cannot occur; the misshapen appear-
^tnce of the cartilage increases with the continued con-
traction during the process of adhesion. The ear finally
becomes indurated, and the skin on its outer surface is
omnovable and follows the outlines of the distorted
* MoBUschrift fOr OhrenheiDcunde, July, 187^— Rev. in A. J. O., roU L, pp.
' nSologie des Tumeure, voL ii. Paris, 1867.
cartilage underneath. Sometimes the organized Ijrmph
which obliterates the cavity enormously increases the
thickness of the auricle, an example of which condition
is shown in Fig. 6. Where a thin plastic layer only in-
tervenes finally, as occurred in Fig. 7, the auricle is likely
to be reduced in size, and becomes comparatively thin
and shrivelled ; in either case permanent and character-
istic deformity results.
In some cases, where the effusion has been slight or
imperceptible even, the plastic exudation does not form
a layer of any great magnitude ; the parts eariy are
found to have a doughy feel, and but little thickening
is left behind ; the mobility of the skin is less affected,
and consequently the ending deformity is scarcely rec-
ognizable.
PROGNOSIS OF OTH/CMATOMA.
This affection probably has no prognostic value in
respect to the occurrence, course, or duration of in-
sanity ; but its continuance may be much influenced by
the congestion or bruising to which the auricle is subject
in violent lunatics and in pugilists. The trouble cannot
be said to augur against recovery, since it occurs in de-
mentia when bodily health is improving, as in Case V.,
nor is it obnoxious to any particular form of insanity.
In Hun*s reported cases, nine of the patients died in-
sane in the asylum, nine were discharged unimproved,
and six remained when the report was made— one of
them in a state of dementia.
Generally the disease runs the course already described,
without any complication that endangers life, although,
when extravasated blood becomes putrescent there may
be danger of septic poisoning. In one instance occur-
ring in the writer's practice (Case XI.) the sympathetic ir-
ritation about the head at one time caused considerable
anxiety.
Hearing undoubtedly suffers considerable impairment
in some cases through the deformity of the outstanding
cartilaginous framework of the ear. In the case of a
pugilist examined by the writer, whose auricle was greatly
disfigured, there were permanent defects in this regard,
apparently due to the interference with the normal ten-
sion of the membrana tympani — vide Case X.
Recurrence of the tumor is, of course, impossible,
where complete obliteration of the secreting surfaces
has occurred, although repeated contusions in an auricle
previously affected may give rise to more or less inflam-
mation of the organ. In several prize-fighters examined,
where the ears had been previously the seat of othaema-
toma, constant bruising of the organ seemed to occasion
very little local disturbance.
TREATMENT OP OTILBMATOMA.
In the treatment of othasmatoma in insane and in-
temperate persons, among whom it mostly occurs, be-
sides the diflliculties encountered in controlling the ac-
tions of the patient, mental disease and intemperate
habits exert an unfavorable influence, and thus delay
recovery. Insane persons are more obnoxious to the
trouble when under great excitement, as in acute de-
mentia ; and their violent and restless movements in-
terfere very much with treatment, whilst pugilists are
indifferent, and generally neglect any advice given them.
It is a safe rule in the beginning to be in no haste to
interfere unless rupture of the sac be imminent, since in
a certain number of cases a manifest tendency to spon-
taneous recovery exbts.
In laying out any plan of treatment in this disease, it
will be well to remember that whatever the supposed
cause or causes may be, we have to deal with a peri-
chondritis, in the treatment of which we should be
suided rather by its character than by its causes. And
furthermore, one should be on their guard in respect to
the strong tendency to interfere in these cases ; this is
well expressed in a paper* on the subject by Dr. Wallis.
* Log. ciL
152
THE MEDICAL RECORD.
[August 9, 1884,
This author treated these tumors as abscesses, and after
incision they were poulticed and treated with stimulating
lotions, " but almost always with unfavorable results —
grangrene, and carious destruction of the cartilage, and
not rarely death, was the end.'* This experience in-
duce^ Dr. Wallis to fall back on nutritious diet, mild
cathartics, and the local application of lead wash — ^in
all other respects treating the swelling as a noli me tan^
gere. This treatment, continued for weeks, was success-
ful in a number of cases. Fischer came to the conclu-
sion that eight weeks* treatment affects neither the ter-
mination nor the duration of the disease, an opinion
coinciding closely with the one held by Marc^, whose
belief was that othaematoma* is not influenced by any
treatment, but usually remains for about four months.
In regard to the views above cited, however, it should
be said that the fatal results alluded to by Wallis are
quite exceptional, similar experiences being unknown to
other writers, while Fischer and Marc6 seem to have
carried the expectant plan too far, since no treatment is
notgQoi, practice in all cases.
Practically considered, othsematoma has an aggressive
and a regressive period. All cases, however, do not
range themselves under so arbitrary a division, since the
affection frequently remains stationary for a longer or
shorter time, and very often exacerbations occur from
repeated contusions of the organ.
In its aggressive stage the observer seldom is offered
an opportunity to take cognizance of the incipient
symptoms ; especially difficult to detect is the hyperaemia,
since the auricles are nearly always in a congested state
in violent lunatics and inebriates. Usually a tumor
is already found to exist, and the first consideration will
then be to limit its extension, if possible. If it is found
that the serous or sero-sanguinolent exudation is not
active, and that the quantity already present is not great,
we may prescribe rest for the patient, and administer
small and frequently repeated doses of th^ tincture of
aconite root with a view to arrest the activity of the
circulation of blood about the head. Locally the affected
region, and beyond even, may be enveloped with a coat-
ing of collodion, the gentle and uniform pressure pro-
duced by its contraction acting as a compress, and
thus promoting absorption. The following case, kindly
placed under my observation by Dr. W. A. Bartlett,
illustrates the treatment and progress of a case of this
kind :
Case VIII.— T. F. W \ aged thirty-five, a profes-
sional gymnast, was first seen on May 15, 1884. He
stated that three weeks previously he had received a
" cross-counter " blow upon the left ear with gloved
hand. This. gave rise to no pain, but, two weeks later
on, the ear was again contused by a powerful blow from
the foot of a person in training. The latter injury even
caused ho pain at the time, but twenty-four hours later
(and one week before the writer saw him), after exer-
cising for two hours the auricle was observed to be un-
usually warm, and several physicians who happened to
be present at the time observed that it was swollen.
Dr. Bartlett, who saw the case May nth, found a fluctu-
ating tumor on the outer aspect of the pinna the size of
an English walnut, the skin over it being hot and tense.
About twenty minims of serum were withdrawn by
aspiration, the last few drops of which were tinged with
blood. Afterward hot fomentations were applied for a
day.
The writer found, four days subsequently to the above,
a tumor, slightly pinkish in color, seated at the fossa of
the antihelix \ it had spread itself almost equally in all
directions, encroaching considerably on the concha. It
had partially refilled again, was '* doughy " to the feel, but
not tender. Hearing was unaffected. Half a drachm of
straw-colored Aiid was removed by aspiration, and the
tumor was painted over with collodion, the patient feeling
the pressure. Small doses of tincture of aconite were
ordered, and rest was advised. The next day the tumor
was softer, aspiration was repeated, and the treatment
continued, with the addition of compression by means
of padding of cotton- wool and bandaging. Tumor seemed
to be in statu quc^ effusion having probably ceased and
reabsorption commenced. A notable ' observation was
now made.
It was found that the collodion contracting upon the
tumor had made it quite tense and blanched in appear-
ance, but that with each pulsation of the anterior auri-
cular artery (which supplies the anterior surface of the
auricle) the entrance of the blood-supply was charac-
teriztd by a glow of deep^ed colorings while the subsi-
dence which succeeded to each diitentioH was accompa-
nied by blanching of the parts. The pulsations of the
temporal artery were visible above and in front of the
tragus.
May 19th. — Tumefaction much less ; the outlines of die
antihelix reappearing. Treatment continued, except-
ing the aspiration. May 2 2d, the improvement has
gone on as before ; treatment same ; massage cautiously
commenced Progress was now uninterrupted, the mas-
sage being gradually increased in force and frequency.
By the 29th inst. no fluid remained, the '' doughy" feeling
was less, and the collodion was omitted. The collodion
during the treatment was peeled off daily and a fresh
coating applied. The aconite seemed to have a notably
good effect. Scarcely any deformity was observable at
this time, but the concha was still smaller than normal,
and the outlines of the antihelix were not sharply out-
lined. The patient when discharged was directed to
continue the massage for some time*
Reabsorption is sometimes retarded by the general
condition of the patient, and it is alleged by some au-
thors that a comparatively scanty distribution of lym-
phatics characterizes this region. Whenever this ten-
dency manifests itself, it will be well to employ measures
likely to hasten reabsorption. We may act on the pre-
sumption here that the inflammatory reaction frequently
attending the regressive stage is wanting or inefficient, and
proceed to employ massage or pressure. In the writer's
own experience the latter has been generally unsatis-
factory ; the application of pressure-dressings being ex-
ceedingly difficult, in lunatics especially, who are usually
unwilling to allow them to remain.
We can avail ourselves, however, of the massage treat-
ment in all cases ; it consists in pressing and rolling the
affected portion of the pinna between the thumb and
forefinger for some minutes or more at a time. This
manipulation is usually unattAided by pain, and, more-
over, has this advantage, that it can, when necessary, be
entrusted to sane patients themselves. At first it may
be practised once or twice daily, and afterward more
frequently, the length of each stance being extended as
treatment progresses.
The behavior of these tumors under continued and even
severe bruisings is instructive. Thus the writer, assisted
by Dr. W. A. Bartlett, recently made a study of othsema-
tomata in pugilists, which showed that recovery was not
impossible under apparently unfavorable conditions, al-
though it should be added that unsightly deformity re-
mained. The following were among the cases ex-
amined :
Case IX. — John F , twenty-nine years of age, in-
temperate, has been a boxer for ten years. Nine years
ago he received a blow from "cross counter" upon left
ear. The auricle became swollen, red, and tender,
the pain extending all about the ear and down the
neck. The tumor never opened, and became indurated
in about one month. While the tumor remained
"soft" it was repeatedly struck in boxing without
other effect than slightly increasing the local sensitive-
ness. After recovery, which took place without treat-
ment, constant bruising failed to produce a recurrence
of the tumor. The outer surface of the left auricle is
irregularly nodular — the fossae being obliterated and the
outlines of the ear completely destroyed, with the excep-
August 9, 1884.J
THE MEDICAL RECORD,
153
tion of the helix, which was not affected. The auricle is
•about three-fourths of an inch thick, and the concha is
reduced in size, due to thickening of antitra^s. The
posterior surface is nomiaL The ear never discharged,
and hearing is good.
Case X. — Thomas A , twenty-six years of age,
has been a boxer for many years. Received a blow
upon left ear from '^ cross counter'* three years ago,
producing a soft, tender swelling of the ear, and much
pain in the organ and side of the head and down the
neck. There was also a '* numb '' feeling and autophonia,
which remains. Hot milk and slippery-elm poultices
irere applied The tumor i^as at first purple in color,
afterward it became red. It remained "soft" for a
period of five months, during which time it was frequently
raptured by blows. Afterward it became hard and de-
formed. The auricle is smooth, all of the markings being
obliterated except the anterior portion of the helix which
is normal, and is fully one inch in thickness. The pinna
seems folded upon itself from above downward. The
concha is impinged upon from behind, leaving a mere
slit in front of the meatus extemus. There is some
deafness in the left ear, due doubtlessly to the blow upon
the organ. The resulting deformity is similar to; that
shown in F^. 6.
In resorting to methods calculated to increase absorp-
tion, however, care must be exercised lest they increase
aoduly the local irritation. In relation to this matter
the]^ollowing paragraph is su^estive : " Physiologically
the membrane of serous cavities secretes a serous fluid,
which is taken up again by the vessels with great facility,
this faculty of reabsorption is demonstrated by the rapid
disappearance of injected fluids. But if the serous
membrane is inflamed, the reabsorption of an injected
fluid is impossible (Rindfleisch), and the irritation of the
serous membrane determines an abundant secretion.
Even a slight irritation is sufficient to transform a serous
bursa into a cystic cavity. Such a transformation of a
subcutaneous serous bursa is known as a hygroma, and
may be called a tumor because of its tendency to persist
indefinitely." ' If extravasation in the begiiming goes
on rapidly, threatening to denude the cartilage more and
more, or where reabsorption comes to a standstill, an
aspirating needle may be inserted into its most depen-
dent part and the fluid evacuated ; the subsequent treat-
ment should then consist in the methods already recom-
mended. The evacuation of fluid may be repeated as
often as the sac refills. The operation can usually be
performed with the ordinary hypodermic syringe.
When the tumor is large and contains a considerable
clot it is best to make an incision large enough to per-
mit the contents, including the clot, to escape, and, pince
fbe tamor is almost sure to refill again, a silk seton may
be passed through the opening thus made and brought
out agaii^ above, to insure drainage. The wounds hav-
ing a strong tendency to reunite should be kept open by
occasionally drawing the seton through the tumor whilst
pressing out the contents. As soon as the secretion
lessens, its removal will be best accomplished by aspira-
tion. It was formerly recommended to bring about ad-
hesive inflammation by keeping up irritation with the
seton, but thb can be much better accomplished by mas-
sage.
When the above treatment is judiciously employed we
may expect to witness a gradual diminution of the tu-
nor anid complete reabsorption of the fluid in three or
bnr weeks ; and, moreover, it is believed that much less
&figQrement will ensue than occurs in cases allowed to
nm their course without such aid. The longer an ac-
^▼ely progressing tumor is permitted to go on toward
spontaneous rupture, the greater will be the separation
of the perichondrium from the cartilage, and conse-
quently the greater the ensuing deformity.
(To be ooatioued.)
^* Condi aad Rannen : Padiological Histology, pp. 167, 168. Philadelphia,
Hepatica — A Useless Drug except to Patent
Medicine Vendors. — Messrs. J. U. & C. G. Ll<^'d, of
Cincinnati, have been investigating the subject of liver-
leat Of late years this drug has been extensively
consumed in the preparation of certain proprietary
medicines. From statistics collected by Messrs. Lloyd
it appears that last year over 340,000 pounds were con-
sumed, of which amount over 300,000 pounds were im-
ported from Europe. Four years ago the entire con-
sumption did not reach 10,000 pounds. Our native
species are named anemone acutiloba, and anemone
hepatica, and very closely resemble each other except in
the shape of the leaves : the former has sharp lobes to
the leaves ; the latter blunt lobes. Our Pharmacopoeia
has recognized but one species — the round-lobed form.
It is proven, however, by Messrs. Lloyd, that nine-tenths
of the native drug of commerce is collected from the
«harp-lobed species, which has never been oflicially rec-
ognized. The medical properties of hepatica are unim-
portant. The plant does not contain an active principle,
and is as devoid of characteristics as is the grass of the
field. Of the vast amount of the drug consumed, it is
creditable that the medical profession uses but a small
per cent. Almost the entire lot is employed in the prep-
aration of certain secret remedies. — Drugs and Midi-
<ines of North America (Cincinnati), July, 1884.
Bicarbonate of Soda in the Treatment of Ton-
MLUTis. — In the early stages of tonsillitis, before the
pain of swallowing is excessive, Dr. Gin6 Partagas claims
that bicarbonate of soda will arrest the inflammation.
He makes the application in the following manner : The
index finger being moistened is charged with as thick a
layer of the powder as will adhere to it, and is then intro-
duced into the mouth and rubbed thoroughly over the
inflamed tonsil. Five or six applications are thus made
at intervals of five minutes, at the end of which, Dr.
Partagas claims, the patient will find the act of swallow-
ing nearly painless. When thus employed in the eariy
stages, bicarbonate of soda will abort the disease, and
later will promote re^lution. In hypertrophy of the
tonsils two or three applications of the powder each day
will reduce the size of the gland very considerably in one
or two months.— ^i/r«a/ de M^decine ei de Chirurgie
Pratiques, June, 1884.
CocAiN. — Dr. Aschenbrandt, of Wttrzburg, has made
some experiments on the action of muriate of cocain on
the human organism. He administered the drug, un-
known to the subjects (who were soldiers), in doses of
about one-sixth of a grain in cases of exhaustion and
fatigue from various causes, and found invariably that
the lassitude was speedily removed, and that the men
could go on for hours without feeling either hunger or
thirst. One of his experiments was made on himself
after a sleepless night, with the prospect of a long day's
march before him, when a dose of cocain (taken in coffee
about 3 A.M.) enabled him to go the whole day without
feeling hunger, thirst, or fatigue, and he dined late in the
afternoon with his usual appetite. He considers the
drug to be a direct nerve food, and not a stimulant
merely ; but its stimulating action is certainly far above
that of alcohol, and it appears to have no injurious after-
effects.
Pagbt's Disease of the Nipple. — Drs. Duhringand
Wile regard Paget's disease as an abnormal proliferation
and degeneration of the rete, with secondary destruction
of the papillae of the corium, and subsequent develop-
ment of scirrhus cancer of the atroph3ring variety. The
cancerous change originates in the epithelium of the
smaller ducts, and advances from below upward and
outward as far as the skin is concerned ; later it attacks
the gland structure ; and the retraction of the nipple is
an early sign of carcinomatous change. — The American
Journal of the Medical Sciences, July, 1884.
154
THE MEDICAL RECORD.
[August 9, 1884.
The Medical Record
A Weekly JoMrnal of Medicine and Surgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
PUBUSUXD BY
WM. WOOD i Co., Nos. 56 and 58 Ufayette Place.
New York, August 9, z884«
BABY.FARMING AS A FINE ART.
The unique feature of a successful baby-farm, in contra-
distinction with all other institutions, is that the most
conclusive test of merit is the small number of the
graduates. This idea was aptly illustrated by a witty
paragrapher on a Philadelphia paper, who imagined a lady
with a burden in the form of a child going to a profes-
sional baby-farmer and negotiating for the child's board
in the ^'horne." In concluding the arrangements the
lady said, '*But what assurance can you give for the
faithful discharge of your trust ? " Proudly conscious of
her peculiar abilities, the baby-farmer made reply,
" Twenty-one deaths out of a possible twenty-three in
the past six months." Needless to say, the new patron
retired convinced she had made no mistake.
The subject no doubt is a sorry one to make a jest of,
yet when the humorist strikes so true a key he may
easily be pardoned for its unseemliness. Every one who
has read of the exposures of baby«farming near this city
must have noticed that the publication of the facts as to
diet, attendance, surroundings, and large death-rate
does not seem to lessen the number of children in the
identical '* boarding-houses " exposed. Under such cir-
cumstances it must naturally be presumed that the per-
sons placing children out in this way do not desire the
best, but do desire the worst, accommodations to be ob-
tained. The patronage of these farms comes not from
that portion of the community sometimes called the
"lower" and *' poorer" classes. In reality, the great
majority of these unhappy infants are the offspring of
well-to-do fathers or mothers, who, even with the heart-
knowledge of their own immorality and crime, prate and
expatiate upon the increase of crime and laxity of morals
due to the leaven of foreign ideas in our body politic
An incident in illustration was given in The Evening
Telegram one day quite recently. The reporter was going
the rounds of the East Side with a sanitary inspector,
and in one of the tenement-houses on Orchard Street
came across this scene : '' On the second-floor there was
a poor half-starved child seated in a chair chewing a
cracker. A man in the room above said the child was
an adopted one. Every week an elegantly attired lady
came to see it. He could tell no more than that, but he
knew the child was oi gentle birth. The doctor found
the woman who had charge of the child, and gave her
some medicine and a ticket to the Seaside Sanitarium."
One other gift has the baby-farmer who really under-
stands her business that commends her to those desiring
her services, and that is the complete obliteration of
identity a child undergoes after becoming a boarder. •
This phase of the industry, it will be remembered, was
brought out in the suit of Sivillar Berkely, claiming to
be the wife of Forrest S. Downing, for the recovery of
her child, who, she asserted, was in the care of a well-
known baby-farmer. The evidence in this case was
strong on both sides, but as might have been expected
was against Miss Berkely. Perhaps under some condi-
tions needless to mention but easy to infer the child
might have been shown by testimony to have been other
than Carlos Wilson or even Miss Berkel/s. An under-
taker during this trial testified that forty-five children
were buried in coffins precisely alike and the circum-
stances of burial the same. These conditions surely
give little opportunity for future recognition, and there
are, and may be, many cases where some certain means
of identification are needed, as in the case cited above.
Another model establishment is the one on One Hun-
dred and Sixty-fourth Street, to which the daily news-
papers have devoted some attention within the last two
weeks. The proprietress of this farm no doubt by this
time has a heart swelling with gratitude to the press for
placing before the public the unexcelled advantages of
the place she presides over. Then there is the " Chil-
dren's Sanitarium *' in New Jersey, near enough to New
York to be of some interest. The devoted guardian of
this charming retreat is the motherly Christian lady who
believes it needless to obtain a permit for burial on the
decease of a child. In this case, however, there is some
hope of punishment, or Jersey justice will be belied.
Some of the baby-fiairmers must attain remarkable pro-
ficiency in their calling, if they pass through the long ex-
perience of the old lady seventy-six years of age, who
applied for permission last week from the Brooklyn
Health Commissioner to establish a baby-farm. She
had been in the business thirty years, and as she was
well recommended her desire was gratified.
Still, with the innumerable evils of the system so appar-
ent, it is unjust to say that all the keepers of baby-farms
are as heartless as they are pictured. Many, undoubtedly,
are even more pitiless than they are painted. From the
very nature of the business, the condition of birth, and
the youth of the inmates, a large death-rate is to be ex-
pected, even in the establishments that have come under
public notice. But when to these are added improper
food, poor sanitary arrangements, lack of care and proper
inspection, it becomes a frightful one. The whole aim
of the typical baby-farmer is to make as much as possible
with the least expenditure of time, labor, and mopey.
Whenever the domestic economy of one of these places
has light thrown upon it there is some show of an in-
vestigation. It subsides, however, and is . only thought
of when another instance comes up. When one of these
inquiries is in progress the baby-farmer seeks to impress
on the minds of all that she is endowed with every in-
stinct a perfect mother should display toward her child.
They give the hearer the same impression he would feel
listening to Madame Frochard in the '* Two Orphans,"
recounting her love and kindness for the blind girl
Louise.
As long as society exists under its present conditions
it is fair to suppose that baby-farming will be a fixture.
August 9, 1884.]
THE MEDICAL RECORD.
155
But if it most be conducted, it should be under a stern
and rigid inspection, with no opportunity for the escape
from punishment of those violating the provisions in re-
gard to it
SPECIAL DEPARTMENTS IN HOSPITALS.
We have received the first annual report of St Mary's
Hospital, Brooklyn. The report contains some facts
that win have an interest to those concerned in hospital
managemeDt and organization.
The medical and surgical staff numbers no less than
tfaffty-Zbrn- persons, not including the pathologist and
curator. These gentlemen preside over eleven different
departments, embracing gynecology, fractures and dislo-
cations, genito-urinary surgery, diseases of the thorax,
diseases of the abdominal viscera, obstetrics, neurology,
dBcases of children, and so on. Each department has
its chief and two or three associates. In other words,
the cases are divided up very much as is done in the city
dbpensaries, instead of having simply a medical and
soigical service. This decidedly novel plan has now
been practically tried for a year, there having been 617
patients treated during the time. Regarding its workings,
we cannot do better than quote the words of the report :
"Whatever forebodings, as to the practicability of
such an arrangement, may have existed at the outset,
and while some without due reflection viewed this new
departure with doubt or disfavor, and not a few predicted
non-cohesive disaster, the results as set forth in this first
annual report will, it is hoped, clearly prove not only its
practicability, but that a high degree of co-operative ef.
fidcncy in the professional service has been effected.
Tht history of each patient on entering the hospital is
carcfiilly recorded, and he or she assigned to the appro-
priate department, after which the head or chief of such
department assumes his or her care and treatment, and
becomes responsible and, in a measure, accountable to
the entire faculty as a supervisory body. In this man-
ner not only is the professional work better and more
orderly conducted, and the patient, doubtless, the
gainer, but the most perfect harmony exists, and each
member of the hospital staff finds his intercourse and as-
sociation with his colleagues both pleasant and profitable."
Certainly one year's experiment does not settle the
qoestion of the real wisdom of this new plan. It will be
interesting to study its workings, however, in connection
with the entirely opposite method pursued by certain
hospitals in. this city; as for example Roosevelt, where
^e is but a single chief surgeon for the whole surgical
service.
Bar it may be inquired now whether the Brooklyn
plan is not more just to the patient and physician, and
cqnally fruitful in scientific results.
CONCERNING COMMITMENT TO INSANE ASYLUMS.
Thi lunacy laws of most communities need overhauling
in order to provide proper security against the incarcera-
tion in asylums of persons who are not in fact insane.
This is true in this country, for there have been within a
fev years several remarkable instances of unjust com-
BBtment through the cupidity or hatred of relatives. The
same is true also of England, as will appear from the
io&owing statement of a recent litigation, which we take
fi-om one of the legal journals : A case of unusual im-
portance is that of Weldon v. Winslow, recently tried in
the Queen's Bench Division of the English Court, and in
which the judgment has been reversed by the full Bench.
The action was against Dr. Forbes Winslow, the alienist ;
it was brought by Mrs. Weldon, whom Dr. Winslow had
advised was a proper subject for restraint in an asylum,
and whose husband he had aided in endeavoring to put
her under such restraint.
The action was for assault and also for libel — the as'
sault being the attempted restraint, the libel being hi»
letter to the husband sa}'ing that immediate steps to se-'
cure her should be taken ; meaning thereby, as plaintiff
alleged, that such steps must be taken to put her in con-*
finement as a lunatic.
The doctor relied for his defence as to the assault on
an order made on certificates under lunacy statutes ; and
as to the libel, upon his privilege, as a physician, to write
such a letter without malice and in discharge of his duty.
Mr. Justice Manisty, in a lengthy opinion, in which Justice
Williams concurred, and which will probably soon appear
in the current reports, condemned the course of the de-
fendant, who was the proprietor or manager of the asylum
to which it was proposed to take plaintiff, for having
taken any part in the arrangements for procuring the
physicians' certificate, and also criticised the conduct of
the physicians, who, instead of making two separate and
independent examinations, went together to see her, and,
after having an interview together with her, took turns in
stepping out, that each might make, what they called, a
separate and independent examination.
The Court held that the fact that those steps were
taken in pursuance of the plan of sending the plaintiff to
an asylum of which the defendant was the proprietor,
where he would receive compensation for receiving her,
was sufficient evidence of improper motive to require the
submission of the case to a jury, and that the Judge at
the trial erred in assuming that Dr. Winslow would not
be actuated by sordid motives, and dismissing the action
for want of evidence to show any improper motive.
The Court evidently appreciated the eccentricity of
. the plaintifi; for they said that the great difficulty in the
argument of the case had been to get at the facts, for the
plaintiff, both at the trial and on the argument in the ap-
pellate Court, conducted her own case.
But they rightly said that it is not every mere harm-
less delusion of eccentricity which requires a person to
be confined in an asylum.
Few professional positions are more difficult and deli-
cate than those in which a lawyer or physician stands
when called upon to advise upon a question of this kind,
and to take the necessary steps to secure commitment.
The only safe and right course is for those concerned to
consult either a medical man, or, better still, a competent
lawyer conversant with such subjects ; in either case se-
lecting one who has nothing to do with the asylum to
which it is contemplated to commit the subject, and to
separate entirely the matter of application for commit-
ment from any connection with the subsequent custody
and management. The convenience and saving of time
effected by relying on the aid of the physician of an asy-
lum for securing commitment, is not worth purchasing at
the cost of the mischief which may be involved.
156
THE MEDICAL RECORD.
[August 9, 1884.
LEPROSY, AND ITS DANGERS.
Good results may follow evil methods, and whether Dr.
O'Donnell be a charlatan and an alarmist or not, he has
excited interest in a subject th'at deserves the attention
of the American people.
Leprosy is not a disease of which those who are cleanly
and chaste need ever have any fear ; but as a large num-
ber of American citizens possess neither of these virtues,
it is well that they provide against the contingency of
elephantiasis graeconim. For there is little doubt that
leprosy is contagious, just as syphilis is contagious, i.e.^
through the agency of the secretions and blood. Among
licentious people it may spread with rapidity. The in-
fluence of heredity is also potent in increasing the num-
ber of victims. Lepers reproduce lepers, though fortu-
nately the second generation dies before it can be pro-
ductive.
The contagion of leprosy, according to Dr. George
Thin, lies unquestionably in the bacillus Upra^ first dis-
covered by Hansen. This bacillus resembles very
closely that of tuberculosis. Its habitat is the lymph or
white blood-corpuscle, which it changes into the leprous
cell. It makes of this an irritative body, producing the
peculiar exudations and low grade inflammatory condi-
tions characteristic of the disease.
The parasitic theory of leprosy is an interesting one,
and, if true, would throw a new light upon methods of
prophylaxis and treatment. It is difficult, however, to
explain satisfactorily by this theory the fiauits of heredi-
tary transmission of the disease, and especially such a
one as is given by Dr. A. W. Saxe. That writer says :
The healthy wife of a leper gave birth to a leprous
child. Her husband died. The still healthy widow mar-
ried a healthy man, and gave birth again to a leprous child.
As regards China and leprosy, it is to be borne in
mind that, if we are to legislate against the disease, we
must not single out China. Leprosy exists also in Mex-
ico, the West Indies, India, Norway, Sweden, New
Brunswick, Australia, the Sandwich Islands, Eastern
Africa — in fact, on the sea-coast in nearly ail tropical
regions.
In India there are said to be over 100,000 lepers ; the
number in China is unknown, but is unquestionably
great. The Hawaiians, of all people, are most scourged
by it, nearly one-tenth of the population being affected.
Four years ago there were between fifty and one hun-
dred lepers in the 'United States. Whether this number
has increased we cannot say. One thing is certain,
however, that the disease cannot be spread by the
simple exhibition of cases of leprosy before the public.
However bad the taste or useless and sensational the
object of such a performance, it would be as innocent
to public health as the exhibition of a like number of
cases of syphilis.
The citizens of New York who have been so worried
over the possible introduction of leprosy into this city,
should be informed that for years there have been one or
more lepers in the city hospitals, one even having served
for a time as a nurse in Bellevue Hospital.
While leprosy is a disease about which much is un-
known, there are certain facts that are tolerably well
established. These have been formulated by Dr. A. W.
Saxe (" Report on Hawaiian Leprosy ") as follows :
" I. Leprosy is not a form of syphilis.
'' 2. It is a specific and well-marked disease.
" 3. There are two varieties — the tubercular and anas,
tkctic [some add a third, the tnacular'],
" 4. These varieties may be distinct or associated.
" 5. It is more common in males than females.
" 6. It is hereditary.
<' 7. Itfis contagious.
** 8. It is incurable.
<' 9. Europeans are to a certain extent exempt from the
disease, probably from greater precautions in avoiding
the contagion.
*' 10. The causes of the disease are unknown.
" Finally, leprosy disappears with improved hygienic
conditions of a people, cultivation of the soil, and ab-
solute isolation of all lepers."
In some cases, we would add, the disease seems to
disappear despite the most favorable conditions forit8
propagation, as has been noted in the Virgin Islands by
Dr. Bonn.
THE PROGRESS OF THE CHOLERA.
The reports from the cholera-infected districU show, at
date of writing, that the disease is unquestionably de-
creasing at Marseilles, Toulon, and Aries.. On August
3d, for the first time since the epidemic began, no deaths
from cholera at Toulon were reported. The} number of
deaths daily in that city has fallen to an average of three
or four, while the cases in the hospitals number about
one hundred.
At Marseilles the daily death-rate has varied between
seven and twenty-eight. The number of new cases has
gradually fallen.
On the other hand, a few cases of cholera have oc-
curred at various places in the neighborhood of the
stricken cities, and in several cities and towns in Italy.
A case of cholera is also reported to have occurred at
Geneva, Switzerland.
The New York Times has continued to publish excel-
lent cable reports of the cholera^s progress. Consul
Mason, of Marseilles, has also given an interesting ac-
count of the development of the epidemic. This gen-
tleman writes :
" The present situation may be, therefore, summarized
as follows : The epidemic which now prevails at Mar-
seilles aind Toulon is Asiatic cholera, imported, beyond
all reasonable doubt, from Saigon, China, by the French
transport Sarthe, to the port of Toulon. At first the
disease was of the type medically classified as ' benign,'
but its malignity has since increased by its further dif*
fiision and development under the influence of con-
tinued hot weather. At Toulon the epidemic has spread
in some degree to neighboring villages, and frx>m Mar-
seilles it has penetrated as far toward the interior as Aix,
in Provence. The sea-going commerce of Marseilles is
for the time almost entirely suspended. Italy, Spain,
Tunis, and Algeria, impose quarantines of from seven
to fifteen days upon all vessels from these two mfected
ports. Ottoman ports absolutely refuse entry to such
vessels upon any and all conditions. A strict quaran-
tine of seven days has been established on the land fit)n-
tiers of Italy and Spain against all persons coming from
France ; and the conditions of these frontier quarantines
August 9, 1884.]
THE MEDICAL RECORD.
157
in respect to baggage and merchandise are daily becom-
iog more rigid and exacting. Under these hopeless con-
ditions, nearly all the steamship lines between Marseilles
ind other Mediterranean and Eastern ports have sus-
pended operations, and have, or will soon, close their
offices m Marseilles. On the French island of Corsica
no vessel from Toulon or Marseilles is permitted to land
passengers, baggage, or merchandise. In Lyons, and
at the Paris terminus of the Paris, Lyons, and Mediter-
ranean Railway, all passengers, baggage, and freights, as
well as cars coming from Marseilles, are fumigated, dis-
infected, and subjected to the strictest surveillance.'*
Chairs of Hygienk have recently been established
at the Universities of Prague and Gratz.
WiLLARD Insane Asylum. — Dr. P. M. Wise has been
appointed Superintendent of the Willard Insane Asylum,
in place of Dr. Chapin.
A Diagnosis. — '* Congestion of the right kidney " is
the diagnosis made by his attending physician of an in-
disposition from which Rev. Henry Ward Beecher has
been suffering.
Legislating about Cholera. — M. Paul Bert has
proposed in the French Chamber a law which compels
eveiy doctor to report without delay the appearance of a
case of cholera*
Not in Favor of Women. — ^The University of Hei-
delberg has been offered the sum of 100,000 marks on
condition that it would admit women to its courses. The
offer was refused.
The Summer Sanitary Corps. — During the week
ending July 26th the summer corps of physicians visited
5,328 houses and 25,536 families, treated 945 patients,
and distributed 2,520 circulars and 1,085 ^^^^ excursion
tickets. Of the diseases treated 463 were diarrhoeal, 126
of lungs and throat, and 59 contagious.
Suicide cm Account of Headache. — One often
hears patients declaring that they will kill themselves if
die pains from which they suffer continue. Suicide,
simply on account of physical pain, is, however, rare.
Recently such a case was reported, the victim having
spparently suffered from brain tumor. Only last week
we referred to the case of an epileptic who shot himself,
because of his incurable affliction.
Cholera and the Migration of Birds. — ^A cable
dispatch says : The fact that the swallows, which migra-
ted from Marseilles at the outbreak of the pestilence,
have not yet returned, and that there are no sparrows at
all in the city, is adduced as evidence that the atmosphere
is still vitiated This migration of the birds has made a
deep impression upon the public mind, and has led to a
demand for a purification of the atmosphere by means of
bonfires.
A New Treatment for Ulcer of the Stomach.
— M. Debove proposes to treat gastric ulcer by practi-
cally annulling the function of the stomach. He gives
&e patient the following dose three times daily : Poudre
deviande, 25 grammes; bicarbonate sod», 10 grammes.
He gives this generally by the syphon tube. In addi-
tion he lets the patient drink a litre of milk daily. It
is believed that the alkalinized food passes through into
the intestines without exciting gastric action.
A New Medical College in the District of
Columbia has been organized with the following Fac-
ulty : Dr. John T. Winter, Professor of Materia Medica ;
Dr. Howard H. Barker, Professor of Obstetrics and
Dean of the Faculty ; Dr. T. E. McArdle, Professor of
Surgery; Dr. Samuel F. Adams, Professor of Theory
and .Practice of Medicine -, Dr. G. W. Cook, Professor
of Physiology ; Dr. G. William West, Professor of Anat-
omy. The new college is to be called the Medical De-
partment of the " National University."
Static Electricity as a Preventive of Cholera.
— Professor R. Vigouroux contributes to Ze Progrls
Medical an article upon the above subject. He refers
to the experiments of Boillot, Angus Smith, and Chap-
puis, which prove the great disinfectant properties of
ozone. He then shows that by the static electrical bath
upon the insulated stool ozone is disengaged most per-
fectly and effectively. The electrical bath gives also a
stimulus to nutrition which is of importance. Vigouroux
concludes that a daily electrical bath on the insulated
stool is the best prophylactic against cholera.
An Office Thief. — Dr. A. H. Friedenberg, of this
city, writes : " Will you kindly allow space in your jour-
nal to warn your readers against another office thief. He
is of medium height, slender, blonde, with a smooth face
and but a small blonde mustache; he is a German,
speaking English fluently, but with a slight accent, well
dressed and genteel-looking, and about nineteen or twenty
years of age. He follows the same methods as his pre-
decessors in his specialty. He must wait for the doctor,
or if that is denied him, he sends the servant on some
errand, while he waits in the hall." He managed to steal
a microscope from our correspondent.
Ammonia as a Prophvlactic against Cholera. —
Dr. S. W. Ingraham, of Chicago, writes : " During the
years 1865 and 1866 I spent much of my time in New
York City, and as the cholera was quite epidemic there
during those two years I took occasion to ascertain what
class of people were least subject to it. I found that the
men who worked in horse stables were rarely, if ever,
attacked with the disease, and that their families were
less liable to the contagion than persons of other occu-
pations living in the same localities, with the endemic in-
fluences nearly or quite equal. Upon special examination
I found the clothes and even the skin saturated with am-
monia to such an extent that when they came in close
proximity to me I could plainly discern its odoriferous
properties. From this I was led to believe that their
whole bodies were more or less under the influence of
the ammonia, and that the cholera contagion would not
attach to them.''
Doctors and Sanitation. — The following will be read
with interest, as it shows, if we mistake not, that it is the
plumbers and architects who have been the real sanitary
reformers ! Says The Sanitary News : " The great fault
of all medical journals and practitioners lies in this fact,
which The Sanitary News has often endeavored to point
out to their near-sighted or averted gaze, namely, that
the most efficient and reasonable sanitary work is accom-
158
THE MEWCAL RECORD.
[August 9. 1884.
plished by men outside the medical profession. The
really useful and valuable sanitary work which conserves
the public health is done by these same * perpetrating '
architects and by plumbers, when tliey design and execute
those measures which cheat the physician out of his bill
by preventing the causation of disease by defective drain-
age, etc. What have the medical gentlemen accomplished
in their own branch of sanitary work ? Have they been
^ble positively to prevent one single disease ? " Will
pot our excellent contemporary the News now publish
some letters from •* A Plumber to a Young Doctor," for
jexample, telling him how to avoid typhoid fever, cholera,
jsmall-pox, etc. ?
The Waste of the Medical Profession, that is
Ko say the number of annual losses by death and other-
wise in Great Britain and Ireland is, according to Sir
^yon Playfair, about 1,600. The Lancet denies this and
says that the number of deaths annually among the twenty
odd thousand British doctors is only about 525, while
jthe number. newly registered is over a thousand annually.
Applying the same death ratio to the United States the
annual loss by death should be between 1,500 and 2,000.
The annual additions to the medical ranks, judged by
^he number of students graduated annually, is over three
thousand.
An English Cholera Commission. — The English
Government has at last appointed a Commission, consist-
of Dr. Klein, F.R.S., and Dr. Heneage Gibbes, to pro-
ceed to India and study the cholera. They are expected
to act in conjunction with an Indian Cholera Commis-
sion also recently appointed. It is gratifying to learn
that two such well-quali&ed gentlemen have been ap-
pointed for this important work. Still, although there is
a broad field for investigation, one cannot but think that
Ihe English Government has been vtxy laggard in ap-
pointing the Commission, and that its action now re.
minds one of locking the stable-door after the horse is
stolen.
Scientific Investigation into Cholera. — ^The phy-
sicians of Marseilles have been experimenting with a
pumber of old remedies for cholera, and, as might be ex-
pected, with little success. Inhalations of oxygen (and
ozone?) seem to relieve dyspnoea somewhat. Intra^
venous injections of saline solutions have done no per-
manent good. A Professor Reitsch, heretofore unknown
to the scientific world, claims to have accomplished some
extraordinary results. He has, he says, successfully in-
oculated dogs with the cholera bacilli A correspon-
dent of the Times takes the trouble to telegraph across
the Atlantic that Professor Reitsch has also discovered
a way of studying the cholera microbe alive under the
microscope ! It is needless to say that this in one of the
first things that the discoverer of this microbe himself
performed. The same wonderful Professor has discov-
ered an infallible way of determining the severity of an
attack in any case by an examination of the dejections.
This method he (naturally) keeps secret. We suspect
that Professor Reitsch is a humbug, or else is greatly mis-
represented by cable.
Cholera and the Temperature. — Simultaneously
with the appearance of the first two virulent cases of
Asiatic cholera at Marseilles, there began a period of in-
tense sultry heat, which, with the exception of one day
continued till the last of July. On the evening of ju^^
28th, this stifling heat was accompanied by dense swinns
of mosquitoes which settled upon the lower part of the
city, and were only driven off by fires of pitch and resin
which were lighted along the streets during the night.
It is remembered that a similar visitation, accompanied
by a similarly dead, stifling atmosphere, had marked the
beginning of the great epidemic of 1865, and this circum-
stance, added to the steady increase of the disease at
both Toulon and Marseilles, produced a panic which con-
tinned several days. During this period many thousands
of people removed to suburban residences or the interior.
The Doctors and the People of the Infected
Cholera Districts. — There is no doubt much exaggera-
tion in the dispatches regarding the relations of the
people to the doctors in the cholera districts.
One report says : The lower classes dislike and oppose
the physicians because they have gotten the notion that
the physicians have been instructed to help the cholera
along in order to get rid of the surplus population. A
paper read by a physician in Berlin lauding the cholera
as sweeping off beings unfitted for the struggle of exist-
ence, has been widely reproduced in France, and has
helped to. prejudice the people against the doctors and to
confirm them in their belief that the government has
adopted views similar to those of the fierlin essayist. An
instance of the popular hostility toward the physicians
occurred in Marseilles, July 30th. A doctor was going
into the slums to attend a patient, when he was con-
fronted by a party of the sick man's neighbors, armed
with knives, who chased him away and prevented his
ministering to the sufferer.
On the other hand the Municipal Council of Marseilles
has resolved to erect, in a prominent place, a tablet to
commemorate the noble self-sacrifice of the doctors and
Sisters of Charity who were victims of the epidemic Dr.
Patras, who died July 31st, will have a street named after
him.
THE SIMS MEMORIAL FUND.
To the Medical Profession and Others thnmghout the
World:
The great achievements of Dr. J. Marion Sims call
for some more lasting testimonial than obituaries and
eulogies. To him m^ical science is indebted for much
brilliant and original work, especially in gynecological
surgery. Those who have been benefited by his teach-
ings and new operations, and such as have had the direct
advantage of his personal skill are among the first to
recognize and acknowledge this debt
To him is due the honor of giving the first strong im-
pulse to the study of gynecological surgery in America.
It is believed that the medical profession everywhere,
the vast number of women who owe their relief from
suffering directly to him, and those who realize the
benefits he first made possible, will gladly unite thus to
honor the man through whose originad and inventive ge-
nius such blessings have been conferred upon humanity.
At the sugj^estion of many fiiends, therefore, the sub-
joined committee has been oiganized, and it is proposed
that a suitable monument be erected to his memory in
the city of New York.
To this end the active cooperation of the medical
profession and the many other firiends of Dr. Sims
throughout the world is respectfiilly solicited. Contribu-
August 9, 1884.]
THE MEDICAL RECORD.
159
tioDS d one dollar and upward may be forwarded to the
journal i^hich has been constituted the treasury of this
(and— The Medical Rscord, New York.
FORDYCE BARKER, M.D., Chairman.
GEORGE F. SHRADY, M.D., Secretary.
Thobias Addis Emmst, M.D,, New York.
T. Gaillard Thomas, M.D., "
William T. Lusk, M.D., '*
William M. Polk, M.D., *«
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Frank P. Foster, M.D., «
E. S. Gaillard, M.D., *<
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Samuel D. Gross, M.D,, Philadelphia, Pa.
William Goodell, M.D., **
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William H. Byford, M.D., Chicago, lU.
A. Reeves Jackson, M. D., "
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C. D. Palmer, M.D., "
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W. t. Howard, M.D., "
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Seth C. Gordon, M.D., Portland, Me.
Frank K Beckwith, M.D., New Haven, Conn.
A W. Knox, M.D., Raleigh, N.C.
L. W. Oakley, M.D., Elizabeth, N. J.
A T. Woodward, M.D., Brandon, Vt.
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List of Addftional Subscribers.
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Mrs. C. K Fleming. « " i 00
Mrs. Sarah J. Wier, Mobile, Ala 2 00
W. H. Huger, M.D., Charleston, S. C 5 00
G. R Famam, M.D., New Haven, Conn 10 00
S. H. Chapman, M.D. *' " 5 00
W. L. Bradley, M,D., " " 3 00
C. A Lindsley, M.D., *' •* 2 00
G. Eliot, M.D., " " I 00
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C. T. Baldwin, M.D., Birmingham, •* i 00
Lewis Barnes, M.D., Oxford, " i 00
W. J. Lewis, M.D., Hartford, " i 00
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W. C. Wile, M.D., Sandy Hook, " 2 00
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A. W. Tracy, M.D., «* « i 00
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J. G. Anthoin, M.D., Antrim, N.H i 00
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M. H. Felt, M.D., Hillsboro Br., " i 00
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IC)0
THE MEDICAL RECORD.
[August 9, 188^
l^eprortB 0f 3ocUtus.
^vitialtt pCjedicaX Association.
FIFTY-SECOND ANNUAL MEETING,
HeldinBelfcLst^ Ireland^ Tuesday^ Wednesday^ Thursday^
and Friday^ July 29, 30, 31, and August i, 1884.
(BY CABLE TO THE MEDICAL RECORD.)
(Conduded from page 139.)
Thursday, July 31ST — Third Day.
The Council met from 9.30 a.m. to 1 1 a.m. when the
General Session was called to order by the President.
THE ADDRESS IN PHYSIOLOGY
was then delivered by Peter Redfern, M.D. {vide page
113). This was listened to with marked attention by a
large audience. At the conclusion a vote of thanks was
tendered the orator.
THE REPORT OF THE MEDICAL REFORM COMMITTEE
was next presented, and after some discussion was
adopted.
THE MEDICAL ACT AMENDMENT BILL
was brought up and discussed by Drs. Waters, Stokes,
Brown, O'Connor, and others. The general sentiment
was against such amendments as has been made by those
really opposed to the measure. The ostensible intention
of the latter parties was to thus impede its passage. The
main objects of the bill are the adequate representation
of the profession in the Council, the provision for an
uniform qualification for the Register and the mainte-
nance of safeguards against the assumption of illegal pro-
fessional titles. This bill was finally endorsed.
After the transaction of some miscellaneous business
the Association then adjourned until Friday.
Friday, August ist — Fourth Day.
The meeting was called to order at 10 a. m., when the
address in obstetric medicine
was delivered by Dr. Geo. H. Kidd (see p. 141).
At the 2 P.M. session the Reform Committee's report
was reconsidered and again presented, and the points
therein discussed by various speakers.
The reports of the various committees were then pre-
sented and adopted, after which the Association adjourned.
REPORTS OF SECTIONS.
SECTION ON SURGERY.
Thursday, July 3 ist — ^Third Day.
The Section was called to order at 2 p.m. by the Presi-
dent, Sir Wm. McCormac.
No address on surgery was delivered.
TRANSPORT SPLINT.
Mr. John Fagan demonstrated his transport splint,
and also exhibited some cases upon which excision of
the knee had been performed.
NEW ELASTIC TOURNIQUET.
Dr. J. Ward Cousins showed a new elastic toumi.
quet and explained his mode of application as well as its
adaptability to a large range of cases. Its principal
claims were simplicity and efficiency.
SECTION ON PUBUC MEDICINE.
Thursday, July 3 ist — Third Day.
The Section was called to order by The President,
who delivered his address, taking for his subject the
GENERAL CHARACTER OF EPIDEMICS.
In the course of his- remarks he referred to the preva-
lence of cholera on the Continent, and urged due vigi-
lance on the part of the profession and Government of
Great Britain against the invasion. Nothing was of more
importance than the purification of the drinking-water,
attention to perfect sewerage, and the free use of disin-
fectants. In fact, the purer the water of a district the
lower was the death-rate. The labors of Pasteur, Badd,
and Koch were appropriately referred to and eulogized
SECTION ON MEDICINE.
Thursday, July 3 ist — ^Third Day.
The chair was occupied by the President, Dr. J, W. T.
Smith, of Belfast.
THE causative RELATIONS OF PHTHISIS,
was introduced by Dr. Douglas Powell. His line of
argument was against the contagiousness of the disease.
Dr. J. Ward Cousins disputed such an assumption,
and exhibited an antiseptic inhaler, which he claimed to
be efficacious in killing the infecting bacilli.
Professor Gardiner spoke in support of Koch's
views in regard to contagion.
Dr. Dyce Duckworth presented the subject of "Rheu-
matoid Arthritis."
SECTION ON PHARMACOLOGY AND THEURA-
PEUTICS.
Dr. Shoemaker, of Philadelphia, presented the sub-
ject of
OLEATES,
and urged a further investigation into their nature and
action.
SECTION ON OBSTETRIC MEDICINE.
Wednesday, July 30TH — Second Day.
The President of the Section, after calling the meetiqi
to order, delivered an address in which he defended thf
rights of obstetric men to operate, contending in thi
connection that no men could be competent gynecolo
gists who were not surgically inclined.
Saturday was occupied in excursions to Giant's Ca
way, Garron Tower, Newcastle, and other points of i
terest.
About six hundred members were present at the mc
ing.
August 9, 1884,]
THE MEDICAL RECORD.
161
THE AMERICAN OPHTHALMOLOGICAL
SOCIETY.
Tmntiith Annual Meeting, held July \6th and 17M, at
the Grand Hotel, Catskill Mountains, N, Y.
First Day — ^Wkdnesday, July i6th — Morning Ses-
sion.
In the absence of the President, Dr. W. F. Norris, of
Philadelphia, presided
Dr. 0. F. Wadsworth, of Boston, was elected to fill
the vacancy caused by the resignation of Dr. Richard H.
Derby, Secretary and Treasurer.
^ The first paper was entitled
irldectomy in chronic iritis,
by Dk. Hasicet Derby, of Boston.
A case in vrhich frequent attacks of iritis had occurred
vas described. The patient had obtained relief from the
use of atropine. She finally passed into the hands of
another surgeon who dii^osed glaucoma and performed
irideaomy. After this the attacks of iritis became less
fitqucnt The doctor, however, thought that the ini-
pro?cment was to be attributed more to the natural ten-
dency of the disease to wear itself out than to any good
^ects of the operation, and concluded that under these
drcnrastances an operation was not justifiable.
Dr. H. Knapp, of New York, stated that in many in-
stances recurrent iritis stops spontaneously. He would
restrict the operation of iridectomy to those cases in
rhich with the iritis there is a tendency to cyclitis and
glaacoma. In genuine iritis he does not recommend the
operation.
Dr. Charles S. Bull, of New York, read a paper
entitled,
CASES OF RESTORATION OF THE EYELID BY TRANSPLAN-
TATION OF FLAP WITHOUT A PEDICLE BY WOLFE'S
METHOD.
T?ro cases were reported in which the upper lid was
the one operated on, the flap being taken from the front
of the fore-arm, and after being deprived of all subcuta-
neons tissue, being placed on the denuded lid, and, when
Mcessaiy, held in position with sutures. The dressing
consisted of gold-beaters' skin, with iodoform gauze,
boiated cotton, and a bandage. This dressing was
left undisturbed for three or four days. After this the
dressing was repeated every day, or every other day.
In the third case the lower lid was operated on, the
flap being taken from the anterior surface of the chest.
In those cases in which sutures were applied, there was
a little suppuration at their seat, but in all the cases a
satisfactory result was obtained.
Dr. B. E. Fryer, U. S. Army, then reported
A successful case of SKIN TRANSPLANTATION WITH-
OUT A PEDICLE TO THE LOWER LID AFTER REMOVAL
OF AN EPITHELIOMA.
In this case, after removal of the epithelioma by ex-
cision, a flap was taken from the fore-arm and applied to
the raw surface of the upper lid. No sutures were ap-
plied, but the flap was held in position with gold-beaters'
iin plaster. Two layers of this were applied and allowed
to dry. It was then found that they kept the edges of
fee wound in perfect apposition. The lids were stitched
together with fine silk sutures. As the patient in return-
ing to her home would be exposed to cold, a pad of ab-
sorbent cotton was applied to protect the part. This was
amoved on the arrival of the patient at her home. On the
oghth day the plaster was removed, and perfect union
foandtohave occurred. Three months after the opera-
ton there had been but slight contraction. The doctor
W particular stress on tlus method of dressing these
'ounds. If the operation were done at the patient's
•toose he would dispense with the pad of cotton.
CASE OF GANGRENE OF THE LID WITH SUBSEQUENT
RESTORATION OF TISSUE WITHOUT A PLASTIC OPERA-
TION.
Dr. Richard H. Derby, of New York, reported a
case which, when first seen, was found to have marked
gangrene of the lower lid. The case then passed from
observation, and was not seen for four weeks. When he
returned, it was found that the skin had restored itself
and that there was very little deformity.
The discussion of these papers was entered into by Drs.
Pooley, Prout, Harlan, Little, Howe, Andrews, Lippin-
cott. Fryer, Green, and Wadsworth.
HYSTERICAL MONOCULAR BLINDNESS, WITH MYDRIASIS
AND BLEPHAROSPASM,
was the title of a paper read by Dr. George C. Harlan,
of Philadelphia.
A case of monocular blindness was described, in which
it was accidentally discovered that the blindness, as well
as the spasm of the face which was present, was much
benefited by the application of a Charcot magnet. A
piece of wood made to imitate the real magnet was pre-
pared, and with this the same results were obtained The
patient afterward presented herself with an hysterical af-
fection of the elbow-joint, which was also relieved by the
imitation magnet.
Dr. H. Knapp, of New York, read a paper entitled
NEURO-REHNITIS WITH FULMINANT BLINDNESS.
Case I. — An apparently healthy man, after a day of
severe headache went to bed and slept well, but the fol-
lowing morning on awakening found that he could see
with neither eye. In the absence of any other adequate
explanation, the blindness was attributed to uraemia.
Fxamination of the urine, however, failed to reveal any
abnormality. The diagnosis of uraemic blindness was
concurred in by a number of prominent physicians. Ex-
amination of the eye showed well-marked choked disks.
The treatment consisted in the induction of perspiration
with salicylate of sodium, and the subsequent use of iodide
of potassium and calomel. After the lapse of some time,
the islet of retinal tissue regained its functional activity,
and the man could see objects held in a certain position,
provided they were not brought too close to the eye.
He could thus read Snellen 50, and could correctly indi-
cate the names of playing-cards. The doctor thought
that the attack might be attributable to some abnormity
about the frontal lobes of the brain in the region of the
chiasm.
Case II. — A girl eleven years of age had had spells of
loss of vision for a few days, after which she awoke one
morning to find herself blind in the left eye. The right
also became blind in the course of the same day. The
urine was normal. Salicylate of sodium and calomel
were given. This was followed by profuse diarrhoea.
Two days later there was light perception, and steady im-
provement set in from this time. Two months later the
eye-sight was completely restored. It was thought that
there might be something causing pressure in the neigh-
borhood of the optic chiasm or cavernous plexus. If
there were such a condition the diarrhoea which was
induced would be of benefit.
Dr. Charles Kipp, of Newark, N. J., referred to a
case of choked disk which he had had under observation
for fifteen years and in which no symptoms of brain or
other trouble had been observed. He thought that
probably in some instances optic neuritis was due to
other than cerebral lesions.
Dr. H. Knapp called attention to the fact that disease
of the frontal lobes might exist for a long time without
producing alarming symptoms.
Dr. George C. Harlan, of Philadelphia, stated that
he had examined a number of patients in blind asylums,
with atrophy of the optic nerve, without finding any evi-
dences of serious disease.
l62
THE MEDICAL RECORD.
[August 9, 1884.
Dr. a. Alt, of St. Louis, had seen a case of neuro*
retinitis with large hemorrhage, which was thought to be
due to a tumor of the brain and with marked impairment
of the general health. Under the use of iodide of potas-
sium the health was restored. There is, however, atro-
phy of both optic nerves.
Dr. W. F, Norris, of Philadelphia, read a paper on
HEREDITARY ATROPHY OF THE OPTIC NERVE.
In a family of twenty-three persons which had been ex-
amined by Dr. Norris, fourteen were found to have con-
genital atrophy of the optic nerve. Bichloride of mer-
cury and strychnia were administered, but in only one
case did improvement ensue.
Dr. Norris also reported
TWO CASES OF ORBITAL TUMOR.
The first case was one of myxo-sarcoma of the orbit oc-
curring in a child four months old. The tumor was
twice removed, but returned after both operations. In
the second case, the tumor was an osteoma, which ap-
peared in a woman thirty-two years of age. The growth
involved so much of the orbit, that it became necessary
to remove the eye. This eye had been bhnd for some
time. The tumor was chiselled away. There has been
no return of the disease.
Dr. J. A. Andrews, of New York, read a paper on
JEQUIRITY.
He objected to the plan usually followed in the use of
this drug. His method is to employ a one per cent,
fresh solution, which is brushed over the eye once. The
eye is examined after twenty-four hours and the applica^
tion repeated, if necessary. In this way he has had
good results with no accidents.
Dr. Norris had observed that the conjunctiva seems
to lose its susceptibility to the action of the drug after
frequent applications.
Dr. H. S. Schell had used preparations which had
been preserved for weeks by the addition of four grains
of boracic acid to each ounce of the infusion.
Dr. Wadsworth had preserved" the infusion active
and free from bacilli with the addition of two per cent
of carbolic acid.
Dr. J. S. Prout stated that he had used quinine a
number of years ago in the class of cases for which
jequirity was recommended. It had produced very sat-
isfactory results.
Adjourned.
Afternoon Session.
The Society again met at 4 p.m., to examine a number
of microscopical specimens prepared by Dr. A. Alt, of
St. Louis, and to witness the demonstration of a new
form of perimeter by Dr. E. Dyer, of Newport.
Evening Session.
The Society was called to order at eight o'clock.
The first paper was read by Dr. H. S. Schell, of
Philadelphia, on
EMBOLISM of THE CENTRAL ARTERY OF THE RETINA.
An old lady suddenly lost vision in the left eye. There
was found to be on examination insufficiency of the mitral
valve and hypertrophy of the left ventricle. Special at-
tention was called to the fact that after massage of the
eyeball a current was induced in the vessels, but this
current, instead of being continuous, was broken into
segments. No benefit followed treatment.
Dr. a. Mathewson, of Brooklyn, then read a paper
on
THE NATURAL HISTORY OF CATARACT.
A man who had suffered from cataract for some years
suddenly regained vision. An examination of the eye
showed that the lens had disappeared, and it was after,
ward found in the lower part of the vitreous. Two years
later a severe attack of glaucomatous inflammation re-
quired the removal of the eye. The lens was found to
be extremely small.
Other members reported cases of a similar 'character.
Dr. W. W. Seely, of Cincinnati, described his expe-
riences in certain refractive cases, alluding particularly
to lack of balance of the ocular muscle and its relation
to refractive changes. He thought that if all cases of
so-called mixed astigmatism were examined after paraly-
sis of the accommodation, many of them would be
found to be examples of simple hypermetropic astigmaf-
tism. A number of illustrative cases were cited.
Dr. L. Webster Fox presented a paper on
THE CLINICAL HISTORY OF A CASE OF SYMPATHETIC
OPHTHALMIA.
A boy received a punctured wound near the cornea of
the left eye. It was treated with cold applications and
little inflammation ensued. Later, however, dimness of
vision manifested itself in the right eye. At this time
there was barely light perception in the eye. Vigorous
treatment was instituted, but did not abort the inflamma-
tion. Later, iodide of potassium and mercury were ad-
ministered, but with no benefit. A recent examination
showed the right eye atrophied to half its normal size,
with no perception of light, 'and the left eye, becoming
atrophied, light-perception doubtful.
Dr. J. A. LippiNCOTT, of Pittsburg, Pa., read a paper
entitled
TWO CASES OF ORBITAL ABSCBSS.
The first case occurred in the latter part of 1877 in a
child of feeble powers of resistance, and the abscess fol-
lowed an attack of erjrsipelas of the face and scalp. A
small abscess of the nght upper eyelid developed, which
was opened and a poultice applied. Six days later the
eyeball began to protrude rapidly and the pain and gen-
eral symptoms became more marked. The ball pro-
truded more than half an inch. Diplopia was observed
and the sight appeared to be unimpaired.
An exploratory incision was made under ether, and
pus being found a free incision was made, allowing the
escape of a quantity of pus. It was decided to not in-
sert a tent, but a poultice was applied, pressure made,
and a supporting treatment instituted. Under this treat-
ment the patient improved, and the protrusion became
less marked. Two days after the operation on the right
eye it became necessary to open an abscess behind the
left ball This rapidly healed without further treatment.
An examination made a short time ago showed very
slight protrusion of the right eye. V = JJ.
Case II. — A. R , scarcely twelve months old, was
seen in the latter part of 1880. Swelling and chemosis
of the lids had appeared three weeks previously. There
was no protrusion of the ball until a few days before she
was seen by Dr. Lippincott. At that time the ball pro-
truded to the extent of its diameter, the pupil was of
natural size and irresponsive. The pain did not seem to
be severe and there was only slight fever.
An aspirating needle was introduced above the globe
and an abscess containing fetid pus was found ; this was
evacuated and a poultice applied Improvement of the
general condition at once began, but one week later the
opening closed, and as there evidently was pus still be-
hind the globe, a second opening was made, and at this
time healthy pus escaped. Pus continued to flow for
two weeks when the opening closed. The child coi>
tinned to improve, and a recent examination showed;
very little protrusion of the ball, considerable swelling;;
of the lids, and partial ptosis. The eyeball is fireelf
movable. The disk shows decided white atrophy, and
the vessels of the retina are contracted. Vision is lim-:
ited to light-perception.
Dr. Samuel Theobald, of Baltimore, described aj
case of this nature, which he had recently seen occurring
August 9, 1884.]
THE MEDICAL RECORD.
163
jo a roan run down from over-work. Four days after
the beginning of the symptoms deep fluctuation was felt,
and the abscess was opened. Poultices were then ap-
pb'ed Two dfays later it was found necessary to evacu-
ate a collection of pus which had formed beneath the
ball Perfect recovery followed, the vision being re-
stored, and the mobility being normal.
• Bk. Charles J. Kipp, of Newark, read a paper on
ABSCISS OF THE FRONTAL SINUS, ETHMOID CELLS, AND
SPHENOIDAL SINUS.
J. B , aged fifty-four, had suffered for many years
from headache. The left eye was slightly protruding,
and a tumor was seen involving the upper part of the
orbit. Sarcoma was diagnosed, but a few days later, in
attempting to remove it, the swelling broke^ and a large
qoaotity of pus escaped. A drainage-tube was intro*
duced. Shortly after the operation the patient had pneu-
monia, from which he died. After death it was found
that the frontal sinus, the ethmoidal cells, and sphenoidal
sinus had been converted into one large pus cavity, from
the walls of which numerous spicules of bone projected.
Dr. Kipp also reported a case of distention of the
frontal sinus. A woman, aged fifty-seven, presented a
painful tumor below the left eyebrow. She had suffered
from nasopharyngeal catarrh for a number of years. On
pressure, fluctuation could be discovered. An opera-
tion was declined. The case was seen one year later, at
which time the sac accidentally ruptured, and the con-
tents escaped into the nose. The cyst continued to
refill for some time, but after some months the discharge
diminished, and at the present time the sac seldom be-
comes distended. The treatment consisted in the appli-
cation of nitrate of silver solution to the mucous mem-
brane of the naso-pharynx, the frequent washing-out of
the nasal cavity, and the emptying of the distended
frontal sinus by pressure made with the flnger.
Dr. L. Howe, of Buffalo, read a paper entitled,
CHANGES IN THE EYE IBIMEDIATELY AFTER DEATH.
The observations were made on a man, aged flfty-four,
dying of consumption. One of the conditions noticed
was a wrinkling of the cornea, which it was said might
readily be mistaken for fracture rupture of the lens. He
had also seen the same condition after hanging.
Dr. NoRRib asked whether any rose-colored macula
bad been observed after death by hanging. These had
been observed in the case of beheaded criminals.
Dr. Howe had observed none.
Dr. MriTENDORF called attention to the fact that Dr.
Derby had made a report some time ago in reference to
the condition of the eyes after hanging. In six eyes ex-
amined, m five dislocation of the lens had been observed.
Adjourned.
Second Day — Thursday, July 17TH — Morning
Session.
case of glioma of the retina.
Dr. Theobald reported a case of glioma in which he
enodeated the eye four years ago. The patient is still
onder observation and there has been no return of the
&ease. In another case he had performed the opera-
tion. Twelve months later the patient died from some
oiiscure disease of the brain. There had been no return
<tf the glioma. The age of the first case was twelve
jears, that of the second nine years.
Dr. Mittendorf asked if any of the members had
Ken a case of glioma in which the patient did not die
iftcr operation. Although the operation prolongs life,
k thoQght that it did not save it. It was unusual for
k dis^ise to develop as late as in the cases reported by
Dr. Theobald.
, Dr. Sutphen, of Newark, reported a case of glioma
i&a child nine years of age. Enucleation was advised,
tnt declined. Five months later the child was brought
suffering with choreic symptoms. Thinking that the
chorea was due to the eye trouble it was enucleated.
The child recovered while taking Fowler's solution.
Dr. Mathewson thought that some of the rare cases
in which the disease had not returned after operation
might be accounted for by a mistake in the diagnosis.
Dr. Knapp said that there could be no doubt of per-
manent recovery occurring after true glioma. These
cases are, however, rare. In his own experience he had
had but one case. This had been under observation for
fourteen years.
Dr. William Thompson, of Philadelphia, made a
partial report of the progress of the examination of the
employees of the Pennsylvania Railroad as to their color-
sense and acuteness of vision and hearing. He also
considered the importance of national legislation on this
subject, and described what had already been done in
this direction.
Dr. George C. Harlan reported
TWO cases of swelling of the optic papule, prob-
ably CONGENITAL.
The first case was that of a short-sighted student, who
consulted Dr. Harlan in reference to glasses that he was
wearing. An ophthalmoscopic examination which was
then made showed that there was swelling of the optic
papule to the extent of 3 or 4 D. He was advised to
be cautious in the use of the eyes. The case was seen
subsequently, but no change was noted.
The second case was that of a girl aged fifteen years.
She complained of pain in the eyeball, increased by use,
and occasional double vision in a vertical direction.
There was hypermetropia, and also swelling of the
optic papule. Weak convex, slightly smoked glasses
were given. With this the vision was j^t- A tonic treat-
ment was instituted. The patient sood afterward passed
from observation, and has not been seen since.
Dr. Risley reported the case of a young married
woman who consulted him for asthenopic symptoms.
There was found to be hypermetropic astigmatism and
swelling of the nerve to the extent of two or three diop-
trics. The condition was the same in both eyes. There
had been no dizziness and no more headache than could
be accounted for by the eye-strain. There was nothing
abnormal about the urine. The proper glasses being
given the symptoms disappeared, and a year later had
not returned. There had at this time been no change
in the appearance of the eye.
Dr. Mittendorf also reported a case of hypermetropic
astigmatism with a similar condition of the nerve. He
attributed this appearance to an abnormal development
of the connective tissue elements of the optic disk.
This view was held on account of the silky appearance
of the retina. This case had been under observation
for over a year.
Dr. G. Hay, of Boston, reported
TWO cases in which rahlman's hyperbolic lenses
IMPROVED VISION.
The first case was that of a lawyer, in whom the cor-
nea was decidedly prominent. Vision was improved by
a cylindrical glass, but it was made still better with
hyperbolic lenses.
The second case was one of pronounced conical cor-
nea. In this case also vision was much improved.
Dr. O. F. Wadsworth, of Boston, read a paper on
MYXODERMA, with atrophy of the optic NERVES.
The patient was a married woman, forty-two years of
age. There was no history of syphilis. Menstruation
had been regular until three years ago, when it ceased.
Six years ago it was noticed that the lower part of the
face, the hands, and the feet became full and oedema-
tous, but did not pit on pressure. This condition in-
creased. At the present time the hands and feet are
very much enlarged. The lower part of the face and.
i64
THE MEDICAL RECORD.
[August 9, 1884.
what is unusual, the nose is much enlarged. The lips
are thick and the speech is slow, as though the tongue
were enlarged. The skin is not particularly dry, but she
never sweats. Her mental condition is good, although
her husband thinks that her memory is not as good as
formerly.
The affection of vision was first noticed in the right
eye a year and a half ago. This gradually increased
until there was only light perception. In the left eye
vision was xl. The field was contracted upward and
outward. The optic disks, especially that of the right
eye showed the appearances of simple gray atrophy. No
apparent cause could be discovered for this condition.
The fact that the atrophy appeared in the course of the
myxoderma did not prove that there was any connection
between the two, but considering that our knowledge of
the cause and pathology of myxoderma is so incomplete
he thought it well to place this case on record. He had
examined other cases of myxoderma, but this was the only
one in which any alteration of vision had been observed.
Dr. Little had also examined the eyes of those suffer-
ing with this affection, but had been unable to find any-
thing abnormal.
Dr. Thomas R. Pooley, of New York, read a paper
entitled
ACUTE DACRYO-ADENITIS,
A girl, twenty years of age, who for some time had been
suffering with chronic trachoma and trichiasis, was seized
with diphtheritic inflammation of the conjunctiva of the
left eye. This caused the complete destruction of 'the
eye. Three weeks later, when the purulent discharge was
beginning to abate, pain began to be felt in the right eye
and a swelling made its appearance at the upper outer
angle. This was tense and red. Hot applications were
ordered and she was put on the use of quinine and iron.
The following day an incision was made through the lid,
but no pus was obtained. The following day there was
marked improvement. The hot applications were con-
tinued and a pressure*bandage applied. She made a
rapid recovery, and now vision is entirely restored. It
was thought that probably the inflammation of the lachry-
mal gland was due to septic absorption.
Dr. H. Knapp, in speaking of the differential diagnosis,
said that the diagnosis could be made by pressing deeply
into the orbit. It would then be found that the swelling
was limited to the gland, and that it gave a nodular sen-
sation, some of the nodules being harder than others. It
is not very rare to have inflammation of one lachrymal
gland, but it is rare to have the inflammation appearing
in both glands within one or two days. In the cases
which he had seen there had been no infectious disease,
and in the majority no conjunctival trouble.
Dr. Miller, of Providence, stated that he had had
one case of acute bilateral inflammation of the lachrymal
gland. The patient was suffering with gonorrhoea at the
time and his physician regarded it as a case of gonorrhoeal
ophthalmia. The inflammation subsided in the course of
a few days under the use of hot applications.
Dr. W. F. Mittendorf, of New York, read a paper on
POLYCORIA.
The patient. Miss R ^ sought advice for some ab-
normity of vision. Seven years previously the right
eye had been lost. There was compound myopic astig-
matism in the left eye. On examining it five pupils were
found. With suitable glass V. = JJ, and the range of
accommodation was good.
The father of this lady also had a similar defect in the
iris. In the right eye there were two pupils, the lower
of which was divided into two by a band passing across it.
Dr. W. W. Seely, had examined a family in which a
number of its members had polycoria. The interesting
point was the termination, all these persons becoming
blind.
Dr. Mittendorf stated that his patients were aged
thirty-two years and sixty-flve years, and that neither had
exhibited any indication of failing sight.
Dr. E. Hxn'CHiNSON, of Utica, described
A plastic operation performed to relieve the
CLOSURE OP THE LIDS, THE RESULT OF CICATRIZA-
TION.
The man had his face injured by the premature cxplo- '
sion of a blast. This caused destruction of the left eye,
and such contraction of the lids of the right eye that it
was impossible for him to open them. The sight of the
right eye was uninjured. The operation consisted in
cutting deeply through the external commissure, then dis-
secting up a web of conjunctiva which was put into this
opening and secured there. After he had recovered from
this operation there was great ectropion, which was re-
lieved by making a deep V-shaped incision and free dis-
section and bringing the parts together. The lid was
thus restored and a very satisfactory result obtained.
Dr. J. AuB, of Cincinnati, read a paper on
REMOVAL OF FOREIGN BODIES FROM THE VITREOUS.
He reported three cases in which pieces of iron had
entered the vitreous humor. In all of these the piece of
iron was removed by means of an electro-magnet passed
into the eye. In these cases the eye and the sight were
saved.
A fourth case was reported in which the piece of iron
had become encysted and could not be removed with the
magnet. In this case it became necessary to enucleate
the ball, and after the removal of the eye it was found
impossible to remove the foreign body with forceps be-
fore cutting the lymph which surrounded it.
Dr. Knapp said that where a foreign body can be
seen, it is usually not a difficult matter to remove it, the
question was as regards those cases in which it passes
out of sight. He had in one case succeeded in removing
the foreign body. He felt inclined to say, judging from
his own experience and the recorded experience of othen,
that those cases in which the foreign body enters the eye
and passes out of sight, the best thing to do would be to
enucleate the eye. In this way he thought that the great-
est good would be done to the greatest number.
Dr. Mittendorf, agreed in this opinion.
HYPERMETROPIC ASTIGMATISM PASSING INTO MYOPIA,
was the title of a paper by Dr. S. D. Risley, of Phila-
delphia. In 1875, ^^ ^^^ ^^^ ^ child suffering from
violent headache. There was hypermetropic astigmatism.
The ophthalmoscope revealed the usual appearances of
choroidal and retinal irritation. With a suitable cylin-
dro-spherical glass vision was normal. This entirely
relieved the symptoms. The patient passed from obser-
vation and was not seen until 1882. At this time there
was found to be myopic astigmatism. The proper glasses
being given, the symptoms from which she had suffered
disappeared and vision was again made normal.
Dr. Knapp thought that many of the cases of astigma-
tism in young girls of nervous temperament were not
real deformities of the cornea, but that they would dis-
appear under proper hygienic surroundings. He thought
that slight degrees of error might be overlooked.
Dr. Theobald said that the indication for correction
in slight degrees of myopia was the presence of asthen-
opic symptoms, which are sometimes due to disproportion
between accommodation and convergence. In slight de-
grees of myopia, where there is no asthenopia there is no
discomfort, and correction may not be necessary.
The Society then went into executive session.
The following officers were elected : President — Dr.
W. F. Norris, Philadelphia ; Vtce- President— Dr. Hasket
Derby, New York ; /Recording Secretary and Treasurer
—Dr. O. F. Wadsworth, Boston ; Corresponding Secre-
tary—T>x. J. S. Prout, Brooklyn ; Committee on Puhlica-
tion — Drs. O. F. Wadsworth, Hasket Derby, and G.
Hay ; Committee on Membership — Drs. John Green, G.
August 9. 1884.]
THE MEDICAL RECORD.
165
C. Harlan, A* Mathewson, S. Theobald, and J. J. B.
Vennync.
The following were elected to membership : Dr. Miles
Standish, of Boston, Mass.; Dr. John Van Duyn, of
Sfiacuse, N. Y., and Dr. S. O. Richey, of Washington,
D.C.
The place for holding the meetmg of next year was
• not decided on, but its selection left to the secretary.
Tlic time of meeting is the third Wednesday of July.
The Society then adjourned.
THE SURGICAL SOCIETY OF PARIS.
Stated Meetings June 4, 1884.
M. Marcus S^e, President, in the Chair.
(Special Report to Thb Mbdical Record.)
AfTER the Society had been called to order, the report
was read of the committee for the organization of an
ANNUAL CONGRESS OF FRENCH SURGEONS.
This report gave rise to a lengthy discussion.
M. BoECKEL then read the history of a case operated
upon by himself for the
REMOVAL OF THE ENTIRE UTERUS PER VAGINAM
OD account of cancer of the cervix. The operation was
undertaken in October, 1882. After pushing the uterus
as far down as possible, the posterior cul-de-sac was
divided by a transverse incision, and the anterior part
dissected away, so as to leave the organ attached only
bj the broad Ifgaments. A double ligature being placed
on each, the ligaments were then divided. In the left
broad ligament M. Boeckel found an enlarged and de-
generated gland, which he excised. This was followed
by a free hemorrhage, which was arrested by haemostatic
forceps applied somewhat at random and left in situ.
As the intestines showed no tendency to come out
through the wound, no sutures were passed through the
peritoneum. The vagina was tamponed with cotton
dusted with iodoform.
The patient seemed to be making a good recovery,
mtii it was found that the urine was constantly passing
iway from a wound made in the left ureter by the
luemostatic forceps. The only remedy for this condition
seemed to be
NEPHRECTOMY,
which was accordingly performed. The patient re-
corered promptly, and was discharged cured two weeks
after the last operation. Seven months later, however,
she died from cancerous infiltration of the vaginal walls
and the neighboring glands.
From a study of this case M. Boeckel concluded that :
fiist, the antiseptic method renders justifiable the under-
taking of very serious operations ; and, second, the total
txtirpation of the uterus should be considered an excep-
tkmal operation, to be undertaken only when the cancer-
oas infiltration is localized.
M. Verneuil agreed with the author that hysterec-
tomy ought to be undertaken only in exceptional cases.
He thought that the treatment of carcinoma of the uterus
bjr cauterization and local applications gave the best
diance to the patient.
M. Terrier had recently performed this operation,
aod spoke of the difficulties attending it. One of the
greatest of these is met with in pulling down the broad
ligaments, so as to permit the application of the liga-
tures.
M. PoLAiLLON did not agree with the author of the
paper regarding the indications lor the operation. He
would operate only in those cases in which the entire
Qtgaa, and not the cervix alone is involved in the can-
cerous process. But if the new growth has advanced
veiy £ar no operation is of any avail.
M. Lucas-Championni£rs had seen Billroth perform
the operation in a case in which one of the broad liga-
ments was involved in the carcinomatous degeneration,
and was surprised at the ease with which the removal
of the organ was accomplished. The main difficulty he
thought was one of diagnosis.
M. Terrier did not agree with M. Polaillon, but ad-
vocated the removal of the entire uterus. He thought
that the attempt to destroy the new growth by the gal-
vano-cautery and chloride of zinc was not unattended
with danger.
M. Tri£lat did not think the results obtained in the
past seven years by extirpation of the uterus were such
as to offer much encouragement. He himself had never
had the courage to attempt it. Indeed, he thought there
was little to hope for in any operation, as by the time
that the patient fell into the surgeon's hands the disease
was usually very extensive.
M. BouiLLY was convinced, from experiments made
upon the cadaver, that it was often impossible to depress
the uterus sufficiently to render the vaginal operation
practicable.
M. Polaillon stated, in support of his opinions, that
the mortality in total extirpation of the uterus was one in
three, while that from removal of the cervix was three in
twenty. He had had two cases of removal of the new
growth by the galvano-cautery and chloride of zinc, in
which there was no return of the disease after five years.
Another patient, seventy-two years of age, operated upon
by the same method, had rtsmained well for one year.
M. Boeckel then exhibited a patient, seventeen years
old, upon whom he had performed
osteotomy by macewen's method
for knock-knee. He had performed upward of twenty
osteotomies and nearly as many osteoclasies. The re-
sults of osteotomy were uniformly good, but he had met
with three accidents in his osteoclasies. In one case he
had ruptured the external lateral ligament ; in another, a
suppurative periostitis had been excited which required
four months to cure ; and in the third case there remained
an incurable pseudarthrosis.
The Society then adjourned.
Stated Meeting, June 11, 1884.
The Society having been called to order, the
discussion on vaginal hysterectomy
was resumed
M. Verneuil stated that he had performed ablation of
the cervix twenty times, twice for hypertrophy of the
anterior lip, once for sclerosing metritis, which he had
mistaken for an epithelioma, and seventeen times for
cancer. Of the latter cases one had died and two had
been lost sight of after three years had elapsed without
return of the disease. Of the remainder * the average
duration of life after the operation was nineteen months.
The speaker did not condemn the total extirpation of
the uterus, but he considered that the existence of a
limited epithelioma of the cervix was not a sufficient
indication for the operation.
M. Despr^s had removed the cervix seven times,
three times for hypertrophy of the anterior lip, and four
times for cancer. He did not think that an operation
was of much value in prolonging life, for the average
duration of life in those not operated upon was eighteen
months. When the general condition was bad, life was
prolonged not one hour by the removal of the new
growth.
M. Tr^lat was surprised that M. Verneuil should have
had so many opportunities to practise amputation of the
cervix, since the patients usually present themselves to
the surgeon only after the disease has progressed too far
to render this operation of any avaal. He was in accord
with that gentleman in respect to the methods of tceat-
166
THE MEDICAL RECORD.
[August 9, 1884
ment employed, and he believed that these methods
were the best adapted for prolonging life. He had seen
patients gain flesh and be restored to apparent health
under this treatment of the local affection.
M. Berger then made a report upon a memoir sub-
mitted by M. Kirmisson entitled
INGUINAL ANEURISMS.
The author stated that the appearance of an aneurism in
the groin is often preceded by an abscess or enlargement
of the inguinal glands. Malgaigne and others had al-
ready noted this fact. As regards the treatment, M.
Kirmisson expressed a decided preference for
LIGATURE OF THE EXTERNAL ILIAC ARTERY
over either mechanical or digital compression. Of the
four methods at present in vogue he would retain two,
those of Sir Astley Cooper and Marcellin Duval. The
procedures introduced by Bogros and Abernethy he
looked upon as dangerous. The author did not regard
the wounding of the peritoneum as a serious complica-
tion, but on this point M. Berger differed from him very
decidedly, and he insisted upon the necessity of laying
aside the bistoury as soon as the aponeurosis of the obli-
quus externus had been divided. Secondary hemor-
rhage, when it occurred, was to be attributed, M. Berger
thought, to non-uion of the wound and to suppuration.
M. Verneuil did not agree with M. Berger as to the
cause of secondary hemorrhage. It was due, he be-
lieved, to septicaemia. When there was no fever there
was no cause to anticipate hemorrhage.
M. DsPRis, while believing with M. Verneuil that
septicaemia was a common cause of secondary hemor-
rhage, thought that the accident was not less frequently
due to mechanical causes.
M. Farabceuf showed the excellence of Cooper's
operation, by which the artery is reached most surely
and by the shortest path. He agreed with M. Berger
that no cutting instrument should be used after the di-
vision of the aponeurosis of the external oblique muscle
had been accomplished.
M. Terrier related a case of
extirpation of the^spleen,
and exhibited the organ removed, which weighed a little
over thirteen pounds. The patient was suffering from
a slight degree of leucocythaemia, the examination of
the blood showing a proportion of one white to two
hundred and seventy-five red globules. The operation
was successfully completed, but the patient died twentv
hours afterward from capillary hemorrhage into the peri-
toneal cavity. The result in this case, the speaker
thought, lends confirmation to the views of those who
refuse to perform any operation upon the subjects of
leucocythaemia. Such operations are nearly always fatal,
though an Italian surgeon has reported one successful
case in which the proportion of white to red corpuscles
was as one to thirty.
The Society then adjourned.
^ovtzapan&encR.
The Question of Tying the Umbilical Cord af-
TER Labor.— Dr. John T. Booth, of Wyoming, O., relates
the history of a case where an illegitimate child was bom
and the cord was cut but not tied. The probable object
was to let the child bleed to death. Instead of this it
did well, there being no hemorrhage at all. Dr. Booth
raises the old query whether tying the cord is necessary.
Some have claimed that it is not, and undoubtedly in
many, if not in most cases, there will be no hemorrhage
if the physician wait till the child has breathed a few
times. But the present practice of tying is a safe and
wise one.
OUR LONDON LETTER.
(From our Special Correspondent)]
THE MEDICAL BILL AND ITS CHANCES — ^THE COLLEGES
—OBSTRUCTION AT THE COLLEGE OF SURGEONS— THE
RECENT DISAGREEMENT AT THE COLLEGE OF PHYSI-
CIANS.
I^NDON, July 19, 1884.
The present aspect of medical affairs is far from reassur-
ing. I am afraid, if your readers were to give an impar-
tial opinion on what may be termed medical politics here,
it would be very far from complimentary to the powers
that be.
The Government Medical bill is very likely not to
pass, and few tears will be shed over it should it fail.
There is scarcely any chance of its passing except in an
emasculated and mutilated condition, and I believe the
general opinion of the profession is that sooner than pass
such a bill we had better go on as before. It is feared
that the Government will accept Sir Lyon Playfair's
amendment, which virtually neutralizes any good the
measure may effect, by allowing the twenty licensing
bodies to go on as before. Many people imagine this
gentleman to be a medical man, as he was formerly termed
Dr. Playfair. The doctorate was a German Ph.D., and
its owner has no claim to represent the profession, al-
though at the last general election Dr. Playfair so adroitly
used his title as to make many of his constituents think
he was really a medical man.
What are the colleges about ? Nothing* creditable. At
the Surgical College the obstructives continue in power.
They form a nice little family party, and when examiner-
ships fall vacant elect one another to them, and draw
nice salaries. The Senior Vice-President, Mr. Savory,
has received ;^9,ooo as fees for acting as exam-
iner for a long series of years — about twenty, I think.
He is one of the most unpopular examiners the college
ever had, and is reputed — ^justly or unjustly — to delight
in plucking. He is not ungentlemanly ; he often smiles
blandly on his victims, and the worse their ignorance the
more pleased Mr. Savory seems. The only faint hope of
reform lies in the fact that the Council have carried Mr.
Heath's motion to " consider the mode of electing the
president, and any alterations suggested in the method
of proceeding in the election" in November next
Meanwhile, to break the old vicious rule of going by
seniority, Mr. Holmes, the Junior Vice-President, de-
clares that when it comes to his turn he will decline the
presidency. We hope Mr. Holmes will have the courage
of his convictions. If he has, he will acquire more re-
pute as a reformer than he has ever done either as a
teacher or an examiner.
Meanwhile the sister college has been rioting with
closed doors. The proceedings of the Fellows have been
declared to be secreta collegii^ so they do not appear in
the medical journals. What really occurred is no secret,
although the most important part of the affair has not
as yet been discussed in print. Some weeks ago, at
a meeting of Fellows, the usual list prepared by the Coun-
cil of proposed new Fellows was submitted to the Fel-
lows present, and — unheard-of insolence — ^rejected by
them. Why ? The real grievance is that, of those pro-
posed by the Council, almost all of them are not practis-
ing purely as physicians at all, although, of course, they
all possess the M.R.C.P. The objectors, in fact, de-
scribed them as general practitioners. Another wound
was the fact that the list did not comprise a single Uni-
versity man. I must explain that by a "University
man " the older members of the profession mean a grad-
uate of Oxford or Cambridge. In times past these alone
were eligible for the Fellowship. Sir William lenner
is an M.D. Lond., and not a blind worshipper 01 tradi-
tion. On the present occasion, so far from denying what
August 9» 1884.]
THE MEDICAL RECORD.
167
Id fact could not be denied, he got up and defended it.
He said the college had tried to get the general practi-
tioners to join it and take the L.R.C.P.» which was in-
stituted for them, and, in short, why shouldn't general
practitioners be made Fellows? This was virtually the
nst of his argument, but the Fellows did not see as he
saw, and after a stormy discussion refused the list bodily.
Hiereupon the Council took a month to consider before
making out another list, and have even taken counseUs
opinion. However, the real subject of offence has been
declared to be a college secret, so none of the journals
gire any account of it, but merely give a meagre outline
of what took place.
Meanwhile, those who have been offered the Fellow-
ship by the Council and refused it by the Fellows are
in a nice position. It is now customary for those who
art proposed by the Council to be officially asked
whether they will accept the proffered dignity (and pay
their fifty guineas) before bringing their names publicly
before the Fellows. Many years back, two gentlemen
who had been duly elected Fellows in the general meet-
ing of Fellows refused point-blank to accept the Fellow-
ship. To avoid future indignities of this kind the Coun-
cil adopted the present plan. Now where are they ?
CfSMLisifif CkangisiHiJUSiaii^HS OHdZhOigs ef OjfUtrs
strvifig m th4 Meaicai Ihdarimifii^ United StaUs Army,
frm July 27 to August 2^884.
Hkad, John F., Colonel and Surgeon. Ordered to
Portsmouth, N. H., to meet the Greely party, and con-
sult upon the proper course of treatment, with a view to
the entire restoration to health of Lieutenant Greely and
die men of his command. S. O. 177, par. 14, A. G. O.,
July 30, 1884.
Wright, Joseph P., Major and Surgeon. Sick leave
of absence extended three months on surgeon's certificate
of disability. S. O. 176, par. 12, A. G. O., July 29, 1884.
Woodward, Joseph J., Major and Surgeon. Sick
leaye of absence extended six months. S. O. 1 78, par.
9,A.G. O., July 31, 1884.
McEldsrry, Hknry, Captain and Assistant Surgeon.
So much of S. O. 165, par. 12, .A. G. O., July 16, 1884,
as assigned him to duty in Department of the East, is re-
Toked, and he is ordered to report in person to the
Snrgeon-General of the Army for duty in connection
fith the World's Industrial and Cotton Centennial Ex-
position at New Orleans, La. S. O. 173, par. 12, A. G.
0., July 25, 1884-
FiNLEY, J. A., Captain and Assistant Surgeon. Granted
bve of absence for one month, with permission to apply
for one month extension, to take effect about September
1, 1884. S. O. 91, par. 2, Headquarters Department of
Texas, July 22, 1884,
Taylor, A. W., First Lieutenant and Assistant Sur-
ra. Ordered for temporary duty at Fort Riley, Kan.
0- 153, par. I, Headquarters Department of the Mis-
soon, July 29, 1884.
Gandy, C. M., First Lieutenant and Assistant Sur-
SeoQ. Granted leave of absence for one month, to com-
Bcnce between August 15th and 30th, provided he
fcmish medical attendance at Fort Brady, Mich., during
las absence. S. O. 144, par. 4, Headquarters Depart-
>»cntof the East, July 30, 1884.
n
A Man during a Lifetime of Fifty Years, ac-
wding to a paper recently read before the Academy of
Sciences, Paris, sleeps away an aggregate of six thousand
^ works away the same period, eats away two thou-
Hod days, walks away eight hundred days, is ill during
fcre hundred days, « and amuses himself with the remain-
b of his half century on earth.
ptjedical Stems.
CoKTAoious Diseases — ^Weekly Statement. — ^Re-
port of cases and deaths from contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the week ending August 2, 1884 :
Week Ending
Casts,
July 26, 1884 . .
August 2, 1884
Deaths.
July 26, 1884. .
August 2, 1884
5
J
5
3
I
150
94
I
Prevention of Attacks of Cholera. — Surgeon-
General Cornish says : " It is within the experience of
all, that an attack of cholera in the individual is often
aborted by timely treatment. During an epidemic, what
can be commoner than the following tjrpical case ? A
man is suddenly seized with a feeling of oppression and
sinking about the epigastrium, followed by two or three
frequent and copious watery evacuations, and, if there
be no actual sickness, a feeling of nausea and faintness.
Such attacks often occur in the early morning, the patient
having gone to bed perfectly well, and slept soundly
until the desire to relieve the bowels was felt. Besides
these symptoms, there is generally a clammy skin, a
weak pulse, and mi^ch nervous anxiety. Now, let a case
of this nature be treated instantly, by some combination
of opium with a diffusible stimulant (a full dose of chlo-
rodyne and brandy is perhaps the best and simplest
remedy to be found at hand), let him be put to bed, and
have warmth applied to his feet and epigastrium, so as
to favor sleep. In nine cases out of ten, when the pa-
tient falls asleep, the diarrhoea is checked ; and when he
awakes, he will feel quite easy and comfortable. In the
tenth case, the remedy may fail and the disease progress
until all the symptoms of aggravated cholera appear in
their due order. What becomes of the coniagium of
cholera, supposing the disease be due to an infective
germ, when the early diarrhoea is checked?'* — Indian
Medical Gazette,
The Ethics of the Skin. — Mr. Malcolm Morris,
one of the ablest and most versatile of our brilliant
younger school of dermatologists, has, says the British
Medical j^ournal, made a decided hit by his sparkling
and amusing, but very sensible and useful lecture, under
this head, at the International Health Exhibition. The
lecture was a pungent criticism of some of the morbid
aspects of modem aestheticism. First, it was shown
physiologically how much of a man's individuality lies in
the skin. Remove an arm or a leg, or both arms and
legs, there is yet left an individual man. But take away
the skin, as the author of '^Sartor Resartus" took away the
raiment, and individuality is gone. The color of the
complexion is due to the pigment-follicles, the red color
of the cheeks to the terminals of the biood-vesseb, seen
through the transparent skin. The color of the skin is
a test of health. But, within the last few years, we have
experienced a remarkable artistic movement. The ef-
fects have been evident in the picture-galleries, they have
displayed themselves in domestic life. Lastly, there has
sprung up a taste that can only be postulated as a taste
for disease, decrepitude, and decay. In one school, we
find a bevy of woebegone women, ill, limp, and unwhole-
some. The men are not more attractive in a sanitary
sense. They look like convalescents, ill-fed, and out of
condition. This school is not very wide in its range, but
1 68
THE MEDICAL RECORD.
^ugust9, 1884
its influence is felt beyond the limits of its own lines. In
the paintings of the older masters are ruddy Madonnas,
clear-skinned goddesses, and chubby angels. In the
more recent pictures, an etherealized skin is unduly pop-
ular. Of course, this repudiation of warm tints suited
unhealthy people. Fashions change ; and a time may
come when it will be fashionable to be healthy, when
normal hair will be popular, and natural skin the rage.
When this sanitary millennium is reached, it is possible
that the world will recognize that it is not attractive to
daub the face with starch and rouge and bismuth, and
paint after the manner of the heathen ; that the bloom
upon the peach cannot be beautified by whitewash ; and
that no chemical process can heighten the tinting of the
heather-bell.
Corrosive Sublimate Solutions. — Sir Joseph Lister
writes to the British Medical Journal ihzi one drachm by
weight of a solution of one part of corrosive sublimate in
one part and a half of glycerine contains two-fifths its
weight, or twenty-four grains of the sublimate. This,
multiplied by 1,000 (the proportion of water required),
gives 24,000 grains, which is very nearly three pints.
It is, however, much more convenient to use fluid meas-
ure than weight, and a fluid drachm to the glycerine solu-
tion referred to requires four pints of water to produce
the I to 1,000 solution.
The Micro-organism and Vaccine of Yellow Fe-
ver.— Prof. Domingo Freire, President of the Central
Junta of Public Hygiene, Brazil, has sent to the Sanitary
News an account of his experiments with the vaccine of
yellow fever. We extract the following, calling attention
to the unsatisfactory way in which he estimates the pro-
tective value of his attenuated virus : " The method of
culture which I have followed is Pasteur's. I withdraw
. blood, or any other organic liquid, from persons sick with
yellow fever, or from the bodies of the dead, using the
most scrupulous precautions, and introduce these liquids
into Pasteur's flasks, previously sterilized, and containing
a solution of gelatine or beef ' bouillon. ' In these condi-
tions the microbe develops abundantly, and becomes of it-
self attenuated by the action of the air, which filters through
the tampion of amianthus with which the flask is corked.
The purity of these cultures is demonstrated by microsco-
pic examinations, of which you will find a good illustration
in my memoir ' Experimental Studies on the Contagion of
Yellow Fever.* The microbe appears in the form of lit-
tle black points, like grains of sand (780 diameters) ; in
the mature form it presents the appearance of round
cells with an ash-gray or black rim, containing in their
interior yellow and black pigment and some granulations '
which will be the future spores. These cells burst at a
given moment, and pour out their contents, 1.^., the spores,
the pigments, and a nitrogenous substance composed of
ptomames, which I have isolated not only from vomited
matter, but also from the blood itself^ and from the urine.
The yellow pigment, being very soluble, produces the
icteric infiltration of all the tissues by a sort of tinctorial
imbibition which may go on even after death ; the black
pigment, as well as the detritus resulting from the rup-
ture of the cells, being insoluble, is carried into the gen-
eral circulation and produces obstructions in the sanguine
capillaries, whence the apoplectic symptoms so common
in yellow fever, and in the urinary tubules, whence the
suppression of the urine, a very frequent and terrible
symptom in this disease. I have described this micro-
scopic organism under the name of Cryptococcus xantho-
genicus ; its development resembling that of this genus
of algae. After having demonstrated the contagious na-
tare of yellow fever by experiments upon barn-door
fowls (see my memoir), I made experiments in preven-
tive inoculations, first upon animab and afterward upon
men. I did not fear to do this, because a multitude of
experiments upon animals had previously convinced me
of the perfect safety of inoculation with attenuated cul-
tures. Up to this date I have vaccinated four hundred
and fifty persons, for the most part foreigners recently ar
rived. Freedom from yellow fever has been pronounced
among those thus vaccinated, for they have passed
through a quite severe epidemic, and only six deaths have
occurred among the four hundred and fifty vaccinated
persons, that is to say, less than two in a hundred, while
more than a thousand deaths have occurred among the
non-vacdnated \ the mortality of the non- vaccinated ack
being about thirty to forty per hundred. Thus, if we take
one hundred vaccinated persons, under the most favor.
able conditions as regards receptivity, we have only two
deaths during the entire epidemic ; if we take one hun-
dred non-vaccinated sick, we have thirty lo forty dece-
dents, which gives a mortality fifteen times greater among
the non-vaccinated. Even if the mortality were only ten
times or five times less great among the vaccinated, the
preventive measure would be worthy of adoption. The
protective inoculation for charbon gives an immunity to
one-tenth, and that of vaccination for small-pox guaran-
tees an immunity to one-fifth, according to the calcula-
tions of Bousquet."
Where Hip Diseases are Treated. — Dr. N. M.
Shaffer, of this city, writes : " Will you please permit me
to correct a misstatement which occurs in your issue of
May 31st, in your review of Dr. Gibney's work on
*Thc Hip and its Diseases?' The reviewer alludes to
the Hospital for the Relief of the Ruptured and Crippled,
of which he says, *• where more cases of hip disease are
annually treated than in any other similar institution in
the country.' A few brief exdttcts from the annual re-
ports of the Hospital for then<elief of the Ruptured and
Crippled and those of the New York Orthopaedic Dis-
pensary and Hospital will prove the incorrectness of
your reviewer's statement. Cases of hip disease annually
treated by the Hospital for the Ruptured and Crippled:
For the year ending April 30, 1879, ^^7 5 ^^r the year
ending April 30, 1880, 160 ; for the year ending April
30, 1881, 170; for the seventeen months ending Sep-
tember 30, 1882, 251; for the year ending September
30, 1883, ^73- Total for five years and five months,
921. Cases of hip disease annually treated by the
New York Orthopaedic Dispensary and Hospital: For
the twenty-one months ending September 30, i83o,
401; for the year ending September 30, 1881, 328;
for the year ending September 30, 1882, 376; for the
year ending September 30, 1883, 420. Total for five
years and nine months, 1,525."
Benzoin promotes bronchial and cutaneous exhala-
tion ; a large part of the acid is excreted by the kidneys
as benzoic acid, and a part is changed into hippuric
acid, so that it renders the urine decidedly add. It and
the benzoate of ammonia are very useful when the urine
is very alkaline or ammoniacal, and loaded with phos-
phates. It renders the urine acid, and arrests ammonia-
cal and fermentative changes in the bladder. Phosphatic
calculi are said to be dissolved by the long-<:ontinued use
of it. Foul smelling, unhealthy, and sloughing wounds,
and flabby granulations are improved by the ointment or
tincture. It destroys fetor and stimulates to a more
healthy growth. It has some antisepdc powers, and
prevents fermentation and putrefaction, and is as useful
in ulceration of the bowels as it is in open superficial j
ulcers. It may be given in pill form.
Errata in Dr. John N. Mackenzie's Article ojt
CoRYZA Vasomotoria Periodica, in The Medical
Record of July 19TH. — Page 59, first column,- 25th line
from commencement of article, for "mere "read "more;'
second column, 1 8th line from top of page, for " intelligent^
read "intelligible ;" 25th line from top of page, for " Dale/^
read " Daly." Page 60, first column, 39th line from topj
for "imparted" read " impacted ; " second column. i5tl
and 23d lines from top, for " Haek " read " Hack ; " 44tt
line, for "bulging" read "overlying." Page 63, 37tl
line from top, for " cough " read ** sneezing."
The Medical Rec^^^
A Weekly Journal of Medicine and Surgery
Vol. 26, No. 7-
New York, August 16, 1884
Whole No. 7x9
©rigitml %xXitXts.
THE CAUSES OF DISEASE,
As Viewed from the Standpoints of Predisposi-
tion, Hereditary Influences, Racial Pro-
clivities, Epidemic Constitution,
and Vital Resistance.
Bnng the Substance of the Presidential Address delivered
July 29, 1884, before the Fifty-second Annual Meeting
of the British Medical Association^ held in Belfast^
Ireland,
By JAMES CUMING, M,D., F.K.Q.C.P.,
inKOCrr-KLKT op THS ASSOQATION, and PROmSOR OF MBDiaNB EN QUBBN'8
oaaBom, asd physician to tub royal hospital, bklfast, irblano.
i (Special for Thb Mkdical Rboord.)
Tax principal interest in regard to the progress of medi-
cal sdence is at present concentrated on the study of
mmute organisms as causes of disease. The identifica-
doQ of the special parasites, the study of their mode of
invading the body, of the places of their development, of
thdr effects in respect of nutrition, function, and tissue-
change, present subjects for investigation of surpassing
interest and engage the attention of numerous observers.
Evidence is rapidly accumulating which leaves little room
to doubt that micro-organisms are the active agents in
the production of epidemic and endemic diseases. A
flood of light has been thrown on some of the obscurest
points of pathology, the reproduction and increase of con-
tagions elements, the immunity acquired by passing
through a disease against a recurrence of the same mal-
ady, and on the question of the incubation and latency
of contagious diseases. Nothing can be of greater in-
terest than the observations on the attenuation of virus,
opening out unexpected possibilities of mitigating the
severity of some of these scourges of the human race,
aod making the hope of the ultimate extirpation of several
of them not altogether a fantastic one. In the main we
have to look to foreign observers for our instruction in
these subjects, for in these coimtries the researches ne-
cessary to elucidate such problems are trammelled by
legislative interference and markedly discoujoiged by
popular sentiment. In recent years it had becoipe one
of the commonplaces of general addresses on medicine
that disease was to be regarded as simply a perverted life^
process, and diat there was an essential identity between
physiological and pathological processes. We used to
congrattdate ourselves on the strides we had made in ad-
vance from the notions of the earlier physicians who re-
prded disease as an intrusive foreign element at war
vith the vital principle. Boerhaave is credited with being
Ae first to formulate the great principle, " Morbus est
vita praeter naturam." And undoubtedly this conception
fid lead to clearer notions of many of the phenomena of
chronic disease. But what is the outcome of the most
ncent researches on bacterial action ? It is, that when
bacteria enter a tissue they come into conflict with the
proper tissue-elements, abstract the nourishment con-
tained in the juices to the detriment or exclusion of the
VHmal cells, and give rise to different chemical changes
vlucfa disturb the normal metabolism of the healthy
parts. After all, in different language, the old idea was
Bot so very wide of the mark as we supposed. If the
vital activity of the parasite gets the upper hand, the life
of the normal cells of the organism is enfeebled or de-
stroyed, and vice versa. It is the old struggle between
Omiuzd and Ahriman within the sphere of nutritive ac-
tivity. Now investigations on these subjects, can only be
conducted by those who have the leisure and aptitude for
original research, and must accordingly be left in the
hands of the few. But there is another vast field of in-
quiry which is not beset with the same difficulties, and
which forms the necessary complement of the study of
the parasite. We know that there must be a certain re-
ceptivity in the system, some diminution in its wonted
powers of resistance, or some original proclivity— some-
thing which we are in the habit of terming predisposition —
which renders the body liable to the attacks of the para-
site and furnishes an appropriate soil for its growth. This
predisposition may be either a general one expressed by
a proclivity in some countries or in certain races, or in
particular temperaments, or it may have been acquired
by the individual either at a certain period of life, or
under the influence of a variety of causes in his diet,
occupation, or surroundings.
Now it is precisely with reference to these points that we
can get most light— I had almost said the only light— from
the general experience of the profession. A great deal
of medical literature is founded on hospital practice, which,
valuable as it is, wants the element of tirne. The float-
ing population of hospitals passes rapidly ifrom under ob-
servation, and it is only from the medical men who have
known patients for years, and often the stock from which
they come, that we can get information which necessarily
presupposes continuous observation spread over long
periods.
It is in respect to questions of this kind, which are so
clearly within the scope of every practitioner of medicine,
that I look for the best results from the labors of the
Collective Invest^tion Committee, which I have no
doubt will prove one of the most valuable of the agencies
for good in this Association ; and I am not without hope
of a still larger and more ambitious effort, which will
embrace not only this but all civilized countries in its
operation, and that we may have an international collec-
tive investigation of disease. From such an organization
we could obtain an immense amount of information on
the subject of climatic and telluric influences, and on the
question of racial proclivities to disease, as well as on
the important subject of diathesis.
The subject of the proclivities of different races to dis»
ease is one of great interest, and has been but little
investigated. The fiacilities which the vast colonial* em-
pire of England offers for observation to medical officers
of the public services have enabled them to see much
of disease in different countries of the world ; and, no
doubt, there is a good deal of information entombed
in the army and navy reports, but we have but little
definite knowledge. That the negro race enjoys a com-
parative immunity from yellow fever, and that even a
slight admixture of negro blood brings with it a certain
degree of protection from this malady, seems well ascer-
tained. The comparative freedom of the same race from
stone, and, on the other hand, their marked liability to
elephantiasis and to tetanus are clearly made out
Again, there is reason to believe that different branches
of the Aryan or Indo-European family present some
peculiarities in respect of liability to morbific influence.
In France, where, from the requirements of military
service, statistics with respect to some classes of affec-
I7Q
THE MEDICAL RECORD.
[August i6, 1884.
tions are easily accessible, it has been found that in the
provinces where there is most Teutonic blood there is a
notably greater number of exemptions from service owing
to varicose veins and hernia than those in which the in-
habitants are of Celtic origin. On the other hand, it is
considered by some that the Celtic people do not bear
surgical operations so well. When Velpeau was re-
proached with the greater mortality after operation in
Parisian, as compared with English hospitals, he is re-
ported to have replied that the flesh of a Frenchman was
not the flesh of an Englishman. And all who, in recent
years have had the privilege of visiting the wards of M.
Charcot in the Salpetridre, have been able to notice a
variety of rare and complex diseases of the nervous sys-
tem which are certainly but rarely to be met with in these
countries, and which he has used in so able and instruc-
tive a way. Again, it is probable that drugs act diflerently
on different races; the negro, for example, bearing
mercury better than the white, and being somewhat differ-
ently affected by opium. There are also the analogous
facts of the insusceptibility of some animals to poisons
which act with fatal effect on others.
Without entering on the subject which was so hotly
debated some time ago, whether a change of type in
disease has taken place, there can be no doubt that a
change of epidemic constitution, using the term in a
wide significance, has taken place, and that the same
diseases do not prevail with the same frequency. There
can, I think, be no doubt that typhoid fever is much more
common in Ireland than formerly, if indeed it existed at
all, and that typhus is much less frequent
Now the important subject of diathesis is closely allied
to this class of inquiry^ and is eminently adapted for
collective investigation. It is a condition in which large
numbers of individuals are implicated, and in which a
large array of facts is of primary importance, and it is
also one in which continuous and prolonged observation
is eminently and especially necessary.
What may be the nature of the peculiarities of structure
and of function which imprint a particular character on
the morbid manifestations which an individual exhibits it
may not be possible for us to ascertain with certainty,
but there is no fact capable of more overwhelming clini-
cal demonstration or which is of more cardinal impor-
tance in the management of disease. It is a state in
which, under the influence of exciting causes, or perhaps
without any exciting cause, morbid phenomena are
manifested, diverse in their seat, their extent, and their
character, but united by a common pathological bond,
which is shown in their mode of evolution and recession,
and in a kindred demeanor with respect to therapeutic
influences. It is a constitutional state which exists
before, and often long before any local manifestation
whatever, which is, I have said, obscure as regards its
nature, but distinctly recognizable in its effects, and
which we know in several instances to arise from well-
recognized causes. It enrolls the individual who is
affected with it in a category apart from those who are'
not iinder its influence, and in this way approximates to
a racial peculiarity, the analogy being all the closer that
diathesis is in many instances capable of transmission to
the descendants of those who are its subjects.
I dwell on this the more because I think it specially
the province of the practical physician, and because it
constitutes the most typical expression of a class of facts
which are forced on us by daily experience. We all
know that an affection of the nervous system or the
digestive system represents a different thing, as regards
the outlook and the present danger, in one family as
compared to another. There are not wanting indica-
tions of a tendency which takes its direction from very
high quarters to assign an undue predominance to ana-
tomical change to the exclusion of constitutional states.
The greatest living pathologist. Professor Virchow, of
Berlin, in his address at the International Medical Con-
gress in 1 88 1 spoke as follows : '' How has it now come
to pass that symptomatology has entirely lost the high
position in which it still stood little less than a genera-
tion ago, to such an extent that in most universities it is
no more taught as a specialty? Have symptoms no
more any importance for the physician ? Can a diag-
nosis be made without a knowledge of symptoms ? Cer-
tainly not. But for the scientific physician the symptoms
are no more the expression of a hidden power, recognii.
able only in its outer workings; he searches for this
power itself, and endeavors to find where it is seated in
the hope of exploring even the nature of its seat
Hence the first question of the pathologist and of the
biologist in general is, Where ? That is the anatomical
question. No matter whether we endeavor to ascertain
the place of the disease or of life with the anatomical
knife or only with the eye or the hand, whether we dissect
or only observe, the method of investigation is always
anatomical."
I do not think that this doctrine will find acceptance
with practical physicians. We believe that many morbid
phenomena are not to be looked for as merely the ex-
pression of local change, but as portions of the effect of
some specific cause ; that the disturbance of fimction,
otherwise the symptom, often precedes the tissue al-
teration, and that we might be justified in stating the
seeming paradox, that the symptom sometimes causes
the lesion rather than that the lesion causes the symp-
tom. Medicine teems with instances in which anatomical
change alone would lead us very far from the result which
clinical observation indisputably establishes, and there
is no lesson which experience teaches a physician more
decisively than that it is not the extent or degree of
an inflammatory affection which fiimishes the most ac-
curate measure of its danger or the most reliable indica-
tion for its treatment. Indeed, in dealing with many
cases of disease our question is not. Where is it ? but,
What is it ? Is it gout or syphilis or malaria? and so on;
as we are well assured that if we have got the key to the
enigma all the varied anatomical changes will become
explicable, and, what is of far greater moment, will be
found amenable to remedies. We have often occasion
to observe that anatomical changes, not to be easily dif-
ferentiated, follow from life processes which are very ^
similar. That symptoms without morbid anatomy are
inadequate and misleading for the purposes of the phy-
sician, has been only too amply demonstrated in the rec-
ords of medicine ; but it is no less certain that morbid
anatomy without symptoms — that is, without giving a due
and even a preponderating weight to the origin and prog-
ress and vital character of the disease — will lead to error
hardly less disastrous.
It had been one of the characteristics of Irish med-
icine that this conception of the essentially vital char-^
acter of morbid manifestations has been firmly grasped
and strongly insisted on. In the latest work of Dr.
Stokes — a name always to be mentioned with honor as
one who was an honor alike to his profession and to his
country, and who has special interest for this Association,
of which he was President at the Dublin meeting — ^he says:
*' So far as medical experience goes, we are forced to
admit that the foundations for the healing art must rest on
another, if not a broader basis than that of anatomica]
and of chemical changes in disease. There are differ*
ences — and for want of a better name we may call then
vital — which more intimately relate to life and health thai
to the anatomical or chemical changes produced by dis
ease ; and these are to be reached by the study of the livin|
phenomena of the body and of the influence of agent
upon them. In truth, the fruitless attempt to base med
icine upon anatomical or even chemical changes shouI<
be a lesson to those who neglect the infinitely varies
mutations of vital or of nervous action."
It is not that this great physician did not recognize L
the fullest manner the necessity for the closest physia
examination during life and the most careful scrutiny c
morbid products : much of the labor of his life, as is we
August i6, 1884.J
THE MEDICAL RECORD.
171
known to us all, was devoted to the elaboration and per-
fection of that physical diagnosis of which he was so con-
smninate a master ; but that he refused to recognize the
i«sDlts of disease as adequate to the interpretation of
morbid processes.
It is impossible not to believe that if clinical evidence
liad not been allowed to be overborne by pathological
theory, there would have been much less difficulty and
modi less confusion about the relationship between pul-
monaiy consumption and struma or scrofula. We may
sdect this as an illustration, because scrofula is an affec-
tion with which we are very familiar in this country, al-
Aoogh probably it is not more general here than in Eng-
land and Scotland. On broad public grounds there ^e
few conditions of greater moment than scrofula as influ-
encing the well-being and development of the youth of
the community. Defacing the comely skin and cloud-
ing the clear eye of childhood, disfiguring and scarring
the neck and crippling the supple limbs, it is undoubtedly
one of the most wide-spread and unsightly forms of hu-
Qian infirmity. Complex in its causation, and favored
by all the concomitants of poverty, insufficient diet, scanty
clothing, want of light and air and sunshine, it is no doubt
in many instances connected with the use of a dietary
deficient in animal and vegetable fats, a view strongly
advocated by the late Professor Hughes Bennett, and
which has received the support of an authority no less
eminent than Mr. Jonathan Hutchinson.
Now I cannot but believe that if the facts of the clin-
ical history of scrofulous affections had not been over-
home by pathological considerations, there would be
much less difficulty in ascertaining the relations between
scrofala and pulmonary consumption. The reports of the
Collective Investigation Committee have shown a pre-
ponderating testimony in favor of the view toward which
the current of medical, as well as popular, opinion has
been setting — ^tbe communicabiiity of pulmonary con-
somption. Now after a period during which consump-
tion seemed in a fair way of being considered to depend
on anything but tubercle, we have come to the convict
tbn that, broadly speaking, tubercle is the anatomical
element of the malady. There is no doubt that a path*
ological product, not to be distinguished from tubercle,
is met with in some scrofulous glands, and from this cir-
comstance, if we dealt with disease simply as pathological
anatomists, and not as physicians and surgeons, we should
pronounce an opinion very favorable to the identity of
the two affections, and state that an individual with a
scrofulous gland and another with pulmonary consump-
tion were alike the victims of tubercular disease, and sil-
though we would in doing this group together affections
widely different as regards their gravity and prognosis,
we would be acting on strict pathological lines. But
when we examine another numerous class of strumous
cases, those in which the eye and skin are affected in
diildhood, we find no evidence of tubercle whatever i
indeed, in the progress and issue of the affections, decisive
evidence that tubercle is not present at all, and accord-
ingly we are able to convince ourselves, not only from
thu circumstance, but firom the examination of many
oore advanced forms of these affections, that tubercle is
not a necessary accompaniment of struma. Now, so
smch have the minds of pathologists been influenced by
file occasional presence of tubercle in struma, that it has
been broadly stated that consumption is a further stage
ef sarofiila and that the two affections are identical, ex-
cept in so far that scrofula represents an external and rudi-
mentary form of the disease of which pulmonary phthisis
B^more advanced and complete manifestation. At
ftis point clinical observation has a right to enter and
Mver a formal protest Dealing simply with the facts
vhich come under our notice we find in scrofula a con-
dition Qx>st common in the young, although by no means
esdnsively confined to them ; revealing itself by a va-
nety of manifestations very chronic in their character,
liable to be set up by trivial exciting causes, and remark-
ably prone to affect lymphatic structures. These phe-
nomena are in the main capable of easy recognition, and
form a clinical type which is evidently a natural one.
They are evidences of a diathesis which makes those un-
der its influence a class different from others in the vital
endowments of their tissue. Of those who exhibit this
diathesis in childhood, a considerable proportion grow
up into fairly healthy men and women, capable of per-
forming the duties of active life, and giving no palpable
indications of disease. But they still show a certain vul-
nerability of tissue, and proneness to some chronic affec-
tions of the same kind, in fact a particular " cachet "
which explains the anomalies in their vital reaction.
Nothing can be a more legitimate atld incontrovertible in-
ference from the facts than that an individual may have
been distinctly and markedly scrofulous, and yet never
exhibit any indications of consumption.
On the other hand, of the consumptive patients who
present themselves to a physician for advice about their
lungs, a large proportion, estimated at about eighty or
ninety in the hundred, have never had a history of scrofu-
lous affections in childhood, and show no present evi-
dence of the taint. It is quite exceptional to And a
phthisical sufferer showing such indications. Clearly, then,
an individual may become phthisical without being scrofu-
lous, and considering the wide diffusion of struma and
the great frequency of pulmonary consumption this seems
decisive. In a recent able work on scrofiila Mr. Treves
has laid down the proposition, as the result of the obser-
vation of a great number of cases, that there is a decided
antagonism between scrofulous diseases of all kinds, and
that if a patient has one severe, or even well-marked
manifestation of scrofula, he is not likely to develop
another strumous disease at the same time. Contrast
with this the well-known law of Louis, that the presence
of tubercle in any organ after the age of fifteen involves
as a necessity its existence in the lung, and we see how
contradictory these assertions are if we depend altogether
on the character of the product The product known as
tubercle has, after the age of fifteen, the property when
present of causing the development of a similar morbid
product in the other parts. Therefore, the tubercle
found in scrofula in childhood has not the same rela-
tions to the system as the tubercle found after fifteen
years of age. It is, of course, unnecessary to say that a
lymphatic gland furnishes one of the easiest and most di-
rect channels for the conveyance of infection into the
system. Now this is not a mere question of terminology,
for the attempt to unite different states on the basis of a
common anatomical character invariably associates them
in the mind as identical in all essential respects and is
very misleading.
We ought to deal with the recent observations which
point to the bacillus tuberculosis in the same spirit.
When we are informed by Koch that he has found the
same parasite in caseous bronchitis, caseous pneumonia,
phthisical sputa, and in the hyperplasia of lymphatic
glands, a clinical observer is justified in listening to
these statements with the greatest interest, but with con-
siderable reserve. He has a right to inquire how is it
that an infective granuloma does not infect, and how is it
that an enlarged lymphatic seems to demean itself in
very much the same way, whether it is the seat of a sim-
ple chronic inflammatory process or of a new formation
containing an intrusive organism profoundly dangerous
to the economy and tending to invade one part of the
system after another.
In fact, while we ought to welcome every new method
of investigation, while we ought to do nothing to dis-
courage the boldest flights of pathological speculation, to
us the crucial test must always be the clinical one, the
facts drawn from the direct observation of morbid pro-
cesses during life. And in spite of any pathological gen-
eralization or anatomical induction we must hold rigidly
to our clinical facts and decline to allow them to be
warped or strained in the slightest degree.
172
THE MEDICAL RECORD.
[August i6, 1884,
Looking at the matter from the point of view of a
practical physician, how different is the outlook as re-
gards a young person brought to us with a strumous
ophthalmia and enlarged glands in the neck and one of
the same age with a little dulness and a few moist sounds
in the apex of a lung. Is this wide difference in prog-
nosis a question merely of a difference in seat of an iden-
tical pathological product ? Is there not, as a rule, some
antecedent condition which favors, if it does not deter-
mine, the appearance of the morbid state ? Is it not a
rare thing to find a phthisis beginning without, for ex-
ample, a period of loss of appetite or indifferent health
of some kind ? Do I then wish to say that there is
no connection between scrofula and consumption? I
should not wish to be understood as making this state-
ment.
There exists a certain kinship which makes the two con-
ditions sometimes overlap, and there is some evidence
that a hereditary tendency may sometimes be expressed
in the one form and occasionally in the other.
It is proposed to inaugurate at this meeting a section
devoted to pharmacology and therapeutics. The sub-
jects embraced in this section have hitherto been scat-
tered through different departments, but the increasing
importance of their study justifies their being assigned to
an independent section. The study of the action of
drugs on the body both in health and in disease, and the
study of all the means by which a disease may be miti-
gated or cured, form a necessary complement to the study
of the disease itself, and even throw as much light on its
nature.
In recent years the efforts in the direction of estab-
lishing rational therapeutics have been followed by great
and encouraging success, while the search after spe-
cifics has disastrously failed. The study of antipy-
retics presents, in a striking light, the results of inquiry
conducted in a strictly scientific method and spirit, and I
am glad to find that one of the earliest discussions in the
new section is to be devoted to this most valuable class
of agents. New remedies of unquestionable power are
being placed in our hands. It is impossible to read the
account of the employment of kairin without being struck
by its great efficacy in reducing temperature.
In recent therapeutics we find also an illustration of
what I have before endeavored to show. In treating acute
disease, it is, as a rule, the functional trouble that engages
our attention and constitutes the aim of our therapeutic
measures. Heat, delirium, circulatory or nutritive dis-
turbance, adynamic symptoms — these are the conditions
to which we direct our remedies. How comparatively
rarely do we attack the tissue-change directly, and how
comparatively inoperative are our therapeutic agents in
this direction. It is true, of late years and since the in-
vestigations of Pasteur, that wider and more attractive
possibilities have come into view, and the hope is enter-
tained that agents may be placed in our hands which,
without injuring the body, may prove incompatible with
the life and development of some, at least, of the parasite
organisms. That a particular salt promotes the growth
of an organism, that another in even exceedingly minute
quantity is fatal to it, gives some ground for the notion
that it may be practicable to destroy some of these for-
midable enemies even within the body. Again, the
methods of therapeutic research have been much im-
proved.
The employment of the alkaloids or active principles
of drugs in conducting experiments on their nature, in-
stead of tinctures and powders of necessarily uncer-
tain strength, has enabled a degree of accuracy to be
obtained m estimating the effects produced which was
formerly quite unattainable, and give additional scientific
precision to the conclusions which are attained. For my
own part, I regard every advance in therapeutics with
great interest. The true dimity as well as the chief at-
traction in our studies lies m their practical utility. If
our efforts were not quickened by something more than
love of knowledge or scientific curiosity, the study of dis.
ease would be at best but a repulsive one.
'' Res ipsa omari negat contenta doceri."
No doubt there is an intellectual gratification of a high
kind in contemplating a well-ordered field of knowledge
where the divisions are clearly mapped out, and their re>
lations, extent, and connections can be accurately under-
stood. And it is also true that the study of medicine
exercises a powerful and beneficial influence on the
development and cultivation of the intellectual faculties.
It was said by Dugald Stewart that the study of medi-
cine had an important influence on the development of
one of the keenest intellects of modem times.
" No science could have been chosen more happily,"
he says, '' to prepare such a mind as that of Locke for the
prosecution of those speculations which have immortalized
his name, the complicated and often equivocal phenoim
ena of disease requiring in the observer a far greater
portion of discriminating sagacity than those of physics
properly so called ; resembling in this respect much more
nearly the phenomena about which metaphysics, ethics,
and politics are concerned."
It is not possible that medicine should be cultivated
on exactly the same lines as other sciences. In the first
place, we are necessarily precluded from experiment; in the
next place, we have but limited control over the subjects
of our art. It v/as long ago pointed out by Bichat that
pathology, the science of disease, has no exact analogue
among the physical sciences. Physiology bears the same
relation to living bodies that medianics and the like do
to inert matter. But there is no pathology of the physi-
cal sciences. We cannot suppose gravity to become
deranged in its operations or chemical affinity as subject
to morbid action. Nor can we suppose these forces are
susceptible of remedies. Accordingly the processes of
disease nmst be made the subject of investigations of a
special character ; to be conducted, certainly, according
to the general principles which govern all scientific re-
search, but not on the same lines or by the same method
which other branches of inquiry demand. The study of
life and its manifestations, of its beginnings and its end-
ings, conveys the idea of effort, sometimes baffled, some-
times victorious, of an incessant struggle with its eviron-
ment compared with which the physical forces seem types
of serenity and calm.
Bacon advised physicians to raise their thoughts above
common cases, and to turn them to prolonging and re-
newing the life of man. But, like much of the advice
which men of great intellectual attainments have given
to our profession, it only served to show that he had
failed to recognize the essential conditions of our art.
It is given to philosophers to generalize : to us the in-
dividual is everything. Aristotle and Seneca advised
that, for the good of the race, delicate children should
not be brought up. It is our duty to fan the puniest
flicker of vitality and to preserve it from extinction as
long as and as far as the most jealous care and solicitude
can be effectual for the purpose. What the sick or
suffering ask of us is, to have their pains and maladies
mitigated or cured in the speediest and most effectual
way. ''Melius anceps remedium quam nullum^ is a
maxim which may not be a very wise one, but which
certainly would fairly represent the desire of the great
majority of the human race. There is deep truth in the
saying of Bacon : " They be the least physicians which
being learned incline to the traditions of experience, or
being empirics incline to the method of learning," for it
indicates that the physician should draw firom all sourcef
of knowledge alike. It used to be a reproach to physi*
cians that they followed too implicitly the teaching of
their masters and that they were unduly slow to accept
new ideas ; at the present day we are no longer liable to
this reproach. One is almost inclined to suggest that
even an undue haste is occasionally shown in adopting
suggestions which rest on insufllcient evidence or obsef«
August i6, 1884.]
THE MEDICAL RECORD.
173
varioa It shows, however, a change in the habits and
temper of mind which is in close accordance with the
general spirit of the age. It is well that novel views
should meet, as they are sure to do at our meetings, that
rigoroas and searching criticism which is the surest test
of tmth and which best proves its strength and vitality.
It is one of the numerous advantages of a great assoda-
tioD like this that different men may seek different ser-
vices from its strength and organization. One regards
especially its usefulness in bringing the weight and in-
fluence of a great profession to l^ar on public questions ;
another may value it for its beneficial influence on the
statos and relations of the members of the profession
themselves ; while others again attach more importance
to its strictly scientific aspect, and desire that its re-
sources and energy should be devoted to the encourage-
ment of research, the fostering of investigation, and the
general farthering of medical science. In the elasticity
of its constitution, in the adaptability of its machinery,
and in the independence of its branches, there is ample
scope and abundant facility for the utilization of the
Taried energies of its members. In this respect it is no
nnfitting representative and exponent of the great pro--
fession out of which it springs. Called as we are to deal
irith the evils and mischances to which every form and
variety of human activity are exposed, our points of con-
tact with the public are well-nigh innumerable.
"Quidquid agunt homines," the worn-out limb, the
jaded sense, the weary brain alike come under our ken.
Eveiy avenue of pleasure may become the portal for the
ingress of pain. And so our studies embrace a vast and
complicated range of subject, and give to medical science
a wide and far-reaching scope of activity. And as it is
DOW, so it has been and will be. When hygiene and
preventive medicine have done their utmost, there will
still be only too ample scope for the physician in dealing
with the innumerable forms of human infirmity. The
Ibmidations of our art have been laid in antiquity beyond
the reach of historical research ; in this progress it has
reflected innumerable aspects of human thought; its
tenns are the monuments of forgotten theories ; to its
storehouses of knowledge all civilized ns^tions have
brought their contributions.
It will be found that if in its course of development
medidne has shared the errors and shortcomings in-
separable from human progress, its advances have been
in the main fairly abreast of those made in other branches
of knowledge.
It is for us to maintain in our day the dignity and use-
yoess of a profession which has included in it so many
gpod smd fiamous men, and which has been for so many
centuries among the foremost branches of intellectual
ictirity.
Refusing to be Vaccinated. — ^There are persons
here and there to be found who refuse to be vaccinated,
and some of them give the ground of their refusal to be
"principle." A person of this character appeared in an
English court not long ago to answer the charge of re-
insmg to allow his three-year-old child to be vaccinated.
The noagistrate fined him, although his action was stated
to be ** on pripciple.'* As the fine was not paid and
coold not be collected, the offender was sentenced to
PortSDKmth prison for fourteen days, but without hard
labor. While in jail he was obliged to wear the criminal's
pib, had to sleep on a plank bed, and was compelled to
pick oakum. He wished to secure his own food, offering
to pajr for it, but the authorities declined to let him have
loytlung except the ordinary prison fare. These facts
were brou^t before the judge by his counsel, who con-
tended that he was not an ordinary prisoner and should
not be subjected to such treatment ; but the court de-
eded djat the law had been broken, and that the offender
ttnld not claim any better treatment than any o^er
pnsoner.
PRACTICAL OBSERVATIONS ON THE HUMAN
EAR AND ITS DISEASES, WITH ILLUSTRA-
TIVE CASES.
By SAMUEL SEXTON, M.D.,
* AUXAL 8UKGBON TO TMB NEW YOKK BYB AND BAX IKnUCAXY.
I. — ^The External Ear.
(Contmued finom No. 7x8, p. 153.)
Sometimes it happens that the regressive stage runs
on into a chronic condition, and the walls of the cyst
fail to unite, or else a permanent sinus remains. Under
these circumstances it will be necessary to destroy the se-
creting surface of the cyst. This may be accomplished
either by the application of escharotics or irritants to
the walls of the cyst, or by scraping them with the cut-
ting instrument shown in Fig. 2. In regard to the se-
lection of an irritant for this purpose, I have found none
equal to a strong solution of iodine. The operation
consists in making a tolerably free incision into the
tumor, or in enlarging the sinus where one of small
size exists, cleansing out the cavity, and then freely
painting its surface with Churchill's solution of iodine.
The wdls of the tumor are afterward to be kept in con-
tact by pressure. In my own experience, the injection
of small quantities of the tincture of iodine into these
tumors has proven to be temporizing and unsuccessful.
Case II. is an example of the advantages of the method
recommended above. When the operation already de-
scribed fails, or for any reason seems inadvisable, the
surface of the walls of the tumor may be abraded
throughout with the fenestrated cutting scraper. This
method, which was the suggestion of Dr. G. H. Fox, is
preferable to escharotics, since the disorganization of
tissue is entirely within the operator's control. This
treatment was employed in Case III. Where any pro-
jecting ed^es or sharp folds of the cartilage prevent the
walls commg together, they may, where the correcting of
deformity is desired, be extirpated by dissection. This
can readily be done by making a sufficient incision down
into the outer surface of the auricle, and with knife and
scissors removing the inequalities of the distorted carti-
lage. If thought advisable, the surfaces of the cavity
may be afterward treated by painting with iodine or
scraped. After the operation the walls should be kept
in contact by bandaging (pressure). In the writer's ex-
perience, otoplastic operations can be performed with
considerable freedom in these cases without fear of un-
due reactive inflammation, the wounds healing readily
in the insane, even where low recuperative action might
be expected to exist.
The occurrence of othaematoma in the mentally sane
is uncommon ; a glance at the literature of the subject
shows that it has been comparatively seldom the subject
of observation among foreign writers, while American
authors have thus far reported only some ten cases.'
The writer ventures to introduce here a few illustrative
cases occurring in his own practice, beheving that an
account of their behavior and management may be of
interest in this connection, none of them having been
hitherto reported.
Case XI. — A gentleman, forty-three years of age, a
lawyer by profession, who had always been healthy, came
to consult me on November 22, 1876, with the following
history: On November 12, 1876, he discovered the
presence of a small tumor on the upper and outer aspect
of the left auricle. It gave him so little trouble that he
did not consult his physician. Dr. W. C. West, of Mon-
roe, Mich., until a week afterward. Dr. West then
removed the small collection of serum which the tumor
contained by aspiration. The effusion now increased
> Vide C. J. Blake : Statistical Rept. of 1,633 Cases of Diseases of the Ear.
treated at the Mass. Ch. Eye and Ear Inf. during the year 187a : one case of
otha:inatonia— A. J. Otol., vol. iii., po. 193-196. H. Knapp: Arch. Otol., voL ix..
pp. i95-4oa. Roosa: Trans. Am. <
, voL 1., pp. a3-ia7. Kipp : Trans.
X*. OT'Soc., vol. L, p. 79. Pomeroy: Ibid., vol. ii.. pp. 83-^6. Buck : Diagnosis
and Treat, of Ear Diseases. Pooley : Msdical Record, vol. xix., pp. 3«3-3«5-
174
THE MEDICAL RECORD.
[August i6, 1884.
more rapidly than before, and on the 21st of November
the operation was repeated, the liquid withdrawn now
being sero-sanguinolent. Urgent business at this time
requiring the patient's presence in New York, he came
to my office as stated above. The tumor was now
found to be about the size of an olive, but thinnerf and
to have a purplish color. The distention was causing
some discomfort, and half a drachm of bloody serum
was evacuated by aspiration, after which the organ did
not appear much larger than normal. The patient re-
mained six days in New York, during which time there
was but little change in his condition ; the cyst was
evacuated daily, and twice a few drops of tincture of iodine
were injected, which increased the irritation somewhat
— the auricle becoming slightly more swollen and tender
to the touch, but receding a^ain to its former state.
While in New York the patient's business required much
activity both of a physical and mental nature. Before
leaving for home he recalled having folded up the auri-
cle upon itself by an accidental blow with his own hand
while playing with one of his children a short time before
he discovered the cyst.
The patient left for his home on November 28th.
He took a severe cold during the journey, and Dr. West
found him, on fiis arrival the next day, suffering very
much from the distention of the cyst, the contents of
which were evacuated as before. On the 29th he was
restless, the temperature going above 100°. A purga-
tive and aconite were ordered, together with cooling
lotions and gentle pressure. The latter, however, could
not be borne. On the 30th the patient felt better, but
the local trouble was extending, and now a colored spot
was discovered on the back of the auricle. Iodine was
injected into the cyst
From this time on the patient continued to grow
worse ; the eyes became sensitive to light, and there
were darting pains through the head. The inflammation
extended itself to the parts above the ear ; there was
now effusion both in front of and back of the cartilage.
Sedative doses of aconite were continued, and a laxa-
tive and quinine were given ; an incision fully an inch in
length was made, which laid the anterior aspect of the
cyst freely open. The wound was then packed with lint
soaked in carbolized oil. " The operation afforded im-
mediate relief," says Dr. West, in his report of the case
to me, '^ and in a few days there was an improvement in
the symptoms." Tonics were then given. The patient
was confined to his bed, however, during the month of
December, and for the period of another month to the
house. In May, 1877, the auricle was yet quite tender
to the touch, and sensitive to draughts of air, although
the parts had been for some time entirely healed. When
the patient came to see me, in February, 1880, it was
found that the auricle was considerably deformed, the
superior portion of the cartilage being much contracted,
the antihelix quite obliterated. In reviewing the case,
it was evident that the long railway journey, the want
of proper rest, and, above all, the cold contracted, made
a severe case out of what would have been, perhaps, a
mild one.
Case XII. — R. B , a packer, forty years of age,
came to the New York Eye and Ear Infirmary, August
2, 1877, with a small sanguineous tumor on the outer
aspect of the left auricle, between the helix and anti-
helix, near the superior border. The tumor was of a
deep red color, and slightly painful when handled. No
urgent symptoms were present, and no subsequent visit
was made.
Case XIII.— Ellen M-
a tailoress, aged twenty-
seven, but looks much older. Came to the New York
Eye and Ear Infirmary November 29, 1880. She
is very intemperate, and the teeth are nearly eroded
away by caries until they are about on a level with the
gums. She states that one month ago the left ear was
violently jerked by her husband, and that the next morn-
ing it swelled up and was of a very dark purple color.
A day or two afterward the husband opened the swollen
tissues with a blade of his pocket-knife. This operation
increased the swelling, and a few days afterward a
" doctor" laid the outer aspect of the tumor open with a
lance. The cyst now became intensely swollen, and was
as large as the patient's **fist." The husband then canie
home again in a drunken state and struck her on the
Fio. 7.
ear, causing a discharge of its contents to take place
from the superior surface of the auricle. Flax-seed
poultices were constantly applied to the ear during the
attack. The posterior surface and the lobule were at
no time affected. From the first the ear was for a while
painful. For the past two weeks the swelling has dimin-
ished, but since yesterday it has again increased in size,
the patient says '* from the effects of taking cold in the
ear." The tumor is now hard, and in size about one
inch in thickness, and from above downward one and
three-fourths of an inch in length. It is oval in shape;
it& outer surface is corrugated and somewhat resembles
an almond that has been divested of its outer cortex.
It is not sensitive to the touch, and in color is dark red,
like the rest of the face and neck. Hearing is unaffected.
The ears are naturally small. Fig. 7 shows the affected
eai's appearance at the time of her first visit. The local
treatment was expectant ; internally the tincture of aco-
nite root was ordered in small and frequently repeated
doses. Rest and better personal hygiene recommended.
December 6th. — She comes to-day with a painful al-
veolar abscess at the root of the left upper central in-
cisor tooth. Sent to the dentist to have tooth removed.
December 9th. — The left side of the face is much
swollen from the presence of the alveolar abscess, which,
however, is no longer painful. The ear is also without
pain. Were it not for the unsightliness of the abscess
and the painful mastication, the patient would not have
returned to-day for treatment She was not again seen.
Case XIV. — Mr. S , a dry goods merchant, aged
twenty-five, came to consult me on October 17, 1881.
Two months previously he had received an injury to
August 1 6, 1884.]
THE MEDICAL RECORD.
175
the right ear by being jammed against a door while
in a state of intoxication. Twelve hours afterward he
.experienced soreness of the auricle, which was limited
to the upper part of the helix ; this continued without
observable swelling for six weeks. Two weeks ago he
BOticed that the outer aspect of the ear was *' puffed
out," and two days later an incision was made into it by
a physician to whom he went at the time ; there was an
csape of sero-sangumolent fluid, but by the next morn-
ing the incision had closed and the cyst had refilled.
Tiro days later another physician was seen, who cut the
parts open with scissors, and on the following day increased
the size of the opening by making a crucial incision. It
seems that these measures were not sufiEicient to prevent
the filling and distention of the sac, and that five days be-
fore coming to me a ** piece was cut out," and the cavit>'
then packed with oakum. Subsequently efforts were
made to b^dage the ear to the head. The oakum was
alloired to remain for three days, and the ear was then
poulticed When I first saw the case the auricle was
veiy much enlarged, had an angry look, and was of a
purplish color. (See Fig. 8.) It was not very tender to
Fig. 8.
the touch. Hearing was unaffected. It was very evi-
dent that the patient was in a state of chronic alcoholism,
and he was told that treatment would be almost unavail-
ing unless he left off* stimulants. The fluid which had
again accumulated was now removed by aspiration, and
ic was determined to try pressure so soon as the neces-
sary dressings could be borne. On October 19th, 21st,
23d, and 30th, improvement was uninterrupted ; the fluid
removed at each visit was found to be more and more
thin and pale, and the quantity less and less. The ear
was not so angry in appearance, the outlines of the helix
began to show themselves, and the sac diminished in
size. The tissues were, however, considerably infiltrated. '
The patient now resumed his intemperate habits, with
the result of exasperating very much the condition of the
ear, the organ becoming much worse after each debauch.
Being unable to improve his habits in this regard, the
treatment was finally suspended before a cure was ac-
complished.
Remarks, — In reviewing the four cases above, and the
writer's other two cases, viz., Case I. and Case VIII.,
before given, it will be convenient to arrange them in
the following tabular form :
The Author's Cases of Othematoma in the Mentally Sane,
>o. Age. Sex.
Occupation.
Ear af-
fected. I
Habits.
Causes.
^.. 43 M. Negro minstrel Right. Temperate. | Trauma.
^••. 35 M. Gymnast. Left. | Temperate. Trauma.
3-.. 43 M. Lawyer. Left. Temperate. I Trauma,
4. . 40 M. Packer. Left. Temperate. Trauma(?).
5-.. 27 F. Tailoress. Left. 1 Intemperate. Trauma.
*••.; 25 M. Merchant. Right ' Intemperate. , Trauma.
It will be seen that in five of these cases the cause
^M traumatic, the injury in one of them being shght. In
one case the history in this regard is incomplete. Five
were males and one was a female. Hearing was not
impaired by the disease in any of them. Four of the
patients were temperate and two were intemperate.
Of the ten cases reported by other American writers,
the right ear was aflfected in four, the left in four, both in
one, and in one case the side affected is not stated. It
will thus be seen that of the sixteen cases occurring in
this country, of which a full history is given, and includ-
ing the writer's six<:ases, the left ear was most frequently
affected. In nearly all of them there was a history of
trauma, and where this factor was seemingly absent, as
shown by the history, it appears that the parts about the
external auditory canal were the seat of inflammatory
action, or had been wounded in operative procedures
(trauma) consisting of incisions into the cartilage.
One can well believe that " perichondritis " could ex-
tend itself from the cartilage of the canal to the pinna in
such cases. Gruber mentions two cases where the
trouble began in the cartilage of the canaL
Othaematoma in the insane has its peculiar interest
also, and it is believed that the following cases will prove
instructive. They were placed under the writer's obser-
vation in the New York City Lunatic Asylum.
Case XV. — Female, aged thirty-two ; under the care
of Dr. E. E. Whitehome. Has dementia, and is vio-
lent. On October 19, 1882, the left auricle suddenly
became the seat of a haematomatous tumor the size of
a pigeon's tgg ; it v/as of a dark purple color, and was
situated on &e outer surface. The swelling impinges on
the concha, and occludes the external auditory meatus.
Its progress was at first slow, remaining stationary for
six weeks, when it again commenced to gradually in-
crease in size without active inflammatory symptoms.
There was fluctuation, but no pain ; the skin was thick-
ened, movable, and very much less discolored. Outline
of helix remains, but antihelix, and fossa obliterated ;
meatus more free. The posterior surface of the auricle
was unaffected. Self-inflicted injury, due to the long-
continued practice of violently pressing the ears with her
hands, had doubtlessly given rise to the trouble ; it was
with much difficulty that they were removed from the
ears long enough to permit an examination of the
parts being made. She always has numerous marks on
the chest and elsewhere from self-inflicted injuries. The
case progressed favorably from this time on, without any
treatment, spontaneous recovery finally taking place.
Case XVI.— Eliza , aged thirty, admitted Sep-
tember 30, 1882, with acute melancholia ; under the
care of Dr. G. H. Gorham and Dr. H. A. Craig. On
December 23d slight redness and swelling of the fossae
of the left auricle was observed, the inner surface of the
organ being unaffected. On December 24th the concha
was invaded, occluding the meatus, and the ear was poul-
ticed. The tumor increased in size until the 28th, when
it was as large as a hen's egg. It remained stationary)
the poulticing being continued, until the 30th, when it
was laid freely open by a horizontal incision, evacuating
a blood-clot and bloody senim. The cavity, which was
about one and a half inch long by one-half inch wide,
was syringed out with carbolized water and afterward
packed with oakum and balsam of PenL December
31st a compress was applied. The outer surface of the
auricle now presented a smooth convex surface ; the topo-
graphical outlines of the cartilage were absent, the con-
cha and lobule even being indistinguishable. The tragus
was unaffected, but was in contact with the tumor. The
swollen tissues were of a dark purple color. From the
wound made by the incision there was constant and
profuse oozing of sero-sanguinolent fluid, which trickled
down the neck of the patient. The arms of the patient
had to be confined to prevent further infliction of self-
injury to the ear. Subsequently an abscess formed on
the posterior surface of the auricle, and ruptured in that
situation, the contents discharging fh>m both anterior
and posterior wounds. Gradual healing of the parts took
176
THE MEDICAL RECORD.
[August 16, 1884.
place during January, the walls of the cyst uniting and
the abscess healing by granulation. February 24th ear
completely healed. An examination in May showed the
existence of considerable thickening in the superior por-
tion of the auricle, with partial obliteration of the concha.
The organ is not reduced in size apparently, although it
has a shrivelled look, the outlines of the antihelix being
distorted. The integument was not markedly adherent,
and its color normal.
Case XVII. — Mrs. Barbara K , aged forty, admit-
ted July, 1883, with acute melancholia. Has delusion
that devils are in her head, and hallucinations of hearing.
To prevent devils "crawling" into her ears and to ex-
clude annoying voices she tlmists foreign bodies, such as
pebbles, rags, and the like, into her ears. On August
6th the whole right exterior ear was observed to be
intensely hyperaemic, but not thickened. The meatus
externus, however, was occluded by swelling of its walls,
and a little pus was found on S3ninging out the canal.
On the 8th the auricle was much more swollen, the
markings becoming indistinct. Hot applications were
made, and on the 9th pus flowed from the meatus freely.
On the 13th it was observed that considerable purulent
discharge was escaping from over the superior margin of
the concha. Hot fomentations were employed, and the
rupture healed by granulation about August 28th, leav-
ing the cartilaginous portion of the external auditory
canal occluded, the walls being in contact. The concha
and fossa of the helix were obliterated and the tissues
indurated ; the auricle is greatly thickened and shrivelled.
Hearing is unimpaired on this (right) side.
On August nth the left ear was found to be inflamed
also, and some dirt and a small piece of rag were removed ;
afterward pus escaped. The ear was then treated the
same as the right had been. When the symptoms abated
the auricle remained thickened, and the canal was much
reduced in size. [The clinical history of this case was
kindly furnished by Dr. Dent, Assistant Superintendent.]
It will be observed that in two of the above cases
there were complications attended with suppuration ; in
one of them — Case XVI. — this was due probably to con-
tusions of the parts during the progress of the othaema-
toma, and in the other case (XVII.) the othaematoma
seems to have been caused by trauma and suppurative
inflanunation in the external auditory canal.
The treatment of contusions of the ears, of course, at-
tracted the attention of ancient physicians. Thus Paulus
^3genita, in treating of these injuries, did not think any
treatment required ; since it was necessary, however, to
do something, he recommended that a local application
of myrrh, aloes, etc., be employed. Hippocrates found
that some of these injuries were much more grave in their
nature than others, and he seems not to have found their
treatment satisfactory. He shows a want of faith in band-
ages or cataplasms, as he believed that they favored the
formation of abscesses and established suppuration ; the
ear, indeed, seemed to stand in need of such applications
less than any other part, and none were sometimes good
treatment. When suppuration (efiusion ?) threatened,
tliere need be haste in making an incision, for often the
matter (?) was absorbed again [italics the writer's] . Were
he forcea to open it (the tumor ?) he preferred transfix-
ion with a cautery, since by means of this method the
parts get well soonest, and yet it should be well under-
stood that deformity will ensue and the ear be smaller
than the other if thus burnt through. If an incision
were decided on it should be freely made on the upper
(outer ?) side, for, he says, the pus (?) is found to be sur-
rounded with a thicker covering than one would have
supposed. After incisions, which may not always be
followed by evacuation of mucus (serum ?), cataplasms
and pledgets are to be avoided. The true nature of othae-
matoma was unknown in the time of Hippocrates, and
in the treatment of the affection he was probably not
aware that a separation of the perichondrium from the
cartilage takes place, and that the detached surfaces sup-
ply the serum, which he wrongly believed to consist of
mucus. The cases which have been given, occurring
both in the mentally sane and in the insane, while show.
ing that the afiection is obnoxious to both classes, at the
same time teach us that the trouble in the latter is sub-
ject to influences which usually render its management
more difficult than in the former. In the treatment of
othaematoma in the insane it would be well to keep in
mind that subsequently to the period of intensest local
congestion there is very often, probably, a decrease in the
temperature of the auricle, which may be due to more or
less complete restoration of vaso-motor dominance, a
condition scarcely distinguishable to the eye from active
turgescence, although to the touch the parts are cold even«
Opportunity to test this matter by thermometrical obser-
vations has not been afforded me, and I am therefore
unable to state the exact degree of depression which prob-
ably exists. To pursue this topic further, however,
would lead us too far.
Concluding remarks in regard to treatment. — One
should not be in haste to interfere in these cases ; in
general it may be said that the dictum of Hippocrates^
namely, that the employment of cataplasms and pledgets
are to be avoided, is as safe a guide now as it was in his
own day. But while excessive poulticing is to be avoided,
there are probably some few cases where hot fomenta-
tions or light emollients of various kinds may, when judi-
ciously applied, prove grateful in an auricle highly in-
flamed. As regards pledgets, however, their employment
is always liable to do harm, since they give rise to undue
irritation if employed early, and the distention produced
by them later on, when thrust into the cyst, prevents the
walls of the tumor coming together and adhering to each
other. The employment of ointment has not, seemingly^
been a favorite mode of treatment, but I have no doubt
that belladonna ointment would be beneficial where the
cutaneous circulation is languid. In tlie regressive stage
I have found dilute tr. of arnica of service, as in other
contusions.
Internally the fluid extract of aconite may be given in
small and frequently repeated doses ; four or five drops
in half a glassful of water is a convenient form of ear
ploying the drug ; of this mixture a teaspi onful may be
given every hour or two, or oftener if required. I have
seen throbbing in the tumor and local congestion dimin-
ish under this course.
Where suppurative processes arise, as they some*
times do, in the inner portion of the auricle, the post-
aural region, or contiguous to the cartilaginous canal,
the calcium sulphide (Calx Sulphurata of the Pharmaco-
poeia) is indicated.
That these patients should be kept quiet, and usually
in a restful attitude, need not be dwelt on here. The
self-infliction of further injury, or its production by
others, among insane persons, should be prevented. At-
tention to general health, of course, must not be over-
looked.
OTHEMATOMA IN THE LOWER ANIMALS.
This form of disease is said to affect dogs, an ac-
count of its occurrence in whom has been given by Mr.
S. Ogier Ward.* Wilde states that he observed the
trouble in a valuable pointer. I have myself never seen
a n^ell-defined case of othaematoma in a dog, unless iso-
lated hard lumps in the pendants portion of the organ be
such. It would seem that some shrinking of the auricle
would be produced by perichondritis rather than the
** lumps " alluded to by writers.
The cat, it would seem, is liable to othaematoma, an
example of which I was shown by my friend. Dr. E.
G. Loring, some months ago. The animal (a male)
which was the subject of the trouble was of the Angora
strain, and was one year and a half old. He was a fine
example of the kind, and, perhaps owing to high breed-
ing, very excitable, not to say wild and uncontrollable.
> Loc du
August 1 6, 1884.]
THE MEDICAL RECORD.
177
Over two weeks before I saw the case the entire in-
ner surface of the left auricle was swollen out, the af-
fected organ forming a long, pointed tumor. The ef-
fusion was gradually reabsorbed, and when the writer
examined the ear afterward, it was smaller than the right
one, and somewhat thickened and shrivelled. The pres-
ence of some cutaneous trouble in the post-auricular re-
gion and over the vertex was noted. The auricle had
assumed its natural color. Subsequently to the above.
Dr. Loring informed me, the right auricle was affected
in the same way the left had been. There was no evi-
dence of the auricle having been scratched. The animal
has since run away.
The writer has frequently examined the ears of pugil-
istic cats with ears deformed by lacerations produced by
biting and scratching, but has never before met with an
example where deformity characteristic of perichondritis
existed.
A CASE OF INDIGENOUS LEPROSY.
By W. H. GEDDINGS, M.D.,
auchn, s. c.
Miss , twenty years of ajge, descended from an Eng-
lish family which has resided in South Carolina for several
generations, was kindly referred to me for treatment by
my friend, Dr. F. L. Parker, of Charieston, S. C. At
the age often, while in the enjoyment of good health, a
white spot appeared on the right leg immediately below
the knee, about the size of a ten-cent piece, devoid of all
sensation and not rising above the level of the skin.
Three months later a second spot appeared on the left
%fl)ow, presenting the same characters as the first, but
8Dm)mitded by a brownish areola. Similar anaesthetic
oacolas continued to appear during the first year of the
&ease over various parts of the trunk and extremities,
poring the succeeding year the skin became indurated
a drcumscnbed patches of a dirty yellow or brownish
color, and presenting a lardaceous appearance. Unlike
tfae maculse these infiltrations were not anaesthetic.
Sonihaneous with their development islets of yellowish
pigment appeared over various portions of the integu-
ment, at fii3t about the size of a lentil, but gradually
Cila^mg and by confluence forming extensive patches.
Darii^ file succeeding eight years she remained in about
be same condition, but in February, 1882, hemispherical
^iberdes about the size of a split pea appeared over the
^ especially over the eyebrows and chin.
i,Freseni condition, — Patient, who is well developed.
presents a rather cachectic appearance. The skin, with
the exception of a small area over the sternum, is every-
where of a dirty brownish-yellow color, while that over the
sternum is abnormally white, presenting the appearance of
ordinary leucopathia. The brownish discoloration is evi-
dently due to excessive deposit of pigment, which, appear-
ing as small spots, has gradually spread over the whole
body. Over the face are a number of round tubercles of
various sizes, the more mature being somewhat larger
than a fiill-grown marrowfat pea. They are distributed
over the whole face, but are much more numerous on the
chin than elsewhere. On the forehead, especially over
and above the eyebrows, may be seen the flattened re-
mains of tubercles, which, according to the patient's
statement, had disappeared during a recent attack of
fever. These latter give the face- the peculiar leonine
expression so often observed in leprosy. The skin over
the great toes and corresponding metatarsal bones is
much swollen, of a dark, dusky red color, and is very
painful.
Isolated cases of leprosy have been observed in Charles-
ton and its vicinity for many years, the present being the
latest of a series of twenty that have been brought to my
notice during the past twenty-five years. This comprises
only those cases that I have myself seen or which have been
described to me by physicians familiar with the disease.
Although more common among the whites, it is by no
means confined to that race, one of the patients being a
full-blooded negro and several of them mulattoes. Of
the above cases four were Jews. In none of these cases
was the disease hereditary, although in one instance a
mother and her daughter were aflected at the same time.
In all these cases except the one just mentioned, there
was not the slightest evidence of contagion, nor has it
ever been deemed necessary to isolate those affected
with the disease. When well enough they walk about
the streets of the city, attracting but little attention, as
the people know from experience that in this country
they run no risk of contracting the disease by coming in
contact with those afl'et:ted with it. As isolated cases of
leprosy have been observed on the coast of South Caro-
lina for nearly forty years without any apparent increase
in the number of cases, it may safely be inferred that
there is but little danger that the disease will ever be-
come endemic in this section.
FIBRO-CYST OF UTERUS WEIGHING ONE
HUNDRED AND THIRTY-FIVE POUNDS.
By C. C. STOCKARD, M.D.,
COLUMBUS, MIM.
The following case presents some points of interest other
than the size of the tumor, which, so far as I can learn, is
the largest on record. It is especially interesting fi-om a
diagnostic point of view, inasmuch as the physical char-
acteristics of the fluid contents were not those of fibro-
cyst, according to Attlee, but were those of ovarian-cyst,
according to Drysdale, the post-mortem showing the
tumor to be the former.
The patient was a negro woman, aged about fifty years,
who was the mother of several children, and had enjoyed
good health up to the time of the development of the
tumor.
Some twelve years ago, according to her statement,
she first noticed a lump in the right iliac region. This
continued to grow larger till about seven years ago, when
she was seen by two of our physicians, who considered it
a case of ascites and tapped her, drawing off" several
gallons of clear fluid. There was a reaccumulation, and
the enlargement had reached its former size at the end
of a year after the tapping.
A few years later, as the abdomen became greatly dis-
tended, there would occur about once each month an
oozing from the right side of the abdomen below the
navel, which would continue about a week, and during
178
THE MEDICAL RECORD.
[August 16, 1884.
this time sufficient fluid would escape to give her con-
siderable relief. During all this time her general health
continued good, and she did the work about her house,
cooking, etc. Since February of this year there was no
more of the oozing, and she suffered so from the disten-
tion that she had to give up work and could not get
about without help. This was her condition when I was
asked to see her on May 2d. I found her truly a wonder-
ful sight
The abdomen measured in its largest circumference
sixty-eight inches, and from the ensiform cartilage to the
umbilicus, twenty-seven inches — the navel being a little
below the knees, as will be seen in the illustration. The
skin in the neighborhood of the umbilicus was thickened,
and resembled more the skin of an elephant than that of
a human being. The umbilicus was about five inches in
diameter and three inches long. Asking two confreres
to see the case with me, we decided to tap, to give re-
lief for a while, and the patient was anxious to be tapped.
Accordingly, in company with Drs. Mayo, Vaughan, and
Sykes, I proceeded to tap her at 2 p.m. May 6th. A
few hours previous to this the photograph was taken.
With a many-tailed bandage around the abdomen in
the usual way, the trocar was introduced* about five
inches above the umbilicus in the median line. With-
drawing the trocar from the canula a muddy chocolate-
colored fluid flowed, a portion of which was preserved in
a clean bottle for subsequent examination. After several
gallons had discharged the fluid came quite slowly, and
another trocar was introduced four or five inches higner
up. From this puncture came a clear, slightly amber-
colored fluid, which the patient said was like that drawn
at the preceding tapping. After running from this canub
some little time it ceased, and the canula being partially
withdrawn was pushed into another cyst, which also dis^
charged the clear fluid. After the flow stopped from
the &*st canula introduced, it was withdrawn and inserted
about six inches above the second.
The tapping lasted about two and one-half hours, and
eight gallons and seven pints of fluid was withdrawn>-a
considerable amount remaining, which, with the solid
part of the tumor, left the abdomen still quite large.
Neither of the two kinds of fluid coagulated on standing,
even for several days. The colored fluid had a speci&c
gravity of 1.02 1, solidified on boiling, and under the
microscope showed blood-corpuscles, granular masses,
an abundance of beautiful cholestcrine crystals, and what
I considered to be the ovarian cells of Drysdale. Not
being an expert with the microscope, however, I would
not insist that the Drysdale cell was present, and I re-
gret that I did not send a specimen of the fluid to Dr.
Drysdale for examination.
The specific pavity of the clear fluid was 1.015. On
adding nitric acid, a drop at a time, a coagulum the size ,
of a (£rop would sink to the bottom till the whole solidi-
fied. This fluid contained also cholesterine crystals and
the cells which I supposed to be ovarian.
The patient be^an coughing immediately, but with this
exception was quite comfortable for a few days, when a
profuse watery diarrhoea set in. This was checked, bnt
she continued to grow weaker, till death occurred of ex-
haustion, on the sixth day after being tapped. For three
days after the tapping fluid discharged from the points oi
puncture, saturating clothing and lidding several times.
Post-mortem examination was made two hours after
death occurred, before there was rigor mortis. Incision
through the abdominal wall and peritoneum showed a
network of veins over the surface of the tumor, some of
them so large that we took them at first glance for intes-
tines adherent to the tumor. The tumor with the uterus
and ovaries was removed and the abdominal incision
was closed, as this was all that was agreed to by flie
family.
The liver was seen to be considerably enlarged — ^would
have weighed, I suppose, eight pounds. The tumor was
attached by a pedicle, about an inch in diameter, to the
posterior portion of the fundus uteri, and around the
pedicle the wall was some two and one-half or three
inches thick, and got gradually thinner.
As Dr. Prudden, the Curator of the Museum of the
College of Physicians and Surgeons, where the tumor
now IS, has promised to present it to the New York
Pathological Society, I will leave a full description of it
to him.
Besides the main tumor there was a fibroid in the uterine
wall about three-fourths of an inch in diameter, a small
polypus in the uterus, and a cystic tumor of left ovary.
Besides these, Dr. Prudden writes me, there was in the
left Fallopian tube an encapsulated fibroma, four milli-
metres in diameter, and a small cyst of the broad ligament
The solid portion of the tumor weighed fourteen pounds,
and the fluid, weighed at the same time, twenty-foui
pounds, which, with the seventy-one pounds drawn at the
tapping, make one hundred and eleven pounds. Thai
which escaped after the tapping, with considerable tha)
was lost during the post-mortem examination, at a lov
estimate, was three gallons, or twenty-four pounds ; sc
that I feel confident the entire tumor with its contents
as it was before the tapping, would have weighed on<
hundred and thirty-five pounds or more.
The Lehigh Valley Medical Associatiok vnl
hold its annual meeting at Mauch Chunk, Pa., Oi
August 19, 1884. Dr. Theophilus Parvin wUl delive
the annual address.
August i6, 1884.J
THE MEDICAL RECORD.
179
gljKpin*B at ^OBpitaXs.
PHILADELPHIA HOSPITAL.
CuNic OF JAMES TYSON, M.D.
CHRONIC PARENCHYMATOUS NEPHRITIS.'
Gkntlbmen : Before giving you the history of this pa*
tient, I desire to call attention to some of the more
salient points in his present condition. In the first place,
I ask you to note the extraordinary pallor of his counte-
nance and of his skin in general. This was even more
marked when he was first admitted. Another symptom,
which some of you may have noticed already, is oedema.
There is a translucency of the skin which, even if you
did not know that the limbs were larger than natural,
would lead you to suspect that there was effusion into
the subcutaneous connective tissue. This would be con-
firmed by the effect of pressure, which produces a deep
pit, continuing for some time. This oedema affects the
feet, legs, and thighs, and to a less extent the hands and
&ce. It also affects the abdominal walls. While on
this point I shall examine to see if there is any effusion'
into the peritoneal cavity. There is no fluctuation and
no dulness on percussion. These two symptoms, pallor
and oedema, are the only ones that are exhibited in a
saperficial examination.
The histoiy which we have obtained from him is as
follows : He is forty-two years of age ; was born in Ire-
land, and has been employed around stables most of his
life. He was admitted to the hospital on September 12,
1883. His family history seems to be good. He has
heen temperate, and has no history of venereal disease,
having married early. He has been suffering from his
present ailments for two years. In the commencement
of it he caught a cold, followed by a little dry cough,
which has since passed away. One year ago he noticed
that he was swelling— his face, and subsequently the legs
and body. This is significant, that, although he dates his
present illness two years back, yet he did not notice the
swelling until one year ago. Even then, although he did
not feel well, he continued at his work. He suffered
also from nausea, dizziness, and defective vision on ad-
mission, but these include all that is essential in his con-
dition before admission. One more fact, however, should
be stated. He had diphtheria in the beginning of his
sickness. This may be of some importance in connec-
tion with the etiology of his disease.
As we have before seen, the most evident symptoms
are pallor and swelling. The swelling began in the face
and hands, and this fact suggests at once a cause for it
Given a case of general oedema, we find that it either
begins in the lower extremities, in the face and upper
extremities, or it begins in the abdominal cavity. These
ficts are cues to the place where we should first look for
the disease. It may be laid down as a general rule that
cedcraa, beginning in the lower extremities, is due to
cardiac disease ; beginning in the abdominal sac, to he-
patic disease ; and beginning in the face, to renal disease.
TTiis is not an inflexible rule, but it will often save time
in the investigation of a case. Adopting this rule in the
present case, we should expect to find the cause ol
Ac trouble in the kidneys. HeiKe an examination of
the urine is suggested. The test I employ in your pres-
ence is the simplest, and under ordinary circumstances is
sofficiently reliable ; I boil the urine and add a little acid
to dissolve any phosphates that may be precipitated. It
will be found that the albumen will be precipitated at a
lower temperature the greater the amount — that is, if
&ere is large albuminuria the albumen will begin to fall
at a lower temperature than if the amount is small. You
observe that a copious precipitate has formed. It is
^ A cfinkad lectore deiivered at the Philadelpliia Hospital, by James Tyson,
zft; '^l^ ** pby«idansto the hospital and Professor of Geoeral Pathology
•a HortMd Anataaay in the Uaiveraity of Pennsylvaaia.
scarcely likely that so large a deposit could be due to
the presence of phosphates, yet I have known urine to
be as opaque as this simply from the deposition of phos-
phates, so that it is never safe to omit the addition of an
acid. This precipitate does not dissolve.
This, then, is a case of albuminuria as well as of drop-
sy, and a case of large albuminuria. Is this sufficient to
show that there is renal disease ? I believe that, except
where there are evident quantities of blood or pus in the
urine, there is no one of the various causes which pro-
duce albuminuria which will give such a large precipitate
of albumen as we have here. I have no doubt, there-
fore, that this is a case of some form of Brighfs disease.
At the same time, it does not do to stop here. We are
not satisfied to-day with simply learning that the patient
has Bright's disease, but we desire to know what form of
the disease he is suffering. We have examined this man's
urine microscopically and found a large number of casts.
These casts are of a peculiar kind, and through their
age we are enabled to be absolutely certain as to the
diagnosis.
As to casts, let me briefly call attention to what they
are and how they are formed. They are molds of the
uriniferous tubules, and are formed of an albuminous
material which coagulates after it has been filtered fi'om
the blood-vessels into the tubules. This material having
been poured out, entangles whatever it may find in the
tubule. If the epithelial cells are loosely attached, these
are embedded in the material. After a time, the cast
shrinks and becomes smaller than the tubule, slips out
and appears in the urine as an epithelial cast. If, on the
other hand, the uriniferous tubule has its epithelium
closely attached, the cast slips out, leaving behind the
epithelial cells, and appears as a hyaline cast of small
diameter. This is the most favorable form of casts,
being found with the least departure from health, as
in congestion. Again, it constantly happens that the
tubule is entirely bereft of its epithelium, and then if the
albuminous material is poured out its diameter is meas-
ured by that of the lumen of the tube plus twice the
thickness of the epithelium cells. It slips out and we
have a hyaline cast of large diameter. These occur in
chronic forms of Bright's disease, where the epithelium is
stripped off" and we have an empty tube into which the
material is poured. If, instead of the epithelial cells
being loosely attached and slightly degenerated, there
happens to be blood, as there often is, in acute inflam-
mation of the kidney, these corpuscles are imbedded in
the cast, forming a blood-cast. If the cells lining the
tubule have undergone complete fatty degeneration and
have become filled with fat-drops, or the degeneration
has even gone further, so that the cells have broken
down and free fat-drops and fatty cells become imbedded
in the cast, it passes out in the form of a/^/- or oil-cast.
These of course indicate advanced degeneration of the
kidney, or rather of the kidney- cells. This is the form
of casts which we find in the present instance, and in
addition to them, fi-ee oil-drops and fatty cells ; these
latter are evidently fi-om the kidney. It is not always
easy, and indeed it requires a considerable experience
to recognize a renal cell which is slightly altered ; but
there is no cell from any other part of the genito-urinary
tract which exhibits the characteristics of this fatty cell,
so that when fatty cells and free oil-drops are found it
may be concluded that they come from the kidneys.
These are the facts on which the diagnosis is based :
the presence of oedema, which started m the face and
hands ; the existence of a large amount of albumen and
fatty casts, and free fatty cells and fat-drops on micro-
scopical examination.
In this case we are able to infer with considerable cer-
tainty, what is not always possible, the form of kidney
disease present. This is a case of chronic parenchyma-
tous nephritis. This means that the disease affects the
parenchyma of the kidneys or the tubules — the essential
secreting substance of the glands or the parenchyma, as
i8o
THE MEDICAL RECORD.
[August i6, 1884.
distinguished from the blood-vessels and intertubular
connective tissue. At the same time there is, strictly
speaking, no such thing as chronic parenchymatous ne-
phritis in the true etymological sense of the term. There
is an acute parenchymatous nephritis, because there is an
acute inflammation which in the beginning involves
nothing but the uriniferous tubules. The acute disease,
however, cannot continue long before the interstitial tis-
sue becomes involved. This stage, I believe, has been
reached in the patient before us, and in every instance
of chronic parenchymatous nephritis. The more correct
term would be diffuse nephritis, because we have in-
volved not only the parenchyma and the proper secret-
ing substance, but also the interstitial connective tissue,
probably not excepting the adventitia of the blood-ves-
sels. There are even some cases of acute catarrhal
nephritis which are diffuse, in which it seems that simul-
taneously both elements of the kidneys are involved.
On the other hand, there are cases in which the intersti-
tial connective tissue is the starting-point of the disease,
and the tubules are only secondarily involved. This is
what is known as interstitial nephritis.
This, in a few words, is the morbid anatomy of this
man's kidneys : They are large, pale, and very white.
If the capsule is stripped off, there will probably still be
found white points scattered over the surface of the organ.
It is the size and color of this kidney that have given it
the name of the large white kidney. This white color is
due to two principal causes. In the first place, to the
fact that many of the cells have undergone fatty degen-
eration, and, as you know, fat by reflected light gives a
white color. The little white spots before mentioned
indicate that in them the degeneration is more advanced.
Tissue from these spots will show the uriniferous tubules
filled with oil-drops, and no epithelium cells can be de-
tected. In the second place, an important cause of the
white color is the bloodlessness of the organ. The fatty
degeneration of the cells is accompanied by an increase
of their number, and the tubules become choked with
them ; and this with the overgrowth of connective tissue
causes pressure of the blood-vessels, producing marked
anaemia.
A word in regard to the etiology of this form of chronic
parenchymatous nephritis and diffiise nephritis. The most
frequent causes are scarlet fever and diphtheria, which
produce the acute form, which is very prone to run into
the chronic disease. Any of the infectious diseases may
produce it. But it may also arise de novo, I have
called attention to the fact that this man had diphtheria,
but I stated that it was impossible to say whether or not
this was the cause of the nephritis. We have no data to
judge from. When we come to look for the causes of
chronic parenchymatous nephritis arising de novo^ they
are not easily found. One of these causes is no doubt
long exposure to malaria ; not a brief exposure but the
living for some time under the influence of a decided
miasmatic influence. Exhausting diseases, like con-
sumption, will also produce this affection. Formerly it
was thought that the only form of kidney trouble result-
ing from exhausting disease was amyloid degeneration,
but it is now known that these diseases often cause this
form of Bright*s disease. Another cause is perhaps long-
continued exposure to cold and wet, especially if the
feet are continuously wet. Acute inflammation of the
kidney is frequently produced in this way. There are,
however, many cases in which a cause cannot be dis-
covered.
Given this condition, what is the prospect of recovery
and what shall be done for the cure of the disease?
This is a form of kidney disease in which very much
can be accomplished by a judicious treatment. There
is a most unfortunate popular error in regard to the
prognosis of kidney disease. To most persons to be
told that they have Bright's disease is, as it were, a death-
knell ; but I would much rather have renal disease than
have consumption. The prospect of cure is more reason- |
able, while the disease is less unpleasant to other people.
The popular notion that kidney disease is incurable is
erroneous. Some cases cannot be cured, but many of
these could have been, had they come under treatment
earlier. There is an important fact in the pathology,
on which improvement in this disease depends. The
large white kidney sooner or later undergoes contrac-
tion, from the contraction of the interstitial connective
tissue, and this is a favorable change. Of course this is
not recovery. It is really going on to a form of renal
disease in which recovery is less likely to occur, but it is
a condition more compatible with life. In chronic
parenchymatous nephritis the urine is diminished in
quantity and of low specific gravity. When contraction
takes place the urine increases in quantity, although the
specific gravity may still remain low ; the amount of
albumen diminishes and all the symptoms assume a
more favorable character. If a case has lasted a long
time, we look for this method of improvement rather
than a cure by removal of the diseased tubules and the
overgrown connective tissue.
What is the proper treatment "i There is one thing
that must be done immediately, that is to put the patient
to bed. You cannot expect any improvement, except
in rare instances, unless the patient is put to bed. If
this is done the patient, often in the course of a few
days, assumes a better appearance, the albumen dim'm-
ishes, and the appetite improves. Whatever else is done
will depend upon the symptoms. If there is dropsy, it
should be removed. A diuretic will probably be re-
quired. The best diuretic in these cases is digitalis. It
may be given in the form of powder, infusion, or tincture.
The infusion has the reputation of being tlie best form,
and it is probably a good one, but not better than the
freshly prepared tincture. The reason that the infusion
seems to act better than the other preparations, is prob-
ably because it is given in so much larger doses. It is
not infrequent to hear of a tablespoonful of the infusion
being given, while only one grain of the powder or ten
drops of the tincture are prescribed. A tablespoonful of
the infusion is equivalent to three and three-fourths
grains of digitalis, while fifteen drops of the tincture are
equivalent to one grain of the powder. When I began
to practice medicine, five drops of the tincture three
times a day was the universal dose. I very rarely begin
with a less dose than fifteen drops of the tincture, or one
grain of the powder three or four times a day for an
adult If I use a smaller dose it is on account of the
sensitiveness of the stomach. In determining the dose
of digitalis and of other remedies, I am influenced to a
certain extent by the size of thie patient. There is no
doubt that a man weighing three hundred pounds re-
quires a larger dose than one who weighs only one
hundred and fifty pounds, for the same reason that an
ox or a horse requires a larger dose than a man.
I ordered this patient fifteen drops of the tincture of
digitalis, four times a day, but the improvement was
not rapid. The nausea was not increased, but the dropsy
did not lessen. I felt that something more was neces-
sary, I therefore gave him a jaborandi sweat, which is
often a most valuable measure in this disease. A favorite
method of administering jaborandi in this house is by
enema. To an infusion of two drachms of the powdered
leaves a pint of hot water is added. Of this one-half is
first injected into the bowel, the remainder in half an
hour, if sweating does not occur earlier. The lower
bowel is very tolerant of the drug, and the stomach is
thus saved, although the infusion may also be admin-
istered by the stomach. In this case the sweat was
most successful. Not only were the bedclothes satu-
rated, but large amounts of water also came from the
mouth. Occasionally the bowels are acted on and the
urine increases in quantity. After this single sweating,
the dropsy diminished more rapidly ; the urine increased
in quantity. When first admitted, the proportion oi
albumen was one-half the bulk of the urine. It is noiN
August i6, 1884.]
THE MEDICAL RECORD.
181
hardly half. Often the albumen does not begin to dis-
appear with the improvement in the other symptoms.
In regard to other means of giving jarborandi, when
patients are comatose or in convulsions, it must either
be given by injection into the bowel or hypodermically,
in the form of the active principle, pilocarpin. The latter
is really the most elegant method. One-fourth to one-
half a grain will usually produce the desired result. I
generally give one-fourth of a grain, and if the patient
does not sweat in fifteen minutes repeat the dose. If
the symptoms are urgent, I sometimes give half a grain
at the first dose. Another good remedy is the fluid ex-
tract in doses of a teaspoonful every half hour until
sweating is produced. Sometimes only one sweat is re-
quired, sometimes it has to be repeated every other day
or once a week. Jaborandi does have the effect of pro-
ducing a feeling of prostration. But I have never seen
any harmful results. Some writers have laid a great deal
more stress on this point than I think it deserves. I
think that the prostration is due only to the drain from
the system and not to any specific effect. It is the pros-
tration which foUows any form of sweating.
Often the digitalis, which has previously failed to act,
will immediately show its effects after a jaborandi sweat.
The amount of serous effusion is sometimes so great that
the vessels are so pressed upon that they cannot absorb.
The patient sweats, the pressure is removed from the
blood-vessels, and the remedy taken into the system.
The same thing follows another mode of treatment which
is often valuable — purgation. It is sometimes necessary
to clear out the bowels before diuretics will act. For
this purpose elaterium is often selected, because it has
the property of producing watery stools. It may be
giren in doses of from one-tenth to one-sixth of a grain,
filood-letting ^u:ts in the same way. I recollect a case
which occurred in my wards several years ago. A patient
had been receiving large doses of digitalis which had
failed to act For some reason in my absence the resi-
dent physician bled the man. The digitalis immediately
b^;an to act ; in half an hour the pulse was down to
forty per minute. It would seem as though the medicine
had lain away somewhere, either unabsorbed or inactive.
WhDe speaking of blood-letting, let me say that in the
coma or convulsions of Bright's disease, blood-letting
b often of decided benefit. I sometimes employ this
remedy, and I believe it would be well to employ it more
frequendy.
There are other measures to be employed to improve
the quality of the blood and counteract the effect of the
disease on the system. As soon as the stomach .will
admit it the patient should receive iron in full doses.
The best preparations are those in which the iron is com-
bined with a vegetable acid, as the citrate, tartrate, and
acetate of iron. The well known Basham's mixture
contains the acetate of iron. The solution of the
acetate of iron is now officinal, but it may be prepared
according to the following formula :
5. Tinct ferri chloridi 3 ij.
Ac acet. destillat 3 ij.
Cura^oae f 3 j.
Liquor ammoniae acetatis ad § vj.
Misce.
The dose of this is a tablespoonful.
Easily assimilable food should be given. One of the
best forms of food is milk, but its use is not so important
in this disease as in interstitial nephritis. The milk
should not be too rich. A poor milk or skim milk is
more suitable ; too much nitrogenous matter must not
^ given* There is no doubt that an excess of nitro-
genons food is hurtful in all forms of Brighf s disease.
We now know that the urea is derived almost entirely
from the food which is eaten. The old view was that
it was the result of the wear and tear on the tissues.
Bot JQst as the ashes of a steam-engine are derived from
fte fiiel put into the fire-box, so is die urea derived from |
the food placed in the stomach. Eggs are not suitable
food for cases of Bright's disease, nor is butcher's meat.
I would not exclude animal food altogether. Oysters,
fish, white meat, and game may be allowed. In refer-
ence to eggs, there is no doubt that too much albumen
in the blood is irritating to the kidneys. It has been
proven b^ experiment that when large amounts of albu-
men are mjected into the blood, the amount of albumen
excreted exceeds that which was introduced. This
shows that something more must have been added, and
this must have come from the blood. Highly albumin-
ous food should therefore not be given.
An interesting question is as to the cause of the
anaemia. The common impression is that it is due to
the drain of the albumen from the blood ; but the fact is
that the quantity of albumen excreted, even in large
albuminuria, is very small ; and while it may contribute
a little to the anaemia, its effect must be very slight.
The amount of albumen passed in the urine throughout
a week would be made up by that contained in one
pound of beef. In fact the anaemia is partly due to in-
sufficient assimilable food. There is often nausea which
prevents the patient from taking a sufficient amount of
food. It must be admitted, however, that the loss from
the blood contributes somewhat to the effect. Albu-
minuric patients should be clothed in woollen garments,
because they are peculiarly sensitive to cold.
It sometimes happens that the patients get well up
to a certain point. The dropsy passes away and all the
symptoms except the albuminuria disappear. The ques-
tion now arises. Is there anything which will directly
influence the quantity of albumen ? I do not believe
that there is anything that will do this except the gradual
relief of the circulation. I have tried astringents, tannic
and gallic acid, and the astringent salts of iron, but with-
out benefit. Benzoic acid has been recommended.
Fuchsin, one of the aniline dyes, has been said to act in
this way. I have given it until the secretions were
stained by it, but without any effect in diminishing albu-
minuria. These things get their reputation in cases in
which relief has followed after their administration as
a matter of coincidence rather than as a result. Thus
a pregnant woman has albuminuria, and immediately after
the burth of the child the quantity of urine increases
and the albumen diminishes. If benzoic acid or some
other drug was being taken at this time, a careless |ob-
server would be likely to attribute the improvement to
the drug. The only way to influence these albuminurias
is to improve the circulation in the kidneys, and this
occurs gradually through the restorative powers of nature,
aided by such adjuncts as the physician can bring to
bear. A method which I have lately used to a con-
siderable extent, and with some success, is the use of
gentle but persistent counter-irritation over the region
of the kidney, drawing the blood to the surface into the
branches of the lumbar arteries which connect with the
renal arteries. It is not easy to produce gentle and
persistent counter-irritation. The only way in which I
have been able to do this has been by means of weak
mustard plasters, prepared with molasses or white of
egg. Msule in this way the plaster does not burn so
much ahd may be worn constantly, or nearly so; for
this is necessary, that the irritation should be persistent.
Under this treatment the albumen gradually diminishes
and sometimes disappears altogether, when all other
measures fail to influence it.
Unusual Susceptibility to Small-pox and Vac-
cine.—Dr. W. Thornton Parker, of Fort Union, N. M.,
writes : ** Among the recruits lately arrived at this post
is a man who was vaccinated successfully when two
years of ag6. Soon afterward he contracted small-pox,
and in May of this year was again successfully vac-
cinated."
l82
THE MEDICAL RECORD.
[August i6, 1884.
The Medical Record
A Weekly journal 0/ Medicine and Surgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
PUBUSHED BY
WM. WOOD & Co.. Nos. 56 and 58 Ufayette Place.
New York, August 16, 1884.
THE INTERNATIONAL MEDICAL CONGRESS.
Cable despatches up to the hour of our going to press
state that the eighth session of the International Medical
Congress was formally opened on Sunday, August loth, at
Copenhagen, Denmark, by the President, Professor Pa-
num, of Copenhagen, who delivered an address of wel-
come to the members, the King and Queen of Denmark,
the Council of State, and the King and Queen of Greece
being present. The attendance was large, comprising
over three hundred Danes, one hundred Swedes, about
one hundred Norwegians, and nearly eleven hundred med-
ical men of other nationalities. America was fairly rep-
resented, as was also Great Britain, France giving the
larger proportion of the latter number.
The scientific work of the association was duly inau-
giu-ated on Monday and was divided into that of general
sessions and meetings of sections. Considering the
amount of material announced and the lack of an under-
standing as to a definite programme of proceedings, there
was at first considerable difficulty in settling upon a sys-
tematic arrangement and order of subjects ; but the ses-
sions, general and special, as will be seen, were kept well
employed and were well attended.
It is impracticable at this stage of the proceedings to
give a full account of the doings of the Congress, it being
still in session as we write, but the accounts received
thus far show how much of strictly scientific work was
done. In our next issue we hope to publish still fuller
cable despatches, with such addresses received as shall
be deemed interesting to out readers. Our arrangements
with our correspondent at Copenhagen are as perfect to
this end as has been possible to make them, and we
trust to our ability in giving the earliest authentic ac-
counts of the work of the Congress obtainable on this
side of the Atlantic.
It has been announced that the session will close on
Saturday, after a full week of work, and we have reason
to expect that the summarized results will be of sufficient
interest to our readers to warrant the necessary pecuniary
outlay for cable despatches necessary to the fulfilment of
our promise.
It is quite probable that the next congress will be
held in America, as the invitation on behalf of the
medical profession here through the American Medical
Association has been favorably received, and will doubt-
less be acted upon accordingly. No' definite action has
yet been decided upon up to our present advices.
THE DOCTOR IN FICTION.
It is to be presumed that doctors are gratified to find
that novel-writers have of late taken them up so largely.
Few of the more prominent novelists have now left us
untouched. The late Mr. Charles Reade has recorded
the wonderful deeds of a medical woman, in order to
prove to the dull-eyed public that medicine was an art in
which the gentler sex could shine. Mr. Howells has in.
troduced his *' Dr. Breen," and has therein shown that the
general tendency of women, however medically inclined,
is to collapse on the matrimonial rock. Miss Phelps
some time ago tried to portray an impossible creature
who was called " Dr. Zay." She was described as being
lovely, scientific, and homoeopathic By virtue of the
first two qualities she cured a patient, and subsequently
became his wife. We do not know what lesson Miss
Phelps sought to inculcate — if any ; but it strikes us that
to try and make something heroic out of that last out-
rage upon common-sense — a homoeopathic woman— is a
great waste of talent.
Mr. Henry James has given an excellent portrait of a
New York fashionable physician, in his ^'Washington
Square." More recently he has been marrying a young
American doctor to ^' Lady Barbarina," the daughter of
an English peer, and showing the effects of the union of
American medicine with English aristocracy. The re-
sult is not a happy one to the contracting parties, and
the young doctor is obliged to take down his sign, give
up his researches into cerebro -spinal meniagitis, and live
in London with his mother-in-law. We are informed
incidentally of the peculiar absence of social position
which the average English doctor is accorded by his
hereditary legislators.
We cannot say whether Mr. Cable, in his **Dr.
Sevier," is writing a novel which is to solve some social
problem or simply to portray a unique character.
Doubtless our Louisiana colleagues can better appreciate
his work.
In a recently published novel, entitled " A Country
Doctor," Miss Jewett brings up again the question of
wonjen and the study of medicine. It must be confessed
that her novel, though somewhat prolix, deals with the
subject at issue in a way that commands respect Her
heroine is a young woman who is brought up under the
tutelage of a '* country doctor," himself a charmingly
and truthfully drawn character. She feels as she grows
up that she possesses an especial fitness for practising
medicine, and an overwhelming certainty that she is not
like other women. She wants to practise medicine, not
to be a wife and mother. Her trial comes when she falls
in love with a not over-brilliant young man. After a
hard struggle she gives him up, and makes the Hippocra-
tic oath have something of the significance of a conven-
tual vow.
It is not improbable that there are some such women |
as Miss Jewett portrays, women who have a certain
instinctive aptitude for making sick people feel better, I
and who can follow out this aptitude better as doctors
than as nurses. Their number is naturally very small.
In " A Country Doctor *' their feelings and ambitions
are well shown. Here is none of the namby-pamby
transcendentalism, the globules and matrimony of '' Dr.
Zay."
August 16, 1884.]
THE MEDICAL RECORD.
183
THE PATHOLOGY OF OBESITY.
PltoFESSOK Ebstein's monograph upon the treatment of
corpulence has excited a large amount of attention from
the medical profession, and has called forth a consider-
able number of articles upon the same subject. Ameri-
can physicians do not meet so many cases of obesity as
do their European canfrtres. Nevertheless, the disease
exists here, and it will be worth while for our readers to
keq> themselves acquainted with the progress made in
oar knowledge regarding it Probably most physicians
who have tried to reduce obesity by prescribing the
regulation anti-fat diet have been disappointed. Doubt-
less this is often the fault of the patient or the environ-
ment; but one cannot resist the conclusion that, aside
from all extraneous considerations, anti-fat diets and Ban-
tittgism generally are often inherently befficient The
very fact that £bstein's work has been so eagerly read
points to this same conclusion. Ebstein has certainly
famished the profession with some valuable and practical
hints in this direction. But it is yet too soon to say that
his new diet of fat and nitrogenous food is to be any
more successful than earlier ones. We have already ex-
pressed the opinion that theoretically it has but feeble
support, while, practically, it is known that Voit has
actually fattened animals with fatty and nitrogenous food.
Leaving this question for the future to decide, therefore,
we would now call attention to an interesting review of
the subject of obesity, or morbidly great corpulence,
which Professor Kisch, of Prague, has recently con-
tributed to the Deutsche Medizinal Zeitung.
In normal conditions there is a tendency for the de-
posit of fat in the cormective tissue of certain regions,
such as the subcutaneous tissue — especially of the abdo-
men and buttocks — also in the mesentery, omentum,
regie pubis, beneath the pericardium, about the large
fessels— especially the renal vessels — in the orbit, etc.
On the other hand, there are a few places where fat is
oerer present, as for example in] the lids and the male
sexual organs. The estimates of the normal amount of
k in the adult vary greatly. Kisch gives it as one-
twentieth the weight of man and one-sixteenth the weight
of woman. This normal amount reaches its height in
men at the age of forty, in women at the age of fifty.
The influences which produce obesity are numerous,
and the endeavor of Ebstein to reduce them in most
cases simply to errors of diet and exercise will hardly suc-
ceed Obesity not unfrequently attacks children before
puberty, being the expression of anaemia, chlorosis, faulty
living and heredity. But it is generally at a later age
that the trouble comes on. It is, no doubt, a fact
that a fuU diet containing an excess of non-nitrogenous
food, the use of alcohol, and sedentary habits are the
most frequent exciting, if not primary, causes of obesity.
As we have said before, the question whether fat is a
pathogenetic factor in producing fatness must, in view of
Ebitein*s positive statements, remain for the present un-
settled.
Women are more subject to obesity than men, a fact
that is easily explained in view of their more sedentary
life, their inclination to non-nitrogenous foods, and per*
haps to the lesser activity of their sexual life. For it
««ms quite certain that the active exercise of the sexual
fimction is an element in preventing accumulation of fat.
We ought to mention, however, that Professor Ebstein
discredits this — ^and the Professor has been obese himself
if we are rightly informed.
There is a certain tendency to corpulence which is
racial. Among the English and Germans there are more
fat men and women than among the Celtic, Gallic, Latin,
or American races. The Bushmen and South Sea Isl-
anders are inclined to take on fat, while the North
American Indian is proverbially fatless. In Mr. Herbert
Spencer's Social Statics are many interesting facts con*
ceming this racial obesity or leanness.
Most of the stories regarding excessively fat people
are exaggerations. The fattest person whom Kisch has
ever seen weighed only 385 pounds. The celebrated
Daniel Lambert is credited with weighing 52 stone
II pounds. A man named Ed. Bright is quoted by
Dr. Copeland as weighing 608 pounds. Erchenmayer
cites the case of a girl, ten years of age, who weighed 219
pounds. Most of the Dime Museum £sit people weigh
considerably under 400 pounds, and it is very doubtful
if that limit is often exceeded by human beings of ordi-
nary height.
According to Toldt, connective-tissue cells and adi-
pose-tissue cells are not identical. Toldt believes that
adipose tissue is a special fat organ, having a separate
and well-characterized set of blood-vessels and an inde-
pendent nutrition-process which results in the manufac-
ture of fat. Some physiologists look upon adipose tissue
as a distinct metabolic organ, and Toldt's view has
certainly much in its favor. According to it, we must
suppose obesity an abnormal activity on the part of true
fatty tissue, combined with a morbid taking on of the fat-
making function by ordinary connective tissue.
The pathological changes and the consequent func-
tional disturbances in obesity are of much interest Pro-
fessor Kisch has investigated this subject, and contributes
some original observations to it
First, as regards the heart, an organ which is inclined
early to show signs of disturbed action. The fatty heart,
as distinguished from the fattily degenerated heart, is
affected, according to Leyden, in three degrees of
severity. In the first there is simply a thick layer of
adipose about the organ ; in the second, with the fatty
deposit there is a softening or relaxation of the muscles,
dilatation of the cavities, and enfeeblement of action.
In the third form there is combined with the fatty heart
an arterial sclerosis. The symptoms in the higher grades
of fatty heart resemble considerably those of fatty de-
generation, and need not be here enumerated. Kisch
has made sphygmographic tracings in four hundred cases
of fatty heart with the following result : In thirty-six per
cent of cases there was a pulsus tardus ; in thirty-two
per cent of cases the pulse varied from one of a slightly to
one of a completely dicrotic character ; in twenty-four
per cent, of cases an increase of tension from arterial
sclerosis was shown ; in four per cent of cases there
was simple arythmia. The value of these examinations
is, of course, slight of themselves. It is to be assumed,
though it is not stated, that the patients had no valvular
disease of the heart and no kidney lesions.
As regards the respiratory organs, Kisch found in many
cases bronchial catarrhs. Naturally such sjrmptoms as
dyspnoea, and even pseudo-angina, were frequent 9
184
THE MEDICAL RECORD.
[August 16, 1884.
The digestive organs of the obese are very likely to be
deranged. Gastro-intestinal catarrh, dyspepsia, constipa-
tion, hemorrhoids are present, and are due partly to
dietetic errors, partly to the weakness of the heart and
the incapacity or disinclination on the part of the patient
to take sufficient exercise. An enlarged and fatty liver
is of frequent occurrence, but its existence is not easy to
make out by physical examination.
Urates, uric acid, and oxalate of lime are found in the
urine. It is well known also that the obese are liable to
glycosuria, and Kisch found sugar in the urine of many of
his patients at periodic or irregular intervals.
Owing to the increased activity both of the sweat and
the sebaceous glands, fat persons are subject to " catching
cold" and to attacks of rheumatism. Such skin diseases
as boils and carbuncles are relatively frequent
The bodily temperature shows an inclination to mount
up, and in fevers the corpulent burn actively. Their
feebler resistance to fevers was first pointed out by Hip-
pocrates. Liebermeister states that they are less amen-
able to antipyretic measures.
Parallel with increase of fat is a decrease of sexual ap-
petite and sexual power. Kisch found in several cases
absolute azoospermia. Women are inclined to amenor-
rhoea and sterility. Among 215 obese women Kisch
found 49 cases of amenorrhoea, 119 of scanty menstrua^
tion, and 49 of sterility.
The blood of the obese is poor in red blood-corpus-
cles. Obesity is, in fact, a disease of diminished and per-
verted oxidation. There are not only too few red cor-
puscles, but there is too much water and an excess of fat.
THE EXTRACTION OF FOREIGN BODIES FROM THE
BLADDER.
As a general rule, persons who have foreign bodies in
their bladders do not apply for surgical relief until some
time has elapsed. In many cases this is doubtless due to
the fact that they at first suffer but little pain; after
a time, however, the foreign body causes cystitis, is
covered with layers of phosphates, gradually increases in
size, and becomes a source of constant irritation and dis-
comfort to its host. The conditions, therefore, of surgical
intervention are widely different according as the foreign
body is recent or old. In either case, extraction per vias
naturales may be very difficult ; but it is evident that an
old foreign body, which has become the nucleus of a
secondary calculus, is peculiarly interesting from the diffi-
culties which it offers.
For a long time it was supposed that a lithotomy oper-
ation was imperatively demanded. It is possible, how-
ever, to remove it otherwise by two operations : At the
first the calculus is crushed by the lithotrite ; at the sec-
ond the foreign body is extracted in its primary condition.
Guiard {Ann. des Mai. Geniio-Urin.^ April, 1884) has
recently removed a large calculus, the nucleus of which
was a hair-pin, from the female bladder by two opera-
tions, with very slight inconvenience to the patient. And
Dr. Heuriet has recently read a paper, before the Soci^t^
de Chirurgie, on the application of lithotrity to foreign-
body calculi.
As regards recent bodies, their nature, consistence,
and form are of importance, and very variable; and
these are especially difficult data to obtain, for the reason
that patients seem to delight in deceiving the surgeon in
all genito-urinary matters. If the body is flexible, as a
gum catheter, it may be cut or bent double and drawn
out, unless too large for the urethra. If of iron or wood
the lithotrite is useless; if friable it may be broken
up and taken out piecemeal. Civiale recommended a
special instrument for cutting up the foreign body, and
then leaving its removal to nature. But while this pro-
cess might be successful in some instances, there are too
many probabilities that some of the pieces may renudn
to give further trouble.
Removal per urethram^ then, while often difficult,
merits, by reason of its great importance, serious atten-
tion. The surgeon should know in what part of the
bladder the body is situated, and in what position he can
secure it. Heuriet has shown by actual experiment upon
the cadaver, that these foreign bodies are governed by
what he calls laws of accommodation, as is the foetus in
utero, with, of course, the exception of rounded bodies.
From his experiments Heuriet drew the following con-
clusions : I. The transverse diameter of the bladder is the
most constant ; it is the only diameter which persists when
the viscus is completely empty, and which, in that state,
furnishes a resting-place for foreign bodies, provided they
are not above a certain size. 2. As the bladder becomes
distended, other diameters are formed and it tends to be-
come spherical. Its transverse diameter then attains its
maximum, which is 10 ctm. or more (4 inches). Its ver-
tical diameter continues to increase and may attain
excessive dimensions. 3. The maximuw of the trans-
verse diameter is almost at an equal distance from the
summit of the bladder, whatever may be its development,
and the cervical region perhaps a little nearer to the
latter. 4. Foreign bodies, quite rigid, and 12 ctm. (4.2
inches) long, can only lodge completely in a distended
bladder, and in a vertical or oblique diameter. 5. Bodies
6 or 8 ctm. (2.4 to 3.2 inches) long generally assume a
transverse position. It is only when the bladder is full and
considerably distended that they may take a vertical or
oblique position, or rest on one extremity in the region
of the neck. When they have a transverse position they
may float, provided their specific gravity and the amount
of vesical dilatation permit ; but hollow bodies, such as
a piece of catheter, almost always remain at the base.
The transverse diameter, therefore, is that which varies
least, whatever may be the state of distention of the
bladder, being smallest when the bladder is distended
and greatest when it is empty. These peculiarities have
a remarkable influence on the direction which foreign
bodies take, and we know a priori that they tend to as-
sume a transverse position. On entering the bladder
from the urethra they are situated in an antero-posterior
median plane. But after micturition the antero-posterior
and vertical diameters are effaced, and the body changes
its position ; its posterior extremity receives an impulse
from the corresponding wall of the bladder which tends
to approach the neck. This impulse moves the anterior
extremity from the median line, where it was at first, to-
ward the right or left, on account of the persistence of
the transverse diameter. At the same time, as the
bladder contracts, the posterior extremity is pushed for-
ward by the diminution of the antero-posterior, and
August i6, 1884.]
THE MEDICAL RECORD.
185
downward, by the diminution of th^ vertical diameter.
Thus the transverse diameter is the only one which the
body can assume when the bladder is empty. It may,
therefore, be laid down as a rule that ri^id and elongated
foreign bodies tend to assume a transverse position. But
if their dimensions exceed 6 or 8 ctm. they cannot rest
in this position, but must lie obliquely.
Those accustomed to vesical manipulations know that
the contractions of this organ commence by a raising up
of the posterior face and floor. These parts seem to
advance toward the neck, leaving two prolongations on
each side, which subsequently approach the neck. The
neck is the fixed point and all other parts contract to-
ward it, and the diminution of the capacity of the
bladder commences by shortening of the antero-posterior
I diameter, which is followed by shortening of the vertical
diameter.
I The elevation of the floor of the bladder is a very
essential point in enabling the surgeon to grasp a frag-
ment In cases of enlarged prostate great difficulty
may be encountered until the bladder commences to con-
tract, raising the base and thus bringing the body within
reach of the instrument. In searching for a body in an
empty bladder, it may be impossible to move the instru-
ment save in a lateral direction, and if this cannot be
done the operator may be sure that the bladder has not
been entered. When, however, the bladder is distended,
as by an injection, these conditions immediately change.
The foreign body becomes movable, and its position is
no longer regulated by physiological but by physical
laws. The case is analogous to the state of hydramnios
in the pregnant woman. The foetus simply floats about
and has not stable position. Distention of the bladder
by injection, therefore, so far from favoring the search
for and extraction of the body, really hinders these
manceuvres.
Life ! — Dr. S. W. Francis' latest definition is — Can :
Can^Can: Can't I
The American Dental Association held its annual
meeting in Saratoga last week.
Quarantine at New Orleans has been reduced
from forty to ten days for ships from infected ports.
The State Board of Health of Kentucky has is-
soed a circular of instructions regarding the prevention
of cholera.
Fatal Accident to a Medical Student. — Another
filial accident has occurred in the Alps, the victim being
a medical student, son of Professor Bamberger, of
Vienna.
Another Grave-robberv near Philadelphia. —
Two men, one of them a Dr. J. B. Welder, of Philadel-
phia, have recently been arrested for grave-robbery at
Norristown.
^ Popularity of the London Health Exhibition. —
Upward of one and a-half million have visited the Inter-
national Health Exhibition during the two months it has
been open to the public.
Lepers Returned to China. — ^The authorities of
the city of San Francisco have sent back to China nine-
teen Chinese lepers, paying their passage and giving each
one $5. Nineteen cases lost to science.
The Cholera in the United States. — The proba-
bilities are that the present European epidemic will not
be a severe one, and that the cholera will not reach this
country until next spring or summer.
Jefferson Medical College. — Dr. Robert £.
Rogers, Professor of Medical Chemistry and Toxicology
in this institution, has tendered his resignation of the
chair, to which he was elected in 1877.
An Italian Doctress. — Fraulein Giuseppina Cat-
tani has recently passed her medical examination at the
University of Bologna cum laude. Miss Josephine is a
pioneer among Italian medical women.
A Dangerous Project. — A St. Louis physician pro-
poses to publish an '* Encyclopaedia of Medical Wit and
Humor." We earnestly urge our respected and ambi-
tious confrere to make it a pocket edition.
An Austrian Cholera Commission. — The authori-
ties of Vienna have sent a commission composed of two
physicians and three sanitarians to Toulon and Mar-
seilles for the purpose of investigating the cholera epi-
demic.
Massachusetts General Hospital. — TTie Boston
Medical and Surgical Joumctl is '^ glad to state that at the
request of the Board of Trustees, Drs. H. J. Bigelow
and R. M. Hodges have withdrawn their resignations
from the staff of visiting surgeons."
The Successor of Dr. Wm. Pepper. — The Medical
News states that Dr. William Osier, of McGill Univer-
sity, Montreal, is favorably mentioned in connection with
the Professorship of Clinical Medicine in the University
of Pennsylvania, lately held by Prof. Pepper.
An Ancient Hospital Confiscated. — The Hospital
of Jesus in the City of Mexico is said to have been founded
and endowed by the conqueror Cortez. The government
has recently confiscated the property on the plea that the
terms of the founder's will had not been complied with.
Pasteur's Hydrophobia Vaccine a Success. — ^The
government commission which has been making experi-
ments similar to those of M. Pasteur in connection with
finding a preventive for hydrophobia, has reported tliat
its investigations decisively confirm the correctness of
the distinguished scientist's theory.
Living Quadruplets. — An apparently authentic ac-
count is given of the birth of four living male children
by a woman named Mrs. H. W. Pullman, who resides
near Eureka, Mo. The mother had previously given
birth to triplets, and the husband may well look forward
to the next pregnancy with interest.
Hydrochinon — Another Antipyretic. — Dr. Paul
Seifert reports upon the antipyretic value of hydrochinon,
C,H,0„ a benzol-compound resembling resorcin. He
finds that it reduces temperature as quickly though not
quite so permanently as quinine. It has no irritative or
toxic effects. The dose varies from one to four grammes.
1 86
THE MEDICAL RECORD.
[August i6, 1884,
The Carnegie Laboratory at Bellevue Hospital
-Medical College.— Plans for the erection of this new
laboratory have been filed and work upon it will soon
be begun. The building will be fifty feet square, and
five stories high. It will be on East Twenty-sixth Street,
on the south or opposite side from the present College
Building.
That Office Thief. — Our warning of last week came
too late to prevent the robbing of Dr. Francis J. Quin-
tan's office in West Fifteenth Street. Dr. Quinlan was
robbed of clothing, valuable books, and surgical instru-
ments. One of the most aggravating things in connection
with these robberies is the stupidity and inefficiency of the
city's detective force. We have yet to learn of any case
in which they have done anything but look "devilish sly.'*
What Cholera has done for Russia.— Cholera first
appeared in European Russia in 1823, says the Nowoje
Wremja^ and continued until 1838. During this time
500,000 persons were attacked, and 240,000 died (43
per cent.). In the second epidemic (1847-59), out of
2,589,000 attacked, 1,032,000 died (40 per cent.). In
the next epidemic (1865-72) there were 326,968 deaths.
Altogether cholera has attacked 4,000,000, and killed
[,600,000 Russians.
Specific Directions for Preventing Cholera. —
The five points to be looked after in attempts to prevent
cholera, as laid down by the Illinois Board of Health,
are : i. The condition of the water supply; 2. The dis-
position of night-soil, garbage, and sewage; 3. The
cleansing of streets, alleys, and other public places ; 4.
The supervision of food supplies, and of market-places,
«laughter-houses, and similar establishments ; 5. The gen-
eral sanitation of every house and its surroundings.
The Cincinnati Board of Health. — Our valued
contemporary the Cincinnati Lancet and Clinic has for
some time been trying to awaken the profession to an
interest in reforming the sanitary management of the city
of Cincinnati. A year ago the Cincinnati Board of Health
was constituted of five saloon keepers and one quack
doctor, now it has reformed enough to substitute a street
paver for the quack. The medical profession is, how-
ever, still not represented at all in the sanitary councils
of the city. This is certainly a very anomalous condition
of afifairs and we trust that the Lancet and Clinic will
keep at work until some improvement is brought about.
Water and Disease — Sanitary HvdroI»hobia. —
The following two items have recently been put in cir-
culation. The tendency of modern sanitation is appar-
ently to make people afraid of water, creating a kind of
sanitary hydrophobia : " Of 142 epidemics of typhoid fever,
observed in various localities, in 125 cases the epidemic
had no other determining cause than the use of water
containing impurities " (** Reports Local Government
Board, England "). " If any taint (however small) of in-
fective material gets access to wells or other sources of
drinking-water, it imparts to large volumes of water the
power of propagating disease " (" Mem. Local Govern-
ment Board, England, July 13, 1883 ").
The Epidemiological Society of London held a
conference on July 2 2d. The president of the society.
Dr. Norman Chevers, C.I.E., opened the meeting with
an address entitled '' Health in India," and was followed
by Dr. William Squire on " Change in Type of Epidemic
Disease." The conference was concluded July 23(1^
when ah all-day sitting was held. The subjects treated
were '' Leprosy in India and the Best Means of P^eveQ^
ing its Increase," by Surgeon-Major Pringle, M.D. ; "The
Behavior of Typhus in England during the Present Cen-
tury;'* and "A Consideration of the Present Aspect of
Cholera in Europe." The latter subject was opened by
Dr. Lawson, Inspector-General of Hospitals, and excited
warm discussion among a number of medical gentlemen
who were present.
A Discussion on Germ-Pathology and Cholera
took place at the monthly meeting of the Newport Medi-
cal Society, August 5th. A number of New York and
Boston physicians took part, including Drs. W. T. Lusk,
Leroy Satterlee, and Dr. H. O. Marcy. The latter gen-
tleman read a paper on the relations of micro-organisms
to infectious diseases. He referred to the apparent con-
tradiction between Florence Nightingale, in her communi-
cations to the New York Herald^ and Dr. Koch, in his
official letter to the Mayor of Toulon, the one of whom
claims that personal contact with cholera was not to be
feared, while the other strenuously condemns the possi-
bility of even the slightest risk of personal contagion.
Dr. M. argued that the true safety lay in the mean be-
tween the two extremes of opinion, and that constant
and perfect sanitation, with avoidance of both direct and
indirect exposure to the disease were required.
An Attorney-General who Understands Blood-
PuRiFiERS. — Time was, says The Medical Chronicle^ when
a gentleman holding in this State the exalted office of
Attorney-General, had too nice a sense of the proprieties
of his position to descend to recommend, in, his offidal
capacity, a quack preparation, as is done in the following
communication, which is being extensively advertised in
the newspapers: "The State of Maryland, Office of
Attorney-General, Westminster, Md., April 28, 1884.
Charles C. F. Schroeder, Esq.: Dear Sir — I am personally
well acquainted with Dr. J. W. Steele and Dr. Wm. M.
Hines. They are practising physicians of this county,
of excellent standing and large experience, and thor-
oughly competent to speak as to the merits of your Iron
Tonic and Blood Purifier. Very truly yours, Charles
B. Roberts." Our contemporary very justly protests
against the prostitution of the Attorney-General's office
to any such business as the above.
Cholera and the Acad6mib de MAdecine. — At the
session of the Academic de M6decine July 2 2d, a letter
from M. Fauvel was read, in which he adhered to and de-
fended his view that the cholera at Toulon and Marseilles
was not Asiatic and not contagious. M. Fauvel's views
may safely be considered the expressions of obstinate
senility.
M. Jules Gu6rin delivered an address on cholera which
was eloquent and interesting, though in some regards
rather antiquated. M. Gu6rin talked of " epidemic con-
stitutions," atmospheric and organic influences, and the
evolution of epidemics under certain fixed laws. He
thought the contagiousness of cholera a secondary matter,
denounced quarantine, and commended the English
m ethod of inspection.
August i6, 1884.]
THE MEDICAL RECORD.
187
Progress of the Cholera. — A temporary increase
in the number of cases of cholera at Toulon and Mar-
seilles occurred during the latter part of last week owing
to the intense heat and the return of many fugitives. On
the whole, however, the violence of the disease has greatly
abated in the cities mentioned The number of deaths
occuning daily has rarely exceeded four or five at Toulon
and fourteen at Marseilles. On the other hand the dis-
ease has undoubtedly gained a firm hold in Southern
France and Northern Italy. Many small towns have
been attacked with great violence. Thus says a Times
correspondent : " In the little village of Gignac, near
Montpellier, forty cases of cholera have been found, and
there have been numerous deaths. The panic there was
so terrible that the fathers and mothers of families fled,
leaving their little children uncared for. At Vogue, a
village of less than eight hundred souls, in the Arddche,
over thirty cases, with seven deaths in the twenty-four
hours have occurred. An outbreak of cholera in Algiers
is feared. Some of the reports of deaths firom cholera in
the villages near Toulon are particularly heart-rending.
In some of them more people died of cholera in a day
than in Toulon during the same twenty-four hours. In
Bordeaux there have been three deaths.''
Reports . state that examinations of the water firom
the wells and fountains in all the places visited by cholera
show the presence of vast numbers of microbes.
The English cholera (cholera nostras) has broken out
seriously at Northampton and in villages near Blackburn.
Over two hundred were reported sick at one time.
So far as the mortality of the disease is concerned, the
statistics of the Pharo Hospital, Marseilles, are instruc-
tive. These statistics show that 521 cases of cholera
have been admitted, of which 313 ended fatally, or about
do per cent. This b a high mortality rate for the disease.
A number of changes have been made in the various
quarantine regulations : Spain has established a ten days
quarantine against infected Italian ports. The Belgian
Government has quarantined against all Mediterranean
ports. At the port of New York, the Health Officer
has issued some further regulations. Vessels on which
cholera develops during the voyage to this port will, of
coarse, be detained, the sick removed to the hospital,
and the well persons to the Quarantine of Observation.
Any cargo of which there is any suspicion will be dis-
charged in Quarantine. The baggage of passengers from
an infected district, or section of country bordering there-
on, is required of captains to be kept separate firom
other baggage. Vessels discharging in Quarantine will
be thoroughly disinfected before being allowed to come
up to the city. The same rules will apply to baggage or
cargo shipped from an infected to a healthy port and re-
shipped here. Vessels with cargoes wholly or in part of
tags will not be given pradque if coming from infected
ports, and if from healthy ports, satisfactory evidence
that they have not been reshipped firom infected districts
win be required, as well as evidence that they have been
collected where no suspicion of cholera exists.
Cheap Quinine. — Physicians should know that qui-
nine is steadily decreasing in price, and has lately been
sold as low as $1 an ounce. It is poor policy, therefore,
to use the so-called '' cheaper alkaloids " when quinine,
which is more efficient, costs but little more. The cause
of the decline in price is said to be the removal of the
tariff, and an over-production on the part of foreign manu-
facturers. The world's production to-day is estimated at
4,500,000 ounces, of which Germany and Italy manufac-
ture by far the greatest portion. There is considerable
made in England, but this is of a superior quality, and
its enhanced cost limits its consumption and consequent
production. America consumed forty per cent, of the to-
tal production, or about 1,800,000 ounces. Prior to the re-
moval of the tariff, 1,500,000 ounces were produced here,
but the effect of the removal of the duty has been to de-
crease the manufacture and make the United States more
dependent upon foreign supplies. It is estimated that
now not more than 1,000,000 ounces are manufactured
in the New World, but this is in part due to the destruc-
tion by fire, in Philadelphia, of the works of the largest
American producers, who now send their bark to Europe
to be prepared for the market. From the East Indies
the shipments of the raw material to the United States
were over 6,000,000 pounds, of which a very large pro-
portion was shipped to Europe for account of the Amer-
ican manufacturers. Of late years the quality of the
product has materially improved, the quinine now sold
having not more than from two to five per cent, of the
lower alkaloids, while it is but a short time since that
quinine having ten per cent of these was deemed a satis-
factory article. This improvement is believed to be due
entirely to the better quality of the bark obtained from
the cultivated tree.
EIGHTH SESSION,
Held at Copenhagen^ Denmark^ August 10-16, 1884.
BY CABLE TO THE MEDICAL RECORD.
Sunday, August ioth — First Day.
The eighth annual session of the International Medical
Congress was formally opened on Sunday, August loth,
by Professor Panum, of Copenhagen, who delivered
the following
ADDRESS OF WELCOME.
After thanking the King and Queen of Denmark, the
King and Queen of Greece, and the State Council, he
expressed his great gratification at the large audience
present, and hoped that the present session of the Con-
gress would tend to advance the science of medicine,
and that a broad and liberal spirit, becoming the grand
object in view, would characterize all its deliberations.
Sir James Paget followed with a brilliant address, in
which he thanked Denmark on behalf of Great Britain
for its gift of a princess who was a model prince's wife.
He concluded by hoping that the present Congress would
be equally successful with that held in London.
Professor Virchow, in behalf of Germany, hoped that
the Congress would honor that country by its choice for
a fiiture meeting.
Professor Pasteur also addressed the Congress in
some general remarks, in which he referred to the cos*
i88
THE MEDICAL RECORD.
[August i6, 1884.
mopolitan character of science, and the impossibility of
conforming it to any particular country.
The King and Queen of Denmark, Council of State,
and King and Queen of Greece were present. Sixteen
hundred members were in attendance ; of these eleven
hundred were foreigners, including one hundred English-
men and about fifty Americans.
In the evening
A GRAND BANQUET
was tendered the members. It was largely attended.
Monday, August hth — Second Day.
The Congress in its general session to-day listened to
the address of Professor Pasteur, of Paris, on
MORBIFIC micro-organisms AND VACCINIA MATTERS.
He described his different well-known experiments in
the inoculation of rabies by injecting the virus into
the veins of dogs, and the results in protection against
the evil effects of the bites of rabid animals. He referred
to the report of the French Government Commission ap-
pointed to investigate hydrophobia, stating that twenty-
three dogs had been experimented upon by protection.
All had been bitten by rabid animals in June last, and
yet all had remained healthy. Of nineteen unprotected
animals, similarly bitten, fifteen went mad. It was the
intention of the Government Commission to repeat these
experiments. In closing he emphasized the necessity of
attempting to protect animals only, but if the dogs were
protected the disease would be exterminated.
At the meetings of the sections, sixteen in number, the
different Presidents delivered their addresses.
meetings of SECTIONS.
Section on Anatomy, — Papers read : " The Glandular
Cells during Activity," by Professor Ranvier, of Paris ;
"Terminations of Sensitive Cutaneous Nerves," by Pro-
fessor Merkel, of Konigsberg ; " Rotary' Movements of
Forearm," by Professor J. Herberg, of Christiana.
Section on Physiology. — Papers read : " Mucous and
Albuminous Matters," by Dr. Hammarsten, of Upsala ;
" Fugitive Corpuscles," by Dr. R. Norris, of Birmingham ;
"Coagulation of Blood," by Dr. Wooldridge, of Cam-
bridge ; " Oxyhaemoglobin," by Dr. C. Bohr, of Copen-
hagen ; " Glandular Cells," by Dr. Langley, of Cam-
bridge ; " Functions of Cutaneous Nerves," by Dr. Blix,
of Upsala.
Section on Pathology. — Papers read : " Necrosis of
Coagulation," by Professor Weigert, of Leipsic ; " Bac-
terial Inflammation," by Professor Cornil, of Paris ; " Je-
quirity," by Dr. C. J. Salomousen, Copenhagen.
Section on Medicine, — Papers read : " On Uniform
Nomenclature of Auscultatory Signs in the Diagnosis of
Diseases of the Chest," by Professor Austin Flint, of New
York ; " The Blood-Corpuscles in Anaemic and Leucae-
mic Diseases," by Dr. S. Laache, of Christiana.
Section on Surgery, — Papers read : " The Iodoform
Treatment," by Professor Mosetig-Moorhof, of Vienna;
On Antiseptics— "The Sublimate Treatment," by Dr. M.
Schede, of Hamburg ; " The Treatment by Oxygenated
Water," by Professor Paul Bert, of Paris; "Permanent
Antiseptic Dressing," by Professor Esmarch^ of Kiel ;
" Anaesthetics in Surgery," by Professor Bert, of Pans •
" Colotomy," by Professor Bryant, of London.
Section on Obstetrics. — Papers read : " Myomata Uteri
by Laparotomy," by Professor Koeberle, of Strasburg ;
"Supra- Vaginal Amputation," by Dr. Margary, of Turin;
" Caesarean Section,'* by Professor P. Miller, of Berne,
and Professor Eustache, of Lille.
Section on Laryngology. — Papers read : " The Prog,
nostic Significance of the Several Local Manifestarions
Observed in Tuberculosis of Larynx," by Dr. J. Solis
Cohen, of Philadelphia.
Section on State Medicine. — Papers read: "School
Hygiene in Denmark," by Professors Hertel, of Copen-
hagen, and Key of Stockholm, and Mr. Holbech, of
Copenhagen.
TuEspAY, August i2TH — ^Third Day.
At the general session to-day the address
ON THE NATURAL PRODUCTION OF MALARIA AND THK
MEANS OF MAKING MALARIAL COUNTRIES HEALTHIER,
was delivered by Tommasi Crudeli, of Rome. (See next
number of The Medical Record.)
INVITATION for CONGRESS IN AMERICA.
A communication was received from Dr. Billings, ou
behalf of the American Medical Association, inviting the
Congress to hold its next session in Washington, U. S.
the work in the sections.
In the Section on Pathology^ Professor Grancher, of
Paris, read a paper on " The Relations of Scrofulosis and
Tuberculosis," and Professor Roquemondane, of Limoges,
remarked on Ixodes, an almost unknown human para-
site.
Section on Medicine, — Professors Ewald, of Berlin, Jac-
coud and Grancher, of Paris, presented the subject of
** Tuberculosis in its Different Relations to Etiology and
Pathology.''
Section on Surgery. — Dr. Lewis A. Sayre, of New
York, exhibited his plaster-of-Paris jacket, and demon-
strated its application. Professor Oilier, of Lyon, read a
paper on " Excision and Orthrotomy in Tuberculous Joint
Diseases," and Professor MacEwen, of Glasgow, Scot-
land, presented the subject of " Orthopedic Osteotomy
for Genu Valgum and Club-foot."
Section on Obstetrics, — Professor Mikulicz, of Cra-
kow, read a paper on "Antiseptics in Laparotomy." Pro-
fessor Simpson, of Edinburgh, also read a paper on '* An
International Nomenclature in Obstetrics," and Professor
Halberstma, of Utrecht, on " The Significance of Albu-
minuria in Pregnant Women."
Section on Ophthalmology, — ^The following papers were
read : Dr. Redard, of Paris, " On the Examination of
Vision of Railway Employees ; " Professor Rachlmann,
of Dorpat, on "Trachoma;" Professor Sattler, of Er-
langen, on " The Anatomy of Ciliary Muscle."
Wednesday, August 13TH — Fourth Day.
This day was devoted to excursions in steamers, which
included one to the tomb of Hamlet at Elsinore.
i
August i6> 1884.]
THE MEDICAL RECORD.
189
Reports at SacUtUs.
NEW YORK PATHOLOGICAL SOCIETY.
Stated Meeting y June 25, 1884.
Frank Ferguson, M.D., President, pro tern.
Dr. Ferguson reported on the specimens presented
by Dr. Wackerhagen at the last stated meeting.
Dr. J. H. Ripley presented, on behalf of a candidate,
a specimen of Phihisicat Ulceration of the Larynx.
Dr. C. H. Knight presented specimens of
; NASAL POLYPI,
removed from a patient who gave a history of nasal ca-
tanfa^of four years' standing, frontal headache, loss of
smell, and, for the last six weeks, complete obstruction
of the meatus.
The interesting point in the clinical history was with
rq;ard to the occurrence of asthma. There was no evi-
dence, on physical examination of the chest, of pulmo-
nary disease. Removal of the pol}'pi had given the pa^
dent relief.
Dr. W. M. Carpenter referred to hypertrophy of the
nasal mucous membrane as an etiological factor in hay
fever, to which attention had been directed by Dr. Roe,
of Rochester, and Dr. Sajons, of Philadelphia, and
others.
Dr. Knight remarked that the sjrmptoms in his case
were those of asthma, rather than hay fever, and that the
I^tient had not been a sufiferer from the periodical a£fec-
tion known as hay asthma or hay fever.
Dr. Ripley remarked that the tendency was toward
&e production of emphysema when there was obstruc-
tioQ to the entrance of air into the air-vesicles.
Dr. Knight remarked that probably the condition
of obstruction, in his case, had not existed sufficiently
long to produce emphysema ; at least there was no cvi-
dence of its existence on physical examination.
Dr. H. N. Heineman presented a specimen illustrat-
ing
general tuberculosis.
Patient, aged seven months, was admitted to Mount
Sinai Hospital June 7, 1884. Father has phthisis. Up
to five weeks ago had been well. Then mother noticed
frequent chilly appearance, but got better. For the past
four weeks has been unusually quiet, and rolled its head.
Three weeks ago had slight convulsive seizures, and for
sometime frequent stools with straining; urine dimin-
ishcd in quantity.
On admission there was frequent respiration, cyanosis,
twitchmgs of both arms (chiefly the left), and a hydro-
cq)halic cry. Seemed to suffer, but was observant. On
the succeeding day opisthotonos and conjunctivitis mani-
fested themselves. Depressed fontanelle.
Rve days later there was paralysis of the extremities,
most marked on right side. Pupils even and contracted.
Opisthotonos gone. Died quietly June 2 2d. The tem-
pccunre varied between 98° F. and 101.2° F.; was 96.2°
F. on one occasion.
Autopsy. — Brain : much serum and pus in pia and be-
neath it, over the base ; some over convexities. The
nght parietal lobe contained a collection of tubercles,
ttdi the size of a French pea, with softened centres, and
nombering about twelve in all. The ependyma of the
fateral ventricles contained translucent miliary tubercles.
Tl»€ kings were studded with fine miliary tubercles. The
Wneys, spleen, and liver contained miliary tubercles.
Dr. Ripley asked if the child's lungs were examined
More death.
Dr. Heineman answered that they were, and that
tile (Sagnosb of general tuberculosis was made, from the
iKt that the father had phthisis and the child gave a his-
tory of emaciation, etc., which could not be accounted
for readily by the general physical signs. A moderate
amount of bronchitis was developed before death, and it
was supposed that there was pulmonary tuberculosis.
The condition of lungs, as seen in the specimen, would
not necessarily give rise to physical signs.
Dr. Ripley was not prepared to accept the last state-
ment, as when there exists any considerable amount of
tubercular infiltration there are not only the physical
signs of bronchitis, but there is a change in vocal fremitus
and resonance and the pitch and quality of the respira-
tory murmur.
In a case which he had seen rebently, in which tubercles
did not exist except in the lungs, he was obliged, in ab-
sence of a tubercular history, to make a diagnosis by
means of physical signs ; there were a few bronchial
riles, and decided clumges in vocal fremitus, resonance,
and respiratory murmur. In a case with so much infil-
tration as existed in the lungs presented by Dr. Heineman
he believed that, as a rule, there was some change in the
physical signs mentioned which could be recognized.
The specimen was, therefore, additionally interesting
on account of the absence of any such change.
With regard to the temperature in tubercular menin-
gitis, he made an autopsy on the body of a child who
died of that disease, and during the last few days of life
the patient's temperature was 97^^** F. As Dr. Heine-
man had said, there was, very often, no preagonistic rise
of temperature in this class - of cases. Dr. Ripley had
the records of between fifty and sixty cases of tubercular
meningitis, and the temperature had generally been low.
The symptoms, he thought, varied somewhat with the
extent of invasion of other organs. Sometimes the tem-
perature throughout was as high as 103° F., but, as a rule,
it was subnormal, or not higher than loi^ F.
In Dr. Heineman's case, the temperature rose to
102° F. and over, and Dr. Ripley thought it quite prob-
able that the general tuberculosis increased the rise.
Dr. Ferguson asked Dr. Ripley if he had noticed any
ratio between the amount of exudation and the rise of
temperature in tubercular meningitis.
Dr. Ripley had* not definite data on that point, but
thought that the temperature was not especially influenced
by the quantity of exudation.
The committee appointed to memorialize the late Dr.
Willard Parker next offered the following :
IN MEMORIAM — willard PARKER, M.D., LL.D.
It is with deep and unfeigned regret that we record the
death of our first acting president, Dr. WiUard Parker,
who expired on April 25, 1884, at the ripe age of eighty-
four years.
He was so well and capable up to a very short time
ago that his decease then would have been an unmiti-
gated grief to us, and to all who loved him. But during
the last eighteen months of his life the infirmities of age
and the pangs of sickness had borne so heavily upon
him that our sorrow is greatly subdued in view of the
peace which l\as come upon him. To us is now only
left the gratefiil duty of recording his manifold virtues,
his great and honorable services to his profession and to
the public, and to express our sincere sympathy to his
family.
The New York Pathological Society was founded in
June, 1844, just forty years ago, and several years before
the London Pathological Society was established. For the
first few months of its existence its meetings were presided
over by temporary chairmen, elected at each meeting.
Near the end of its first year, viz., in October, 1844, the
distinguished and lamented Dr. John A. Swett, then the
leading medical pathologist of this city, was elected presi-
dent, and Dr. Parker, who was well grounded in surgical
pathology, vice-president.
Ill-health, soon followed by death, prevented Dr.
Swett from serving, and we are not aware that he ever
filled the presidential chair. But so highly did he appre-
190
THE MEDICAL RECORD.
[August 16, 1884.
date his membership in our Society, that in his treatise
on *^ Diseases of the Chest/' which contained a course of
lectures delivered at the New York Hospital, he an-
nounced himself as simply Physician to the New York
Hospital, and member of the New York Pathological
Society.
Dr. Parker, our first acting President, was successively
re-elected in the years 1845, 1846, and 1847, with little
or no opposition, and quickly gave our Society a stand-
ing before the medical world which few other men could
then have given it. Still he had good material to work
with, for during these three years it counted among its
members, William C. Anderson,* Daniel Ayres,* John H.
Borrowe,* Gurdon Buck,* H. D. Bulkley,* Alonzo Clark,
James Crane, Edward Delafield,* Abraham DuBois,
George Elliott,* Joh» Forry,* Anthony Gescheidt,*
Chandler Gilman,* Middleton Goldsmith, John H. Gris-
com,* Thaddeus Halstead,* Charles E. Isaacs,* W. W.
Jones, William H. MacNeven,* JohnT. Metcalfe, George
A. Peters, John C. Peters, Alfred C. Post, William C.
Roberts,* Gustavus A. Sabine, Lewis A. Sayre, John O.
Stone,* John A. Swett,* Isaac E. Taylor, Robert Tomes,
WilUam H. VanBuren,* Hugh Walsh,* Robert Watts,*
James R. Wood,* Dr. Wotherspoon,* and others of like
ilk.
Of these thirty-seven early members no less than twen-
ty-two have died (those marked thus, *), and this So-
ciety has repeatedly been compelled to go in mourning
for lovable and useful men, who could ill be spared.
When Dr. Parker was called to the first presidency
he was in the prime of life, just forty-five years of age,
having been born in 1800. He was a native of New
Hampshire, and had only been six years in this city.
But he was already Professor of Surgery in the College
of Physicians and Surgeons, and was deservedly very
popular, having risen rapidly to the position of one of
the foremost surgeons and physicians, and most accept-
able teacher and lecturer, not only in the eyes of New
York, but of the whole country.
He had been a pupil and assistant of Dr. John C.
Warren in anatomy and surgery, had served in several
hospitals, and been a teacher and professor of anatomy
and surgery in other colleges.
He was an excellent presiding officer, and took a warm,
well'Sustained interest in the welfare of this Society.
Among his earliest services to it was the active part he
took, with others, in 1845, in housing it in the College
of Physicians and Surgeons, where it has remained until
this day, and, hopefully, always will remain, to the honor
and credit of both.
It was no small benefit to the infant society to be
settled so conveniently for its peculiar work, and at such
a small annual expense. This has enabled it to preserve
all its records and minutes for forty years ; to have them
widely published in various journals, and to issue several
v(^umes of its transactions free to its members.
Dr. Parker was always a thoughtful pathologist, rather
than a minute pathological anatomist ; just as he was a
great conservative surgeon and hygienist, rather than a
mere operator. Although he had a wonderful knowledge
of anatomy and of the principles of surgery, the glamour
of even major operations never seemed to have the
slightest charm for him. He always appeared to think
most surgical operations were unfortunately rendered
necessary by the imperfections of medical and hygienic
art, greatly aided by the ignorance and obstinacy of
patients. He obviously regarded great pathological
specimens as so many failures in the treatment of dis-
ease. He was always rational, rather than merely em-
pirical, or mechanical, and ever aimed to prevent disease
and avoid operations, rather than to drug his patients,
mutilate them, or make post-mortem examinations of them.
Still he rejected no aids in the study of disease, and
always maintained his active connection ¥dth this Society,
even when loaded with numberless other cares and bur-
densome honors, and while laboring so hard, from 1866
down, in the establishment and working of the Metro-
politan Board of Health, where his views on hygiene
could have full play. He was ever ready to sustain us
with his presence and example, and with a strong hand,
kindly heart, active brain, and ready purse. Even in the
last year of his life, when almost crushed with the in-
firmities of his great age and the pangs of disease, he
delighted to counsel for its welfare and honor, and to re-
view its early history and struggles.
For these and many other things this Society owes
a debt of gratitude to the memory of Dr. Parker, which
it is not only eminently becoming for it to acknowledge,
but which we are only too happy to promptly and frankly
render.
To those who knew him in his prime we need not say
that we were very proud of our first president as a peat
and good man, a faithful citizen, an eminent physician
and surgeon, a brilliant teacher, and a careful watchman
over the public health.
Many of us went further, and took a justifiable pride
in those winning personal and mental endowments which
a kind Providence had showered upon him ; in his manly
beauty and impressive stature, in his attractive, gentle-
manly appearance and kindly presence, in his great
mental vigor and physical activity, in his exceptionally
regular and correct personal habits, in his buoyant and
even joyish temperament, in his spotless morality and
deep religious convictions, we thought him an embodi-
ment in himself of almost all that is good, useful, lova-
ble, and we are, and all his friends should be, greatly
comforted in his loss that these high qualities were at
our, and their, service so long, and so far beyond the
period of life ordinarily allotted to man, for work and
for the comfort of his fellows.
He has gone to join that not small band of our illus-
trious deceased presidents, himself by far not the least,
quorum pars magna fuiU His closes, for a time, the list
which contains the honored names of Wm. H. Van
Buren, Robert Watts, Edmund R. Peaslee, Gurdon
Buck, Ernst Kracowizer, James R. Wood, John A*
Swett, Erskine Mason, Charles E. Isaacs, Jackson Bol-
ton, David S. Conant, Wm. B. Bibbins, and Henry Van
Arsdale.
Dr. John A. Swett, our first nominal president, died
at the early age of forty-five years. Dr. James R. Wood,
our second president, was born in 18 16, and died aged
sixty-five years. Dr. Wm. H. Van Bureu, our fourth
president, was bom in 1819, and died aged sixty-five
years. Dr. Charles K Isaacs, our fifth president, was
born in 1822, and died aged forty-eight years. Dr. Jack-
son Bolton, our eighth president, was bom in 18 15, and
died aged fifty-one years. Dr. Robert Watts, our ninth
president, died aged fifty-five years. Dr. Edmund R,
Peaslee, our tenth president, was bom in 18149 and died
aged sixty-five years. Dr. David S. Conant, our four-
teenth president, died aged forty-five years. Dr. Gurdon
Buck, our sixteenth president, was bom in 1807, and
died aged seventy. Dr. Wm. B. Bibbins, our eighteenth
president, was bom in 1825, and died aged forty-six
years. Dr. Emst Kracowizer, our twentieth president,
was born in 1822, and died aged fifty-three years. Dr.
Erskine Mason, our twenty-fourth president, died aged
forty years. Lastly, Dr. Willard Parker, our first presi-
dent, was born in 1800, and died aged eighty-four years.
Thus it will be seen that, with the sole exception of
Dr. Parker, none of our deceased presidents lived to be
very old men. Only one beside him. Dr. Gurdon Buck,
reached his seventieth year. No less than three---viz.,
Drs. Van Buren, Peaslee, and James R. Wood — died in
their sixty-fifth year. Drs. Bolton, Kracowizer, and
Watts died respectively in their fifty-first, fifty-third, and
fifty-fifth years. No less than six died before they
attained their fiftieth year — viz., Dr. Isaacs, at forty-
eight ; Dr. Bibbins, at forty-six ; Drs. Swett and Conant,
at forty-five ; and the beloved Dr. Mason at the very
early age of forty years.
^^ugust 16, 1884.]
THE MEDICAL RECORD.
191
Many of our deceased presidents were always delicate j
and many were cut off by sudden and sharp sick-
ness. Dr. Parker c^me from a long-lived and excellent
pre-Revolutionary stock on both sides of his family. He
lived upon a farm until he was nineteen years old, and
although he worked hard and performed excellent service
for the rest of his life, he always took great care of his
general health.
Our senior living ex-president, in point of years, is
Dr. Alfred C. Post, thirteenth president, born in 1806,
aged seventy-eight Our senior ex-president, in point of
service, is Dr. Thomas M. Markoe, fourth president, born
in 182 1, aged sixty-three years. Then follow Dr. John
T. Metcalfe, seventh president, aged sixty-two ; Dr. John
C. Dalton, twelfth president, born 1825, is aged fifty-nine ;
Dr. Thos. C. Finnell, fourteenth president, born 1827^ is
aged fifty-seven ; Dr. Abraham Jacobi, sixteenth presi-
dent, bom 1830, is aged fifty-four ; Dr. Henry B. Sands,
seventeenth president, born 1830, is aged fifty-four ; Dr.
Lewis A. Sayre, twenty-first president, born in 1820, is
aged sixty-four years ; Dr. Joseph C. Hutchison, twenty-
second president, born in 1827, is aged fifty- seven; Dr.
Alfred L. Loomis, twenty-third president, bom in 1831,
is aged fifty-three years ; Dr. Herman Knapp, twenty-fifth
preadent, is aged fifty-two years ; Dr. Francis Delafield,
twenty-sixth president, born in 1841, is aged forty-three
years; Dr. Charles K. Briddon, twenty-seventh presi-
dent, bora in 1827, is aged fifty-seven; Dr. Edward G.
Jancway, twenty-eighth president, born in 1841,. is aged
forty-three years; Dr. John C. Peters, born in 1819, twen-
ty-ninth president, is aged sixty-five years ; Dr. Edward L.
Keyes, thirtieth president, bom in 1843, is aged forty-one
jrears; Dr. T. E. Sattcrthwaite, thirty-first president, born
in 1843, is aged forty-one years ; Dr. Ed. C. Seguin, thirty-
second president, bom in 1843, is aged forty-one years ; Dr.
George F. Shrady, bora in 1837, is aged forty-seven years.
It will be seen that the majority of our presidents have
been young men. Dr. Swett was under forty years of
age when elected president ; Dr. Parker, forty-five ; .Dr.
James R. Wood, thirty-two ; Dr. Markoe, only thirty ;
Dr.VanBuren, thirty-one ; Dr. Isaacs, only twenty-nine ;
Dr. Metcalfe, thirty-one ; Dr. Van Arsdale, thirty-seven ;
Dr. Bolton, thirty-nine ; Dr. Watts, forty-nine ; Dr. Peas-
Ice, foity-four ; Dr. Dalton, thirty-four; Dr. Post, fifty-five;
Dr. Finnell, thirty-five ; Dr. Conant, forty ; Dr. Jacobi,
ihirty-four ; Dr. Buck, fifty-eight ; Dr. Sands, thirty-six ;
Dr. Bibbins, forty-two ; Dr. Kracowizer, forty-six ; Dr.
Sayre, forty-nine ; Dr. Hutchison, forty-three ; Dr. Loo-
mis, forty; Dr. Mason, thirty-eight; Dr. Knapp, forty-
two ; Dr. Delafield, thirty-four ; Dr. Briddon, forty-nine ;
Dr. Jancway, thirty-six ; Dr. Peters, fifty-nine ; Dr. Keyes,
thirty-six; Dr. Satterthwaite, thirty-seven; Dr. Seguin,
thirty-niDc ; Dr. Shrady, forty-six years.
Signed by authority, John C. Peters, Chairman,
Geo. L. Peabody.
Lactic Acid occurs in sour milk from the spontaneous
fermentation of sugar of milk under the influence of
casein ; this transformation is called lactic fermentaiion.
A similar change is produced in dextrine, glucose, cane-
SQgar, etc., by the action of casein and other protein
compounds.' It is found in many vegetable products
vbidi have turned sour. The sarcolactic acid of flesh
ud muscle is very sour, and in excess causes rheuma-
^ It is soluble in ether, alcohol, and water, coagulates
mlk and albumen, displaces carbonic and acetic acids,
and yields salts soluble in water and alcohol. It has been
«ed in dyspepsia in place of hydrochloric acid ; and when
ffvcn in diabetes symptoms of acute rheumatism have
appeared which have subsided on stopping the acid. In«
^unmation of the joints and pericardium have been
^ansed by it in animals. It is useful in all alkaline dis-
cues, including typhus and typhoid fevers, erysipelas,
^thcria, etc
THE BERLIN SOCIETY OF INTERNAL MEDI-
CINE.
Stated Meetings June 30, 1884.
Herr Leyden, President, in the Chair.
(Special Report to Ths Mbdical Rkcord.)
The Society having been called to order, the first
speaker of the evening was Herr Mendelsohn, who
presented some preparations showing
tubercle bacilli in the urine and kidneys.
The patient had suffered for some time from a bladder
trouble and incontinence of urine, and died rather sud-
denly from meningitis. The urine was cloudy, alkaline
in reaction, and contained albumen. The urine having
been evaporated and the driecl sediment stained, the
tubercle bacilli were seen to be present in large numbers.
Koch, in his latest work on the etiology of phthisis, has
described the bacilli obtained by culture as large bodies
twisted into multiple serpentine shapes, the smallest of
them looking like the letter S. The bacilli found in the
urine, and also in pus taken from the kidney post mor-
tem, presented exactly this appearance.
Herr A. Baginsky then exhibited some specimens
demonstrating the
changes induced in the intestinal canal of chil-
dren BY chronic catarrh.
He had not seen any mention made of this condition
in any of the recent text-books. The affection attacks
first the mucous coat, but passing gradually into the
deeper layers induces there changes of a very serious
character. A child, seven months old, was brought to
him for treatment, suffering for some time from diarrhoea
and great emaciation. The stools were thin, mucous,
and of a greenish color. After a period of temporary
improvement the diarrhoea returned, and soon the child
died. At the autopsy the mucous membrane of the
large intestine was seen to be swollen and thickly studded
with granulations, so that the intestine, when smoothed
out, looked like a coarse file. On microscopical exami-
nation the glands of Lieberkiihn were found to have
undergone peculiar changes. They were of all sorts of
odd shapes, presenting warty outgrowths and bifurcations,
and on careful section the epithelium was seen to be the
seat of hyaline degeneration. The speaker expressed the
opinion that Lieberkiihn' s glands possessed a certain
digestive function, and that the patholoncal changes oc-
curring in them should be more caremlly studied than
they have hitherto been.
Herr Boecker then related a case of
gangrenous inflammation of the larynx,
situated in the aryteno-epiglottidean fold. Laryngeal
examination showed large shreds of gangrenous tissue
hanging down from the neighborhood of the pyramidal
sinus. The patient stated that he had been suddenly
seized, ten weeks before, with sore throat apd difficulty
in deglutition. At the same time there was considerable
dyspnoea, and when this subsided the breath became so
extremely offensive that he could not eat.
Herr Altmann then read an interesting paper on
some of the
SUCCEDANEA OF DIGITALIS.
He had made a number of trials during the past year
with caffeine and adonis vemalis in the treatment of
cardiac and renal diseases, and thought that a recital of
the results obtained by him would not be without in-
terest. His experience with
CAFFEINE
had been that under its influence the heart's action was
strengthened and the arterial tension increased. Its in-
192
THE MEDICAL RECORD.
[August 1 6, i884«
fluence in reducing the frequency of the pulse was not as
marked as that of digitalis. The urine was invariably
increased in quantity during the administration of the
drug. It had been stated by Riegel that the simultane-
ous exhibition of narcotics weakened the action of caf-
feine, and the author's experience had led him to the
same conclusion.
ADONIS VERNALIS,
a wild plant of the order of ranunculaceas, growing in
southern Europe, was at one time employed as a drastic
cathartic, and also as a heart-tonic, but had soon been
forgotten. Some trials had of late been made of it by
Dr. Bubnoff, at the instance of Professor Botkin, when
it was found to possess some really valuable properties
as a heart-tonic and diuretic. Cervello had found the
active principle of the plant to reside in a glucoside to
which he gave the name of
ADONIDINK.
Its action was very similar to that of di^italine in
strengthening the cardiac pulsations, increasing arterial
tension, and, after its continued administration for a
length of time, increasing also the irritability of the
striped muscular tissue.
The author had employed adonis in a number of cases
of valvular disease, fatty degeneration, and myocarditis,
as well as of parenchymatous nephritis. He gave in de-
tail the history of two cases in which he had employed
adonis with signal success after having been obliged to
discontinue digitalis on account of the dangerous symp-
toms produced Yet adonis did not act equally well in
all cases. In two instances he was forced to give it up
owing to its causing pain in the kidneys and general
malaise. The simultaneous administration of narcotics
in these cases had seemed to influence its action in no
noticeable degree. All observers agreed that there was
no cumulative action of the drug. That large doses
might be given without danger was evidenced by the fact
that the Russians were accustomed to take it in unlim-
ited quantities as a remedy against the drinking habit.
It was given medicinally in infusion or decoction
(3 j.-ij. to 5 vj.), in doses of a tablespoonful four or more
times a day. In conclusion, Herr Altmann submitted
that adonis vemalis is a cardiac regulator in the same
sense as is digitalis. It strengthens the heart's action
and reduces the number of its pulsations, raising at the
same time arterial tension, and increasing markedly
diuresis. The indications for the use of adonis are the
same as for digitalis, but it is more rapid in its action
than the latter drug, and never exhibits any cumulative
effect Finally, it may often be productive of good re-
sults where digitalis has failed.
Herr Michaelis had had a case of excessive ascites
and oedema which had resisted all the ordinary diuretics,
and in which digitalis gave rise to most alarming symp-
toms. As a last resort he determined to try adonis, and
was delighted to find that under its influence the excre-
tion of urine was at once increased. The ascites and
knasarca disappeared within a short time.
Herr W. Lublinski was induced to try adonis ver-
nalis on the recommendation of Professor Botkin, of St.
Petersburg. He had used it in a number of cases of
dropsy consequent upon valvular insufficiency, cardiac
debility, and Bright's disease. The principal effect of
the drug, and that by which it won its fame in Russia, is
seen in increased diuresis. He had observed one pecu-
liarity in the diuresis of adonis, which was that the spe-
cific gravity remained high, although the total amount of
urine excreted was so greatly increased. This was due
to the fact, noticed by Botkin, that there was an in-
creased excretion of urates and chlorides during the ad-
ministration of the drug. The speaker had not observed
the favorable influence upon the heart which others had
claimed for adonis. In a few instances only had he seen
any increase of strength in the heart's action, neither
had the pulse become less rapid and more regular, nor
the dyspnoea less urgent. In most cases he was obliged
to fall back on digitalis in order to obtain this result.
In addition to Uiis disadvantage, adonis possesses some
very unpleasant, though not dangerous, properties.
Herr Lublinski's patients had complained much of the
extreme bitterness of the drug, and he had found nothing
which would in any noticeable degree disguise this taste.
It often caused nausea, and even vomiting, and some-
times had to be discontinued on account of a diarrhoea
which was excited by it In summing up the results of
his experience, the speaker maintained that adonis ver-
nalis could never be accepted as a substitute for digitalis in
all cases. It is useful in those cases in which it is desir-
able to induce diuresis ; but even here it should be given
only when digitalis is contraindicated by the existence
of a very slow pulse, or when a cumulative action is to
be feared. He stated, for the benefit of those who might
wish to try it in their practice, that it could be obtained
of Gehe & Co., in Dresden.
The active principle, adonidine, is a glucoside, con.
tainin^ no toxic proi)erties. It is amorphous, dissolving
freely u alcohol, but only slightly soluble in water and
ether. The maximum dose for a frog is i^ grain. It
has no cumulative action.
Herr Lenhartz had used adonis in a number of cases
of pleurisy, nephritis, weak heart, etc., in which all other
remedies had failed. The results were in general very
fisivorable. He was especially pleased with the diuretic
action of the drug.
Herr Leyden stated that he was engaged in the at-
tempt ,to make other more satisfactory preparations of
adonis than those hitherto in use, but his labors had as
yet been unproductive of result The active principle
was unsuited for internal administration, owing to its
slight degree of solubility in water. Adonis had advan-
tages as well as disadvantages in comparison with digi-
talis. It exerts no regulating action upon the heart, and
seldom slows the pulse to any appreciable degree. Its
chi^ advantage is that it has no cunaulative effect, and
further, it causes no such digestive disturbances as are
frequently seen to follow the prolonged administration of
digitalis. It can also be given in many cases of weakened
heart and slow pulse in which digitalis would be contra-
indicated. It is, upon the whole, the best succedancum
of digitalis that we possess.
As regards
convallaria,
the speaker said that his early experience with the drug
had not been of such a nature as to encourage him to
continue in its use. Squills resembled adonis in its diu-
retic action, but it was less reliable. He thought the
history of adonis exemplified very strikingly
THE relations BETWEEN PHYSIOLOGICAL EXPERIMENT
AND MEDICAL PRACTICE.
There are many substances which possess properties
similar to those of digitalis, and which give almost iden-
tical results in experiments upon frogs. But in practice
it is found that the various drugs are by no means of equal
value. Thus it is evident that in the treatment of patho-
logical conditions we cannot rely wholly upon the prop-
erties of any drug as determined in the laboratory, but
must determine anew for ourselves, by actual experi-
ment, what value each substance possesses when brought
face to face with disease.
The Society, on motion, then adjourned.
The Forceps in Breech Presentations. — Profes-
sor R. Harvey, of Calcutta', advocates the use of the
forceps in breech presentations in certain cases {Indian
Medical Gazette^ June, 1884). In this opinion he is now
supported by Huter, Haake, Lusk, Gooch, Hamilton,
Miles, and Agnew, so that the older views as to the
inutility of this procedure need to be somewhat changed.
August 1 6. 1884,]
THE MEDICAL RECORD.
193
THE BIOLOGICAL SOCIETY OF PARIS.
Slated Meetings July 12, 1884.
M. Paul Bert, President, in the Chair.
(Special Report for Thb Mbdical Record.)
The Society was called to order by the President.
M. Mairet detailed the results of some experiments
made by him to determine the modifications occurring in
the
elimination of phosphoric acid
in the subjects of epilepsy, melancholia or mania In the
latter disease the results differ according to the particular
phase during which the investigations are made. In the
stage of excitement there is an increase in the elimination
of nitrogen and phosphoric acid. In the period of de-
pression the nitrogen and alkaline phosphates are dimin-
ished, white the earthy phosphates are increased. There
is a decrease in both nitrogen and phosphates during a
remission. In epilepsy there is an increased elimination
of these substances during an attack. In melancholia the
earthy phosphates are increased in amount, and the
alkalme phosphates and nitrogen are diminished. M»
Mairet thought his investigations were of practical value
as furnishing indications for the treatment of these affec-
tions.
M. Henninger described the method employed by
him in determining the
PROPORTION OF NITROGEN IN UREA.
This method was a modification of that proposed by Dr.
Kjedal, of Copenhagen. It was very simple, and could
be completed within two hours.
M. Grbhant then called attention to the dangers of
the
DISINFECTION OF BAGGAGE BY NITROUS VAPORS,
as was done in some of the railway stations. The porters
who removed the disinfected baggage incurred no slight
risk. Experiments upon dogs had shown that the res-
piration of nitrous vapors was always dangerous, and
m%ht even be fatal in its consequences. It was very
well to try to kill the microbes, but it was hardly the cor-
rect thing to kill men at the same time.
M. Rabuteau thought that the question raised by M.
Grdhant was one of very grave importance. The inhala-
tion of nitrous vapor determines profound changes in the
blood, the effects of which may not be seen immediately.
Workmen exposed to these fumes had been known to die
suddenly after they had returned to their homes, although
vhile at work they had experienced no ill effects.
M. Henninger cited the case of a chemist in Edin-
burgh, who died in consequence of inhaling these vapors.
His laboratory assistant was also made very ill, but finally
recovered.
M. Grkhant read a note upon
ALIMEITFATION BY PEPTONES,
and demonstrated a simple method of making peptones
for therapeutic use.
M. BouCHERBAU had prescribed peptones in a number
of cases of mental disease, and had observed a marked im-
provement in the physical condition, and sometimes also
in the mental state.
M. Henninger mentioned a paper which he had
published upon the
rectal administraiion of peptones.
He also related an instance in which a patient, who had
become greatly reduced, lived for several weeks upon in-
jections of peptones. He always added sugar and
laudanum to the enemata. He had never seen any in-
flammation of the rectum following these injections.
M. Quinquand had studied the effects of peptones in
the direction of increased bodily weight and augmentation
in the quantity of urea excreted. He had tound an in-
aeased formation of urea to take place at the same time
that the patient gained in weight This he thought,
proved conclusively that the peptones were assimilated^
He related several cases in which he had observed bene-
fit from this mode of alimentation.
M. Dastre thought that the facts related by M. Quin-
quand were especially valuable in disproving the state-
ments made by certain German writers. These latter,
having examined only the products of respiration, pre-
sumed to assort that peptones were inert.
The Society then adjourned.
THE HOSPITALS MEDICAL SOCIETY OF
PARIS.
Stilled Meetings July 11, 1884.
M. BucQUOY, President, in the Chair.
(Special Report for Thb Medical Rboord.)
The Society having been called to order, M. Besnisr
delivered an address of some length upon the desirability
of preparing for
THE APPROACHING CHOLERA EPIDEMIC.
He thought it necessary for the physicians of Paris to
bestir themselves if they wished to avoid a repetition of
what had just occurred at Marseilles. The daily papers
were full of the visit made by Dr. Koch, in the character
apparently of sanitary inspector and adviser to the phy-
sicians and municipality of that city. Now, either the
physicians knew beforehand all that Dr. Koch told them,
and his advice was therefore superfluous, or else they did
not know it, and then it was not to Dr. Koch that they
should have applied for instruction. M. Besnier then
spoke of the measures that had been taken in Paris to
prepare for the probable appearance of the disease.
Two hospitals, of the opacity of two hundred beds each,
had been made ready, one on each bank of the Seine.
In the event of an epidemic, therefore, there was ac»
commodation for four hundred patients at once, and then
there would be time enough to prepare for niore if occa-
sion arose. He stated, in answer to a question of one
of the members, that experiments were now being con-
ducted to determine the practicability of
BURNING THE CHOLERAIC DISCHARGES.
This was to be done by means of portable furnaces
mounted on wheels. The dejections could be thrown
into the furnaces as soon as they were received. If this
idea were practicable, it would certainly be an efficient
way of destroying every contagious principle.
M. Vallin then read a very interesting paper upon the
TRANSMISSIBILITV OF PULMONARY PHTHISIS.
The paper was in reality the report of the committee on
phthisiology appointed by the Society some time pre-
viously. The author first gave the facts upon which was
based the doctrine of the inoculability of tuberculosis,
and stated that the contagious principle was contained
in the tubercular matter, the muscles, and perhaps also
in* the lymph and the milk. It had been admitted that
the tubercular virus was inoculable, but at the same time
it had been denied by some that it could be transported
from one person to another in the ordinary conditions of
every-<lay life. The author thought, however, that the
evidence of the contagiousness of phthisis was certainly
as convincing as that in the case of glanders, and there
were very few who would care to deny the contagious-
ness of the latter disease One fact worthy of careful
study in this connection was the danger of the formation
of
CENTRES OF CONTAGION
in houses in which a number of phthisical patients had
been collected together. Cohnheim, who had formerly
denied the contagious nature of tuberculosis, was con-
verted to the opposite opinion by the fact that his ani-
mals all became tuberculous, although they had not been
194
THE MEDICAL RECORD.
[August i6, 1884.
inoculated, simply from living in his laboratory, which
had become infected with the tubercular virus.
It has been denied that the facts observed in animals
were applicable to man, but the cases of contagion re-
corded by the Collective Investigation Committee in
England are so numerous as to be virtually conclusive.
Of the 1,078 answers received to their circular con-
cerning the transmission of tuberculosis, 261 were
affirmative. Of this number there were 190 cases in
which phthisis occurred in those who had no hereditary
predisposition. A similar result was obtained by the
German committee. One case in this category was
particularly striking. Dr. Hyades, a physician attached
to the Cape Horn mission, stated that phthisis was un-
known among the natives of Terra del Fuego before the
advent of the English missionaries, and this despite
the fact that they lived in the open air, but scantily
clothed and exposed to all the vicissitudes of an intem-
perate climate. But after they had been partially civil-
ized, although they were now warmly clad and lived in
decent houses, they were nearly decimated by phthisis.
Among the missionaries with whom they lived there were
several with tuberculosis.
It had been asserted that those who became tuber-
culous after nursing phthisical patients, became so in
consequence of the fatigue and anxiety from which they
suffered. But if this were the case, those who nurse pa-
tients with cardiac, renal, or other chronic diseases ought
equally to become consumptive, and this, experience
shows, does not occur. It is true the negative testimony
against the contagiousness of tuberculosis is very strong,
but taken in connection with the positive testimony on
the other side, it only proves that pulmonary consump-
tion is not as markedly contagious as some other diseases,
measles or small-pox for example.
Having thus established, M. Vallin continued, the con-
tagious nature of the disease, he would now lay down
some general rules bearing upon the
PROPHYLAXIS OF TUBERCULOSIS.
Physicians should be careful, while seeking to enforce
the necessary prophylactic measures, not to preach too
strongly the theory of contagion in phthisis. For the
public was very selfish and quick to take alarm, and if
once people became convinced that there was a real
danger of contagion in this disease, they might run to
the extreme^ and shun the consumptive as they would a
leper. A patient with phthisis should always sleep alone,
in a well-ventilated room. Especial care should be
taken in the case of patients with the buccal, pharyngeal,
or laryngeal forms of tuberculosis, and it would be well
for these to inhale iodoform vapor, in order to render
their breath as innocuous as possible. Children con-
valescing from measles and bronchitis of the smaller tubes
should be kept away from association with consumptives.
Patients should be forbidden to expectorate in their
handkerchiefs or on the ground, but should use spittoons
containing some damp sand or sawdust. The spittoons
should be washed in boiling water or in a solution of
chloride of zinc, one ounce to twenty ounces of glycerine
and water. The rooms in which phthisical patients have
died should be disinfected by burning sulphur, one ounce
to every cubic yard.
Finally M. Vallin summed up the
CONCLUSIONS OF THE COMMITTEE
briefly, as follows :
1. The transmissibility of pulmonary tuberculosis is
very probable, though not as yet indubitably proven by
facts.
2. Isolation of consumptives, in the same sense as that of
patients suffering from diphtheria or small-pox, is neither
necessary nor desirable. Yet in view of the probable
contagiousness of the disease, the public should be urged
to adopt certain prophylactic measures similar to those
enunciated in the body of the report.
The Society then adjourned.
^owzspan&zncji.
THE PERIOD OF GREATEST RISK FROM
CONSUiMPTION.
To THB Editor of Thb Mbdicax. Rbcorix
Sir: In The Medical Record of July 12th there is an
article by Edgar Holden, M.D., entitled "When are we
at Greatest Risk from Consumption ? " He writes as fol-
lows: "Rare facilities for prosecuting an investigation
to obtain a correct result have led me with considerable
labor to a conclusion as startling as I trust it will be
found conclusive, viz., that death from consumption, in-
stead of being, as is almost universally supposed, most
prevalent in early adult life in this country is in reality
not so, but grows relatively more frequent as life ad-
vances.'' He supports this position with suitable argu.
ments, and a diagram showing by figures the actual and
relative mortality from the disease at different periods of
life. I do not object to, but concur in his conclusion,
although it is not so novel and consequently so startling
as he supposes, but I do object to his appropriating with-
out definite acknowledgment the labors of others. The
subject of the relation of age to consumption was care-
fully examined by myself for the Mutual Life Insurance
Company from the statistics of their own experience and
the best tables of vital statistics then accessible. The
results were published by the company in 1877 m their
"Mortuary Experience of the Mutud Life Insurance
Company of New York." The diagram published by
Dr. Holden is his own, but the statistics and figures on
which it is founded are, with one exception, those pub-
lished in the above-mentioned report and here used by
him without acknowledgment. The one exception is the
experience of the life insurance company with which he
is connected. The statistics of this company are valu-
able, but they can scarcely be supposed to possess, like
Aaron's* serpent, a miraculous power of swallowing all
the others.
Dr. Holden's words would seem to indicate that the
" considerable labor " was his own, the line of argument
his own, and the "startling conclusion'' a discovery of
his own, while at the very time of constructing his dia-
gram he was using another's work, and had before him
Uie pages elaborating the same line of argument and
establishing by statistics a conclusion which had been
known to Laennec, Watson, and Christison.
RespectfuUy yours,
E. J. Marsh, M.D.
Patbxson, N. J., July ai* 1884.
SHALL OFFICERS OF THE ARMY ENGAGE
IN PRIVATE PRACTICE ?
To THK Editor of Thb Mbdical Rscokd.
Sir : On July 19th you published in The Record a letter
from Dr. John G. Stanton, in which he complains of the
privilege granted officers of the army to engage in private
practice. The statements which the doctor makes are
presented in such an unfair light that they should be an-
swered. It cannot be done better than by giving an
extract from a letter written by Dr. Heiskell many years
ago, when he was in charge of the Surgeon-General's
Office, more so since it seems that his opinions have
been a guide in matters of the same nature ever since.
Dr. Heiskell wrote as follows :
** Whether, by your expression, * putting themselves in
competition * with you, you mean to convey anything
more than that they comply with the applications of
those who desire their professional aid, is not clearly
understood. If neither a breach of professional etiquette
nor any improper means to obtain professional employ-
ment is charged against them, it is not perceived that
this department can, with propriety, interfere in the
matter. . . . When, therefore, it does not interfere
August i6, 1884.]
THE MEDICAL RECORD.
195
with their military duties, medical officers have aright to
give their professional advice, etc., to whomsoever they
please, and they have always been permitted to do so
with a view to their professional advancement. Indeed,
at military posts occupied by a small number of troops,
and where of course the subjects of disease are few in
number, and the complaints of these few present but
little variety of character, it is rather desirable than other-
wise that the army physician should extend his sphere of
action to the citizens immediately around him, so as to
become ^miliar with disease under all circumstances, the
maladies prevailing through the country and among the
dtizens generally, as well as the diseases peculiar to the
soldier, or to military life in camp or garrison. To de-
prive the army surgeon of any reasonable opportunity of
practical advancement in his profession would surely be
inflicting an injury upon the service generally, and es-
pecially upon those who have to depend upon him for
professional aid. ... It may not be out of place
incidentally to state, that to prohibit a medical officer
(when his public duties will permit) from extending relief
to those of his fellow-citizens who may apply for his ser-
vices— Shaving confidence in his professional attainments
^would be as un^acious to them as it would be devoid
of the common dictates of humanity, and might afford
as just and perhaps a better Cause of complaint on the
part of the neighboring community than the one alleged
bj yourselves, which relates exclusively to private in-
terests. . . ."
Such was the language of an officer and a gentleman,
addressed to some physicians at Sackett's Harbor, N. Y.,
and the high social and professional standing the officers
of the medical corps of the army have always enjoyed
will be sufficient proof that it is not their custom " to
pirate outside of their posts."
The statement that there are too many surgeons for
the number of troops is not supported by facts. It is
true that at some stations the garrisons are small, but not
every military post can be occupied by a large force.
And even at such points it has been found much more
satisfactory, for nulitary reasons, to have the duties of
post-surgeon performed by a regular medical officer or
an acting assistant surgeon, than to employ a private
l^jsician, living in the vicinity, and pay him for each
visit Very respectfully, Caduceus.
ELECTROLYSIS IN STRICTURES.
To THS Editor op Thb Mbdical Rxcoro.
Sir : In the issue of The Medical Record for July 26th,
I see an article upon '< Electrolysis in Stricture,*' by Dr.
Streeter, of Rochester, N. Y., which seems to me so ar-
bitrary in its dictum regarding the successful treatment
by the above process, and this dictum seems to be so en-
tirely based on the doctor's own unsuccessful experience,
diat I cannot but attempt a reply.
Having been the assistant of Dr. Robert Newman for
the ]ast four years^ both in dispensary and private prac^
tice, I iiave hiaul ample opportunity of convincing myself
that he (Dr. Newman) is successful with this method,
whatever experience others may have. It is very com-
mendable to report our failures, as thereby we may profit
and arrive at the truth. The conclusions, however, and
comments the doctor arrives at through his failures are
opposed to both logic and facts ; so that the paper gives
the impression as if it were a partisan one and not simply
in the interest of science. If Dr. Streeter does not suc^
€eed with electrolysis it does not follow, by any means,
that ^erefore electrolysis is a failure, but the fatdt should
be looked for in the operator, not in the instrument. If
one single person succeeds by the method (and there are
icores on record who have succeeded), a thousand may
fail, and without its affecting, the fact that it can be done,
in the least.
All recent text-books have acknowledged the success
of electrolytic treatment, and give their authorities.
Many respectable practitioners of standing, all over the
country, have reported their cases for the last fifteen
years, so that now it would be easy to collect one
thousand cases. At the meeting of the American Medi-
cal Association in Cleveland, O., in 1883, one hundred
successful cases were reported, which had been under ob^
servation for from four to eleven years without a relapse.
Under such circumstances it is very unkind of Dr. Street-
er to say : " No recognized authorities upon surgery or
electricity have reported, etc."
Next, it is unfair to resuscitate the ten old cases of
Dr. K , in 1871. It has been shown why these cases
were not a success in The Medical Record of July 15,
1872, and other articles. Besides, the present method
and present knowledge of the electrolytic process as ap-
plied to strictures should not be compared with the
rudimentary experiments of 1871.
Dr. Streeter also says : " In no other similar affections —
stricture of the oesophagus, rectum, etc., have such re-
sults been claimed for electrolysis." Far firom the mark !
They have been claimed, and are on record. Strictures
of the rectum have been cured by electrolysis (New Eng-
land Medical Monthly, September, 1882), and a specimen
was presented to the New York Pathological Society
on April 10, 1872, which proved not only the complete
cure of the stricture, but also that not the slightest relapse
had taken place, to which the most learned and critical
audience present could not take exception.
Butler and others have cured stricture of the oesophagus
beyond any doubt, and even strictures of the Eustachian
tubes have been treated successfully by M. J. Merd^ in
the clinic of Dr. D^sardnes (Medical News^ quarterly
epitome, March, 1883). The method of Dr. Goruki for
nasal strictures, as also that for those of the lachrymal
ducts, are on record.
As to the operation of cutting strictures for a cure. Dr.
Streeter cannot assert that he cured them permsmently,
he is only able to say he thinks he cured them, which b a
praiseworthy modesty.
The success of electrolysis in the cure of strictures is
such an established fact now, and proven by so man^
successful cases on record, and many more joyful spea-
mens of humanity who own a restored urethral calibre,
that these few words are simply meant tC correct
some misleading statements made in the article of July
26th.
Yours truly,
G. C. H. Meier, M.D.
Nbw York City.
%xmQ g^etuB*
Official List of Changes in ihs StaHont and Duties of Officers
serving in the Medical Department , Uniied States Army^
from August 3 to August 9, 1884.
Gibson, J. R., Major and Surgeon. Granted leave
of absence for one month and fifteen days. S. O. 36,
Headquarters Division of the Atlantic, August 4, 1884.
Heizmank, C. I.., Captain and Assistant Surgeon.
Relieved from duty at Columbus Barracks, Ohio, and
ordered for duty in Department of the. East. S. O. i8o,
par. 2, A. G. O., August 2, 1884.
McCreery, George, First Lieutenant and Assistant
Surgeon. Leave of absence extended two months. S. O.
180, par. 4, A. G. O., August 2, 1884.
Hopkins, W. E., First Lieutenant and Assistant Sur-
geon. Granted one month's leave of absence with permis-
sion to apply for one month's extension. S. O. 67, par. i.
Headquarters Department of Arizona, August i, 1884.
196
THE MEDICAL RECORD.
[August 16, 1884.
pcedical Stjema.
Contagious Dissasbs — Weekly Statement. — Re-
port of cases and deaths from contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the week ending August 9, X8S4 :
Week Ending
Casts.
August 2, 1884
August 9, 1884.
Deaths,
August 2, 1884
August 9, 1884.
35'
35
i
22
28
I
Chloral-quinine. — A compound of quinine with
chloral hydrate has been made by Dr. Mazzara by add-
ing the chloral to an equivalent quantity of quinine dis-
solved in chloroform. By evaporating the solution and
redissolving the residue in ether, the new compound may
be obtained in warty crystals, which are said to be vola-
tile at 149° C. and to make fluorescent solutions with
acids. — Lancet.
Supernumerary Testicles. — Dr. W. S. Cheesman,
of Auburn, N. Y., writes : " I have been a little sur-
prised to observe the credence which The Medical
Record gives to accounts of supernumerary testicles.
Not one of these cases has been established by convinc-
ing evidence. Mere manipulation proves nothing, and
The Record's informers seem to have applied no other
test. Well do I recall a case illustrating the liability of
even the most learned and acute to self-deception in this
matter. In December, 1879, <^ Irishman was admitted
to Ward 6, Bellevue Hospital, who, besides having two
aneurisms of his aorta, appeared to have two testicles on
each side. The whole resident staff went wild with en-
thusiasm, and proudly invited some of the more dis-
tinguished of the visiting staff to examine the curiosity.
One and two at a time they came in, handled the speci-
mens, and went awa^ convinced and awed. Now it
happened that a certain surgeon, hearing of the case and
the credulity of his confreres with amazement, demanded
of one of them (a great pathologist and diagnostician) if
he actually believed this Irishman to have/<7f/r testicles.
The other, reaffirming his belief, good-humoredly advised
his interlocutor not to talk about the case tiU he had
examined it ; whereupon the critic asked to be led to
where the marvel lay. There were present at this fiery
trial most of the hospital staff, and, I think, certain of
the visiting Board also. The inquisitor having carefully
manipulated the scrotum and its interesting contents,
inquired of each individual in turn his opinion there-
upon. When all had committed themselves to the
opinion that the 'man had four testicles, he called for
a candle, and then and there demonstrated that
two of the bodies in question were encysted hydroceles
of the cord. To make assurance doubly sure, I intro-
duced a hypodermic needle into each cyst and evac-
uated its serum, whereupon the plump, round, Arm
pseudo-testis collapsed. Since that afternoon my
opinions as to superfluous testicles have conformed
strictly to the teachings of scientific medical literature, to
the exclusion of the sensational evidence of mere man*
ipulation, whether practised by myself or by any one else.
Authors dismiss this subject with the verdict, Not proven.
It is, of course, difficult to understand why, when women
are now and then accorded the most liberal and varied
multiplication of their generative apparatus, and when
men are occasionally vouchsafed that embarrassment of I
riches, a double penis, there should not also occur
undoubted cases of supernumerary testicle. Yet such is
not the fact. All pretended abnormalities of the sort
have, when submitted to rigid criticism, turned out to be
cystic or fatty tumors, or what-not Will not some one
come forward with a dissected specimen (nothing less
will carry conviction) of a scrotum containing three or
more testes, and enroll his name beside that of the dis-
coverer of a supernumerary moon ? **
Dr. G. M. Burdett, of Lenoirs, Tenn., also writes:
'' An acquaintance of mine from Georgia has three tes-
ticles, but judging from his family none of them were
supernumerary, according to Mr. Webster's definition of
the word."
Notes Regarding the Prescription of Corrosive
Sublimate. — Dr. G. G. Davis, of Trewsbury, N. Y.,
writes : " Corrosive sublimate, mercuric chloride, pcr-
chloride of mercury, the latest and best antiseptic,
seems to be but little understood by the profession in gen-
eral Chemically, it is represented by HgCl,,one mercury,
and two chlorine. One atom of the latter element, not
being entirely saturated by the Hg, tends to divorce itself
dnd become free, to which fact the drug owes its potency.
Great care should be taken in making it up into solu-
tions, that the water should be filtered and distilled, or
rain or snow water used In aqueous mixtures, or pure
glycerine. These two articles are the best vehicles, and
most convenient, and should always contain* a little of
some chloride, as common salt, hydrochloric acid, or
chloride of ammonium, to keep the saturation continuous.
I am aware that physicians prescribe this drug in altera-
tive mixtures, tonics or syrups with vegetable extracts
and such trash, which render the remedy perfectly mert
In fact, I know of but two very simple tinctures in which
it may be prescribed and hold its virtues, viz. : gentian
and cardamom. With tr. ferri chlor. and liq. acidi arseni-
osi of the new Pharmacopceia it forms a model remedy
for pernicious anasmia. This is also a scientific mixture
which will not decompose, and is a fair sample of a pre-
scription for its internal administration. I would again
call the attention of the profession to the avoidance of
all organic materials in a mixture containing corrosive
sublimate."
A Case of Intestinal Obstruction from Twisting
OF Gut— Autopsy.— Dr. P. T. Shillock, of Chaska, Minn.,
sends the history of a case of intestinal obstruction pre-
senting several interesting points. The patient was a
single woman aged twenty-eight, previously healthy, who
had suffered for several days from colic and vomiting.
She had taken several cathartic pills which acted sharply.
Griping pains and vomiting continued, however, and she
finally sent for the physician. Dr. Shillock found her
suffering from abdominal pains and tenderness, tympa^
nitis, and vomiting. Pulse, 100. Symptoms of obstruc-
tion gradually became more and more marked, and in
three days she died from exhaustion. The use of mor-
phine, anti-emetics, stimulants, cathartics, and enemata
only gave temporary reliet Dr. Shillock writes : " On
autopsy we found the obstruction to be caused by a
double looping or twisting of the ileum, just a short dis-
tance from the ileo-caecal valve. The stomach, small
and large intestines were all much distended with gas.
The large intestines were also quite congested, whUe the
small intestines appeared normal, except at the point
where twisting took place, being there of a dark red
color. No evidence of peritonitis was present, and all
the other viscera appeared to be normal. Points of in*
terest in this .case that seem to make it worthy of being
reported were as follows : i, The vomited material had
only a very slight fecal odor on the last two days of the
case ; 2, apparent slight causation for such a serious con-
dition ; 3, setting in of menstruation only two days before
her death ; 4, equal distention of intestines both above
and below obstruction, and passage of flatus during lat-
ter part of case."
The Medical Record
A Weekly yournal of Medicine and Surgery
Vol. 26, No. 8
New York, August 23, 1884
Whole No. 720
THE NATURAL PRODUCTION OF MALARIA,
AND THE MEANS OF MAKING MALARIAL
COUNTRIES HEALTHIER.
An Address delivered at the Eighth Session of
THE International Medical Congress, Copen-
hagen, August 12, 1884.
By CONRAD TOMMASI CRUDELI, M.D.,
PROFBSSOR OF HYCIKNB, UNIVBXSITY OP ROMK» ITALY.
(Special for Thb Mkdical Record.)
Gentlemen : Before entering upon my subject I must
crave the indulgence of those of ray colleagues whose
language I have borrowed for any Italicisms that I may
Q$e, as well as jfor the foreign accent which must strike
their ears -more or less disagreeably. Desiring; to re*
spond as well as lay in my power to the invitation with
tdiich I have been honored to discuss the hygienic ques-
tions relating to malaria, I have chosen the French
language as being the one in which, apart from my
fflotber tongue, I could express myself with the greatest
ease and precision.
I shall be pardoned also, I hope, for having employed
the terms " nudaria " and " malarial districts " in place of
the more commonly used expressions <' paludal miasm''
(masM€ paludeai) and "marshy regions " (contries mar^"
cageuses). The substitution is not a happy one from a
literary point of view, but I have made it deliberately and
for the following reason : The idea that intermittent and
pernicious fevers are engendered by putrid emanations
from swamps and marshes is one of those semi-scientific
assumptions which have contributed most to lead astray
the investi^tions of scientists and the work of public
administrations. This idea, so widespread and so well
established by the traditions of the school, is radically
fiJse. The specific ferment which engenders those fevers
by its accumulation in the atmosphere which we breathe
is not exclusively of paludal origin, and still less is it a
product of putrefaction. Indeed, in every region of the
globe between the two arctic circles there are swamps
and marshes, steeping-tanks of hemp and flax, large
deltas where salt and fresh waters mix, and yet tiiere is
no malaria there, although putrid decomposition is on
every side. On the other hand, in the same parts of the
globe there are places whicb are not, and never were
marshy, and in which tbcvc is not the least trace of
putrelactioD, but which, nevertheless, produce malaria in
abundance. I reject, therefore, wholly the* paludal as-
sumption, and in order to express this view in the title
of my paper, have been forced to employ terms which to
my hearers may sound like Italicisms.
The Italians generally have not this paludal notion, for
experience taught them long ago that malaria is produced
Dcady everywhere; in marshy districts as well as in
those which m^ht almost be called arid ; in a volcanic
soil as well as in the deposits of the miocene and plio-
cene periods and the ancient and modem alluvia ; in a
soil rich in organic matters as well as in one containing
ahnost none ; in the plains as well as on the hills or
mountains. The word malaria (bad air), which it is the
sad privilege of Italy to have lent to all languages to ex-
press the cause of intermittent and pernicious fevers,
represents then, among the majority of our rural popula-
tions, the idea of an agent which may infect any sort of
country, whatever may be its hydraulic and topographical
conditions and whatever may be its geological formation.
This word, therefore, is the one best suited to designate
this specific ferment in question, and I have on this ac-
count employed it and its adjectival derivatives in order
not to resuscitate the idea of the exclusively paludal
origin of the morbific agent.
I shall not tarry long to speak of the nature of this fer-
ment, for the studies bearing upon that point, although
far advanced, are not yet completed. I may remark,
however, that the idea that the ferment is formed of liv-
ing organisms is a very old one, and has not arisen sud-
denly because of the modem theories of the parasitic na-
ture of disease. From the time of Varrar (who believed
that malaria was made up of invisible mites suspended in
the atmosphere^ to our own day this theory has been
several times advanced by hygienists. Independently of
the general considerations which led Rasori, and later
Henle, to formulate the doctrine of the coniagium vivum
of infection (long before the progress of microscopical
science had revealed the existence of living ferments)^
there were peculiar circumstances as regards malaria
which should have impelled minds to look m that direc-
tion, even in times long past.
Some of these circumstances are of a nature to strike
every serious observer, and deserve a few moments' at-
tention. How could one maintain, for example, that
this ferment is a product of chemical reactions taking
place in the ground, when it is seen to remain constantly
the same whatever may be the composition of the soil
from which it emanates I As long as the paludal theory
held sway the chemical interpretation of this identity of
the product in every latitude was easy. Rica does not
hesitate to admit that when a swampy tract is heated by
the sun's rays to the necessary point for the putrid de-
composition of the organic matters contained in it, the
"chemical ferment," or rather the "mephitic gases," to
which is attributed the morbific action, are developed,
whatever may be the distance from the equator at which
this marshy region lies. But since it has been ascer-
tained that malaria is produced in soils of the most varied
chemical composition, the persistent identity of this pro-
duct has become chemically inexplicable ; while it is
however readily conceivable, if one admits that malaria
is an organized ferment which easily finds the necessary
conditions for its life and multiplication in the most
varied soils, as is the case with millions of other organ-
isms vastly superior to the mdiraentary vegetables which
constitute the living ferments.
The same thing may be said ol the progressive inten-^
sity of the morhtfic production in abandoned malarious
districts^ This fact has been historically proven in sev-
eral parts of the earth, and especially in Italy. A large
number of Grecian, Etruscan, and Latin cities, even Rome
itself, sprang up in malarious territories and attained a
hi|^h state of prosperity. First among the reasons for
this success must be placed the works undertaken with a
view of rendering these places more salubrious, and
which lessened the evil production, but almost never ex^
tinguished it completely. After the abandonment of these
localities, the production of malaria recommenced in a
degree which went on increasing from age to age, and
which has rendered some of these places actually unin-
habitable. This was seen, in the time of the ancient
Romans, in Etruria, when it was conquered and laid
198
THE MEDICAL RECORD.
[August 23, 1884.
waste, and in several parts of Magna Grascia, and of
Sicily. From the fall of Rome even to the present day,
this phenomenon has been manifested in a very evident
manner in the Roman Campagna, in certain parts of
which, even up to the time of the Renaissance, it was
possible to maintain pleasure houses, but which are now
uninhabitable during the hot season. In many cases
the physical conditions of the soil have undergone no
appreciable change during centuries, so that it is impos-
sible to attribute so enormous an augmentation of ma-
laria to an increase in its annual production, itself in-
creased by a progressive alteration of the chemical
composition of the soil. But if, on the contrary, it be
admitted that malaria is caused by a living organism
whose successive generations accumulate in the soil, the
interpretation of this fact becomes very simple.
There are, finally, peculiarities in the local charging
cf the atmosphere with malaria which can be expUuned
only in this manner. If the malarial miasm were com-
posed of gaseous bodies emanating from the soil, or
rather of chemical ferments formed beneath the ground
and raised into the air by gases or watery vapor, the
charging of the atmosphere with the specific poison
ought to arrive at its maximum during the hottest part
of the day, when the ground is heated the most by the
sun*s rays and when the evaporation of water and all
chemical actions attain their maximum intensity. But
this is very different from what actually occurs. The
local charging of the atmosphere is always less strong
during the meridian hours than at the beginning and the
end of the day, that is to say, after the rising, and espe-
cially after the setting, of the sun. Now it is precisely
at these hours that the difiference between the tempera-
ture of the lower layers of the atmosphere and that of
the surface of the ground is the greatest, and that the
ascending currents of air starting from the ground are
the strongest. If malaria consists of solid particles con-
tained in the soil, one may readily understand how their
elevation en masse into the atmosphere should take
place especially at these two periods of the day.
All these facts, which can be easily verified if the
subject of malaria be studied on the spot and without
any preconceived notions, explain the tendency whicli
has always been manifested to attribute this specific
poisoning of the air to a living organism which is multi-
plied in the soil ; and they also explain the ardor with
which hygienists have applied themselves to the produc-
tion of the scientific proof.
Unfortunately the investigations undertaken for this
end have for a long time been fruitless, for the precon-
ceived paludal theory has led investigators to occupy
themselves exclusively with the inferior organisms in-
habiting marshes. Among these organisms they studied
especially the hyphomycetes^ which had already acquired
so great an importance in dermatology ; and their entire
attention was concentrated upon the aquatic algae, with-
out even taking the precaution to determine whether the
varieties which they thought to be malarial were found
in all malarious swamps, or whether they were capable
of living within the human organism. It has thus hap-
pened that each observer has indicated as the cause of
malaria a different variety of alga, whichever he found to
be most abundant in the swampy ground that he had to
examine. Thus Salisbury has indicated the palmella
gemiasmay which is found with us in places perfectly free
from malaria, while it is often wanting in malarious
marshes in the centre of Italy ; Balestra, a species of
alga which is as yet indeterminate ; Bargellini, the pal-
moglosa micrococca ; Saflford and Bartlett, the hydrogas^
trum granulatum ; and Archer, the chitonohlastus cerugi-
nosus. There is not a single one of these species the
parasitic nature of which has been demonstrated ; and
as regards the two last named varieties, it can be posi-
tively denied that they are capable of producing a general
infection, for the diameter of their spores and filaments
is greater than that of the capillary blood-vessels.
It was only in 1879 that Klebs and myself, after having
been thoroughly freed, by a long series of preparatory
studies, from the unfortunate paludal idea, undertook to*
gether some investigations in malarious districts of the
most varied character, marshy and not marshy. We
employed the system of fractional cultivation, making
experiments on animals with the final products thus ob-
tained. We felt ourselves justified in recognizing the
malarial ferment in the schizomycete bacillus. The nu*
merous researches made subsequently by us, and by many
other observers, in the soil and in the air of several malari-
ous localities, as well as in the blood and in the organs
of men and animals specifically infected, have put it
henceforth almost beyond doubt that we really have to
do with a schizomycete. Very recently, MM. Marchia
fava and Celli have succeeded in demonstrating that the
germs of this schizomycete attack directly the red blood-
globules, and destroy them, causing them to undergo a
series of very characteristic changes which admit of easy
verification, and which render certain the existence of a
malarial infection.
Several observations made recently in Rome tend to
demonstrate that the schizomycete of malaria does not
always assume the complete bacillary form described by
Klebs and myself; but this morphological question pos-
sesses no further interest for the hygienist. For him the
essential thing is to know that he has to deal with a liv-
ing ferment which can flourish in ^ils of very varied com-
position, and without the presence of which neither
marshes nor stagnant pools of water are capable of pro-
ducing malaria.
We must not think, however, that all earth containing
this ferment is capable of poisoning the superjacent atmo-
sphere. Popular experience, certain modem scientific in-
vestigation, and the facts which one can often verify when
the soil, which was malarious in ancient times and which
has since ceased to be so, is turned up to a great depth, all
agree in proving that the ground remains inoffensive as
long as it is not placed in certain conditions indispensable
for the multiplication of this specific ferment. Up to this
point the organism lives, so to speak, in an inert state,
and may remain so during centuries without losing any of
its deleterious power. There is nothing in this fact that
ought to surprise us, since we know that the life and the
power of evolution belonging to the seeds of plants of a
much higher order than these vegetable organisms con*
stituting ferments, may remain latent for centuries, and
may then revive at once when these gi-ains are placed in
the conditions suitable for their germination.
Among the conditions favorable to the multiplication
of the malarial ferment contained in the soil, and to its
dispersion through the superjacent atmosphere, there are
three which are absolutely essential, and the concurrence
of which is indispensable for the production of bad air
(malaria). First, a temperature which does not fall be-
low 20° C. (67.5° F.) ; next, a very moderate degree of
permanent humidity of the soil ; and finally, the direct
action of the oxygen of the «ir>u)>on the strata of earth
which contain the ferment. If a single one of these
three conditions be wanting, the development of malaria
becomes impossible. This is a point of prime impor-
tance in the natural history of malaria, and it gives us
the key to most of the methods of sanitary improvement
attempted by man.
Let us see first what can be done in this direction
without the labor of man. For nature herself makes
localities salubrious by suspending for a greater or less
time the production of malaria. It is thus that winter
brings about in every country a freedom from malaria
which \% purely thermic ^ for it is due simply and entirely
to a sinking of the temperature below the required raini-
Indeed, if the temperature in winter rises above
mum.
this minimum, there are often sudden outbrcFaks of ma-
laria. Sometimes, during very warm and dry summers,
the heat extracts all the humidity from the malarious
soil, and thus procures for us a freedom from the disease.
August 23, 1884.]
THE MEDICAL RECORD.
199
which \% purely hydraulic. This raay continue for a long
time (as happened in the Roman Campagna during the
years 1881 and 1882), but may also be completely de-
stroyed by a single shower. Nature also sometimes ren-
ders a district healthy in a manner purely atmospheric^
by covering a malarious soil with earth which does not
contain the malarial ferment, or with a matting formed
0/ earth and the roots of grasses growing closely to-
gether in a natural meadow.
In the attempts of purification by suspending the ma-
larial action, which have been devised by man, the same
thing has been done ; that is to say, it has been sought to
eliminate at least one of the three conditions essential to
the development of the specific ferment contained in the
infected soil. Naturally, the^ have not thought of bring-
ing about a thermic purification, such as nature produces
in winter, because of the impossibility of moderating the
action of the sun ; but they have tried from all time to
procure hydraulic or atmospheric purifications, and
sometimes to combine these together in a very happy
way.
The hydraulic systems are very numerous, for the
problem which is presented, namely, that of depriving
the ground of its humidity during the hot season, neces-
sitates different solutions accordmg to the nature and the
bearing of the soil Sometimes this is done by digging
open or closing ditchest intended to draw away large
bodies of water. At other times a system of drainage is
established, by means of which the water is drawn out
of die earth and its level is depressed, so that the upper
malarious strata, exposed to the direct action of the air,
are deprived of moisture during the hot season. This
s}'stem of drainage is not a modem invention ; the Italian
monks understood it as well as, and even better than, we
do. In deep and loose soils they used sometimes, just
as we do now, porous clay pipes ; but when the subsoil
was formed of compact and nearly impermeable matters,
they employed a system of drainage, the extent and
grandeur of which astonishes us. It is that of drainage
by cavities, applied by the Etruscans, Latins, and Volsci
to all the Roman hills formed of volcanic tufa, the tra-
dition of which I have found still preserved in some
comitries of the AbruzzL
We may sometimes establish a double drainage, from
bdow and from above ; that is to say, to drain the sub-
soil, and at the same time increase the evaporation of
water from the surface of the ground. It is well known
that clearing off the forests of malarious countries has
often proved an excellent means of making lands salu-
brious which were before too damp ; for, by removing
every obstacle to the direct action of the sun's rays upon
the ground, we cause an increase of evaporation from its
surface, and may thus be enabled to exhaust the super-
ficial strata completely of their water during the hot sea-
son. In very moist lands which lend themselves readily
to deep drainage, the combination of the latter with a
dearing of the surface has, in almost every quarter of
Ae globe, rendered possible a very widespread and some-
times quite lasting freedom from malaria. But, although
a nearly universal experience proclaims this fact, there is
a school which, following in the footsteps of Lancisi,
maintains the contrary opinion, that it is necessary to
preserve the forests in malarious districts, and even to in-
crease their extent, since the trees filter the infected at-
mosphere and arrest the malaria in their foliage. This
strange theory was formulated by Lancisi in 17 14, on the
occasion of the proposed clearing of a forest belonging
to the Caetani family, and lying between the Pontine
Marshes and the district of Cistema. Lancisi was com-
pletely imbued with the paludal notion, and conse-
quently believed that the very severe malaria of Cistema
was brought by the winds from the coast marshes, in-
stead of being produced in the soil surrounding the dis-
trict, which was then covered by this forest He believed
then that the forest acted as a protective rampart, and
i« prevented its being cut down. But toward the mid-
dle of the present century the Caetani had the woods
cleared off from the entire belt of land surrounding Cis-
tema. Twenty years later I was able to show that
Cistema had gained greatly in salubrity. I published my
observation in 1879, and, naturally, was tsiken %o task
rather sharply in the name of the sacred tradition.
Happily these recriminations led our Minister of Agri-
culture to have the question studied by a special com-
mission. This commission, after a conscientious exami-
nation extending over three years, of all the malarious
localities in the province of Rome, has just published its
report,* the conclusions of which are entirely in accord
with the facts of universal experience. They were not
able to verify a single fact in support of Lancisi's theory,
while they found many of the same nature as that of Cis-
tema, and which have resulted in overturning the theory
entirely.
It has also been thought possible to practise drainage
from above by means of plantations of certain trees
which would draw considerable moisture from the earth,
a method which might really be serviceable in some
malarious districts. But in accordance with the idea that
malaria is a product of paludal decomposition, the trees
selected have almost always been the eucalyptus. It has
been maintained that trees of so rapid a growth ought to
drain the soil very actively, and also that the aroma of
their foliage ought to destroy the miasmatic emanations. I
have hitherto been unable to verify a single instance of
the destruction of malaria by eucalypytus plantations,
but I do not consider myself justified in denying the facts
which have been stated by others. There is nothing tc
oppose the admission that these plantations, when prop-
erly made, may sometimes have been of great utility. I
maintain frankly, however, that they have not always
been so, and that it is necessary to guard against the
exaggerations into which some have allowed themselves
to fall in recent times. Such exaggerations might have
been avoided if, instead of talking about these planta^
tions on the basis of a theoretical assumption, the results
only had been studied in places where the eucalyptus
abounds. It would then have been known that even in
the southern hemisphere, the original home of the euca-
lyptus, there are eucalyptus forests which are very malari-
ous. This fact has been demonstrated by Mr. Liversige,
professor in the University ofSydney; Australia. Among
us also, although everybody was convinced by the state-
ments of the press that the locality of the Tre Fontane,
near Rome, had been freed from malaria by means of the
eucalyptus, people were disagreeably surprised by an
outbreak of very grave fever occurring throughout the
whole of this colony in 1882, a year in which all the rest
of the Roman Campagna enjoyed an exceptional salu-
brity. If, alongside of these hygienic uncertainties, we
place the agricultural uncertainties, we must conclude that
it is necessary to contend strongly against this fanatical
prejudice in favor of the eucalyptus- tree. These plants
are, in fact, very capricious in their growth. In full
vegetation during the winter in our climate, they are
often killed instantly by a sharp winter frost, by damp
cold, by the frosts of spring, or by other causes which
the botanists have not yet been able to determine. At
other times, if the winters are very mild, these plants
grow too rapidly in height and then are broken short oflf
by moderately strong winds. It should further be men-
tioned that these plantations are sometimes very expen-
sive. In fact, if the earth contains too much water it
must be drained under penalty of seeing the roots of the
eucalyptus rot. Then again, if the subsoil is compact,
it is necessary to dig deep trenches in order to give room
to the long roots of these trees, and often indeed these
trenches must also be drained, as is done for olive-trees.
The conclusion evidently is that it is better to confine
ourselves to hydraulic methods of promoting the health-
fulness of a locality, the immediate efifects of which are
1 D«Ua influenza dd boshi sulla malaria dominante nella regiona maritdma ddla
provinda di Roma. Annali di Agricoltura, No. 77, 1884. Roma : Eredi Botta.
200
THE MEDICAL RECORD.
[August 23, 1884.
less uncertain. And then, when the local conditions are
such as to make it desirable to try the effects of plants
possessed of strongly absorbing powers, it is better to
choose them from among the flora of our own hemisphere.
This is more sure and will cost less.
Simple hydraulic methods of purification, even the
most perfect, do not, however, produce permanent hy-
gienic effects, since the moisture necessary for the multi-
plication of the malaria in the soil is so slight that these
effects may be compromised by anything whatever that
is capable of restoring a moderate degree of humidity to
the ground during the hot season. It has often been
thought that a suspension of malarial production would
be better assured by suppressing at the same time the
humidity of the soil and the direct action of the oxygen
of the air upon the superficial strata of earth which con-
tain the ferment. This has been successfully accom-
plished by the system of overlaying {combines). This
consists in covering the infected soil by thick layers of
uninfected earth, carried there either by the muddy waters
of rivers or by the hand of man. At the same time the
steady drainage of the surface and underground water is
provided for. Last year, I advised our Minister of War
to undertake in another form an hydraulico-atmospheric
purification of the district of the Janiculum surrounding
the Salviati palace on the via della Longara, by draining
the soil carefully and covering with a Jayer of very close
turf all the parts of the surface which could not be mac-
adamized. It would seem as if this system had been
rather successful, since there has not been this year a
single case of fever in the personnel of the new military
college, established in the Salviati palace ; while in the
Corsimi palace, which is situated on the same side of the
via della Longara, but which looks out upon that part
of the Janiculum which is still uncovered, there have been
some fatal cases of fever.
Furthermore, we have had in Rome, during the past
few years, some very evident proofs of the efficacy of
atmospheric methods of purification. I will confine my-
self to the relation here only of the most striking instance,
one which has been furnished us in the building up of
new quarters of the city. There was much discussion at
first as to whether the improvements should be under-
taken in the parts where they now are or in the valley of
the Tiber, for the uncovered lands of the Esquiline and
of the Quirinal werer malarious, and, as nearly everybody
then thought that the malaria of Rome was carried into
the city from the coast marshes, it was supposed that this
state of things was irremediable. We opposed to this
view the fact of the salubrity of the Viminal, which is
situated between the Esquiline and the Quirinal, and
which .ou^ht to be as unhealthy as the two other hills were
the malaria of the latter imported into the city instead of
being indigenous. Believing it to be indigenous, we
hoped that by shielding the surface of these hills from the
direct action of the air (by building houses and paving
the streets), the malaria would cease to be produced
there. That is precisely what has happened, for the new
quarters are very healthy. But the malaria is only held
in abeyance and is not definitely overcome ; for if an
extensive excavation is made in these hills, and the con-
tact of the air with the malarious soil is thus re-established,
during a hot and damp season, the production of malaria
commences anew. A complete atmospheric purification
is nevertheless the most stable of all the methods of ob-
taining a suspension of malarial production, but unfortu-
nately its realization is very limited, for it is restricted to
inhabited localities and to sodded surfaces.
The ideal method of insuring freedom from malaria
should be to obtain a permanent immunity, that is, to be
able to modify the composition of the infected soil in
such a way as to make it sterile as regards malaria, with-
out taking from it the power of furnishing products use-
ful for the social economy. But all the elements indis-
pensable for obtaming such a result fail us utterly just
here. We do not yet know what ought to be, in general
tenns, the composition of a soil incapable of producing
malaria, yet retaining those properties which are suitable
for vegetadon. When we shall have arrived at this first
stage, there will still be a long road to travel ; and the
most difficult part will be to discover a practical means
of imparting this salutary composition to sdl the numerous
varieties of malarious soils.
Scientifically, then, in the present state of our knowl-
edge, we are unable to affinn anything on this point
Practically, we are not much further advanced. It is
very probable that the combination of hydraulic purifica-
tion with a forced cultivation of the soU has sometimes
determined changes in its composition by which it has
been rendered sterile as regards malaria. If that has
happened, it has happened by chance, and we are unable
to reproduce the result at will ; for we have not all the
data which might enable us to understand how it has
come about. Most of the purifications obtained in an-
cient times, by means of forced cultivation, continued
during centuries, have not been definite at all, but the
production of malaria has been simply suspended.
Hardly was the regular cultivation of the fields inter-
rupted than the production of malaria recommenced.
Among the numerous examples that I might cite in this
connection, I will limit myself to that of the Roman
Campagna. This seemed to have been made perma-
nently healthy under the Antonii, but after the fall of the
empire it began again to produce malaria, as if the
forced cultivation through so many centuries had never
been.
One might, strictly speaking, be content with such a
result, and boldly undertake forced cultivation of all
malarious districts, without stopping to ascertain whether
the fireedom from malaria so obtained would be definite,
or whether the production of the poison were onljr sus-
pended. Unfortunately one b never sure of arriving at
such a result, and no one can say d priori whether the
forced cultivation of a given malarious tract will render
it healthful. It must always be remembered that the
first eflfect of forced cultivation, which requires an over-
turning of the soil by means of the plough, the spade,
and the pick, is an unfortunate one, from a hygienic point
of view, whenever we have to deal with a malarious
country. Experience has shown, especially in Italy and
America, that this overturning of the soil almost invari-
ably increases the local production of malaria. And this
can be readily understood, since the ploughing and the
digging in a soil containing the specific ferment inaeases
the extent of surface of the ground in immediate contact
with the atmosphere. This first mischievous effect is
often gradually weakened by the continued cultivation,
and may end by disappearing. At other times, on the
contrary, it persist^ obstinately, and one is often forced
in desperation to the resolve to level the ground again
and to varnish it, so to speak, with a thick sowing of
grass, if he wishes to suspend or weaken the malarial
production.
However, when the local conditions will permit, it is
well to try whether, by means of forced cultivation of
the soil, it may not be possible to increase the efficacy
of the hydraiUic method of procuring immunity from
malaria, or of the hydraulico-atmospheric method of
** overlaying." The moment that it is known that this
cultivation has firequently been advantageous, there
comes forward a crowd of social reasons which induce
us to attempt it, even though we be persuaded that we
are about to engage in a game of chaiice. But to dare
to attempt it is not all that is necessary, we need also the
possibility of so doing, and just here we find ourselves
in a vicious circle from which it is not easy to emerge.
Forced cultivation cannot be accompUshed without the
presence of agriculturists in the region during the entire
year ; and the agriculturists cannot remain in the region:
during the fever season, for they run thereby too great a.
risk. For the solution of this question there is but one-
means : try to increase the power of resistance of tU
August 23, 1884.]
THE MEDICAL RECORD.
201
kutMon crganism to the attacks of the malaria. It is to a
search after the means of accomplishing this result that
I have devoted myself during the past few years.
There is nothing to hope for, as regards malaria, in
acclimation. Individual acclimation is, and always has
been, impossible. The malarial infection is not one of
those a fiirst attack of which confers immunity from other
attacks. It is, on the contrary, a progressive infection,
the duration of which is indeterminate, and which is of
such a nature that a single attack may suffice to ruin
Ae constitution for life. Collective or racial acclimation
certainly existed in the past, at a time when specific
remedies for pernicious malaria were unknown ; and
even later, when the employment of these remedies was
very limited. The acclimation was due to a natural
selection made by the malaria upon successive genera-
tions, from which it took away, almost without opposition,
all those who possessed but a feeble individual power of
resistance to the specific poison, while it spared those
who possessed this power of resistance in an extra-
ordinary degree. The first were, according to the Gre-
cian myth, the human victims destined to af pease the
monster y or demon^ who opposed the violation of the ter-
ritory over which he had up to that time exercised an
absolute sovereignty. The second became the founders
of the race, and through them, from generation to gen-
eration, the collective power of resistance to the malaria
was progressively increased. In our own days a like
selection may take place among barbarous races, as it
does among the cattle and the horses in a malarious
region, but it has become an impossibility among civ-
ilized nations. By means of the specific remedies which
we possess, the use of which is now so general, the lives
of a laige number of individuals whose resisting powers
are very feeble are preserved ; and these individuals
beget others whose power of resistance to the action of
the specific pobon is still more feeble. This results,
after a number of generations, in the physical degrada-
tion of that part of the human race which inhabits mala-
rious countries.
We cannot, therefore, in the future, count upon the as-
sistance of external natural forces to increase the power
of resistance of human society against the assaults of
inalaria. Such an object can be obtained only by artifi-
cial means. It has been sought to attain this end by the
daily administration of the salts of quinine, of the salicy-
lates, and of the tincture of eucalyptus, each and every
one tried in turn. But the salts of quinine are dear,
exercise a prompt, though very transient, anti-malarial
action, and, when administered for a long time, disturb
rather seriously the functions of the digestive and ner-
vous systems. The salicylates, when well prepared, are
rather dear, and there is as yet no proof that they possess
prophylactic powers against malaria. The alcoholic
tincture of eucalyptus is useful in malarious regions (as
are all the alcoholics, beginning with wine) in quickening
the circulation of the blood ; may it, perhaps, also act as
a preservative against light attacks of malaria?. Possibly.
But it is very certain that it possesses no efficacy in
places where malaria is severe. It will suffice to prove
this to recall the two epidemics of fever which afflicted
the colony of the Tre Fontane, near Rome, in 1880 and
1882. Everybody was attacked, and there were several
cases of pernicious fever, although a good preparation of
cncal3rptus is manufactured in the place and is distributed
largely to the colonists during the dangerous season of
the year.
Haying several times had occasion to observe, in
jnalarious regions, that when recourse was had to arsenic
m order to subdue fevers, over which quinine had exerted
almost no effect, relapses occurred but rarely ; and hav-
ing been able to satisfy myself that the arsenical treat-
ment sometimes procured a permanent immunity in indi-
viduals who are subject to frequent attacks of malaria, I
hegan in 1880 to employ arsenic • (arsenious acid) as a
prophylactic in certain portions of the Roman Campagna.
This remedy was indicated, in an experiment of this sort,
not only by reason of its durable anti-malarial effects, but
also by its low price, by the beneficial influence which it
exerts upon all the nuditive functions, and because it has
no disagreeable taste and may therefore be given to
everybody, even to children. My first trials in 1880 were
rather encouraging, and I felt myself justified in engaging
some proprietors and the association of our southern rail-
roads to repeat the experiments on a large scale the fol-
lowing year, recommending them, however, to use arsenic
in a solid form as offering an easy and certain dosage.
This extensive prophylactic experiment beean in 188 i,
and acquired constantly increasing proportions in 1882
and 1883, which have become still larger this year. An
experiment of this kind is not easy to conduct in the be-
ginning. The name, arsenic, fiightens not only those
whom we desire to submit to its action, but also the phy-
sicians, whose exaggerated fears have sometimes ren-
dered the experiments of no avail, since they were con-
ducted too timidly and the doses of arsenic employed
were altogether insufficient. But some intelligent men,
especially M. Ricchi, physician-in-chief to the southern
railroads, were able speedily to triumph over these ob-
stacles, and to place the experiment on a firm basis.
The general testimony of all the facts which they have
collected tends really to prove that, when the administra-
tion of arsenic is begun some weeks before the presumed
season for the appearance of the fever, and when it is
continued regularly throughout the whole of this season,
the power of resistance of the human organism to malaria
is increased. Many individuals gained thereby a com-
plete immunity, others a partial immunity, that is to say,
they were sometimes attacked by the fever, but it never,
even in very malarious districts, assumed a pernicious
form, and was easily subdued by very moderate doses of
quinine. Last year, for example, in the district of Borino,
where the malaria is very severe, .M. Ricchi experimented
upon seventy-eight employees of the southern railroads,
dividing them into two equal divisions, one of which re-
ceived no prophylactic treatment, while the other was
submitted to a systematic arsenical treatment. At the
end of the fever season it was found that several em-
ployees among the first half had been attacked by fevers
of a severe type ; while thirty-six of those in the second
division had enjoyed a complete immunity, the three
others having been attacked, but so lightly that they
cured themselves by quinine without seeking medical aid.
Facts of this sort are very encoiuuging, and the more
so as the general health of those submitted to the prophy-
lactic treatment was much improved. It was found al-
most invariably, upon the termination of the experiment,
that there had been an increase in bodily weight and an
amelioration of the anasmia which is so common in ma-
larious districts. But, in order to arrive at such results,
it is necessary to be at once bold and prudent On the
one hand, it is necessary to graduate very carefully the
daily dose, never exceeding at the commencement the dose
of two milligrammes ( ^ f ^ grain) per diem for adults, and
never giving the arsenic upon an empty stomach. On
the other hand, it is necessary to gradually push the dose
up to ten or twelve milligrammes (^^ or -^^ grain) a
day for adults, in districts where the malaria is very
severe, giving the arsenic in such a way that there is
never an accumulation of the drug in the stomach. Most
of the experiments which have been undertaken this year
are being conducted on this plan, and there is reason to
hope that they will give satisfactory results.
We must not, however, rest here if we wish to attain
promptly the end proposed, namely, that of planting
colonies in malarious districts without exposing the colo-
nists to grave danger. Even if we realize perfectly the
hope which I conceived in 1880, and if we are enabled
to prove that arsenic increases man's power of resistance
to the assaults of malaria, we must not imagine that every-
thing is accomplished. It will take a long time before
the use of a preservative method of this kind becomes
202
THE MEDICAL RECORD.
[August 23, 1884.
generalized, we have first to contend against the fear
which nearly every one experiences when arsenic is men-
tioned, and then there will also be difficulty in establishing
everywhere a proper control over its administration. In
every attempt at the colonization of malarious regions it
will be necessary to combat for a long time the diseases
caused by malaria, and we must seek for a method of
combating them by a means which is in the possession
of everybody, and which shall not be dangerous to the
general economy of the human organism. Those who
do not know from actual experience the miseries of a
malarious country, think only of combating the acute
forms of infection, which often place the patient in dan-
ger of 4eath. But this danger, though great, is for the
most part imaginary, provided that assistance be obtained
in time. But that which desolates families, and which
causes a physical degradation of the human race exposed
to the attacks of malaria, is the chronic poisoning, which
undermines the springs of life and produces a slow but
progressive anaemia. This infection often resists all
human therapeutic measures, and is even aggravated by
the use of quinine, which is given during the recurrent
paroxysms of fever. Quinine is, when given for a long
period of time, a true poison to the vaso-motor nerves.
The question, then, is to replace quinine, and the alka-
loids which possess an analogous physiological action, by
an agent the efficacy of which against chronic malarial
poisoning may be greater and the dangers of its employ-
ment less.
A happy chance has led Dr. Magliori to the discovery
of an agent of this sort, which was traditionally in use
by certain Italian families. It is an exceedingly simple
thin^ — merely a decoction of lemon. It is prepared by
cutting up one lemon, peel and all, into thin slices,
which are then put into three glassfuls of water and the
whole boiled down to one glassful. It is then strained
through linen, squeezing the remains of the boiled lemon,
and set aside for some hours to cool. The whole amount
of the liquid is then taken fasting. It is well known
that in Italy, Greece, and North Africa, they often use
lemon juice, or a decoction of lemon seeds, as a remedy
in malarial fevers of moderate intensity ; and in Guada-
loupe they use for the same purpose a decoction of the
bark of the roots of the lemon tree. All these popular
practices tend to show that the lemon tree produces a
febrifuge substance, which resides in all parts of the
plant, but which would seem to be most abundant in the
fruit. In fact, among the popular remedies employed
against malarial infection, that which I have just de-
scribed is the most efficacious, for it can be employed with
good effects in acute fevers. But it is especially advan-
tageous in combating the chronic infection, which is re-
bellious to the action of quinine, and in removing or
moderating its deplorable effects.
Hardly had I learned of this method of .medication,
when I hastened to induce some proprietors in the Ro-
man Campagna to try it with their farm hands ; and, af-
ter witnessing the good results there, I endeavored to
persuade practitioners to make a trial of the same treat-
ment. I was ridiculed a little at first, for they thought
it rather singular that a professor should be trying to
popularize an old woman's remedy. In reply to that I
answered that practical medicine would not have existed,
had it not known how to treasure up from age to age
the facts of popular experience ; and I ventured to re-
mark that, had the Countess de Chinchon waited until
methodical researches had been made into the physio-
logical action of cinchona bark, before popularizing the
remedy, the use of which she had learned from the semi-
barbarous Peruvians, in all probability humanity would
still, as regards nmlaria, be dependent upon the medica-
tion practised in the middle ages. Happily these argu-
ments had the desired effect upon certain distinguished
practitioners, some of whom, especially in Sicily and
Tuscany, have already collected together a tolerably
large number of very encouraging observations. One
of them. Dr. Mascagni, of Avezzo, tried the remedy ii\
his own person, and succeeded in promptly curing an
obstinate malarial fever which had resisted the action of
quinine.
Gentlemen, in dealing with malaria we ought always to
hold popular experience in high esteem, for we owe much
to it. We owe to it the fact that we have been liberated
from the paludal idea, and furthermore, that we have
learned that it is often better, instead of trying to pre-
vent the importation, for the most part imaginary, of
malaria from distant marshes, to suppress its production
in the soil under our feet or in that immediately sur-
rounding us. We owe to it the knowledge, which we
now have, that malaria rises up into the atmosphere only
to a limited height, so that by placing ourselves a little
above this limit in order to eliminate the possibility of
the malaria being carried up to us by oblique atmospheric
currents, we are enabled to breathe an air which does
not contain this ferment, or which contains it only in in-
significant amounts ; thus one may even sleep in the
open air during the night in very unhealthy districts with-
out running any risks. The knowledge of this fact has
led some peoples of Greece, and the inhabitants of the
Pontine Marshes, to sleep in the open air on platforms
raised on poles four or five metres (twelve to fifteen feet)
in height. Some people in the Roman Campagna have
built houses for themselves on top of the ancient tombs,
the walls of which are perpendicular ; the American In-
dians fasten their hammocks as high up as possible to the
trees of the malarious forests; and very recently, the
en^eers of the Panama Railroad had little wooden huts
built in the trees in order to procure safety against the
terrible outbreak of malaria which occurred during the
construction of that iron way. We owe, finally, to this
popular experience the discovery of the specific action of
quinine, and the consequent preservation of thousands and
thousands of human lives. Why should we reject a priori
and without investigation other useful data which it may
yet present to our consideration ? If we wish to make
progress in this question of rendering malarious countries
healthy, we must always hold before our eyes a double
object : to find a means of prophylaxis which may be
accessible to everybody ; and, at the same time, to find
a means, equally within everybody's reach, to overcome
chronic msdarial poisoning and its evil consequences.
Science is still too far behind to permit us to hope that
we shall soon succeed in discovering this second means by
purely scientific researches. We ought, therefore, to gather
together with great care all the facts which point to the
possibility of a solution of this problem, and if the measures
to which these facts point seem to be incapable of doing
harm, we ought to try tnem boldly, and not be restrained
by a false idea of the dignity of science. The social im-
portance of the problem is too great to allow of its solu-
tion being retarded by the fear that scientific men may
be accused of having been outrun by the ignorant. True
science has none of these puerile susceptibilities ; on the
contrary, it deems it an honor to be able to seize all the
observations of fact, whoever may have been their first
recorder, to put them to the crucial test of methodical
experiment, and to convert them into a new stepping-
stone on the march of human progress.
Typhoid Fever and Tuberculosis. — Dr. Gral denies
the existence, advanced by some authors, Of an antagonism
between tuberculosis and typhoid fever. If typhoid fever,
he says, attacks a tuberculous subject, it does not run
an abnormal course, but the tuberculosis assumes an
acute character in consequence. Typhoid fever may be
a cause of tuberculosis by creating a predisposition in
the patient to this disease. In the stage of convales-
cence especially, the tubercular process often becomes
verjr 2s:i\\^n'^ Deutsche Medicinal - Zeitungy June 2,
1884.
August 23, 1884.]
THE MEDICAL RECORD.
203
FOOD RATIONS, IN HEALTH AND DISEASE,
OF PERSONS CONFINED IN THE HOSPI-
TALS. INFIRMARIES, AND PRISONS OF DIF-
FERENT COUNTRIES.
Ak Address Delivered at the General Session
OF the International Medical Congress, Co-
penhagen, August 15, 1884.
By Professor P. L. PANUM, M.D,,
COPKMHAGKN, DENMARK.
(Special for The Msdical Rboord.)
Physicians have hitherto devoted loo little attention to
the study of the proportions, both absolute and relative, of
the albuminoid matters, fats, and hydrocarbons contained
in the diet of the sick, the infirm, and prisoners, as well
as in the separate dishes of which this diet is composed.
A knowledge of these proportions is indispensable in es-
tabbshing a rational dietetic regime for the sick, and also
in determining whether the food, which is supplied ac-
cordinf to fixed rules to the inmates of public institu-
tions, IS of a sufficiently nourishing character.
The objections which have been raised against the cor-
rectness of the average food rations, established by Voit
and other physiologists as suitable for healthy individuals
in good nutritive condition, are not well founded. The
determination of the quantity of the albuminoid sub-
stances, fats, and hydrocarbons contained in the regular
diet lists of hospitals, infirmaries, etc., is a powerful
means of effecting improvements and reforms in the ali-
mentation of the individuals supported in these institu-
tions. But it is essential in all such calculations to ob-
serve every precaution necessary in order to obtain
comparative results. Similar calculations regarding the
different varieties of diet of patients confined in hospitals
would be of great value as a means of recognizing and
estimating the differences of opinion which still obtain
concerning the alimentation of the sick, among phy-
sicians of the present day, in various countries.
Convinced of the great importance of this subject, the
author advanced the following propositions :
Firs/, — Endeavor to obtam information as complete
as possible concerning the rations furnished to the
healthy, or relatively healthy, inmates of hospitals, in-
finnanes, and prisons, as well as to the soldiers and sail-
ors of different countries.
Second, — Endeavor to obtain, by means of similar in-
formation, and with the assistance of the hospital
authorities in the different countries, comparative tables
of the proportions of albuminoid substances, fats, and
hydrocarbons contained in the regular diet lists, together
with the indications for the employment of one or the
other kinds of diet as used in the hospitals.
'Hiird, — It would, however, be necessary to know first
of all : (a^ whether the individuals living upon a regulated
form of diet are ever given any other food, whether this
extra nutriment is given with regularity or not, and
whether or not the amount of food so given can be de-
termined with accuracy ; {b) whether the distribution of
these rations is so systematized that there is nothing in ex-
cess from which the hospital officers or attendants may
derive an illegal profit ; (c) whether the distribution is as
just and equally proportioned as possible, and finally,
whether the food for the attendants is prepared in other
vessels than is that for the patients.
Fourth. — Obtain information as to the system em-
ployed to control: {a^ the good quality of the ingredients,
and {ff) the preparation and distribution of the food.
Fifth. — Insist upon the necessity of according to the
physicians unrestricted liberty in the regulation of the
absolute and relative proportions of albuminoid sub-
stances, fats, and hydrocarbons which should be con-
tained in the hospital diet. This liberty should be
absolute, unfettered by any previous regulations, and free
from interference on the part of the hospital autfiorities.
5«:M. — Encourage the publication in different coun-
tries of cook-books for the sick. These books should be
in accord with the dietary customs of the countries in
which they are published, and should indicate the pro-
portions of albuminoid substances, fats, and hydrocar-
bons contained in the various dishes, in the same way as
the doses of medicinal substances are indicated in the
pharmacopoeias.
Seventh, — Every physician should have suspended on
the wall of his office a chart, after the model of Konig's,
showing the quantitative composition of the ordinary
aliments. In this way the importance of a rationed
dietetic regime would be constantly before his mind, and
the chart would aid him in his dietetic prescriptions.
Eighth, — Those who make a study of popular hygiene,
and who are able to do so, should occupy themselves
with the preparation and rational composition of a
dietary, which shall be sufficient and as cheap as possible
to effect an amelioration of the lot of the poor.
Finally, the author said that he would be pleased to see
the formation of an international association, composed
of physicians of different countries, with the aim of ap-
plying the facts of alimentary physiology to the practice
of medicine and to hygiene. The association would at
the same time be subservient to the interests of science.
ON SOME DISORDERS OF NUTRITION RE-
LATED WITH AFFECTIONS OF THE NER-
VOUS SYSTEM.
Being the Address in Medicine Delivered Before
THE Brftish Medical Association at its Meeting
IN Belfast, Ireland, July 30, 1884.
By WILLIAM M. ORD, M.D., F.R.C.P.,
PHYSICIAN TO ST. THOMAS's HOSPITAL, LONDON, BNGLAMD.
KSpedal ibr Thb Mkdical Rbcobek)
Subjects of discourse are assuredly not lacking when
an address in medicine is to be delivered. To me, think-
ing of many — ^for example, of subjects historical, of sub-
jects ethical, of subjects polemical — has come the final
selection of a subject which, appertaining as yet very
little to any one of these categories, has for some years
very largely occupied my thoughts. A few minutes
after I received the honor of being invited by your Pre-
sident to deliver this address, I happened to meet a
friend whose advice I value very much. He at once
suggested that I should talk about some subject to which
my thoughts had been much directed, and specified cer-
tain disorders of nutrition related with affections of the
nervous system which had certainly interested me very
deeply, and were capable of general discussion. I took
the advice, and set to work to write the paper. Pre-
sently I found that one subject with which I proposed to
deal, the subject of chronic arthritis, was to be handled
in the Section of Medicine by my able friend and col-
league in the last International Medical Congress, Dr.
Dyce Duckworth, and that the influence of nervous sys-
tem on norma] and abnormal nutrition was to be intro-
duced in the Section of Physiology and Pathology, by
Dr. Alexander. On reflection, I decided not to alter
my intention. The fact that the subject which I had
chosen was also in the thoughts of others promised me a
critical audience ; and in the multiplying of observations,
probably all regarding the question from different stand-
points, there was offered, so far, greater probability of
apprehending the truth.
Let me invite you, then, to follow me in considering
some perversions of nutrition of the body, or its parts,
brought about, or appearing to be brought about, by the
morbid agency of the nervous system.
I will ask you to let me put a sort of label on the
matters of discourse, and to speak of them as Neurotic
Dystrophies. They will include conditions of overnu-
trition, and of undernutrition, where the variation is of
quantity rather than of kind ; conditions of misdirected
or eccentric nutrition, where the variation is of kind as
well as of quantity.
204
THE MEDICAL RECORD.
[August 23, 1884.
The little used, or scarcely recognized term, dystro-
phy, will for my purpose cover these various perver-
sions, and the adjective neurotic will indicate the aspect
from which I wish for the moment to regard them. They
will not be exclusively dealt with. This is inconsistent
with the limits of an address. I shall only discuss some
three or four instances, and discussing those shall rather
review than attempt to prove. The general direction of
my thoughts in relation to this subject may be best illus-
trated by certain neurotic dystrophies of joints and mus-
cles.
Muscular atrophy^ produced by joint-lesions, — M. Char-
cot, in last year's Progris Medical^ has treated, with that
marvellous lucidity which belongs to him, of certain ef-
fects upon the nutrition and contracture of muscles, de-
termined to all appearance by aflfections of joints. That
the nutrition of the muscles of limbs in which the joints
are affected by chronic and painful disease is often sub-
ject to impairment, has, as M. Charcot in his paper in-
dicates, been long ago observed But M. Charcot's
method of treatment of the correlation gives to it a new
etiological aspect. Let me quote two of his cases.
A man, aged twenty-three, in the telegraph service,
having been previously healthy in all respects, had, about
a year previous to examination, struck his right knee in
jumping over a fallen tree. It is important to notice
that the injury at the time did not appear to be severe,
and that he walked afterward several miles without diffi-
culty. At length he stopped for a time, and then found
himself unable to walk without a stick. For a week
afterward he kept his bed ; the joint was swollen, but not
very painful, but there was a remarkable loss of motor
power in the limb.
At the time of M. Charcot's lecture on the case, the
patient presented a weakness of the extensors of the legs,
almost amounting to paralysis, associated with some loss
of power and wasting of the rest of the muscles of the
limb. While the whole limb was smaller in volume than
the opposite limb, it was obvious that the anterior aspect
of the thigh was most affected ; the muscles of that re-
gion were limp, and presented no projection even at the
moment of exertion.
Two things were then evident \ paresis of the muscles
of the limb, generally most marked in th/e triceps \ a
wasting of the muscles of the limb generally', again most
marked in the triceps. Tested by electricity, the mus-
cles and their nerves gave so little reaction, both to gal-
vanic and faradic currents, that, to use Af. Charcot's ex-
pression, one would have thought that the muscles were
absent. There was a simple quantitative modification
of both reactions, giving rise to the conclusion that the
condition was one of simple atrophy, and not of a degen-
erative atrophy, with which the well-known " reaction of
degeneration " would have been associated. To these
tests M. Charcot added a third, namely, the application
of the electric spark. He placed the patient on an in-
sulated table, and connected him with a frictional elec-
tricity machine. A spark being drawn from the front of
the thigh, or from the region of the vastus internus, an
energetic contraction of muscles followed. Percussion
of the right triceps produced an evident contraction, and
percussion of the patellar tendon determined marked
shocks, not only on the side of the percussion, but also in
the two upper limbs, particularly in the left. There was
no ankle-clonus. The muscles of the front of the right
leg and calf contracted less forcibly under electrical
stimulation than the muscles of the opposite side. M.
Charcot states that, at the time of his demonstration,
much of the loss of power had already disappeared under
the steady use of electrical stimulation. Discussing the
bearings of the case with the most delicate refinement of
analysis, M. Charcot grasps at once the fact tliat the
wasting and loss of power exhibited by the muscles was
out of all proportion to the severity of the injury and the
amount of suffering. He dismisses theories of propaga-
tion of articular inflammation to the neighboring muscles.
He dismisses the theory^ of atrophy from prolonged
inertia, and finds himself reduced to admit the existence
of what he calls a deuteropathic spinal affection, giving
rise to the paralysis and the atrophy. In the absence of
the " reaction of degeneration," he finds himself unable
to recognize any indication of a serious change in the
anterior horns of the gray matter of the spinal cord, and
is reduced to the suggestion of a kind of stupor or inertia
of the nerve-cells. He is also reduced to the explanation
of the exalted tendon-reflexes by the hypothesis that,
while the cells of the affected region are in a state of tor-
por, there is a condition of exaggerated reflex excitability
in the rest of the spinal cord.
The second case is that of a hair-dresser aged fifty-one.
Here a chronic rheumatoid arthritis had affected the
wrists, the shoulders, the ankles, the knees, the hips, the
elbows, the fingers to a slight dei^ree, and the cervical
articulations in succession. There was neither pronounced
inflammation nor pain ; but there followed a rapid wast-
ing and a great loss of muscular power. The wasting of
muscles was unequal, falling chiefly in the extensors of
the limbs. These showed the same loss of sensibility to
electrical stimulation which had been observed in the
other case, with one exception : the right vastus extemus
presented the reaction of degeneration. Many of the
atrophied muscles were the seat of fibrillar contractions.
Some of them, the left deltoid in particular, were excita-
ble by simple percussion. The loss of power was in ex-
cess of the wasting. The tendon-reflexes were again
strongly accentuated To the conditions here enumer-
ated M. Charcot adds, from observation of other cases,
"contracture," tonic contraction of certain muscles,
chiefly of flexors.
Summing up these and other cases, M. Charcot argues
that the paresis, wastings of certain muscles, contractures
of certain muscles, and the other associated symptoms, in-
dicate an influence propagated from the affected joint or
joints, incident on the spinal cord, and thence reflected
to the muscles, giving rise in the one set of cases to con-
tracture, where exaltation of function must be supposed
in another set of cases to atrophy, where depression of
function must be supposed.
If we accept M. Charcot's conclusions, we have in this
CTOup of cases a dystrophy of muscles, brought about by
irritation commencing in joints more or less related with
those muscles, propagated through centripetal nerves to
the spinal cord, and reflected thence by centrifugal nerves
to the muscles.
M. P. Berger has related for us some cases presenting
the converse of the observations of M. Charcot just re-
lated. In M. Berger's cases, fracture of the upper part
of the femur near the hip-joint was followed by arthritis
of the knee ; not attributable in any way to extension of
inflammation through the intermediate tissues. M. Ber-
ger's observations would lead to the establishment of the
possibility of a reflex influence reversing the path of the
influence just quoted. In other words, we have before
us observations suggesting that joints being inflamed may,
bjr a reflex influence, give rise to dystrophies of asso-
ciated muscles ; and that bones and surrounding textures
being injured may give rise to dystrophies of neighboring
joints. Such considerations carry us on to search for
the middle term ; to examine if there be any evidence
indicating a direct morbid influence of the spinal cord on
the nutrition of the component parts of limbs in com-
mon ; and secondly, they may lead us to inquire whether
the nutrition of joints and other parts of limbs may be a£.
fected by influences propagated from viscera ; that is to
say from parts which are not components of limbs.
Chronic rheumatic or rheumatoid arthritis as work
of nerve-influence. — Having this in view, I will ask you
to accompany me in considering chronic rheumatic ar-
thritis as a possible work of nerve-influence. I use this
term, chronic rheumatic arthritis, because I am speaking
in Ireland in the presence of many men who must be
well acquainted with the work of Adams, of Dublin.
August 23, 1884.]
THE MEDICAL RECORD.
205
Chronic rheumatic arthritis is, as you will also know, but
one of many names given to an affection of joints, sp6ken
(J by the non-medical public as rheumatic gout. The
ooifoid lesions of this disease are of a kind justifying com-
pletely the application to them of the term dystrophy;
for i^e they include destructive inflammation of articu-
lar cartilages, and subsequently of the bone beneath, they
indade also hypertrophic changes in the S3movial mem-
brane, and in the periosteum around the articular sur-
ftces.
Here, once more, I must refer to the work of M.
I Charcot whose name is associated with the remarkable
observation that a form of chronic joint disease, present-
log both the atrophic and the hypertrophic lesions of
chronic liieumatic arthritis, forms a part of the phe-
Qomena of tabes dorsalis. It is true that the atrophy
predominates enormously; but the hypertrophy can
always be recognized by any one who may care to
I study with care the specimens of joint-trouble exhibited
by M. Charcot. The essential lesion of tabes dorsalis,
as at present recognized, lies in the spinal cord, and is,
so £u, a central nervous lesion. But the actual seat, yon
will remember, is not in the gray matter, but in columns
of fibres, which, to all appearance, are the channels of
centripetal influence, flowing, at least in part, from the
Toluntary muscles. In fact, it is quite possible to argue
that the joint- lesion may be here the result of reflection
of irritation, propagated to the gray matter of the spinal
cotd by the diseased muscle-representing fibres of the
posterior root-zone ; that, in other words, muscles, sub-
jectively presented to the gray matter as in a state of
imtation, can induce by reflection a dystrophy of joints.
If there be any possible acceptance of the idea that
joints, being irritated, can, by reflex trophic influence,
afiect the nutrition of muscles ; and that muscles, or
their centripetal nerves, being irritated, can produce,
also by reflex trophic influences, dystrophies of joints, we
can hardly stop ^ort of accepting a further suggestion to
the effect that some part of the central nervous system,
presumably some part in the spinal cord, presides, in a
common sense* over the nutrition of organs so closely
associated as joints and muscles, perhaps also over that of
bones.
Turning our attention to what is known of the direct
infiuence of the central nervous system upon the nutri-
tion of muscles, we know already that there is a very fair
certainty of the existence of a definite relation between
certain affections of the anterior horns of the gray matter
of the spinal cord and atrophic aflections of muscles.
Associated with an acute inflammation of groups of
cells in the anterior horns, are found the phenomena of
inutile and essential paralysis ; associated with an in-
flammation of the same anterior horns, diflering from
that just mentioned in being chronic, and differing prob-
ably in its method, are found the phenomena of pro-
gressive muscular atrophy. Infantile paralysis and
progressive muscular atrophy have each so distinct a
grouping of symptoms as to confer on each a marked
clinical identity, and on each an assured independence
of the other. Nevertheless, they have in common one
important factor, wasting of muscles ; but the wasting of
mnsdes is, if we may judge by their electrical reactions,
not brought about by the same process in the two cases.
In infantile paralysis, the reaction of degeneration leads
us to infer that the nutrition of muscular (centrifugal)
nerves is seriously involved In progressive muscular
atrophy, this reaction does not appear, there being only
a diminution of electrical reaction proportionate to the
loss of muscular fibre.
/cifU lesion in progressive muscular atrophy. — My
friend. Dr. Gulliver, of St Thomas's Hospital, an inheritor
df the observing faculty and accuracy of his celebrated
Either, has recently communicated to me, quite indepen-
doktly of this address, the notes of a case in which a
joint-lesion appeared as a part of the phenomena of pro-
gresave musciUar atrophy.
In studying this disease, I had long thought that there
were indications, in many cases, of aflections of joints as
well as of muscles. Dr. Gulliver and I have often con-
versed on the subject, and when the patient, whose case
I will now relate, came under his notice, he lost no time
in bringing her to mine.
K. M , a married woman, aged fifty, came under
treatment in June, 1884. Of the family history nothing
was ascertained. Her previous history presented noth-
ing important, save that she had never had rheumatism.
For six or seven months she had noticed a loss of
power in the left arm, but had been able to carry on her
occupation of laundress till within the last six weeks.
About five months ago she began to experience difiiculty
in speaking, which increased till, at the time of observa-
tion, she was unable to articulate in any intelligible way.
She had also a growing difficulty: in swallowing, with im-
pairment of the use of the lips m movements other than
diose of articulation, for instance, in blowing out a
candle, and she had dribbling of saliva. Three months
ago — at least, three months after the commencement of
muscular feebleness — she began to experience pain in
the left shoulder-joint, greatly increased by raismg the
arm, actively or passively. At the time of observation,
the left arm was found to be much wasted, particularly
in the forearm, and in the thenar and hypothenar emi-
nences. The hand had the claw- shape characteristic of
progressive muscular atrophy ; it was the main en griffe
of Duchenne ; and she could not oppose the tips of the
fingers to the tip of the thumb. She could not raise the
left arm to the horizontal position, and all attempts to do
so gave rise to much pain in the shoulder-joint. All
movement involving the shoulder-joint, whether performed
voluntarily or effected by other persons, gave much pain.
The joint showed no coarse changes ; there was no
affection of the right arm or of the legs \ the muscles of
both arms answered equally to the galvanic current ; those
of the left appeared to react a httle readily under the
faradic ; the knee-jerk was more active than usual in both
legs. The tendon-reflexes of the arms were investigated,
but the results were not definite. She could not speak,
bein^ able to produce nothing more than a monotonous
inarticulate sound ; she could not protrude the tongue,
or blow out the lips. The palate was motionless ; and
she swallowed with difficulty.
Although the order of affection of the muscles of the
arm is not recorded, the case is clearly one of progressive
muscular atrophy, in which the bulbar affection is pre-
dominant. And while, as regards the limbs, the left
upper extremity was alone affected, the painful state of
the left humeral articulation indicates the existence of a
definite change in the nutrition of a joint belonging to
the same area of innervation as that of the sheeted
muscles ; and, so far as it goes, the case tends to show
that one central nervous affection may give rise to con-
comitant dystrophy of joint and muscle.
(To bo oontmued.)
Treatment of Ununited Fracture of the Tibia.
— Dr. Eugene Hahn writes, in the Centralblatt fUr Chir-
urgie of May 24, 1884, describing a new procedure em-
ployed by him with success in the treatment of pseudar-
throsis of the tibia. The case was one of compound
comminuted fracture, in which there had been a loss of
a considerable amount of bone-substance, the two ends
of the tibia being separated about three Inches. Various
attempts had been made to secure union without success,
until it occurred to Dr. Hahn to implant the broken end
of the fibula, which bone had been fractured higher up
than the tibia into the medullary canal of the upper
fragment of the ribia. He did so, and union took place
between the two bones with the result of restoring the
usefulness of the limb. The patient wore a light reten-
tion splint on the leg, and was able to walk about with
ease.
206
THE MEDICAL RECORD.
[August 23, 1884.
The Medical Record:
A Weekly youmal of Medicine and Surgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD & Co., Nos. 56 and 58 Lafayette Place.
New York, August 33, Z884.
THE RESCUE OF LIEUTENANT GREELY,
THE EFFECTS OF THE ARCTIC CLIMATE,
AND THE QUESTION OF CANNIBALISM.
Thb Arctic regions have, by the enterprise and heroism
of Commander Schley, been compelled to surrender the
living remnants of Greel/s party, and some of the
dead bodies of victims of this unfortunate expedition.
The fisu:ts of the fitting out of this expedition in the in-
terest of science, the lamentable failure of our Navy De-
partment last year, and the year before, to place supplies
where they were the most needed, and the terrible chap-
ter of su£fering and privation which succeeded the re>
treat of the party in August, 1883, from Lady Franklin
Bay to Cape Sabine, and their long incarceration in the
latter locality — a chapter of desolation and misery of
which the half has not yet been told — are sufficiently far
miliar to the readers of The Record.
If it should be proved that the necessity of cannibal-
ism was added to the horrors of the last year's expe-
riences of this party, the story of hardship and wretched-
ness would seem to be about as black as reality could
make it, or even imagination could paint it.
A private interview with Lieutenant Greely, at his for-
mer home, has enabled us to obtain a somewhat clearer
insight into the physiological and pathological effects
of prolonged residence in the Polar regions, as well as
the straits to which the Greely party were finally re-
duced. He ascertained that such sojourn, by inhabitants
of warmer climates who are in good physical trim, is for
a brief term of years compatible with a high state of all
the organic functions, in which there is entire freedom
from diseased manifestations of every kind ; but there is
a decided limit to the endurance by Europeans and
Americans of such extreme prolonged cold. The system
is at first, and for a long time, by an admirable series of
internal adjustments, braced up against the rigors of cli-
mate ; but after the first year a considerable deterioration
in muscular and nervous energy, and in the calorigenous
processes of the economy is experienced. The severity
of the second winter was found by the party somewhat
harder to bear, but the experience of the previous win-
ter had taught them how best to fortify and protect them-
selves, and husband their forces. The third long Arctic
night, in which the thermometer was never less than three
below zero, and much of the time was down to forty or
fifty below, would, under the most favorable circumstan-
ces, have been a painfiil season to the party ; vital reac-
tion jfz& quite perceptibly lessened ; muscular tone was
impaired, rendering exertion difficult, and rheumatisms
began to prevail. Could the party, however, have had
plenty of food, and full and good shelter, they would un.
doubtedly have all been living at this day. Lieutenant
Greely, in reply to an interrogatory, affirmed his doubts
as to whether his men, if well provisioned, could have
continued to live at Fort Conger more than five yean.
The constitution of the average American is not capable
of prolonged continuous adjustment to more than zero
cold, and such acclimatization could only come about
after a series of generations where the law of sunrival of
the fittest should operate, and in correspondence with a
radical change in organization, in which nutritive and
muscular development should predominate over cerebral
development ; in other words, nature has shown us in
the mentally dwarfed but physically hardy Esquimaux,
the type of organization best fitted for living in those sep
tentrional latitudes. It, however, is no less a matter of
fact that the inhabitants of meridional climes admirably
adapt themselves temporarily to the most extreme cold.
In the retreat fi-om Moscow, in 1812, the Italian regi-
ments stood the cold better than the Germans, and notap
bly better than the Russians, who were accustomed to
the climate." The Turks presented the same relative
immunity at the siege of SebastopoL Longet, from
whom these £u:t8 are taken, remarks that the aptitude to
resist inclement temperature is acquired and lost in torn;
that people nurtured in temperate or cold climatesi who
go to the torrid zone to live, are much less sensitive to
the cold for a time after their return to their native
country, though this lessened susceptibility disappears
after a year or two.
As man can live amid intense surrounding cold only
by keeping his internal temperature at about 98^^ F., all
the calorigenous centres — ^which comprise every living
element or cell in every part of the body — are stimulated
to greatly augmented activity ; the respiratory, digestive,
and assimilative processes are performed with unwonted
energy ; the heart's action and the circulation are nota-
bly quickened. Lieutenant Greely remarked that
breathing air of such intense coldness had something of
the efifect produced by breathing pure oxygen ; as for
pulmonary troubles he heard no complaint of them while
the party was at Fort Conger, in Lady Franklin Bay, at
a latitude of about 83^, where the first two years were
spent; even simple catarrhs were unknown, the only |
thing from which the men suffered being occasional rheu-
matisms, and stiffness of the muscles and joints.
The party had ferocious j^petites during all of this
long sojourn in the North, each man eating with relish
three meals of animal food and two lunches every day,
and craving fats, though not to the extent which some
Arctic travellers report. Not even when the thermo-
meter marked 60^ below zero did these men indulge in
crude blubber or tallow candles^ which tradition has des-
ignated as the customary food of Arctic voyagers ; nor
was even pemmican regarded as a rare and dainty dish
by them. Canned meats, of which they had an abuDd-
ance during the first two years, and a steak or ragout
from the walrus, seal, or polar bear, were prized as the
' Longet : Trait^ de Phys., t iL, page 54a
August 23, 1884.]
THE MEDICAL RECORD.
207
essentia] conditions of well-being. As for spirituous li-
qaorsy tiiej were used with great moderation and doled
oat to the members of the expedition as occasion
seemed to demand, and only when some unusual exer-
tion or exposure brou^t extraordinary £eitigue or pros-
tration ; as means to fortify the sy§ktm against cold or
brace it up for forced marches, whiskey, rum, and other
alcoholic stimulants were regarded as of little benefit.
The party slept well during all their long stay at the
North, except during the last few months of physiological
misery, when the pangs of hunger and the weakened,
disordered condition of their anaemic brains precluded re*
freshing sleep ; in the case of some of them the horrors
of scurvy made their state more deplorable still.
As for the prolonged agony at Cape Sabine, sympa-
thizing, pitying humanity would fain draw a veil over
those appalling scenes which can be imagined, but can-
not be described. If men driven to madness by long
fasting, the only means of sustenance available being
strips of seal-skin, shrimps, and Arctic moss, their scanty
rations being exhausted; entertaining the forlorn hope
that if they might hold out only a few weeks longer de-
hrerance would come to them ; if under such circum*
stances there were no alternative but death or anthropo-
phagy, it may seem to us that death would be prefer*
able to life sustained on such terms^ but we can realize
neither the hunger, nor the desperation, nor even the im-
pelling strength of the most imperious instinct of our na-
ture.
In justice to Lieutenant Greely, it must here be
stated that he denies all km>wledge of cannibalism as
having been practised by any members of his party. If
some of the men, to save their lives, fed on the carcasses
of their companions, it is a matter for which they are in-
dividually responsible, not he.
The results of the autopsy of Lieutenant Kislingbury
are quite significamt. We make no comment on the sworn
statement of the physicians, except to call attention to
the fact that the body was stripped of muscle where the
masde was the thickest ; the pectoral, gluteal, dorsal re-
gions, the thighs, legs, and arms in their entirety, were
denuded of flesh, and there was evidence that this was
done with a knife ; not that the soft parts were gnawed
away by some wild animal ; moreover, the viscera were
intact. Virtually the same thing was done with the body
of Private Whistler, as also proved by post-mortem ex-
amination.
There is, we hardly need say, other evidence, obtained
from members of the rescuing crew, that goes to estab-
lish the fact of cannibalism at Cape Sabine. It is proper
to say, however, that the results of the examination of
the contents of the Kislingbury stomach cannot, by
themselves (^ove absolutely that human flesh was eaten.
Ul this connection we would refer to the letter of Dr.
Heineman (see page 2 16), in which some very sugges-
ti?e questions are asked.
In considering this revolting subject, it is the scientific
or physiological side that claims our attention. Can the
practice of camnibalism by civilifed men — men of natu-
rally human and refined natures — ^be conceived as fossibU
ander any circumstances? What are the psychological
antecedents and accompaniments of anthropophagy?
Is cannibalism ever justifiable, and was it justifiable in
the Greely party, in the straits to which they were re-
duced ? In other words, what is the moral aspect of the
question ?
I. Can the pnu:tice of cannibalism, by civilized men,
be conceived as possible ? It is true that no one of the
readers of this journal can easily imagine the affirmative
of this question in its application to himself; looking at
it, ais he must, from the high normal plane to which,
through ancestral inheritance and moral culture, count-
less evolutionary ages have raised him. And doubtless,
the average civilized man could not be brought to an act
of cannibalism by any process of acute starvation. Lord
Ross has remarked that even the savage Esquimaux will
starve rather than eat human flesh.
But here we must emphasize the work acute^ as op-
posed to chronic starvation. Not one week or two can
easily undo the work of ages, as manifested in the de-
velopment of brain, and the noblest powers of mind.
Amid the general languishment of the organs and tis-
sues, the brain and nervous system the longest maintains
its integrity.* There is prostration, there is hebetude of
the nervous functions, but delirium comes late, if at all,
and when it makes its appearance, the unhappy sufferer
is too feeble to make any energetic effort to save him-
self.
But it is not so in chronic starvation, that may be
many weeks, if not months, in efiecting the deteriora-
tion and destruction of the organism. In all ages, and
among all nations, there have been histories of famine
in connection with sieges, droughts, etc., where pro-
longed inanition has driven men to cannibalism. Such
facts show that anthropophagy has been possible under
circumstances of deepest misery ; and thb brings us to
the second question : What are the psychological accom-
paniments of cannibalism ? Under this head we must be
brief. There is no doubt that the functional integrity of
the brain and mind is dependent on sufficiency of good
food and a healthy nutrition. He that enjoys most the
cerebral acquisitions which he has inherited and culti-
vated, is the man who, ccUeris paribus^ is the best nour-
ished. Conversely, long continued mal-nutrition effects
what Hughlings- Jackson calls gradual dissolution in the
'< topmost layers " of the highest centres ; the individual
is now "lost to his surroundings,'' is "defectively con-
scious." In other words, the victim of chronic inanition
becomes a degraded being, and is capable of lapsing into
a stage where brute instincts and brute appetites pre-
dominate.
In the famine which attends on long sieges, mothers
have been known to devour their own offspring, whose
lives they had taken. " Verily," as Longet observes,
" where the maternal instinct perishes, every other no-
blest instinct must have departed."
The psychological antecedent and accompaniment of
cannibalism, then, is a state of positive frenzy or insanity,
from which every element of moral responsibility is lack-
ing. The words " delirium of famine " appropriately
designate this condition, and are so used by some authors.
To apply this thought to the particular case under con-
sideration, who will say that the life at Cape Sabine did
not present all the conditions requisite for engendering
* According to Chossat's experiment, the nervous system scarcely loses 1.9 per
cent, of its substance. Recherdies Exp^rimentales sur I'lnanidon. Paris, 1843.
208
THE MEDICAL RECORD.
[August 23. 1884.
in some, if not in all the members of the party, the nec-
essary psychical and physiological antecedents of canni-
balism? It seems more probable, however, that the
eating of human fiesh was comparatively a late occur-
rence in the dreadful experience at Cape Sabine ; this
means of sustaining life not being resorted to till their
regular rations were almost if not quite consumed. It
will be remembered that Kislingbury died virtually of
starvation, and that in his stomach there was not a vestige
of animal or human fiesh.
3. Is cannibalism ever justifiable ? 1 Was it justifiable
at Cape Sabine ? Every right-minded person will, we
think, say " Yes ! ** If the question of irresponsibility is
settled in the affirmative, then all discussion of the moral
aspect of cannibalism is foreclosed — there can be no im-
morality in the case. If any or all of this band of devoted
heroes, who so barely escaped being martyrs to science,
were saved by eating the dead bodies of their comrades,
with a deliberate suppression of an irrational sentimen-
tality, and not without due reverence for the dead, we
say that we regard the act under the circumstances as
justifiable. We believe that no pretence has ever been
made that these men murdered any of their companions
for such a purpose.
That we have not misrepresented the terrible state of
mental dilapidation of the party at the time they were
found is apparent from all the testimony. Lieutenant
Powell says that " they were all in such a dazed condi-
tion that they did not realize that they were rescued
until they had been given some ptarmigan, and then they
began to curse the rescuers for not giving them more
food."
THE PROPHYLAXIS OF MALARIA.
The address on malaria, delivered by Professor Tom-
masi Crudeli, at one of the general meetings of the In-
ternational Medical Congress, and which we are enabled,
by special arrangements made in Copenhagen, and by
our cable facilities, to present in full to the readers
of The Record this week, is one of unusual interest. It
deals with questions of vital importance to humanity and
which especially concern very nearly the inhabitants of
our own land. There is scarcely a township in the
United States where malaria does not count its victims,
and in many portions of the country it is as dreaded a
scourge as it is in Italy or on the west coast of Africa.
Even in the immediate neighborhood of New York
pernicious remittents are not unknown, and deaths from
this cause figure in nearly every table of vital statistics.
It is on account of the interest of the subject, as well as
because of the deservedly high reputation of the author,
that this one of the general addresses of the Congress was
selected for presentation in full to our readers.
The author is strongly opposed to the paludal theory
of malaria, to which, indeed, but few authorities of any
weight at the present day incline. We, at least, in this
country need no array of arguments to disprove the no-
tion that the malarial ferment is formed exclusively in
marshy ground and is thence carried by the wind to
other dryer and more elevated regions. An ample and
a sad experience has taught us that it is usually indigen-
ous to the soil on which we live, and that no exceptional
degree of moisture is necessary to its production.
It will, perhaps, be a matter of surprise to some who
remember the confident predictions made a few years ago
of the extinction of malaria by the cultivation of the eu-
calyptus-tree, and who have not noticed the growing si.
lence of those who were formerly most enthusiastic in
their advocacy of this measure, to read the disparaging
comments of the author upon the results obtained. The
setting out of eucaljrptus plantations is attended with a
great expense, which, he claims, is by no means com-
mensurate with the benefits realized, for oftentimes the
good efifects are purely imaginary. The measures which
afford the greatest hope of success in the task of purify,
ing a malarious soil consist, in the author's opinion, in
thorough and systematic drainage and forced cultivation
of the ground. Sowing the land thickly with grass offers
a barrier to the escape of the malarial poison, but is in
the nature of the case an imperfect method of securing
immunity firom infection ; for of course a breach is made
in the ramparts every time that a spade is plunged into
the sod, and the enemy is never slow in forcing its way
through the broken barriers.
The results of Professor Crudeli's experiments in the
matter of individual prophylaxis are those which offer the
most encouragement. This is, indeed, the first difficulty
to be surmounted ; for, as he rightly says, it requires time
and the presence of man in order to repress the format
tion of the malarial ferment, and unless we can insure
man from the attacks of the disease during this prepara.
tory period, the reclamation of the lands can never be
accomplished, at least by civilized nations. The exces-
sive use, or abuse of quinine, like the abuse of mercury,
is nearly as balefiil in its effects as the disease which it is
designed to overcome, hence the desideratum that exists
for some prophylactic remedy that is at once a real pro-
phylactic and at the same time readily obtainable and
suited for popular use. Arsenic, which the experiments
detailed in the address would seem to show does possess
prophylactic virtues, is a drug that could hardly be put
with nfety into the hands of the laity, despite the alleged
existence of the Styrian toxiphagL Whether the decoc^
tion of lemon will prove on more extended trial to pos-
sess the powers that are claimed for it, time and expe-
rience can alone determine. The author shows that he
is endowed with the true scientific spirit in being ready to
examine ihto the merits of a popular remedy of so simple
a nature. And we certainly have reason to hope that
such conscientious investigation and painstaking research
will meet with their reward. The sons of Italy were once
foremost in the ranks of science, and Crudeli and his fel-
low-laborers are doing much to restore to their country
her proud eminence among the nations of the earth.
OUR CABLED REPORT OF THE INTERNATIONAL MEDI-
CAL CONGRESS.
We are happy to announce the completion of our
cable report of the International Medical Congress held
in Copenhagen. The most notable address is one which
we have the pleasure of presenting in fiill — that by Pro£
Crudeli, of Rome. Prof. Panum's address is given io
full abstract, while the remaining proceedings are incor-
porated in the general cable report, including the ab-
stracts of addresses by Sir William Gull and Virchow.
August 23, 1884.]
THE MEDICAL RECORD.
209
We may be perhaps excused for congratulating our-
selves on such a successful accomplishment of a plan for
presenting to our readers on this side of the Atlantic a
foil and authentic report of one of the most notable Con-
gresses held for a long period. We have been enabled
to demonstrate what can be done by cable by giving
an accurate report of the doings of a scientific body in
which subjects of a purely technical character are dis-
We believe we have succeeded in presenting to our
readers a r/sum/ which is sufficiently comprehensive and
isstractive to warrant us in making the efifort* The ab-
stracts of addresses and papers have been carefully pre-
pared by our correspondent with this end in view, and
we are convinced they can speak for themselves.
As will be seen, the meeting was a success from every
point of view — the subjects and addresses were well
selected) and the different orators did them full jus-
tice, thus giving a high scientific tone to the meeting.
Nor were the sections behindhand as to subjects of in-
terest or of speakers to present them. This is evident
through some of the reports which we give of sectional
work.
It would be impossible, of course, to present in the
time allotted, even with the best of cable facility, an ex-
haustive report of the proceedings, but sufficient has been
done to give our readers a fair idea of what was ac-
complished by the Congress as a whole. Further re-
ports by mail will give fuller detail. The social element
of the meeting was what it should be, and though gen-
erous to the full point of royal hospitality it did not
interfere in any manner with the strictly scientific work.
The selection of the next place of meeting, at Washing-
ton, D. C, was good, and as was predicted the invitation
on behalf of the profession of this country was received
with a becoming cordiality. It remains now for the
profession of this country, by every means in its power,
to make the next session of the Congress a success, and
demonstrate in due form its appreciation of the honor
conferred by the selection.
CRUELTY TO THE PAUPER INSANE.
Op late years the worst accounts regarding thp treatment
of the insane, in the East and North at least, have related
to the pauper insane in the smaller almshouses and
prisons. The last story of cruelty toward this class comes
from Pennsylvania. Dr. Thomas G. Morton, for the State
Committee on Lunacy, has sent the following letter to
every physician in the State :
Philadelphia, August 16, 1884.
My Dear Doctor : Two instances of cruel treatment
of msane patients in charge of private parties have re-
cently come to the knowledge of the Committee on
Lunacy. In one case an old man was found naked in
tn outhouse in a very secluded spot of the State, where
he had been confined for more than thirty years chained
by the leg. In the other case neither the public nor the
Committee had any knowledge of the inhumanity prac-
tised upon an old man, who had likewise been chained
for more than a quarter of a century, and it was not
until his death that the particulars were brought out and
made public.
In view of these facts, the object of the committee is
to find out if any such cases are known or believed to
exist, and if so, to send them to the State hospitals for
the insane, where they can receive humane and proper
treatment, and that if you have any reason to believe
any such insane are concealed and badly treated, we will,
on private information from you, investigate such cases
and take the necessary steps for their transfer. Any com-
munication will be, if desired, considered confidential.
Yours, very truly,
Thomas G. Morton, M.D.
Since the publication of the above, another case of a
similar character has been published. It was that of a
young man who had been confined for some time in the
Berks County Almshouse. He had a ball of heavy
weight chained to his leg.
The facts revealed by the Pennsylvania Committee
teach again the lesson that the pauper insane ought not
to be kept an3rwhere except in institutions provided
especially for them, and under responsible medical man-
agement. Poverty may indeed compel counties to care
for some of their own insane poor in workhouses. But
where this is necessary there is no excuse for not having
carefiil and frequent supervisions.
Although medical philosophers and reformers may
reason, demonstrate, and protest they very well know
that there is a bad political method at the bottom of most
of the abuses they condemn. The people must be edu-
cated and then aroused before thorough reform can take
place.
THE CRIME OF A MIDWIFE.
The Louisville Medical News states that a physician in
that city recently returned a death certificate in which
the cause of death was given as placenta previa, adding
that the death was "superinduced by the criminal care-
lessness of a midwife." It appears that the deceased
had engaged the services of a midwife. She had suffered
fi-om hemorrhage for several weeks before labor came on,
but the midwife paid no attention to it. When the labor
pains began, the hemorrhage was very profiise. Still the
midwife did nothing, except leave her patient, saying
that she would return soon. She never came back at
all ; and the patient died.
The News makes the above the text for a very vigor-
ous attack upon the midwife in general, and the German
midwife in particular. As for remedies the editor be-
trays a cynical desire to see all midwives poisoned or put
out of the way by some means.
The suggestion is made, however, and it is one we
cordially endorse, that all midwives be licensed, and, be-
fore being licensed, be obliged to give evidence of some
education and skill At present the chief education
which the midwife receives is the highly subjective one
of having had from five to ten babies herself.
An Enthusiastic Electro-therapeutist. — Accord-
ing to the Medicinal Central-Zeitung, the well-known (?)
therapeutist, Dr. Seimus, has gone to Marseilles for the
purpose of setting up electric machines in the wards of
the hospitals there. By the disengagement of ozone he
hopes to disinfect the air, and perhaps assist in curing
^he patients.
2IO
THE MEDICAL RECORD.
[August 23, 1884
^ews of tttje ySSizzU.
Professor L. Hermann, of Zurich, has been called
to the chair of Physiology at Berlin to succeed V. Wittich.
The Celebrated Physiologist, Professor Carl
ViERORDTy of Tubingen, has resigned, and his place is to
be filled by Professor Griitzner, of Bern.
More Cholera Commissions. — ^The Roumanian Gov-
ernment has sent Dr. Maccovich as a "commission" to
Marseilles, in order to study the cholera.
A Plague Commission. — The Russian Government
has sent Dr. Batorsky to Bagdad, for the purpose of in-
vestigating the plague, now prevalent there.
A London (Canada) Medical Society. — The med-
ical men of London, Canada, have recently met and or-
ganized an association for social and scientific purposes.
Women as Internes in the Paris Hospitals. —
It is stated in the Revue Midicale^ that women are soon
to be admitted to the examinations for positions as in-
ternes in the Paris hospitals.
The Characteristic Enterprise of The Medical
Record finds another illustration in its cable report, in
its issue of 2d inst, of the proceedings of the British
Medical Association at its meeting in Belfast, Ireland, on
July 29th and 30th. — Medical Age.
Journalistic Changes. — The Canadian Practitioner
has a new editorial staff. Drs. Cameron and Nevitt have
resigned, and Drs. J. £. Graham and W. H. B. Aikins
have taken their places. Dr. Wright continues upon the
stafil The Pacific Medical and Surgical Journal and
the Western Lancet have consolidated.
ViRCHOw vs. Pettenkofer. — Professors Virchow and
Pettenkofer are busily arguing with each other upon the
subject of cholera. The gist of their differences lies in
this : Virchow is a contagionist, Pettenkofer is a localist.
That is to say, the latter believes that no specific germ
can produce cholera unless there is a specific local con-
dition to favor it.
Nepotism at the Massachusetts General Hos-
pital.— Some interesting correspondence has been going
on in the Boston Medical and Surgical Journal reizAyt
to the above subject. It is charged that the medical
board appoint as internes^ members of their own or their
friends* families, and that appointments are matters of
personal favoritism rather than of real merit. There
seems to be some truth in the charge, but it is not denied
that the internes are good men.
The First Case of Yellow Fever which has ap-
peared in this country during the present season was
reported on August 15th, and occurred at Key West,
Fla. The patient was an officer on board the U. S.
vessel Galena. The Galena was ordered at once to
Portsmouth, N. H., while the patient was taken in charge
at Key West It is now six days since the case was re-
ported, and there is as yet no further appearance of the
disease.
The Medical Details of Cannibausm. — ^The ac-
count of the examination of the body of Lieutenant Kis-
lingbury, as given by two physicians of this State, and
telegraphed all over the country, were shocking m the
extreme. We cannot see the necessity of medical men
lending their special knowledge for the elaboration of
horrible details regarding the supposed Arctic cannibal-
ism. Is science or the world any better for knowing
that the pectorales muscles were eaten and the recti ab-
dominales were not ?
The Head of Campi. — ^The experiments of Dr. La^
borde, which we have already referred to, upon the head
of the assassin Campi, were rather tame after alL It
was an hour and a half after the execution before fresh
blood was injected into the carotid arteries. The face
naturally became suffused, some electrical reactions were
obtained, but no reactions of the special senses, and
no reflexes. The assassin had agreed before death to
make some signal if the transfusion brought back any
consciousness. Campi's brain was turned over to the
Anthropological Society.
Adulterated Beer. — Imported, and especially Bava-
rian beer, has been supposed to be exceptionally pure.
This is not the case, however, according to recent reports.
These say that so many complaints have been made of
adulterated beer that the Bavarian Government has taken
the matter in hand and ordered an investigation to be
made. All breweries are to be subject to inspection.
At Memmingen the inspection has resulted in the con-
demnation of thirty-three brewers to pay fines ranging
from $50 to $250, according to the degree of impurity of
their beer. Three others were sentenced to eight months
in prison.
The Canadian Medical Association — The Brit-
ish Association for the Advancement of Science.—
The Canadian Medical Association meets next week,
August 25th, 26th, and 27th. The meeting of the British
Association for the Advancement of Science will com-
mence on Wednesday afternoon, August 2 7th, after the
close of the Canada meeting. Over fifty of the phy-
sicians and surgeons who have promised to come out for
the British meeting, have been invited to attend the Can-
ada meeting, and more than half have accepted, among
them being Mr. Lawson Tait, who has promised to de-
liver an address on ^'Abdominal Surgery."
A Cure for Red Noses. — ^The sun which shines for
all is sometimes a factor in producing red noses. It is
very appropriate, therefore, that the New York Sun^
which also shines for all, should devote its columns to
discussing remedies for the congested organ. The fol-
lowing are three ** cures'* suggested by as many corre-
spondents :
" A remedy which 1 have used with best results is the
following : Take of vaseline one ounce, precipitated
sulphur, two drachms. Mix well and apply to the affected
part night and morning, nibbing in well. Continae the
application for one or two weeks and the redness will
disappear. Physician."
** For the benefit of ' A Reader/ Marshall County, W,
Va., I would suggest that a good strong brine might
effectually and permanently cure the red nose of vdiich
he complains. W. H. H."
" Another Plan. A remedy for red noses. Keep on
drinking and it will turn purple. Slap Sticks."
August 23, 1884.]
THE MEDICAL RECORD.
211
The Cholera. — ^The cholera continues to decrease in
extent and violence at Toulon and Marseilles. It has,
however, now spread to over forty places in France, and
to a iaige number of places in Italy. While the disease
has become milder in the two cities mentioned, it shows
a malignant type in many of the small towns which it has
reached.
The First Discoverer of the Cholera Germ. —
Naturally, the questions of priority as to the discovery of
the alleged cholera bacillus now appear. A correspond-
ent of Tike Lancet puts in a claim for the late Professor
Pacini, of Florence, the discoverer of certain corpuscles
in the skin bearing his name. In 1854 he wrote to the
Italian Medical Gazette as follows : " Examining minutely
the diflferent parts of the gastro-enteric tube of subjects
dead from cholera when in the algid state, I was forced
to the conviction that that epithelial lesion is covered by
nothing but a very simple organism of extreme tenuity,
which I shall call ' microbe,' a term generic and modem,
and with special reference to the disease in question,
*cholerigenous microbe.'" This discovery was more
quickly and thoroughly appreciated by foreigners than by
its author's own countrymen, and in 1865, on the next
cholera visitation, Pacini wrote : ''When my scientific la-
bors, having made the tour of Europe, will have returned,
arrayed in foreign garb, to Florence, they will have per-
mission to enter the schools, and then we shall be enjoy-
ing the tranquil repose of Trespiano — in our grave, in
short" This bitter forecast, says The Lancet^ has been
verified aloiost to the letter, Pacini's doctrine, rehabili-
tated by the German Cholera Commission, being now
adopted by his compatriots and taught in the Istituti
Pathologici of Italy a year after his death.
We must dissent from the opinion that Pacini discovered
the cholera bacillus. He very likely saw some minute
organisms in the intestine, as many others have done, but
the cholera bacillus, according to Koch's description, is
revealed by a one-twelfth oil immersion with an Abbe
condenser, the tissue being dried and stained with fiichsiu.
It is quite safe to say that Koch is the Columbus of the
Comma-Bacillus, whatever its significance may turn out
to be.
Suggestions Relative to Epidemic Cholera. — The
Massachusetts State Board of Health has issued a circu-
lar under the above title. It contains an excellent account
of the measures to be taken by individuals and municipal-
ities in order to prevent cholera. The following disin-
fectants are recommended : For clothing, towels, bedding,
and other textile fabrics, a solution of bichloride of mer-
cury, I part to 1,000 ; carbolic acid, i part to 30 of
water. Subjecting to a temperature of at least 212° F.
(100° C.) for an hour, either by boibng or baking, is rec-
ommended as quite efficient when practicable. It would
be better still to burn all soiled clothing. For water-
dosets, urinals, sinks, and cesspools : solution of bichlo-
lide of mercury (corrosive sublimate), i part to 1,000 of
water ; solution of carbolic acid, i part to 30 or 40
of water ; solution of chloride of zinc, i part of liquor
zinci chloridi, U. S. P., to 200 of water. For the disin-
fection of excreta the choleraic discharges should re-
ceive special attention. It is therefore recommended
that such discharges be received in metallic or earthen
vessels and treated with the solution of bichloride of
mercury, i to 1,000, or by the chloride of zinc solution.
Undoubtedly the better mode of treating the discharges
is by complete destruction by fire. For this purpose,
when practicable, the erection of small fiirnaces, stoves,
or crematories is desirable wherever cholera hospitals
are established. In consequence of the fluidity of the
excreta it would be preferable to receive them into saw-
dust, or other light combustible material previous to
burning. Bodies of persons deceased firom cholera should
be wrapped in cloths saturated in a solution of bichloride
of mercury previous to burial. For the disinfection of
houses sulphur is recommended, as advised in previous
circulars of the board. Efifective disinfection by burning
sulphur requires eighteen ounces to each space of one
thousand cubic feet. The sulphur should be broken in
small pieces, burned over a vessel of water or sand, so
as to avoid danger from fire, and, if the room is large, it
should be put in separate vessels in different places. The
room should be tightly closed for six hours, and then
aired ; it is better that the room should be warm than
cold. Of course, efficiently disinfected air is, during the
process of disinfection, irrespirable. Most articles may
be disinfected in this way, if hung up loosely in the fumi-
gated chamber, although it would be an additional safe-
guard to expose anything thick, like a bed-mattress, to
prolonged heat at a temperature of 240^ F.; and, indeed,
keai must, with our present knowledge, be considered
the best disinfectant. With this end in view, local boards
of health are advised to procure furnaces and laundries,
as is commonly done in other countries, to be used for
the sole purpose of disinfecting articles which have been
exposed in the infectious diseases, as reconmiended in
the " Ninth Annual Report of the State Board of Health''
(pp. 255 et seq.). Of course, a much simpler disinfect-
ing furnace than that described will answer every purpose.
For ordinary use, in disinfecting houses, the sulphur pro-
cess is thf best.
Prince Bismarck's Physician, Dr. Schweininger,
who was some time ago made a professor, has now^ it is
said, been given an order of nobility and made Professor in
the Faculty of the Berlin University, with authority to de-
liver certain courses at Charity. Apropos of Dr. Schwein-
inger, the German papers publish in the humorous
column the following story : '< A servant in Munich was
showing the sights to a country visitor. The latter
wanted to know all about the figures and statues on the
University Building. Rather than confess ignorance
his city friend gave the names of distinguished contem-
poraries to the various gods, goddesses, and other im-
mortals in stone. 'And that figure,' he said finally,
pointing to a very classically dressed statue on the facade
of the left wing, 'is Dr. Schweininger.' 'Aha I' said
the admiring visitor, ' but where then is his coat ? '
*0h,' replied his friend, 'since he cured Prince Bis-
marck, the people have sent for him firom all over the
country, and he has had to travel so hard that he has
worn off his clothes ! ' "
Criticising the Louisiana State Board of Health.
— The Mississippi Valley Medical Monthly thus criticizes
the Louisiana State Board of Health, which started off
this year with such alluring promises : ^' This Board," it
212
THE MEDICAL RECORD.
[August 23, 1884.
says, '* has neither the ability (financial) nor the authority
to enforce such quarantine regulations as this great Valley
has a right to demand. Nevertheless, in the face of these
facts and in opposition to the expressed will of the National
Board of Health, the Marine Hospital Service, and the
Sanitary Council of the Mississippi Valley, together with
muttering threats of shot-gun quarantine, this Board has
persistently arrogated to itself the right to enforce its
rules and compel the commerce of the United States to
yield tribute to its support. It has disturbed the work-
ings of the National Board of Health ; has rendered the
Marine Hospital Service almost powerless in that locality,
and has done much to prevent the enactment of proper
laws for the enforcement of quarantine by the Congress
of the United States." According to the same journal,
the Louisiana State Board of Health, which thus under-
takes to guard the Mississippi Valley, receives only $6,000
a year besides ** a scanty and contested pittance " from
quarantine and registration fees.
Regulating MiDwivES in the City of Berlin. — The
following regulations have been adopted by the Berlin
Police Department They contain important suggestions
for the municipalities in this country : '^ Midwives, on com-
mencing practice, are to notify the same personally to
the Bezirks-Physikus within fourteen days, and at the
same time to lay before him (i) their license ; (a) the
day-book ; (3) the last edition of the Prussian " Hand-
book of Midwifery for Midwives " ; (4) the instruments
prescribed by the latter. They are required] to treat
their cases strictly in accordance with the instructions
given in the handbook. They must keep a day-book
after a prescribed pattern in which cases must be en-
tered, and they must till up the columns accurately, or
permit the medical man they call in to do so. Besides
the instruments prescribed, which must be kept clean and
ready for use, they must always have such disinfecting
material as is ordered. Every case of pueYp^ral fever,
as well as every maternal fatality, must be notified with-
in twenty-four hours of verification of diagnosis or death
to the Royal Sanitary Commission. They must also
submit to subsequent examinations once in three
years."
THE SIMS MEMORIAL FUND.
To the Medical Profession and Others throughout the
World:
The great achievements of Dr. J. Marion Sims call
for some more lasting testimonial than obituaries and
eulogies. To him medical science is indebted for much
brilliant and original work, especially in gynecological
surgery. Those who have been benefited by his teach-
ings and new operations, and such as have had the direct
advantage of his personal skill are among the first to
recognize and acknowledge this debt
To him is due the honor of giving the first strong im-
pulse to the study of gynecological surgery in America.
It is believed that the medical profession everywhere,
the vast number of women who owe their relief firom
suffering directly to him, and those who realize the
benefits he first made possible, will gladly unite thus to
honor the man through whose originid and inventive ge-
nius such blessings have been conferred upon humanity.
At the suggestion of many friends, therefore, the sub-
joined committee has been organized, and it is proposed
that a suitable monument be erected to his memory in
the city of New York.
To this end the active co-operation of the medical
profession and the many other friends of Dr. Sims
throughout the world is respectfully solicited. Contribu-
tions of one dollar and upward may be forwarded to the
journal which has been constituted the treasury of this
fund — The Medical Record, New York.
FORDYCE BARKER, M.D., Chairman,
GEORGE F. SHRADY, M.D., Secretary.
Thomas Addis Emmet, M.D., New York.
T. Gaillard Thomas, M.D., "
William T. Lusk, M.D., '*
William M. Polk, M.D., "
Paul F. MundA, M.D., «
S. O. Vander Poel, M.D., "
Frank P. Foster, M.D., "
E. S. Gaillard, M.D., «*
Alex. J. C. Skene, M.D., Brooklyn, N. Y.
Samuel D. Gross, M.D., Philadelphia, Pa.
William Gk)ODELL, M.D., "
James R. Chadwick, M.D., Boston, Mass.
William H. Byford, M.D., Chicago, IlL
A. Reeves Jackson, M. D., ''
Thad. a. Reamy, M.D., Cincinnati, O.
C. D. Palmer, M.D., "
George J. Engelbcann, M.D., St. Louis, Mo.
R. Beverley Cole, M.D., San Francisco, CaL
H. F. Campbell, M.D., Augusta, Ga.
R. K Maury, M.D., Memphis, Tenn.
E. S. Lewis, M.D., New Orleans, La.
J. T. Searcy, M.D., Tuskaloosa, Ala.
R. A. Kinloch, M.D., Charleston, S. C.
Hunter Maguire, M.D., Richmond, Va.
S. C. Busey, M.D., Washington, D. C.
Harvey L. Byrd, M.D., B^timore, Md.
W. T. Howard, M.D., *«
D. W. Yandell, M.D., Louisville, Ky.
Seth C. Gordon, M.D., Portland, Me.
Frank E. Beckwith, M.D., New Haven, Conn.
A. W. Knox, M.D., Raleigh, N.C.
L. W. Oakley, M.D., Elizabeth, N. J.
A. T. Woodward, M.D., Brandon, Vt.
Albert H. Crosby, M.D., Concord, N. H.
E. S. DuNSTER, M.D., Ann Arbor, Mich.
Alex. J. Stone, St Paul, Minn.
List of Additional Subscribers.
South Carolina Medical Association $100 00
S. Logan, M.D., New Orleans, La 5 00
R. H. Day, M.D., Baton Rouge, La i 00
Thos. Hebert, M.D., New Iberia, " i 00
F. Formento, M.D., New Orleans, La i 00
J. C. Bickham, M.D., " « S ^
W. D. White, M.D., Abbeville, " i 00
L. Cheves Tibo, M.D., New Orieans, La i 00
J. H. Bemis, M.D., " ** i 00
J. S. Fish, M.D., Rapides, La. . i 00
F. W. Parham, M.D., New Orleans, La i 00
G. Breaux Underbill, M.D., " ** i 00
H. D. Bruns, M.D., ** ** i 00
J. P. Davidson, M.D., ** " i 00
S. E. Chaille, M.D.. " " i 00
A. C. Love, M.D., " " 5 00
Dr. Fox, Opelousas, La. 100
E. Louchon, M.D., New Orleans, La 25 00
G. B. Laurason, M.D., *' *' 100
A. W. de Rialdes, M.D., " " 5 00
Henry Bezon, M.D., " " 2 00
T. G. Richardson, M.D., ** ** 5 ^
A. B. Miles, M.D., «' " 5 ^o
E. S. Lewis, M.D., " " 54 00
August 23. X884.]
THE MEDICAL RECORD.
213
l^eprorts at SiocutUs.
|nteMiati0tmI gJtejflical &angKf^6B.
EIGHTH SESSION,
Held at Copenhagen^ Denmark, August 10-16, 1884,
BY CABLE TO THE MEDICAL RECORD.
(Concfasded fiom page x88.)
Thursday, August 14TH — Fifth Day.
At the General Session, 3.30 p.m., Sir William Gull,
of London, delivered an address
ON THE INTERNATIONAL COLLECTIVE INVESTIGATION OF
DISEASE.
Speaking of the importance of the subject, he main-
tained that its proper consideration promised greater ad-
vances in knowledge than by the ordinary methods. The
time had come when organized co-operation, as against
scattered individual efforts, should be encouraged. This
was, in iajct^ one of the purposes of the Congress and
other similar medical organizations. The field of scien-
tific medicine was too large to be compassed by any
other means. The amount of work that could be ac-
complished by a systematic direction of numerous
workers was practically without limit, and was proportion-
ately valuable. By such means facts could be accumu-
lated on a large scale, and be utilized accordingly. In
conclusioii he referred in detail to the admirable work of
the Committee on Collective Investigation in the British
Medical Association, and urged that the scheme be ex-
tended throughout the scientific world, in order that the
results might be centralized, if need be, in the different
medical congresses hereafter to be held. The subjects
of acute rheumatism and contagiousness of phthisis had
already been worked up by different committees of in-
vestigation, and had given some remarkably valuable
results. The English and German Committees had both
chosen the latter subject, and their conclusions were
strikingly consistent.
MEETINGS OP SECTIONS.
Section on Surgery. — ^There was a discussion of the
subject of
ANTISEPTICS IN SURGERY.
fP^ Professor Lister, of London, being absent, the discussion
was opened by Professor Esmarch, of Kiel, who, after
some general remarks upon the principle of antiseptics,
alluded to the advantage of permanent dressings for
wounds. The rule was to thoroughly cleanse and disin-
fect the parts and then seal them with antiseptic coverings
to prevent the subsequent entrance of germs. This dress-
ing was kept applied as long as possible, consistent with
cleanliness and the absence of constitutional disturbance.
The general practice of German surgeons was to use
catgut ligatures, the latter being completely absorbed in
die wounds. Professor Esnuurch applies the permanent
dressings after main vessels are secured and before the
removal of the tourniquet ^ He does not think it neces-
sary in the large majority of cases to use drainage-tubes,
but supports the deeper parts and keeps them m contact
by pressure. Openings are left for the escape of drain-
age into the bandages, which are sterilized by dry heat
and corrosive sublimate. Other antiseptics are occa-
sionally used, but preference is alwajrs given to bichloride
of mercury. The parts are sometimes supported by
glass splints until healing is accomplished by first inten-
tion. The general treatment carried out is based upon
the grand principles of absolute rest, perfect cleanliness,
and thorough drainage.
Professor Mosetig-Moorhof, of Vienna, advocated the
use of iodoform as an antiseptic in the dressings, but pre*
ferred simple cold water during operations.
Dr. Schede, of Hamburg, thought well of iodoform,
but his best results were obtained when corrosive subli-
mate was used. With the latter erysipelas vanished and
septic troubles were almost unknown. He was in the
habit of employing the corrosive sublimate solution in
the proportion of one to five hundred, and had yet to
meet with the first case in which indications of poison-
ing showed themselves, although there were sometimes
symptoms of tenesmus. Even children bore the corro-
sive sublimate dressing without any bad results.
The general principles of antiseptic treatment were
endorsed by Professors Mikulicz, Neudorfer, Buchanan,
and Schelkley, who followed with remarks, the only dif-
ferences noted being in the methods of application.
Professor Koeberl6, of Strasburg, used only clean linen
with which he wiped the wounds, and had noticed no
erysipelas when the open method of treatment was fol-
lowed.
Professor Plum said that the Danish surgeons agreed
in the main with their German confreres, although the
cost was somewhat of an objection to Esmarch's plan.
Cleanliness was, after all, at the bottom of all antisepsis,
and the soap and the brush, when properly employed,
would work wonders. It was a question, after all, how
simple we could make the matter, and how we could
divest ourselves of useless paraphernalia.
Section on Medicine. — Professor Lupine, of Lyon, read
a paper entitled *^ Clinical Observations on the Toxical
Principles which are formed in Living Organisms," giving
a full r/sum/ of the literature of the subject, and present-
ing illustrations of the relations of cause and effect on
the commoner variety.
Professor Leibermeister, of Tubingen, followed with a
communication on the antipyretic treatment of acute
infectious diseases, advocating the utility of employing
the different well-known methods in particularly well-
selected cases.
The subject of antiseptic treatment of the same dis-
eases was next presented by Professor Bouchard, of
Paris, who also discussed the different methods and their
applicability to individual cases.
A general discussion then followed, in which Profes-
sors Roth6, Lepine, and Pribram joined*
Professor MacEwen, of Glasgow, read a paper on " Oi^
thopedic Osteotomy," which was discussed by Professors
Agston, Chiene, Schede, and Mr. Bryant and Dr. Robin.
The general sentiment was in favor of MacEwen's opera-
tion in proper cases.
Section on Ophthcdmology.-^VK^xs read : " Determin-
214
THE MEDICAL RECORD.
[August 23, i884t
ation of Refraction by Ophthalmoscope," by Professor
Schmidt-Rimpler, of Marburg. This paper was duly
discussed by Dr. Noyes, Mr. Berry, Dr. Yuler, Sattler,
Grut, and Liebreich. On the '* Artificial Maturation of
Cataract,'' by Dr. Ed. Meyer, Paris ; discussed by Drs.
Moore and Samuelson. On ** Infantile Blennorrhoea, its
Prevention and Treatment," by Dr. Christensen, of
Copenhagen. On ** Inflammation of the Eye," by Dr.
Martin, of Bordeaux.
Section on Diseases of Children. — Prof. Hirschsprung,
of Copenhagen, presided. A paper was read by Dr. P.
Rupprecht, of Dresden, on ** The Choice of Antiseptics
in the Treatment of Wounds in Children." He was fol-
lowed by Dr. Sofus Meyer, of Copenhagen, who read a
paper on the ** Prophylactic Treatment of the Ophthal-
mo-blenorrhcea of the New-bom." A paper was read by
the President, Prof. Hirschsprung, on "Intestinal Invagi-
nation and its Comparative Frequence in Different
Countries ; " and one on the same subject by Prof. Rib-
bing, of Lund. Dr. A. Jacobi, of New York, read a pa-
per on " Primary Sarcoma of the Kidney in the New-
born.*'
A GRAND BANQUET.
At five o'clock in the afternoon a grand banquet was
tendered the members of the Congress by the Municipal
Council of Copenhagen. Fourteen hundred guests were
present. The tables were set in a large tent erected for
the occasion upon the Custom House quay. The in-
terior of the tent was decorated with the flags and coats-
of-arms of the different nations. The tables were pro-
fusely ornamented with flowers, another evidence of the
warm hospitality of the Danish ladies. After the courses
had been finished, speeches were made by President
Panum, and by Pasteur, Paget, and Virchow. Many of
the guests went upon an excursion by steamers to Tivoli.
The entertainments of the evening closed with a grand
display of fireworks and electric lights. The whole city
joined enthusiastically in the spectacle.
Friday, August 15TH — Sixth Day.
PROFESSOR VIRCHOW 'S ADDRESS.
Professor R. Virchow, of Berlin, delivered an address
entitled " Metaplasia."
He said that at the beginning of the present century
the processes of life were considered to be merely chemi-
cal Life and thought were bound to certain matter in
the blood, which, becoming solid, formed tissues. Even
Schwann said that cells were formed by a sort of crys-
tallization of the plasma. These chemical doctrines
were of English origin. John Hunter spoke of *' plastic
lymph." These doctrines were supported by the then
physiological views of outrition. The plasma was thought
to supply food directly to the tissues, in fine, to feed
them. As a consequence, the healing art was thought
to consist mainly in regulatiag nourishment, 1.^., the sup-
plies furnished the plasma. Virchow made the first step
-toward the cellular pathology thirty years ago, when he
announced his doctrine omnis celiula e cellula. He said
that the task for nourishment was to keep the cells alive.
These cells then formed tissues and, indeed, to them
belonged all the formative fiinctions. The speaker con-
trasted the nutritive with the formative processes.
Difierences in the matter supplied afiected nutrition,
but the formative process was the same, with the most
varied nourishment All organic operations, said the
speaker, occur within cells, never outside of them. The
speaker defined automatic nourishment of cells, showing
that their nutrition supply was regulated by certain auto-
matic checks, so as to be kept at the proper mean. He
then spoke of the phenomena of growth and the produc-
tion of new tissue forms, to which he gave the tenn
''metaplasia." He described the various theories of
bone formation, and showed the difference between ossi-
fication and calcification. He spoke also of the fomia-
tion of bony marrow, which being a tissue of changing
form, furnishes a good example of metaplasia. He ex-
plained the pathology of osteo-porosis and osteo-malada.
He referred briefly to the subject of the development of
tumors. Lastly he spoke of the white blood-globules,
and of their ability to form new tissue. In them meta-
plasia reached its fiirthest limits.
Dr. Lewis A. Sayre, of New York, gave some demon-
strations of the application of his plaster-of-Paris bandage
for the treatment of spinal disease, and was followed by
Professor Tommasi Crudeli, who showed some micro*
scopic specimens of red blood-corpuscles taken from the
human subject suffering from malaria. The infected
corpuscles responded to aniline and some of these were
seen to contain colored particles. These he consid-
ered germs of bacilli. Healthy corpuscles refused the
stain and contained none of the particles referred to.
MEETINGS OF SECTIONS.
Section on Medicine. — Professor Rosenstein, of Ley-
den, presented a paper on " Malarious Infection in Man, '
which was discussed by Professors Flint, Ewald, and
Mahomed. Professor Grancher, of Paris, next read a
paper on "Subacute Pneumonia," dwelling mostly on its
clinical significance.
Section on Ophthalmology. — Dr. Gayet, of Lyons, read
a paper on " The Results of Great Losses of the Sub-
stance of the Cornea," which was discussed by Professors
Berry, Grut, Noyes, and Nicden. The subject of " Latent
Squint " was presented by Dr. Grut, of Copenhagen, and
was discussed by Dr. Noyes and others.
Section on Diseases of Children, — In the morning
there was a joint session with the Section on Hygiene,
and in the afternoon the regular session was held.
Dr. Schepelem, of Refsnaes, Denmark, read a pa-
per on "The Treatment of Chronic Diseases of
Children at Sea-Coast Hospitals," which was followed
by a communication from Dr. Engelsted, of Copenhagen,
on '' Sea-Coast Hospitals for Scrofulous Children," es
pecially with regard to the Refsnaes Hospital in Den
mark.
In the afternoon session. Dr. Rauchfuss, of St. Peters
burg, read a paper on ** Croup Clinically Considered as
a Well-limited Morbid Entity." This was discussed by
Professor Virchow and others.
RECEPTION BY THE KINGS AND QUEENS OF DENBCARK
AND GREECE.
In the evening a reception was given the Congress at
the Christiansborg Palace, by the Kings and Queens
of Denmark and Greece. The affair was a brilliant one]
August 7$, 1884.J
THE MEDICAL RECORD.
215
and the most bountiful hospitality expressed the royal
appreciation of the distinguished guests. After the en-
joyment of a sociable converse and musical concert, the
members were entertained at a sumptuous supper, at which
the King of Denmark proposed the toast of the foreign
members which was felicitously replied to by Sir William
GulL
Saturday, August i6th — Seventh Day.
THE next congress TO MEET IN WASHINGTON, 1 887.
At 3.30 P.M. the Congress took up the subject of the
place of next meeting. The Committee to whom the
subject was referred, reported back a recommendation
that the invitation to hold the next meeting in Washing-
ton, U. S., be accepted. There was a warm debate over
the sabject ; the English members strongly supported the
decision, however, and it was finally voted by a consider-
able majority to meet in Washington in 1887. After the
rote was announced, Dr. J. S. Billings thanked the Con-
gress in warm terms, and expressed his gratitude at the
hospitality which had been extended to the guests. He
was followed by Virchow and Sir Risdon Bennett
The General Session concluded this day by congratu-
latory addresses in the different official languages. In
French, by Professor Rauchfuss ; in English, by Profes-
sor JacoU ; and, in German, by Professor Hirschsprung.
Professor Panum closed the Congress at five o'clock.
SECTION WORK.
Section on Diseases of the Eye, — Dr. Bjemim, of
Copenhagen, read a paper on '' Refraction in Infants.''
Professor Holmgren, of Upsala, read a paper on the
"Color Sense."
Mr. Yuler, of London, demonstrated the use and ad-
vantages of McHardy's perimeter and of Frost's artificial
eye.
Dr. Klebs showed the method of using the electro-
magnet in removing bits of iron from the eye.
Section an Medicine. — Dr. Proschowsky gave a dem-
onstration of sphygmographic and cardiographic tracings.
Dr. Job. Butzen, of Copenhagen, read a paper on
"The Different Action of the Japaconitine, the Pseuda-
conitine, the French and the German Aconitine."
Dr. Roussel, of Paris, read papers on the '' Direct
Transfiision of Living Blood," and upon <* Medical
Hypodermic Injections."
Dr. Maurice Dupont, of Paris, read a paper on the
"Medical Use of Condensed Air in the Form of Baths
and Douches." He showed illustrations of his new ap-
paratus.
Professor Granger-Stewart, of Edinburgh, read a paper
on the " Influence of Acute Infectious Diseases upon
the Kidneys and their Functions."
There was a joint session of the Sections on Dis-
eases of Children and Hygiene; the papers read
were as follows : " The Normal Increase of Weight
tfirough the Latter Childhood," by Mr. Mating Hansen
and Dr. Wahl, of Denmark ; " Meningitis Tuberculosa
in the First Year of Life," by Dr. Medin, of Stockholm ;
on the " Influence of Cold on Diseases of Children," by
Professor Logroux ; on an " Easily Curable Form of In-
fantile Spinal Paralysis," by Professor d'Espine.
At one o'clock the various sections adjourned, and
after a lunch visited several of the hospitals of the city.
EVENING ENTERTAINMENTS.
In the evening a reception was given at the National
Establishment It was preceded by a concert and fol-
lowed by a ball and supper. The total number of guests
present was eighteen hundred.
The attendance in nationalities was as follows : Danes,
450 ; Swedes, 150 ; Americans, 64 ; English, 120 ;
French, 118; Germans, 234; Austrians, 35.
The Congress is looked upon as a decided success, and
as having been most admirably managed. The social
features were attractive, but the hospitalities were judi-
ciously lavished, so as not to interfere and crowd out the
scientific work.
©Wtttaxrs.
JOSEPH JANVIER WOODWARD, M.D.,
PHILABBLPHIA, PA.
Col. Joseph Janvier Woodward, Surgeon in the United
States Army, died Tuesday morning near Philadelphia.
He was born in that city in 1832. He received his edu-
cation at the Philadelphia Central High School, where he
was given the degree of A. B. in 1850, and that of A. M.
in 1855, having acted as the valedictorian of his class.
After receiving the first degree he entered upon the study
of medicine, and in the spring of 1853 he was graduated
from the University of Pennsylvania. He practised
medicine in Philadelphia until August, 1861, when he
was appointed an Assistant Surgeon iq the regular army.
He had already attained considerable prominence in his
profession through the publication of a number of treat-
ises on abstruse subjects, especially on the use of the
microscope in the practice of medicine. He subsequent-
ly attained such eminence in this particular branch that
he was regarded as one of the leading authorities in cer-
tain departments. He invented an instrument by which
the myopic condition of the eye can be determined with
accuracy. He served in the war, and distinguished him-
self by his gallant conduct. He was brevetted Captain,
Major, and Lieutenant-Colonel on March 13, 18651 for
faithfiil services.
On July 28, 1866, he was made Captain and Assistant
Surgeon, and was promoted to the rank of Major and
Surgeon on June 26, 1876. In 1866 he was selected for
the important dutyof editing the " Surgical and Medical
History of the Rebellion." With this great work his
name will always be inseparably connected. He also pub-
lished a number of papers of great interest and value.
Among them were '* Address on the Medical Staff of the
United States Army." " Remarks on Croup and Diph-
theria." " Typho-Malarial Fever ; Is it a Special Type of
Fever ?" " Remarks on Photojjraphic Micrometry."
" Application of Photography to Micrometry, with Special
Reference to the Micrometry of the Blood in Criminal
Cases." Report on " Medical Literature," and report on
" Causes and Pathology of Pyaemia." When President
Garfield was shot, on July 2, 1881, Dr. Woodward was in
Washington in the Surgeon-General's Bureau. He was
one of the surgeons first summoned to the bedside of the
wounded President. He remained in constant attendance
there until September 7th, when he retired in company
with Drs. Reybum and Barnes.
During his residence in Philadelphia Dr. Woodward
was a member of the Philadelphia County Medical Soci-
ety. He was also a member of the American Medical
Association, of which he was the Second Vice-President
in 1875 ; of the American Academy of Sciences, and of
the Medical Association of the District of Columbia.
2l6
THE MEDICAL RECORD.
[August 23, 1884,
He was a delegate to the International Medical con-
gress in Philadelphia in 1876.
Dr. Woodward will be especially remembered for his
description and differentiation of typho-malarial fevcT, for
his remarkable work in micro-photography, for his micro-
scopical studies of the blood, and for his work in con-
nection with the " Medical and Surgical History of the
War."
Dn Woodward was a man of positive views and some-
what abrupt though not unpleasing manners. He was
an untiring and conscientious worker, never sparing him-
self, and he doubtless wore himself out before his time.
Traits de l* Affection Calculbuse du Foie. Par le
DocTEUR Jules Cyr, M^decin Inspecteur adjoint a
Vichy. Paris: V. Delahaye et Lecrosnier. 1884.
A Treatise on Calculous Disease of the Liver.
By Dr. Jules Cyr.
The large experience which Dr. Cyr's position at Vichy
has afforded him in diseases of the liver entitles him to
rank as one of the authorities in such affections. The
present work on gall-stones is the result mainly of his
own observations, and in consequence bears a mark of
originality which adds greatly to its readableness. At
the same time he has not ignored the labors of others in
this field, so that the monograph, in spite of the author's
modest disclaimer, may justly be regarded as embodying
all that is of value respecting biliary calculi. The chap-
ters on diagnosis and treatment are especially valuable.
History of the Discovery of the Circulation of
the Blood. By Henry C. Chapman, M.D., Pro-
fessor of Institutes of Medicine and Medical Jurispru-
dence, in Jefferson Medical College. Philadelphia:
P. Blakiston, Son & Co. 1884.
An interesting essay, in which the author shows that the
discovery of the circulation of the blood, like all other
great discoveries and movements, was the result of a
gradual intellectual growth and not due solely to the
acumen of Harvey. The credit of the discovery does
not belong, in his opinion, to England, for Harvey,
though by accident of birth an Englishman, was m
thought Italian, and lived and died a student of Padua.
Moreover the earlier workers, to whose investigations
Harvey was indebted for the ideas which led to his grand
discovery, were chiefly Latins or Italians.
The. Relation of Animal Diseases to the Public
Health, and Their Prevention. By Frank S.
Billings, D.V.S., Graduate of the Royal Veterinary
Institute of Berlin ; Member of the Royal Veterinary
Association of the Province of Brandenburg ; Honor-
ary Member of the Veterinary Society of Montreal,
Canada, etc. New York : D. Apple ton & Co. 1884.
The question of the susceptibility of man to infection
from animal diseases is one that has begun to attract
considerable attention of late among hygienists and phy-
sicians, and that promises to become of still greater im-
portance in the future. The more the subject is studied
the more intimate is seen to be the relation between dis-
eases of man and of the lower animals, and a knowledge
of some at least of the more common infectious diseases
of animals is daily becoming more necessary to the phy-
sician who seeks not only to cure but to prevent sickness
in the human race. On this account the appearance of
the work before us is timely. It treats of the higher
purposes of veterinary medicine in seeking, by a careful
study of animal disease, to prevent its extension to man.
The work is divided into three parts, treating respectively
of the diseases of domestic animals, the history of veteri-
nary medicine, and the means of prevention of disease.
Nothing is said of treatment, as the book is not intended
to be a treatise on veterinary medicine, but is rather
adapted to the wants of the hygienist and of all those
interested in the subject of preventive medicine. The
author is very dogmatic in his assertions, and is apt at
times to be rather severe in his strictures on some of his
co-laborers in the same field ; but this is a fault, if fault
it be, common to all pioneers in a new subject who are
thoroughly in earnest and who are of necessity, as the
author confesses himself to be, enthusiasts. The book
might, we think, be somewhat condensed with advantage,
for to the general reader whose time for studies of this
sort is limited, a volume of 440 octavo pages is a little
formidable.
Brain Exhaustion, with some Preliminary Considera-
tions on Cerebral Dynamics. By J. Leonard Corn-
ing, M.D. New York : D. Appleton & Company.
1884.
In these days of hurry and worry the questions considered
in the book before us have assumed a measure of im-
portance unknown to our fathers. We perhaps work no
harder, but we work more irre^larly and with less re-
gard for the necessity of relaxation, than those before us
did. The demands upon our thinking apparatus are
very great, but we take little care to see that the ap-
paratus is kept in |;ood working order. But the time
comes when the brain refuses to work at such high press-
ure, and if then it is urged on beyond its strength it
either stops or breaks away from all control. In this
work on the exhaustion of the brain, the author presents,
in a very clear and intelligent form, the various causes
and symptoms of the complaint, and points out the prin-
ciples upon which its treatment should be pursued. He
insists very strongly upon the damage to the mental fac-
ulties resulting from the custom of late and protracted
evening amusements and the loss of sleep entailed there-
by. He also urges the necessity of a meat dietary for
brain-workers, and shows very clearly the mental superi-
ority of meat-eaters over vegetarians. The subject of
the book is indeed worthy of careful consideration, and
it is presented by the author in such a pleasant and
attractive style Uiat the reader will find himself enter-
tained as well as instructed.
WAS HUMAN FLESH EATEN BY ANY OF
THE GREELY PARTY?
To THX EdTTOB op Tm MSDICAI. Rbookdw
Sir: I address this note with a view of possibly ob-
taining some more definite information concerning the
microscopical examination of the contents of the stomach
of Lieut Kislingbury, and of the other Arctic dead.
According to the reports of the physicians, pieces of epi-
dermis, etc., removed from the stomach and intestines,
were recognized as unquestionably human.
I presume that the eaten flesh was subjected to some
mode of preparation before mastication ; it is also cer-
tain that the digestive process must still further have
changed the tissues, and that, in spite of the general pres-
ervation, a certain amount of disintegration and probably
decomposition must have followed.
Was it possible to make such a microscopical examin-
ation as would justify the unequivocal deduction, from
this alone, that the ''chyme mass " was of human origin ?
Or was the conclusion a partial inference from the con-
dition of the body and the reports of the survivors, which
leave no doubt in the mind of any of us as to the sad oc-
currence of cannibalism ?
In the interest of "expert" testimony, and exact
science, the latter of which so often unjustly suffers ob-
loquy from the former, can our colleagues, on the basis
in question, leave their conclusions unqualified, that the
stomach contents were undoubtedly human ?
I am yours truly,
H. N. Heineman, M»D.
49WBST Firrv-SBysMTH Stkbbt,
August 19, Z884.
August 23, X884.]
THE MEDICAL RECORD.
217
(Sm:vtsvan&enct.
THE ANNUAL MEETING OF THE BRITISH
MEDICAL ASSOCIATION, AT BELFAST, IRE-
LAND
(From our Special Correspondaat.)
Bblpast, August a, 1884.
The Belfast meeting may be pronounced a success. A
Urge number were present, and the general and sec-
tional meetings were well attended. Belfiast is a large
town, and possesses ample acconunodation for a crowd
of visitors. The building in which the meetings were
held — Queen's College — ^is one particularly well adapted
for the purpose to which it has been devoted during
this week, and the college grounds, together with
the adjoining botanical gardens, formed ji pleasant re-
sort for members in the intervals between the meetings.
The only disadvantage has been in the location of the
college, viz., between one and two miles from the chief
hotels. Some could get accommodation near the place
of meeting, but this was necessarily limited, and the ma-
jority of those present had to seek quarters in the centre
of the town. To get to the meetings, therefore, they
either had to walk, ride by tram, or take an Irish car or
other vehicle.
The number of members of the Association present
has been about five hundred odd, and if to this be added
the medical visitors and delegates, and the medical stu-
dents of Queen's College f who were permitted to attend),
the total number probably exceeded six hundred. A
Dumber of American physicians were present, among
them being Dr. Lewis H. Sayre, of New York ; Dr. John
Shoemaker, of Philadelphia; Dr. Frederick Hyde, of
Cortland (delegate from the American Medical Associa-
tion), and Dr. A. Jacobi, of New York. In all, I think,
some sixteen American medical men were present.
From other distant localities there also came representa-
tives, viz., from Guernsey, Paris, Geneva, Jamaica, and
eren India.
On the first day, Tuesday, members began early to as-
semble, register their names and addresses, get their
tickets, and ask for letters and telegrams at the temporary
post-office erected in the porter's lo^e at Queen's Col-
lege for the convenience of members during the meeting.
The latter, as in previous meetings, proved a very great
convenience to members and others present, and the
post-office official placed in qharge of it had indeed a
veiy busy time. Some little hitch occurred at first in the
arrangements for the registration of members, owing to
the official books and tickets having been delayed by the
railway companies. This was promptly got over by the
printing and issuing of temporary tickets, which were duly
exchanged for the proper ones when the latter arrived.
The proceedings might be said to formally commence
with the first general meeting, which took place in the
library of Queen's College, and was well attended. The
library is a detached building, standing in the college
grounds, and the large central hall surrounded by a gal-
lery afforded ample seating space. This room was de-
voted to the general meetings and to the Council meet-
ings. The first general meeting was preceded by a short
Council meeting, at which the following gentlemen were
present : Chairman— Mr. C. G. Wheelhouse, President of
tbe Council ; Dr. James Cuming, President-elect of the
Associatbn ; Dr. A. T. H. Waters, President ; Dr. T.
Bridgwater, Dr. Alfred Carter, Dr. Alfred Carpenter, Dr.
I>cas, Dr. G. F. Duflfey, Dr. Balthazar Foster, Dr. Grigg,
Dr. C. E. Glascott, Dr. Eyton Jones, Dr. W. G. V. Lush,
Dr. McVail, Dr. W. Moore, Dr. C. Parsons, Dr. Edward
J^aters, and Messrs. C. Macnamara, J. Prankerd, and T.
Sympson.
At the Council meeting SS gentlemen were elected
members of the Association, and other business was
transacted.
The general meeting opened at 3 p.m. Dr. A. T. H.
Waters, President, in die Chair. He proposed that the
minutes of the last meeting should be taken as read,
which was adopted unanimously. Dr. Waters made a
few remarks on the prosperous state of the society and
its continued increase in numbers. During the past year
1,040 new members had been added to the Association,
while only 139 members had died. The total number
was now nearly twelve thousand — ^to be exact, he be-
lieved it was 11,800.
He then resigned the chair to Dr. Cuming. A vote
of thanks to Dr. Waters was then proposed by Dr. John
Moore, of Belfast, seconded by Dr. Felce, of London,
and carried unanimously. Dr. Waters was elected a
Vice-President of the Association for life.
Mr. Wheelhouse then proposed the adoption of the
report of the Council and the financial statement for
the year 1883. Some exception was taken by some gen-
tlemen to the sum of £1,660 put down as paid to con-
tributors to the /ourna/f and it was asked for what was
this sum paid. It was remarked that most of the original
contributions were offered gratuitously to the /ournai, and
asked whether this amount was paid for editorial matter?
It was explained that it was paid for scientific reports
and various matter furnished not by the editor or his as-
sistants, but by various gentlemen all over the country.
Details could not be furnished of the individual articles
for which payment was made, but they were such as
were approved by Mr. Ernest Hart in his editorial ca-
pacity, and by the Journal Committee. The financial
statement submitted showed that the total editorial ex-
penses were ;^3,ooo odd, yearly. The financial state-
ment and the report of the Council were adopted.
Mr. Macnamara, of London, was then proposed by
Mr. Wheelhouse, of Leeds, as Treasurer of the Association
for the ensuing three years, in the place of Dr. Wade,
whose term of office had expired. The motion was
made by Dr. Rogers and supported by Dr. Edward
Waters, and carried unanimously. A letter was read
firom the late Treasurer suggesting improvements in the
mode of signing cheques. Dr. Wade thought there ought
to be an additional signature before moneys were paid
away. The letter was referred to the Council for
consideration. A motion to that end by Dr. Ward
Cousins was passed, and then a motion was made by
Dr. McVail (in the absence of Mr. Dix) providing for the
payment out of the general funds of the Association of
the travelling expenses of the members of the Council to
and from the Council meetings. Under the new con-
stitution of the Association, as amended last year, the
Council is now to be a body representative of the As-
sociation at laj^e, each branch electing its own repre-
sentative. Dr. McVail urged that it was desirable that
the members of the Council should attend, and to insure
the distant members doing so, their expenses should be
paid. It had been objected that it was unnecessary, and
that there were in every branch men of means and
leisure who could attend; but Dr. McVail contended
that these were not the men that were wanted, but they
wanted representatives of the rank and file of the pro-
fession. It had been urged that distant branches might
nominate metropolitan members to represent them, but
this defeated the very object of having a representative
Council. After prolonged discussion and speeches by Dr.
Alfred Carpenter, Mr. George Brown, Dr. Bernard
O'Connor, Dr. Balthazar Foster, Mr. Brindley James,
Mr. Ernest Hart, and others, the motion was finally nega-
tived, as it was when brought forward at the Liverpool
meeting last year. Some angry feeling was exhibited in
the course of the discussion. Several speakers main-
tained that the provincial members did not attend well,
and could not be expected to, if they not only had to
neglect their practice but pay their own expenses. It
was alleged that the management was practically in the
hands of the metropolitan members. At some meetings
it was stated that a very large proportion of those present
2l8
THE MEDICAL RECORD.
[August 23. 1884.
were metropolitan members, owing to non-attendance of
provincial members. Mr. George Brown quoted figares
from the British Medical Journal in support of this view,
and energetically exclaimed that ** the members of the
Council were dummies." Mr. Hart maintained that the
average attendance of the country members as compared
with the metropolitan was very good. One gentleman
exclaimed that "those were the dummies who did not
come."
The meeting then adjourned for dinner, and reassembled
in the library at eight o'clock. The building was il-
luminated with the electric light generated by an engine
temporarily erected for the purpose.
On assuming the chair Dr. Cuming delivered his pres-
idential address, which you have already published, and
which was warmly received, and the usual vote of thanks
was then passed.
Lengthy discussion then took place on motions brought
forward by Dr. Bernard O'Connor, which were successively
negatived. The motions were to the effect of permitting
members of branches to elect members to represent
them who did not necessarily reside within the area of the
branch, so that distant branches could be represented
by members who resided near London. The last motion
fell through for want of a seconder.
A somewhat disorderly scene then took place in con-
nection with a motion brought forward by Mr. George
Brown. He was finally declared out of order, and the
meeting terminated between ten and eleven o'clock.
At the second general meeting on Wednesday, at eleven,
it was reported that Dr. Balthazar Foster had been
elected President of the Council for the ensuing three
years. A vote of thanks was passed to Mr. Wheelhouse
for 'his past services in the same capacity. It was an-
nounced that Cardiff had given an invitation to hold the
next annual meeting in 1885 in that town, and this was
unanimously accepted, and Dr. W. T. £dwards, senior
physician to the Glamorganshire and Monmouthshire
Infirmary, chosen President-elect. Dr. £dwards re-
turned thanks. Dr. Ord then delivered the Address in
Medicine (which we publish in our present number). A
vote of thanks to Dr. Ord was then proposed by Dr. A. T.
H. Waters, of Liverpool. He was sure they would all
agree with him that the address had been a very able and
interesting one. Dr. Ord had travelled over a wide field,
and had treated his subject with great success. The im-
portant relations of reflex action in the human system
had long occupied their attention, but he thought
Dr. Ord had placed before them more forcibly perhaps
than it had been done before the important influence
of the nervous system in the production of chronic
rheumatoid arthritis. He (the speaker) had seen cases
of this disease in elderly people, which he felt fully con-
vinced must be traced to neurotic origin. He would
only remark that the influence of the nervous system on
the production of disease no doubt required very deep,
careful, and profound study ; and perhaps the lines of
thought which they had had laid down by Dr. Ord would
give them much material for reflection. He thought
an address of that kind was not only eminently scien-
tific but essentially practical.
Professor Gairdner, of Glasgow, seconded the resolu-
tion. He came there very early that morning in order
to obtain a good place to hear Dr. Ord, but when the
President of the Council pounced upon him at once with
an offer of the duty he was then performing, he felt in the
position, not of the early bird that caught the early worm,
but of the early worm snapped up by that watchful and
ever wary bird the President. He could say that, hav-
ing followed the course of Dr. Ord's investigation, he had
never read a page, word, or line of his writing which did
not bear the mark of something to be very carefully and
deliberately thought over. Under those circumstances,
it would be a very poor compliment to Dr. Ord to there
enter into anything like a discussion upon the address
they had heard. As a teacher of medicine, he (the
speaker) was compelled by his office, as it were, to study
systematically the turns and currents of opinion, and it
was extremely interesting to him to note, and to accen-
tuate the fact, that the drift marked by such addresses as
that to which they had listened was decidedly in favor of
solidism. All he could say there then was that Dr. Ord
had made a most powerful pleading in favor of the neu-
rotic ori^n of disease, which they had been in the habit
of ascribing to other sources. They were all insensibly
biassed by the systematic views which they took of things,
but they must admit that the facts of science were too
complex for them, and would bear looking at from many
points of view.
The motion was carried by acclamation.
Dr. Ord having acknowledged the vote in a few words,
the new Council for 1884-85 was announced, and the
Association adjourned.
In the evening a conversazione was given in Queen's
College by the President of the Association and the Ex-
ecutive Committee. In spite of the unfavorable weather
— it raining heavily during the evening — this was very nu-
merously attended. To this ladies were admitted. The
college was brilliantly illuminated by the electric light,
and presented a festive appearance. The rooms were
crowded to overflowing.
At the third general meeting Dr. Redfem delivered
his address. At the fourth general meeting Dr. Kidd
delivered his address on '< Obstetrics," which was cordi-
ally received and the usual vote of thanks given.
At two o'clock the concluding general meeting was
held in the library, when the discussion on medical re-
form was continued by various gentlemen, and the reports
of the Parliamentary' Bills Committee, Habitual Drunk-
ards Committee, Scientific Grants Committee, and the
Collective Investigation Committee.
In the evening a reception by the Mayor in the Ubter
Hall was numerously attended.
SECTIONS.
Section on Surgery. — Sir W. MacCormac delivered
the address m the Section on Surgery, and spoke of the
advances in visceral surgery — cerebral, thoracic, ab-
dominal— and also of gastrostomy, the early history of
which was disastrous, but which he now considered justi-
fiable, and referred to two recent cases of malignant dis-
ease in which he hftd performed the operation with con-
siderable benefit to the patient and prolongation of life.
He recommended the operation to be performed early
enough in such cases, and considered antiseptics gave a
good chance. He spoke of Howse's plan, of dividing
the operation into two parts, as removing practically all
risk. He then spoke of the radical cure of hernia, but
preferred the term radical treatment. He said the opera-
tion was not new but old ; it was easily done in that for
strangulated hernia as a step in the operation. This was
a great advantage, and he thought in strangulated hernia
the radical treatment, by excising a portion of the sac,
should always be done. In congenital inguinal hernia
he believed a radical cure could be effected. He then
referred to the operation of thyroidotomy. It was one of
the most formidable and difficult operations in surgery.
Its dangers were mainly two, viz., sepsis and bleeding.
To avoid the latter he suggested the ligature of the
vessels first. He questioned Kocher's views as to the
liability to myxcedema and cretinism as a sequel of
removal of the gland ; but he said that neither of these
results had ever followed partial removal of the gland,
and in many cases this was sufficient. He spoke favor-
ably of the operation of ligature of the isthmus of the
thyroid in some cases.
On Wednesday morning at 9.30 Dr. Sayre gave a
special demonstration of the application of plaster jackets
by his method on some living patients. After MacCor-
mac addressed there was a discussion on the treatment
of spinal curvatures, introduced by Dr. Sayre.
Speeches by Messrs. Bernard Roth, C. B. Keetley, E.
August 23, 1884.]
THE MEDICAL RECORD.
219
Freer, and others. Dr. Sayre replied and defended his
views. He opposed the application of heavy metal
splints and apparatus. He showed a little apparatus,
consisting of some vertebrae strung on a wire so as to
represent a curved spinal column, and showed that any
force applied to the vertebras, so long as each end of the
column remained fixed, merely altered the position of the
distortion, but did not remove it, while extension did so
at once. He referred to cases in which the application
of his apparatus had been followed by immediate benefit^
and mentioned a case in which a patient had left the
hospital and resumed hard labor soon after treatment by
this method. Referring to different apparatuses, he said
he had two wagon loads of them at home. He con-
sidered plaster superior to felt Dr. Sayre was very well
received, and his remarks greeted with loud applause.
Perhaps the largest audience in any section was that
which assembled to hear Sir William MacCormac's ad-
dress, and the subsequent debate on the plaster jacket.
Dr. Sayre repeated his demonstration on Friday morning.
Section on Medicine. — In the discussion on albumi-
nuria Dr. George Johnson opened it, and defended his
theory. He considered the limited area of the changes
in the walls of the arteries was an objection to the theory
of morbid blood. Speaking more particularly as to treat-
ment, he said exclusive mUk diet was often good in re-
cent cases. He had known a patient of robust frame
subsist forfyears on about a gallon of skimmed milk daily,
and nothing else, except when travelling and unable to
obtain the milk. He demonstrated the picric-acid tests
for sugar and albumen, seven grains in one ounce of boil-
ing water gave a saturated solution. He said in testing
by this^method never omit to boil, because picric acid
may precipitate urates, which are dissolved on the ap-
plication of heat. He said he considered the only test
for albumen equal to the picric-acid tests was the
potassio-mercuric iodide test with citric acid, and this
was complicated. He then demonstrated the picric acid
test for sugar.
One of the secretaries then read a letter on the
subject from Sir Andrew Clark, Bart., who said that there
was a non-renal form of albuminuria which it was im-
portant to disrin^ish from renal. He said this was
sometimes met with for a few days before and after each
menstrual period ; also from albumen from vaginal and
other secretions, bladder tumors, etc., in women ad-
dicted to impure habits. He spoke of functional albu-
minuria, and described four forms, viz. : nervous and ox-
aluric, mostly in the young ; hepatic and gouty, mostly in
the old. These were worthy of especial study. He said
he bad known albuminuria come on, after a competitive
examination in three out of twenty candidates. He had
known temporary albuminuria in a gouty man after at-
tending a public meeting. He remarked that oxaluria,
high tension in the blood-vessels, and excess of urea, were
followed mostly before long by albuminuria. He spoke
of the importance of study of the causes.
On Thursday afternoon a discussion took place on the
•* Causes of Phthisis," introduced by Dr. Douglas Powell,
of London, who said that he doubted much the contagious-
ness of phthisis. He remarked that many so-called cases
of contagion were very strange. A phthisical man marries
three wives, who all die of the disease, while he continues
to live. How is it that while evolving sufficient of the
poison to kill all three wives, it is not present in his body
in sufficient intensity to kill him ? He considered that
it often began with inflammation at the apex of one lung.
He remarked that if we could cremate all the bacilli we
should still have phthisis left, and other bacilli would be
evolved in time.
Dr. Ward Cousins, of Portsmouth, made a very
spirited and energetic speech. He said he did not be-
lieve in antiseptic inhalations destroying the bacilli. We
could not use sufficiently powerful antiseptics to destroy
bacilli embedded in the substance of the lung. He pro-
tested against covering up the mouth and nose with in- i
"halers to keep out the bacilli which were in the atmos-
phere. What was the use of that when they were already
in the lung ? He remarked that the lower classes were
particularly averse to a breath of fresh air coming near
them, especially such as were suffering from chest dis-
eases. The theory of Koch had given an immense im-
petus to the practice of antiseptic inhalations. Dr.
Cousins employs inhalations in many cases of chest dis-
ease, but he advocated open inhalation. He remarked
that he believed that free expectoration was very desira-
ble in cases of phthisis. Referring to the late Dr. Ram-
adge, he said Dr. Ramadge was laughed at in his day.
Dr. Ramadge invented a whistle for his patients to use.
But Dr. R. was quite right in his theory. It was of
the utmost importance to keep at work, and inflated with
air, that portion of the lung which was not yet attacked
by the disease. Dr. Cousins referred to different inhalers,
and after speaking of some which were heavy, said one
had been brought out which only weighed three drachms.
He then showed his own, which he said only weighed one
drachm twelve grains. He had nasal inhalers to wear on
either nostril, changing from one to the other when you
pleased. He had also a little inhaler for the mouth, to
hold in either corner, and remarked that you could go
on talking with it in. He created great amusement by
continuing his speech with the oral inhaler first in one
comer of his mouth and then in the other.
Professor Gairdner of Edinburgh referred to the views
of Dr. MacCormac, of Belfast, who held that the cause
of phthisis was breathing and rebreathing the same air.
He could not subscribe to Dr. MacCormac's views in
their entirety, nor could any one, he thought, in the
present state of pathology. He could not believe that
rebreathed air in itself produced phthisis. He referred
to miners' lung and other conditions caused by air laden
with foreign matter — these were not phthisis. He, how-
ever, believed impure air to be an important condition in
the causation of phthisis, even more so than exposure to
cold, wind, or damp. He supported Koch in his views.
He also believed in the transmission of phthisis heredi-
tarily, but he did not see how this could take place by
means of bacilli. He could not conceive of bacilli being
given off in the semen or finding their way into the
ovum.
In the Section on Public Health, on Wednesday, Dr,
Barthe de Standfort, of Dax, read a paper in French, on
the " Disinfection of Ships after Infective Diseases," in
which he maintained it was impossible to thoroughly dis-
infect a vessel in the number of days allowed for quaran-
tine. He believed the best disinfectant to be sulphur-
ous acid, which had been recommended to the United
States Government, but not adopted on account of
its cost He held that an infected vessel should be
thoroughly washed, then fumigated for twenty-four hours,
and afterward subjected to very complete ventilation for
four or five days.
He was well received, and at a later stage warmly
thanked his audience, and said he should carry back to
France a lively recollection of his kindly reception in
Belfast.
Mr. Kirker, R.N., read a paper on **The Cholera
Epidemic in E^ypt, 1883," in which he said there were
only 8 victims m Port Said, a filthy town of 17,000 in-
habitants, and thought that Koch had not sufficient war-
rant for predicting that the disease would spread from
Toulon all over Europe. He believed that the British
Isles would this year escape, chiefly on account of re-
cent changes in the weather, with its rain and brisk
breezes. He regarded a hot, stifling, stagnant condition
of the air as the great danger, but while purifying winds
lasted he would say, ** Fear not the cholera of Toulon
and Marseilles." It was more important to find out the
conditions of life of the individual in his home than to
look for germs.
Dr. Cullimore, of London, in a paper on "Quaran-
tine," said that people would prefer the risk of cholera
220
THE MEDICAL RECORD.
[August 23, 1884,
to the rigid application of quarantine, which was not
likely to be carried out successfully for any length of
time. Quarantine by sea could be defended by argu-
ments inapplicable to sanitary cordons and other at-
tempts at isolation on land. A well-managed ship at
sea lying off a port afforded the opportunity of stamping
out a disease which was never offered on land.
Dr. Davies, Medical Officer of Health for Bristol, con-
demned compulsory notification, which he found quite
unnecessary in his district of 220,000 inhabitants. He
had seen as much cholera as most practitioners for in
the first epidemic 2,000 died in Bristol. When threat-
ened they put their drains under disinfection with large
quantities of sulphate of iron. Ships were entering the
port from Marseilles and cases might be brought in, but
he defied them to spread. He did not much believe in
gaseous disinfectants.
Dr. Cameron, M.P., Medical Officer of Health for
Dublin, and President of the Section, said he did not be-
lieve in land quarantine, but he did in a well-established
naval quarantine. He was in favor of washing the inte-
rior of infected dwellings with soap and water. He found
dry chlorine and sulphurous acid would not kill bacteria
but solutions would.
Dr. Grimshaw, Registrar- General for Ireland, spoke in
favor of the notification of diseases, and though the re-
sults had not up to the present time been favorable, he
thought that was because the notification had only been
carried out partially. To be effective it would require
to be reciprocal between the various districts, and even
through the country at large.
THE MUSEUM.
The annual exhibition of objects of interest in connec-
tion with medicine, surgery, and the allied sciences, took
place in the Exhibition Hall, Botanic Gardens, and in
the Queen's College. Subsection A. — i. Preparations,
diagrams, casts and models of anatomical and pathologi-
cal objects, microscopes and microscopic preparations.
Subsection B. — 2. Surgical and medical instruments and
appliances, thermometers, and other instruments for
scientific investigation. Subsection C. — 3. Foods, drugs,
chemicals, and pharmaceutical preparations. Literary
and Sanitary Subsection D, — 4. New medical books. 5.
Ambulances, carriages, and other means of locomotion for
the use of medical practitioners. 6. Sanitarv appliances,
including drawings, models, and apparatus, illustrative of
the ventilation of hospitals, public buildings, and private
dwellings. 7. Plans and models of hospitals, public
buildings, and private dwellings, constructed upon the
most improved hygienic principles. 8. Recent improve-
ments in hospital furniture.
In the Pathological Section I noticed more particularly
the following among many other objects. Sketch of
elephantiasis labii and plaster cast of the tumor — removed
by Mr. Fagan, of Belfast. Specimen of male gen-
erative organs, showing operation of cleft urethra as
practised among the aborigines of West Australia — Dr.
W. Whitle, Belfast. Ruptured intestine caused by crush
without external injury — Dr. James Barrow, Belfast.
Recent Colles' fracture, third day — Dr. James Barrow,
Belfast. Several specimens (about forty) of Colles' frac-
ture— from Queen's College Museum. Bread-cart frac-
ture of tibia and fibula — Dr. James Barrow, Belfast.
Colored drawings of skin diseases — Dr. C. F. Moore,
Dublin. Ten jelly preparations of eyes, showing various
diseased conditions — Mr. Juler, London. Thirty eye
preparations — Mr. A. Hill Griffitlis, Manchester.
In the Surgical Instrument Department there were ex-
hibits by many of the leading firms. Messrs. Steel &
Sons, of Belfast, showed specimens of surgical and other
instruments plated by them. Dr. C. Godson exhibited
a thermostatic nurse for the bringing up of prematurely
born infants, and a four-bladed perforator. He gave a
demonstration (on the foetus) of the latter on Friday,
August I St. Messrs. Wilson & Son, of Harrogate, ex-
hibited Dr. Oliver's urinary test-papers. Among them
was a new cupric test-paper for sugar. A paper is boiled
in a drachm of water for a few seconds, then removed,
the solution reboiled, and one drop of the suspected
sugar added, when, if any be present a yellowish opacity
appears throughout the fluid.
SPECIAL MEETINGS.
Medical Sickness^ Annuity, and Life Assurance Society,
—The First Annual Meeting of the Medical Sickness, An-
nuity, and Life Assurance Society was held in the Greek
Lecture Room, Queen's College, on Thursday, July 31st,
at 12.30 in the afternoon.
New Sydenham Society. --TYit Annual Meeting of the
Society was held on Thursday, July 3TSt,at 9.30 o'clock,
in the Greek Lecture Room, Queen's College— Sir W.
MacCormac in the Chair.
Poor Law Medical Officer^ Association, — ^The Annual
Meeting of the Association was held on Wednesday, July
30th, in the Greek Lecture Room, at i o'clock in the
afternoon. Dr. Joseph Rogers, of London, Chairman
of Council, presided.
Irish Graduated Association.--The Annual Meeting
of the Association was held on Wednesday, July 30th, at
5 P.M., in the Library, Queen's College. The President
of the Irish Graduates' Association, Professor G. F. Yeo,
M.D., was in the Chair.
Meeting of Members of the Royal College of Surgeons,
—A Meetingof Members of the Royal College of Surgeons
was held in the Greek Lecture Room, on Thursday, July
31st, at 5 o'clock in the afternoon.
OUR LONDON LETTER.
(From our Special Correspondent.)
THE HOLIDAY SEASON AND THE HOSPITALS — CHOLERA
AND PRECAUTIONS AGAINST IT — OUTBREAKS OF ENG-
LISH CHOLERA — THE VOLUNTEER AMBULANCE CORPS.
London, August 9, 1884.
The holiday season may be said to have fairly set in,
and although Parliament is still sitting, both doctors and
their patients are running off" to the country wholesale.
At many of the hospitals a large proportion of the staff
have gone off for their holiday, and left the bulk of the
work to be done by a few of their junior colleagues.
At the larger hospitals August and September are pot
by any means the worst months to see hospital practice.
It is true that then most of the ornamental members of
the staff are away, but so are the great majority of the
students, and cases can be examined at leisure without
the overcrowding met with during the session.
No case of Asiatic cholera has yet occurred in Great
Britain, although several false alarms have been raised.
Any ships arriving from which there has been any reason
to dread infection have been promptly disinfected. The
Metropolitan Board of Works are taking measures to
deodorize the sewage of London at a daily cost of be-
tween seven and eight hundred pounds. I understand
that at present about thirty tons a day of chloride of lime
are being used, and. three or four tons of permanganate of
potash. The College of Physicians has issued a paper
of directions as to precautions to be taken against the
cholera.
Several outbreaks have occurred of so-called English
cholera in different parts of the country, and some deaths
are reported. A deficiency in the water-supply is al-
leged to be the cause. This has doubtless led to the
use of impure water.
The Volunteer Ambulance Corps got up amongst the
students of the London hospitals has already attained
some success. I believe nearly every one of ,the eleven
medical schools in London has now its own corps.
Charing Cross Hospital contributes perhaps the largest
number, although having by no means the largest num-
ber of students. This is explained when I state that the
August 23, 1884.]
THE MEDICAL RECORD.
221
movement was started largely through the efforts of Mr.
Cautlie, one of the surgeons to that institution. The
total number of members enrolled now reaches nearly
two hundred. I am afraid that many of them have not
as yet learned to observe due discipline, as I have been
informed by a member that, at some of the parades
which have taken place, about half of those in the ranks
were talking and laughing. In the corps of some hos-
pitals too large a number of officers have been appointed,
so that at some drills more officers than men have made
their appearance.
One must not, however, be too captious, especially
considering that it is volunteer work, and work, too,
rather outside the area of ordinary medical studies. It
is quite as laborious as cricket or foot-ball, but probably
not so enjoyable. Lifting about heavy men and manoeu-
vring with heavy stretchers, is by no means play in the
hot weather we have lately had. Four bearers carry
each stretcher, but one of the movements in the drill
consists in transferring the whole weight to the shoulders
of one bearer, leaving the other three free.
The utility of the organization will, it is thought,
mainly consist in the fact that, when its present members
have gone through their hospital career and are scattered
all over the country, each of them will, so to say, form a
centre whence a similar movement can originate. In
remote country districts each medical man who has been
a member of the Volunteer Ambulance Corps will be
competent to start a local corps, drill and train it. The
advantage this will be, should we ever be at war, is obvi-
ous.
^rms and ^xrg ^evas.
OfidalListcf ChangisiniheSiaiUms and Duties cf Ojfiars
urving in tht Medical Department^ United States Army^
from August 10 to August 16, 18S4.
Bartholf, J. H., Captain and Assistant Surgeon,
Relieved from duty at Vancouver Barracks, Wash. Terr.,
and ordered to take station at Portland, Ore. S. O. 114,
])ar. I, Headquarters Department of Colorado, August i,
1834.
Heizmann, C. L., Captain and Assistant Surgeon.
Ordered to proceed to Fort Ontario, N. Y., and report
for duty. S. O. 163, par. 3, Headquarters Department
of the East, August 13, 1884.
Kane, John J., Captain and Assistant Surgeon.
Granted leave of absence for one month. S. O. 160,
par. I, Headquarters Department of the East, August
10, 1884.
Medical StjenxB.
Oficial List of Changes in the Medical Corps of the U. S.
Navy^ during the week ending August 16, 1884.
BoGERT, E., Medical Inspector. To be Fleet Sur-
geon, Asiatic Squadron.
Babin, H. J., Surgeon. Detached from U. S. S. Min-
nesota. Ordered to Marine Rendezvous, New York.
Whiting, R., Passed Assistant Surgeon. Detached
from Marine Rendezvous, New York. Ordered to Naval
Academy, as Member of Examining Board
Cooke, G. H., Surgeon. Ordered to Naval Academy,
as Member of Examining £oard.
RiXEV, P. M., Passed Assistant Surgeon. Detached
from special duty at Washington. Ordered to U. S. S.
Lancaster.
WooLVERTON, T., Siu-geon, Ordered to U. S. S. Min-
nesota.
Contagious Diseases — Weekly Statement. — ^Re-
port of cases and deaths from contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the week ending August 16, 1884 :
Week Ending
Ei4
1
£
l^
j
j
1
1
Ctues,
Aucrust 0. i88j.
0
7fi
35'
34
3
2
7^
?R
0
0
August 16, 1884
2
30
5=
34
0
0
Deaths.
Aucrust 0. i88j.
0
7
7
3
2
^n
I?
n
0
August 16, 1884
0
3
2
7
13
0
0
Gum Ammoniac contains a small amount of volatile oil
which is somewhat irritating to the skin and mucous
membranes, and is eliminated through the bronchial and
perhaps the mucous membranes. It is chiefly used in
chronic bronchitis and bronchorrhoea, but is far more use-
ful in mucous and torpid conditions of the stomach and
bowels and perhaps urethra. A pill with one or two
grains of aloes and the same of ammonia is often better
than the aloes and myrrh pill. Some attribute virtues
to it in cirrhosis of the liver and other organs, but
muriate of ammonia is better.
Hydrochloric Ether, or chloride of ethyl, or muriatic
ether, is almost identical in its effect with sulphuric ether.
But it is so volatile and inflammable as to be almost un-
manageable in practice. It is sometimes put in Hoff-
mann's anodyne as an agreeable substitute for sulphuric
ether. Hydrochloric or muriatic ether is used in medi-
cine in solution, and is formed in the muriate tincture
of iron, where it is highly prized, and to which more
could be added to great advantagS.
Hydrobromic Ether is obtained from bromine and
alcohol in the presence of phosphorus. It is colorless,
volatile, has a very strong ethereal odor, and a warm,
sweetish taste. It bums with difliculty and is sparingly
soluble in water, but is soluble in alcohol and ether. It
has the same efiects as hydrochloric ether, and produces
anaesthesia without excitement or suffering. It has been
inhaled for sleeplessness. It may be used in place of
hydriodic ether.
To OBTAIN Hydriodic. Ether, distill absolute alcohol
and hydriodic acid together, or alcohol, phosphorus, and
iodine. It is non-inflammable, but has a peculiar pene-
trating, powerful ethereal odor. It is nearly insoluble in
water, but soluble in alcohol. Exposed to air and light
it liberates iodine. Dose : ten or fifteen drops inhaled
several times a day from a handkerchief to bring the
system rapidly under the influence of iodine in chronic
bronchitis and consumption, but more especially in leu-
cocythsemia, pernicious anaemia, enlargement of the liver
and spleen.
Acetic Ether is made from acetate of sodium, 8
parts; rectified spirits, 5 parts, and sulphuric acid, 10
parts ; distilled together. Sulphuric acid is first formed.
It is colorless, limpid, and volatile, having an agreeable
refireshing ethereal odor, and is less inflammable than sul-
phuric ether. It dissolves in all proportions in alcohol and
ether, also in eleven or twelve parts of water. It dis-
solves a little phosphorus and sulphur. When inhaled it
produces perfect unconsciousness, without as much pre-
vious struggling as sulphuric ether, and is less volatile.
From its pungency and agreeable odor, its stimulant and
anti-spasmodic qualities, it is used for several of the
222
THE MEDICAL RECORD.
[August 23, 1884.
minor purposes of sulphuric ether, especially in syncope
and in nervous agitation. Dose, 30 minims, properly
diluted Externally, it may be applied wherever sulphu-
ric ether is appropriate. Its agreeable smell and almost
equally powerful action renders it a good substitute for
sulphuric ether in Hoffmann's anodyne, in the treatment
of flatus and gastralgia, but especially in nervous or hys-
terical sick-headache. It is also used in minor opera-
tions where only the first stages of ether action are
required.
Formic Ether was discovered by Bucholz in 1782.
It is made from 8 parts formate of soda, 7 parts alcohol,
and 1 1 parts sulphuric acid, which are distilled together.
It has a strong agreeable odor, like peach kernels, but a
pungent taste. It dissolves in nine parts of water and in
alcohol. It readily undergoes decomposition into alcohol
and alkaline formiates through the alkali of the blood.
It lowers the temperature 3^ C, and induces signs of
asphyxia, but not so markedly as chloroform ; also mus-
cular relaxation and anaesthesia for several hours ; i or 2
c.a and 4 to 6 c.c. in dogs, cause less asphyxia, but
more somnolence and lowering of temperature, without
complete abolition of sensibility, 6 or 8 grains causes
only drowsiness in man ; it gets into the urine. Formic
and acetic ethers are largely used in combination with
other compounds of methyl, ethyl, and amyl, in the*
manufacture oi fruit essences, which, with the exception
of the essence of orange, are rarely, if ever, made from
the fruits after which they are named. But the addition
of formic ether to sulphuric ether has been suggested, on
account of the great reduction of temperature which it
causes, for inhalation in surgical operations, which, like
ovariotomy, are apt to be followed by extensive inflam-
mation.
Picric Acid, or carb-azotic, is formed by the action
of nitric acid on salycin and its derivatives, on phloridzin,
indigo, aloes, benzoin, silk, etc. It gives ofl" yellow,
suflbcating vapors, is acid, and extremely bitter of taste.
It is soluble in water, alcohol, and ether, and stains the
skin permanently yellow. Its aqueous solution precipi-
tates gelatine. Its salts are mostly yellow, and have a
bitter taste. Potassium picrate dissolves in 260 parts of
water. Given continuously to rabbits, it causes emacia-
tion, diarrhoea, ecchymosis of the intestines, and yellow-
ness of the conjunctiva and urine. In large doses '\X,czm%^^
nausea, diarrhoea, and flatulence, with debility, and
twitching of the cutaneous muscles. It partially dissolves
the blood-disks, and in the white corpuscles the nuclei
exhibit a lively molecular movement. In man it causes
yellowness of the eyes, skin, and urine, and is supposed
to illustrate the mode of production of jaundice in certain
cases, as in yellow fever and acute yellow atrophy of the
liver. It is a supposed remedy for acholia^ or entire de-
ficiency or suppression of the secretion of bile. Picric
acid is trinitophenol, or a trinitophenic acid, and is now
generally derived from phenol. Its intensely bitter taste
gives it its common name, from pikros, bitter. If heated
suddenly, it and its salts explode with violence. It stains
animal tissues yellow, and is used by histologists ; is
largely used in dyeing, and is fraudulently added to beers
to make them bitter. It is of value in toxicological
analysis, as it antidotes and precipitates alkaloids from
their solutions.
Oxalic Acid exists in combination with ammonia, in
guano, with calcium in many plants, such as rhubarb,
curcuma, ginger, squills, orris, valerian, quassia, and as acid
potassium oxalate in phytolucca, belladonna, rumex, and
oxalis, most lichens, and many vegetables. Some urinary
calculi consist of oxalate of calcium. It is also found in the
gall-bladder, in uterine mucus, and in urinary sediments.
It is formed by the action of nitric acid on most or-
ganic compounds ; even sugar, gum, and sawdust yield
oxalates when heated with hydrate of potassa or sodium.
It is generally made from sugar, molasses, or starch, with
nitric acid ; one hundred parts of sugar make fifty-eight to
sixty of oxalic acid. The dark mother liquids left in the pre-
paration of tartaric acid yield it. Treated with glycerine,
it is decomposed into carbonic and formic acids. Acid po-
tassium oxalates, called salts of sorrel or salts of lemon, will
remove iron stains from paper, linen, and leather, but
oxalic acid is generally used. Its taste is intensely sour.
Large doses cause vomiting, with burning pain and con-
striction of the throat and stomach. The vomits are
dark-colored, and may contain blood. When the pain is
very severe, collapse may ensue, with drowsiness. Some-
times the symptoms are unaccountably long delayed
Some patients may live to the twenty-third day, but death
may occur in from three to twenty minutes, or eight hours.
Dark discoloration of the oesophagus, stomach, gelatini-
form softening of the stomach, and even perforation of it
may occur. The blood is said to be universally bright in
color. Antidotes : Chalk in water, slaked lime, dtied white-
wash, etc. It is one of the mobt rapid and unerring of the
common poisons, and hence has rarely been used in the
treatment of disease. Still it can be as safely handled as
arsenic, aconite, or atropine. It has been suggested in
an induration of the stomach and sclerosis of other or-
gans, especially of the brain and spine, in which it causes
softening. It seems to have a specific action on the
lumbar and dorsal spinal cord. In one case there was
great weakness and numbness of the legs and back, so
that the patient could scarcely stand, much less walk.
In another case the first thing complained of was acute
pain in the back, gradually extending down the thighs,
occasioning ere long great torture. In a third case the
patient complained more of the pain shooting down from
the loins to the thighs and legs, than of the pain in
the belly. In a fourth case there was numbness, ting-
ling, and pricking in the back and thighs. In a fifth case,
there was almost complete loss of power and motion in
the legs, which did not pass off for fifteen days. It evi-
dently must be suited to diseases of the spinal cord, op-
posite, or very different from those which it produces.
The only preparations which are used are the oxalates
of cerium and iron. The former sometimes controls
vomiting, due to reflex irritation from pregnancy, nervous
and uterine derangements. It is very insoluble, and
hence often inert, and has been given in doses of firom i
to 8 grains three or four times a day. The oxalate of iron
is also comparatively insoluble, and hence nearly inert
Hvdrobromate of Quinine consists of potassii bro*
midii, gr. 162 ; acid, tartaric, gr. 198 ; quinise sulph.,
gr. 60 ; aquae, | iij. Filter. Dose, 30 to 60 minims. For
hypodermic injections and for intermittents with con-
gestion of the brain or spleen.
Hydrobromic Acid has an agreeable, acidulous taste,
and most of the physiological and therapeutical actions
of the bromides, while it is far less apt to cause acne. It
is also a corrigent to iron, and prevents the headache so
often accompanying its full action and that of quinine.
Added to a mixture of quinine and water, it will make a
clear solution in the proportion of two minims to each grain
of quinine. Added to aconite, it is one of the most sooth-
ing and efficacious remedies in fevers and inflammarions at-
tended with great nervousness, restlessness, even delirium.
It is said not to be useful in epilepsy. Dose of the
dilute acid, 30 to 60 minims, largely diluted in water.
Normal Valerianic Acid is a butylformic acid, ob-
tained by the oxidation of normal amylic alcohol ; it is
an oily liquid, and has an odor resembling that of butyric
acid. Ordinary valerianic acid is delphinic acid, discov-
ered by Chevreul in 181 7 in the oil of the porpoise
{Delphinum phocena\ and subsequently in the valerian
and angelica roots. It is also formed during putrid fer-
mentation or oxidation of albuminoid substances, and
occurs in the urine and faeces in typhus fever, variola,
and acute atrophy of the liver. It is an oily, colorless
liquid, with a penetrating odor, like a mixture of valerian
and old cheese, and sharp acrid taste. It dissolves in
thirty parts of water, and in alcohol and ether in all pro-
August 23, 1884.]
THE MEDICAL RECORD.
223
portions. It is a little remarkable for dissolving phos-
phorus. It is found in the flowers of Anthemis nobilis,
or chamomile, and wormwood, but is prepared almost ex-
dasively by oxidizing amylic alcohol with bichromate of
potash and sulphuric acid. Given with water it is less
disagreeable, and leaves a sweet after-taste. Valerianic
acid bears the same relation to amylic alcohol that acetic
add does to ordinary alcohol Its neutral salts are in-
odorous when dry, and may be given in wafers. Apple-
oj], from applejack, is amyl valerianate. It coagulates
albumen, serum, milk, and is slightly irritating to the
skiiL Its odor is not imparted to urine and blood, but
may be perceived in the peritoneal cavity, which renders
it useful in some peritoneal diseases, especially false peri-
tonitis. It quickens the heart's action and respiration,
then produces debility. In rapid death from it the gastric
mucous membrane is pale, hence it produces paralysis or
collapse of it. Valerianic acid is not used alone in medi-
cine, and its combinations are useless except the valeri-
anate of ammonia. Angelica archangelica is rarely used
in this country, but it is far more agreeable, and quite as
efficacious. Valerian contains one or two per cent, of an
essential oil, the dose of which is two to eight minims,
and is said to reduce the reflex excitability, motility, and
sensibility, and even to antagonize the tetanizing action
ofbrucia. The chief use of valerian is in the treatment
of nervousness, hysteria, and hysterical disorders gener-
ally. There is no doubt as to its great value in these
cases. In epilepsy, chorea, and paralysis agitans valeri-
anic acid is to be preferred. The elixir of the valerianate
of anmionia is not nearly as useful as the tincture, solid
or fluid extract, or the oil, or acid. It has not yet been
used in combination with phosphorus or camphor.
Cancer Statistics in England. — At the Cancer
Hospital, Brompton, 1,974 cases of true cancer were
treated either as out-patients or in the wards. Of these
841 were cases of epithelial cancer, 438 occurring in
males, 403 in females ; 1,069 were registered as ** scirr-
hos," 54 in males, 1,015 ^ females ; 64 were registered
as "soft or medullary cancer," 18 in males, 46 in females.
Cases described as " osteoid " and ** colloid " are not in-
dnded in the above computation. The following statis-
tical statements regarding the above cases of scirrhous
and epithelial cancer have been prepared at the hospital :
Average duration of disease previous to coming to hospi-
tal: sdrrhus, 15.23 months; epithelial, 20.5 months.
Had relations previously affected with cancer, 81. Aver-
age age when attacked : scirrhus, 48 years ; epithelial,
51 years. Had been previously operated on : scirrhus,
138; epithelial, 102. Average lapse of time before dis-
ease returned: scirrhus, 21 months; epithelial, 20
months. Cases ascribed to blow or injury : scirrhus, 60 ;
epithelial, 18. — British Medical Journal,
The Treatment of Dysentery with Corrosive
SuBUMATK AND CoLOCYNTH. — Dr. S. B. Childs, of Brook-
Ip, writes : '* The methods ordinarily advocated for the
treatment of dysentery being generally unsatisfactory,
and for the reason, to my mind, of being irrational, I
vould fain bring before the medical profession a mode
of treatment that at my hands has produced desirable re-
sults. Pathologically considered, we have in dysentery a
localized inflammation, either catarrhal or fibrinous, of
the mucous and submucous membrane of the lower in-
testinal tract That one case may be wholly catarrhal,
mother case wholly fibrinous, or that the catarrhal may
nin into fibrinous, has been amply proven. With any
of these conditions present the majority of medical wri-
ters still advocate sugar of lead, opium, etc., ad nauseam.
Hardly a mixture is given that does not contain more or
less opium. Now, paxalyzing the contractility of the intes-
tinal walb by this nervous sedative certainly does not
care. Castor-oil and Epsom salt have been recom-
mended, but generally in too large doses, and then withal
they invariably have as an adjunct some preparation of
opmm. Having an inflammation of a severe type, it
would seem a desideratum to give some form of medicine
that would produce an alterative action directly in the
tissues involved, and yet at the same time not to excite
any disturbing influence on the system at large. Now,
we have in small doses of bichloride of mercury just what
will answer this requirement. The griping pains and
tenesmus that are so distressing in this complaint can be
readily controlled by tincture of colocynth in minute
doses. My mode of procedure is to give the mercury
alternately with the colocynth, and on the pain being re-
lieved to supersede the colocynth with the tincture of
ipecac." Dr. Childs then gives notes of two cases illus-
trating the eflicacy of his treatment. In the early acute
stage he gave tincture coloc3mth in gtt. -^ doses, alter-
nating every half hour with corrosive sublimate, gr. -j^^.
Musk. — Although musk has been long well known in
the West, yet, says Dr. Macgowan in his report on the
health of Wenchow (** Imperial Maritime Customs "), it
seems worth while to translate what Chinese writers have
to say about it. The musk-deer is found throughout the
mountains of Yiinnan, Szechwan, and Thibet ; it is a
timid little animal, and often dies of fright. It feeds on
juniper-leaves and reptiles ; snake-bones are found in its
stomach. In spring its glandular pouch is greatly swollen
and inflamed. The secretion is discharged with the
urine. Musk-deer always resort to the same place for
micturition, and cover their urine with earth. In such
places deposits of a superior quality are found, amount-
ing sometimes to fifteen catties (a catty is a Chinese
weight of about one and one-third pound). The arti-
cle which is most prized is that which falls from the musk-
deer on to the ground, and is gathered in grains that are
as precious as pearls. These deposits are so [pungent
that, i£ carried through a garden or woods, it prevents
fructification. The poisonous effect of fresh musk on
vegetation is shown also by the blighted appearance of
places which the musk-deer selects for its convenience.
For some distance around these places there is an ab-
sence of plants, and farther off the leaves exhibit a yellow
tinge. This valuable substance no^ sooner leaves the
hunter's hands than skilful manipulators adulterate the
article for wholesale dealers, who further adulterate it
for the trade, by which time it contains only about ten
per cent of genuine musk. Musk is said to be an an-
thelmintic, and to cure the bites of venomous serpents.—
Lancet.
Mr. Lawson Taft on Pneumonotomy. — Mr. Law-
son Tait has written to the British Medical Journal the
following letter, which we believe most persons will agree
is an eminently sensible view of the case : " Sir : I think
the facts that the idea of the application of surgery to the
diseases of the lungs occurred to Sir Spencer Wells forty
years ago, and to others before him ; that all of us en-
gaged m the surgery of the abdomen must have, as I
have often done, restlessly discussed the possibility of
passing above the diaphragm ; and yet that nothing has
been done, form a sufficiently trenchant statement of the
case. Nothing has been done beyond the drainage of
old suppurating pleurisies, and possibly a few gangrenous
vomicae ; and I do not think it is likely that we shall go
much beyond this, in spite of Dr. Biondi's experiments.
I have had several cases of thoracic disease sent to me,
with the tempting request that I should attempt an oper-
ation ; but I have never seen my way to the effort, they
were all so clearly cases of malignant disease. I cannot
imagine that any man in his senses would attempt to re-
move a human lung with a tumor in it. It would not be
resection of parts of four ribs which would permit the re-
moval of a tumor sufficiently large to adinit of accurate
diagnosis ; and I cannot observe, in the literature just at
the moment accessible, that any other kinds of tumors
occur in the lung, save those of hydatid origin, and those
of a cancerous nature. If the tumor were hydatid, the re-
moval of the lung would be unnecessary. If the tumor
proved to be an aneurism, the disaster would be awful.
224
THE MEDICAL RECORD.
[August 23,1884.
For phthisis, I imagine removal of the lung would be a
still more absurd proposal. If one lung were riddled
with vomicas, the chances of the other lung being affected
would amount to certainty. If there were only one lar^e
cavity, not of tubercular origin, or very chronic in its his-
tory, drainage would suffice. The £aicility with which Dr.
Biondi has removed lungs, and parts of lungs, from dogs,
guinea-pigs, cats, fowls, pigeons, and sheep, and the ab-
sence of mortality from such operations, is likely to be a
snare rather than a help. It does not need saying that
the removal of a healthy lung, collapsed by the introduc-
tion of air into the pleura, would be a very easy matter,
and very different from the removal of a diseased and
adherent organ. There would be as much difference
as there is between normal ovariotomy and removal of
a pyosalpinx. It is perfectly clear that these animals,
with their deep and narrow chests, differ very much from
us, with our wide and shallow cavities, in their powers of
enduring the accident of acute pneumothorax; certainly
they would differ from us immensely in the facility with
which pneumonotomy may be performed. Their chests
are built for the endurance of the special efforts of great
speed, and we have lost those physical characters ; and
I venture to say that, if acute pneumothorax were sud-
denly inflicted upon sixty-three healthy adult human
beings, death would be the immediate result in the great
majority of the experiments. The analogy between ne-
phrectomy and pneumonotomy, of which Sir Spencer
Wells makes use, is also a misleading one ; for the func-
tions of the kidney may be interfered with to a consider-
able extent, and even entirely for a considerable period,
without apparent trouble ; but we have no proof that this
is probable in the case of the lung. The only experiment
I ever saw in this direction, the result of an accident, re-
sulted in immediate death. I do not think the severest
critic can say of me that I have any tendency to obstruct
surgical progress; but it seems to me that neither d
priori reasoning, nor clinical experience, will lead us
further than we have got in pulmonary surgery — drain-
age, with the useful addition of costal resection in old-
standing empyema ; and I am quite sure that we may
regard Dr. Biondi's experiments as the outcome of the
work of an enthusiast, misleading in their tendency, and
dangerous for any practicable application which might
be made of them. — I am, etc, Lawson Tait."
The History of the Discovery of the Circula-
tion, recapitulated, divides itself naturally into a series
of epoch-making periods : i. The structure and func-
tions of the valves of the heart, £rasistratus, B.C. 304.
2. The arteries carry blood during life, not air, Gsden,
A.D. 165. .3. The pulmonary circulation, Servetus,
1553. 4. The systemic circulation, Csesalpinus, 1593.
5. The pulmonic and systemic circulations, Harvey,
1628. 6. The capillaries, Malpighi, x66i. — I)r. Henry
C. Chapman.
Perforating Gunshot Wound of the Stomach
AND Liver. — Dr. R. M. Stone, of Omaha, Neb., sends
us the following: *'I was called on May 20th, 1884, to
see Mike P , who 'was shot in the bowels.' I found
a young man of twenty-four, hearty and vigorous in ap-
pearance, lying in a state of unconsciousness, with a bul-
let wound of entrance, badly powder-burned, beneath the
mar^n of the left tenth rib and three inches from the
median line, and a wound of exit over the right tenth rib.
The patient's pulse was good, and though he was suffer-
ing from shock yet there was no evidence of collapse
from serious internal hemorrhage. I had determined on
my way out to the case to perform laparotomy if there
was evidence of serious internal hemorrhage, but finding
no evidence of such condition, and no definite evidence
of perforation of the stomach, I determined to treat the
case expectantly, but saw no reason to hope for favora-
ble results. Dr. James Carter saw the case with me in
the evening, and agreed with me in the very unfavorable
prognosis. The patient died nineteen hours after re-
ceiving the wound, and at my request Dr. M. A. Robert
made the autopsy. We found that the abdominal cavity
was partially filled with bloody fluid, consisting largely of
lemonade, which had escaped from the stomach. The
ball, a 44-calibre, had wounded the omentum, entered
the stomach along the greater curvature, emerged one-
half an inch from its entrance, then entered the liver just
above the gall-cyst, ploughed its way through two and a
half inches of the liver, and then entered the right ab
dominal wall, fracturing the tenth rib and emerged over
it The autopsy demonstrated that a laparotomy could
not have been useful, for, though the wounds of the
stomach could easily have been sewed up, yet the lesion
of the liver and the violent peritonitis that must have en-
sued, together with shock, would have proved fatal"
Extra-Uterine Pregnancy Ending in Suppurat-
ing Cyst of Ten Years' Standing — PERiTONms—
Autopsy. — Dr, G. C. Park, of Murraysville, Pa., writes :
" It may be of interest to the readers of The Medical
Record to recite through the columns of your journal a
brief history of the case of the wife of Dr. W. J. R — -^
of Newlonsbury, Pa. She became pregnant for the first
time in December, 1873, ^^^ ^^^ ^ protracted labor of
five days was delivered by instnunents on September
14, 1874. Sl^c made a good recovery, being able to
attend to her ordinary household duties, and only com-
plained of slight pain below the umbilicus and to the
left of the median line about April, 1875. ^^^ con-
tinued to perform the duties of a mother and housewife,
though there was slight tumefaction near the sigmoid
flexure of the colon ; and in May or June of the same
year (1875) >^^ passed, by the bowels, a quantity of
pus, estimated by her husband at from a pint to a quart.
In 1878, she passed a quantity of hair by the bowels.
In 1882 she passed a laige quantity of pus with a roll of
hair estimated at from three to four inches in length,
and one line in thickness. On May 11, 1884, seven
weeks aflter her eighth labor, one of which was a prem-
ature, and while dressing her hair, she was suddenly
seized with a pain below, and to the left of the umbilicus,
accompanied by chilly sensations, but no rigor. Symp-
toms of diffused peritonitis were soon manifest. On
May 19th she died, aged thirty-four years and thirteen
days. By her own request we were permitted to have
an autopsy, which, with the assistance of Dr. Ewing, I
conducted. On opening the abdominal cavity pus oozed
out, which was preserved and estimated at a quart
The bowels were all glued together by recent adhesions.
Pus extended from the bladder to the diaphragm. The
left lung was adherent to the posterior thoracic wall. At-
tached to the sigmoid flexure of the colon was a tumor
not much larger than an ordinary - sized hen's egg.
This was divided and revealed three teeth, one very
large and the shape of the canine of the adult Coarse
dark hair lined the sac containing the teeth. A mass
weighing about a pound was found beneath the foetal
tumor, placental-like in consistency, ragged and highly
vascular. The right ovaiy showed a small ovarian tumor
and was itself hypertrophied. The stnmge features of
the case «are these : i, her health was good during all
this time ; 2, the long time and no interference with
pregnancy and delivery ; 3, pus formed and escaped by
the bowels without any premonitory symptoms. On May
nth the pus-sac broke, discharging the contents among
the bowels, resulting in the death of the poor woman,
over whose head the sword of Damocles had been sus-
pended for near ten years."
Rectal Etherization. — Dr. S. Banich, of this dty,
writes : ^' Apropos of rectal etherixation, I am glad yon
are giving prominence to the fact that it is dangerous. I
was just on the eve of adopting it in an operation for
trachelorrhaphy after hearing it highly commended by, and
afler seeing it act beautifully in the practice of, one of our
best surgeons. On my next visit, however, I learned
that a patient had died purely from the effect of rectal
etherization, the whole intestinal canal having been found
hemorrhagic."
^,.-/5iOA.'L l:£;:,
The Medical Rec
A Weekly yournal of Medicine and Surgery
..>>
ii.'.
Vol. 96, No. 9
New York, August 30, 1884
Whole No. 721
<3^0itmt l^rtictes.
ON HAY FEVER AND ROSE COLD.
By MORELL MACKENZIE, M.D. Lond.,
CDNSDLTmC rOfTKUM TO THB HOSPITAL FOK EHSSASBS OF THB THKOAT : LBC-
TVm 0:« DISBASBS OP THB THROAT AT THB LONDON HOSPITAL MBDICAL
COLLBOB ; UiTB PHTSIOAN TO THB LONDON HOSPITAL.
In a lecture on hay fever, delivered not long ago at the
London Hospital Medical College (see British Medical
Jwrnal^ May 7, 1884), the present writer alluded to the
complaint as one unknown in the *' good old times." Now,
tiioagb, both in letter and spirit, this statement is perfectly
correct, it too much ignores the fact that an individual
idiosyncrasy rendering people sensitive to the influence
of rose pollen was not very uncommon two hundred or
three hundred years ago. As the term " rose cold '' has
sorviyed in America, while it is quite unknown here, I
think it probable that the complaint may be much more
common on the other side of the Atlantic than it is in
England;, and it is with the view of eliciting some
'' modem instances " that I venture to bring under the
notice of my fellow-workers in the New World some re-
markable examples of rose catarrh as related by writers
of the sixteenth and seventeenth centuries.
As early as the year 1565, Botallus ' (known to fame
as the discoverer of the foramen ovale xn the heart) af-
firmed that he knew persons who held the smell of roses
in deadly hatred, because it gave rise to headache, sneez-
ing, and troublesome itching of the nose. Somewhat
later. Van Helmont ' (15 77-1644) mentions the odor of
sveet-smelling substances as causing headache, and in
some cases difficulty of breathing ; he also gives * the
case of a canon who was ioid astate propemodum asthmati-
cHSj Mdque hyetne liber. It must be allowed, however,
that this passage, though suggestive, is not quite con-
chsive as to the nature of the malady. In 1673 I. N.
finningarus^ says that he has often heard from James 4
ftmii, a professor of the medical faculty in the University
of Basle, that his wife, Ursula Faldsin (a lady, as he is
carefbl to inform us, whose charms were of the '< too, too
solid'' kind, ampli corporis et carnosi), suffered from
ooiyza for several weeks every year during the rose
season.
A few years later we find Ledelius * recounting ^e
case of a merchant of GrOnberg who could not smell a
rose without immediately suffering from itching, followed
hf inflammation of ^e eyes, wiSi profuse ladirymation
and headache lasting some da3rs. We come next to a
case of especial interest, which was published in 1691 by
L Constant de Rebecque.* This passage is important as
conveying the result of an experienced physician's ob-
servation of his own symptoms. He tells us that for
thirteen years he had been afflicted with coryza during
the rose season, which per totum tetnpus quo rosa se mihi
^jfaciendas prabent durat eoque elapso sponte desineU
'CoouBcnanoli duo alter Ae medici. alter de aegroti munere, Lugduni, 1565^
p. 13.
*A»hnaetTnsas, cap. x. (Opera Omnia, Hafhs, 1707, p. 344}.
'Ibid., cap. zxhr. (Opera Onmia, p. 346).
JOj». ct curat, mcdidnal ceatunae qubque centur. secunda, obs. Ixxxvi.
■?'**'f*"l*i '673, p. ^2^.
*UactIL Nat. Curios. Tipaiae, Dec. ii., Ann. a, Obf. 140, p. 309 (probably
* Atran Medidnn Helvetionim, Obs. rar. et curat insign., obs. 92, Geneva,
"9«. p. 150 « seq.
At first he attributed his sufferings to heat, but in the
year 1685, when the summer was exceptionally hot and
there were hardly any roses on account of caterpillars, he
was struck by the fact that his annual disorder did not
trouble him. The symptoms came on at once, however,
after inadvertently plucking a rose toward the end of the
He concludes that something flows from roses
season.
{e rosis aliguid effluere) which stings the nose (in his
case exceptionally sensitive) and aculeis quibusdam solu-
iionem continui et si non sensibus obviam excitet. This
observer, therefore, came very near the mark as to the
real cause of the disease, to which he applied the term
coryza a rosarum odore.
An extraordinary case is related by Herlinus * (on the
authority of Adrian Spigelius, whose name still survives
in one of the lobes of the liver) of a Roman cardinal,
Oliver Caraffa, who could not bear the smell of roses.
This is confirmed from p>ersonal knowledge by another
writer,* who adds that Caraffa was obliged every year to
shut himself up during the rose season, guards being
stationed at all the gates of the palace to stop any visi-
tor who might be wearing or carrying the dreaded flower.
It is, of course, possible that in this case the roses may
have produced some other affection than rose fever, but
as it is distinctly stated that it was the smell to which the
cardinal objected, we may, I think, fairly conclude
that the " sting of the flesh " which tormented him was, .
in fact, rose pollen.
About the end of the seventeenth century Riedlin re-
lates the case of a merchant with whom he was acquainted
who was afflicted with sneezing and catarrh every year
when the roses were in bloom. Riedlin advised his
patient to avoid the cause of his complaint, a point be-
yond which we have not even yet advanced.
Heberden's * observations niake a kind of connecting
link between the rose catarrh of the seventeenth century
and the hay fever of the nineteenth, for though this phy-
sician does not seem to have been at all aware that the
complaint had any connection with flowering plants, he
mentions casually that five of his patients suffered from
catarrh for a month every summer, while another was
similarly affected during the whole of that season.
The author of this paper will feel greatly indebted to
any American physician who may be able to brins under
his notice any well-authenticated case of rose cold.
19 Hablby Sranr, Lomdoii, W.
A Maternal Impression. — Dr. F. W. Epery, of New
Richmond, Wis., writes: '<A lady in her second preg-
nancy was much affected and greatly annoyed by a de-
formed brother-in-law, who spent his whole time in the
house and constantly complained about his imaginary
ills — as he was a confirmed hypochondriac. His de-
formity consisted in a very pronounced posterior curva-
ture in the upper dorsal and lower cervical vertebra, a
long neck approaching the horizontal, with head deficient
in occipital region. When the child was bom it had pre-
cisely the same posterior curvature, and there was a com-
plete arrest of development from the first cervical vertebra
to the frontal bone. There was no brain, and the face
resembled that of the deformed brother-in-law."
1 Henricus Herlinus : De Remediia sudoriferis et analepticisf page 3a. Lipine,
« Job. Pierius . Hieroglypbica, lib. 8, cap. ^s^ page, 96. Francofiirti, 1678.
* Linca Medicae, Augustae Vindelicorum, 1695, p. 177.
* Commentarii de Morborum historii et curatione, Londini, i8o9, cap. xxiv.,
De DestiUatione, p. 1x8 et &eq.
226
THE MEDICAL RECORD.
[August 30, 1884.
ON SOME DISORDERS OF NUTRITION RE-
LATED WITH AFFECTIONS OF THE NER-
VOUS SYSTEM.
Being the Address in Medicine Delivered Before
THE British Medical Association at its Meeting
IN Belfast, Ireland, July 30, 1884.
By WILLIAM M. ORD, M.D., F.R.C.P.,
<iciAN TO ST. Thomas's hospital, lonoon, bmcland.
(Special for Thb Mkdical Rsoobo.)
(Condaued fiom page an.)
Mu ular wasting coexistent with joint disease,—
For some years I have been led to observe, in a certain
grojp of cases of chronic rheumatic arthritis, the coex-
istence with the joint-lesion, always well marked, of
affections of muscles. These have been not merely
weakness of extensors, and tonic contraction of flexors,
the two factors which largely determine the character of
the deformities of the disease, but marked and excessive
wasting of muscles, closely resembling those of progres-
sive muscular atrophy. Together with these, I have
noted the existence of fibrillar tremors, and of electrical
reactions like those of progressive muscular atrophy in
the general, but with some indications of less loss of gal-
vanic than of faradic sensibility, with some slight indica-
tion of the reaction of degeneration.
In addition to those, I have noticed, as others before
me have noticed, a wasting of the tissues other than the
muscles of limbs.
These concern, in the hands, loss of substance in the
soft parts of the digits, the wasting of the skin, which
brings about a satiny or glossy quality of the surface, and a
dwindling of the nails, which we see carried to the full in
extreme true gouty affection of the fingers, where the nails
become small scaly appendages of the carrot-likedigits.
In some cases I have also observed exaggeration of
the so-called tendon-reflexes, and in some fibrillar tre-
mors. In fact, as they present themselves to me, these
are cases of progressive dystrophy of joints marching with
progressive atrophy of muscles, and with atrophy of the
other tissues of limbs. My fi-iend, Dr. Hadden, who has
taken great interest in these cases, has recently presented
a paper to the Clinical Society of London, taking up
some of the points here mentioned, I may here relate
two cases which bear upon this relation.
M. K , a married woman, a^ed sixty, was recently
under my care. There was no history of gout or rheu-
matism in her parents, but she had one sister, who was
said to suffer from gout. She presented the lesions of
rheumatic arthritis in the hands, knees,^ and ankles, but
the hands were most affected. The muscles of both arms
were distinctly wasted ; the skin of the ends of the fingers
was glossy, and the soft tissues around the two last
phalanges were much wasted. The right hand was af-
fected more than the left. The tendon-reflexes were
greatly exaggerated, both at wrist and elbow, particularly
on the right side. The hands showed the adduction de-
formity of chronic rheumatic arthritis rather than the
claw of progressive muscular atrophy. The electrical
reaction, of both kinds, was lessened ; she had, therefore,
slowly progressing in company, arthritis, wasting of mus-
cles, wasting of tissues generally, and wasting of skin,
without the reaction of degeneration. I could, in her
case, detect no reflex cause. She was anaemic, but not
thin, and had worked hard. The case certainly pointed
to a common central nervous origin of all the dystrophies.
A case now under care is more interesting.
The patient, a man, following the occupation of sales-
man, and not the victim of overwork, has been ill for ten
or twelve years. He suffered firom rickets in childhood ;
there is no record of acute rheumatism in his own life or
of any joint-affection in his ancestry. When first ill, he
had occasional attacks of weakness in his limbs, accom-
panied by swelling in the ankles, knees, wrists, and fin-
gers, never in the shoulders or elbows. These attacks
came and went, leaving him, at first, well in the intervals,
but for some years he had not been possessed of proper
muscular power. Two years ago he was violently shaken
by a thunderstorm, since whidi the symptoms of which
he now complains have appeared. He has, now, typical
rheumatoid arthritis of the hands and feet; the right
shoulder is stiff and painfiil on movement, particularly m
abduction ; there is grating ; and a rim can be felt around
the articular end of the humerus. The elbow is not in-
volved, but the wrist is greatly distorted, almost to dislo-
cation. There is wasting of the interossei of the hand,
of the thumb-muscles, of the muscles of the forearm, and
in an excessive degree of the right deltoid ; the right
biceps bein^ also, but not so profoundly, wasted. There
is no paresis, only such loss of motor power as would
correspond to loss of muscular substance. Marked
fibrillar twitchings can be seen in the arms, being more
active in the rieht. The feet show chronic arthritis with-
out any notable wasting of muscles. The knees are
slightly affected, the hips free. There is no loss of sen-
sation anywhere, and no impairment of the functions of
bladder or of the rectum. The deep reflexes are raflier
diminished, the superficial not affected. The electrical
reactions of the muscles chiefly affected are impaired.
The right deltoid is much less sensitive to the galvanic
current than it should be, and responds only to a faradic
stimulation stronger than that which should normally
excite it The biceps give the same reactions in a lesser
degree. The other muscles have normal reactions. In
this case there is no histor;^ of gout, of lead-poisoning, or
of causes likely to give rise to spinal trouble. These
dystrophies of muscle and nerve are not accompanied
by dystrophies of skin. The joint-affection was, to all
appearance, preceded by a distinct accession of muscular
debility.
Articular dystrophie brought about by irritation of
spinal cord, — If the considerations upon which I have
been dwelling indicate the probability that some such in-
fluence as is excited by the spinal cord in producing
muscular atrophy may produce also articular dystrophy,
there are others which bring into stronger relief the infln-
ence of the spinal cord in bringing about directly affec-
tions of joints independently of muscles. I cull from my
note-book a typical case of the kind. A lady, of healthy
family and healthy personal antecedents, wen^ soon after
her marriage, to an evening party. For the reception of
a large number of guests, a tent was provided. Rain
fell heavily all the evening;, and saturated the canvas.
For certam reasons she £d not dance, but sat in the
tent for some hours, with her back to the wet walls, ex-
periencing, although not actually in contact with the
moisture, a sense of intense chill in the back. Within a
day or two arthritis set in in both knees. It was not in-
tense, but presently gave rise to much swelling and de-
formity. The ankles, hips, elbows, hands, and shoulders
were in succession attacked with the same trouble. All
the joints were excessively swoUen, tender, and painfiil;
but the muscles were not noticeably affected. The joint
affection was one of steady progression, not one of par*
oxysmal exacerbations, followed by increased mischief!
and ended by rendering her practically helpless as reJ
garded locomotion, simply by reason of pain. Her mus-
cles retained a fair bulk and strength ; the reflexes were
exaggerated, but it is necessary to remark that the great
sensitiveness of the joints prevented a proper investiga*
tion on this point. The electrical reactions were not, I
am sorry to say, tested. Her mind remained singularly
clear and well balanced ; her bodily functions were not
affected; she became the mother of several children;
and, in spite of locomotive difficulties, manifested an ex-
ceptional power in the direction and discipline of her j
household. All the effects of the long chill received by
the spinal cord seemed to fall upon the joints alone, pro-
ducing, in a typical form, a progressive rheumatic (to usej
the accepted term) arthritis. After reading M. Charcot's
cases, one might be tempted to wonder why such painful
August 30, 1884.]
THE MEDICAL RECORD.
227
action of jobts should not have been followed by
atrophy of muscles. But, as a matter of observation, I
think it will generally be found that the influences which
give rise to violent reflex reactions are themselves mostly
of the lighter kind. Those which are superficial, call
oat rapid and widespread reaction, as, for instance, an
iiritating particle in the nose ; those which are deep and
ioteose, olH out the more concentrated reactions which
end in an inflammation, or are proclaimed by severe pain.
This is but a parenthesis, but it relates to a point in re-
flection of irritation which is worthy of deep thought
Observations of Senator and others on the nervous
^^tdudion of arthritis. — I might illustrate this point
more fully from my records of cases, and should do so,
vere it not that the spinal cord origin of certain kinds of
chronic arthritis has been already contended for by other
observers. Senator, in his all too short paper on Arthri-
tis Deformans in *' Ziemssen's Cyclopaedia," speaks thus :
^ Existing observations seem to point exclusively to the
peripheral variety of the disease, as connected with the
affections of the nervous system.'' Remak and Benedikt
were probably the first to regard articular affections as a
result of irritative states of the spinal marrow and sym-
pathetic. Indeed, Remak went so far as to call arthritis
deformans by a new name, '^arthritis myelitica'' and
" myelitico-neurotica. "
The date of the publications in which these views
vere advanced, is as far back as 1863 and 1864. Sena^
tor, in his comments on them, after mentioning a case
published by Kohts in 1873, in which this disease fol-
lowed a [right, proceeds to say, "The usually s)anmetri-
cal order of its invasion (the invasion of arthritis defor-
mans), can hardly be explained, unless we assume the
existence of some central causes situated in the nervous
system. The disease is often associated with neuralgic
and tropho-neurotic symptoms. Finally, some results of
treatment, particularly diose recorded by Remak and
others concerning the effects of electricity directed to the
central nervous system, serve likewise to support this
view."
That it should be regarded by Senator as diflicult to
explain the symmetrical order of invasion, except upon
the assumption of a central nervous irritation, illustrates
in a forcible way the extinction of the beliefs of one gen-
eradon by the beliefs of its successor. Sir James Paget's
"Lectures on Surgical Pathology" are not many years
old,— they were published in 1853.
In this most fascinating book, written by a man whom
I may ^ly call the most accomplished, as, indeed, also
the most eloquent man in our profession, we find set
forth, in the most convincing way, the argument '' that
ail symmetrical diseases depend on some morbid material
in ^e blood,'' and that certain blood diseases have
'^ seats of election." The reasoning upon which this is
based is found later in the book, where, on pages 24
aseq^Six James proceeds to develop a principle, the
germ of which is in the writings of Treviranus. The
sentence of Treviranus is, '* that each single part of the
body, in respect of its nutrition, stands to the whole
body m the relation of an excreted substance." Accord-
ing to the ideas which follow, every part of the body has
its special nutritional and excretory endowments, inas-
much as it di£fers from all other parts, however identical
iu superficial seeming, in its reaction to alterations of the
Wood When there ,is symmetry on either side of the
vertical plane, the corresponding parts agree in their
reactions, while differing from all others. The second
diapter — on the conditions necessary to healthy nutri-
tion— contains a most interesting sketch of the influence
of the nervous system on nutrition ; but the main ideas
of causation are independent of nervous influence, and
rest on relations between the blood and the tissues.
The idea of some such special endowment cannot be
spoken of without more than respect.
It is held still, in respect of cutaneous diseases, and in
respect of gout, and particularly of goutiness. I main-
tain that it must still be accepted as a truth, but as only
a part of the truth, as regards nutrition, and I enter my
protest against the short-sightedness which fails to recog-
nize now what Sir James Paget did, in his well-balanced
judgment, recognize thirty years ago, the possibility of
the combined action of two dissimilu' processes.
To resume now the line of thought which has been ar-
rested by this excursion, let us, for a moment, review our
position. We have considered possible causation of dys-
trophies of muscle by irritation of joints, of dystrophies
of joints by injuries of bones, of dystroplues of joints by
a sort of subjective irritation coming through channels
of centripetal muscular nerves, of dystrophies of joints
and muscles by irritation or disease of nervous centres.
Digitorum nodi. — Are these all the channels by
which nervous influence may affect the nutrition of
joints ? I think not. For more than fifteen years the
probability that the form of chronic rheumatic arthritis,
called by Heberden, "digitorum nodi," by Haygarth,
" nodosity of the joints ; " by Senator and others the
polyarticular (I am not responsible for the hybridity of
the term) — the polyarticular form of arthritis deformans,
is in many cases a dystrophy, determined by nervous ir-
ritation propagated fi-om the uterus to the spinal cord,
and reflected upon the joints, has presented itself to me.
Let me give briefly the notes of a case which I saw first
in the year 1868.
The subject was an unmarried lady, twenty-six years
of age. She came to me complaining of terrible dys«
menorrhoea, and of what she had been taught to csdl
rheumatic gout She was thin, anasmic, sallow of com*
plexion, had abundant acne on the face, and was hys-
terical, having given up society and all active occupation
for the contemplation of her ailments. There was no
small justification for this absorption. Out of every
month of her life she had only one week of ease. The
menstrual period lasted one week, and was attended with
excessive pain in the pelvis and back. A week before
its conmiencement the smaller joints of the extremities
became swollen and excessively painful. They remained
in this condition till the end of the week following the
cessation of the menstrual period. There were some
variations in the severity of the d^smenorrhoea, and there
were corresponding variations m the intensity of the
joint-affection. During the week of ease the joints
showed a little deformity, but were freely movable, and
free firom pain or tenderness. The '< rheumatic gout "
was the main object of her attention, from its long per-
sistence ; and at first I adopted the idea, already adopted
by others, that the two troubles were the effect of a com-
mon cause, a rheumatic inflammation affecting joints and
pelvic organs at one time. Treatment instituted upon
this hypothesis failed, had long failed to give any relief,
and what may be called the central position of the men-
strual trouble, led me to the opinion that it was the pri-
mary mischief giving rise, in some way that was then not
very clear to me, to arthritis.
The uterine conditions were now steadily attacked.
At the end of a twelvemonth's treatment, the dysmen-
orrhoea was subdued. As it yielded, the joint-trouble
dwindled; and, with its cessation, the rheumatic par-
oxysms disappeared. So did the acne, the unhealthy com-
plexion, and the general ill-health. At the present time,
this lady is stout, healthy, and vigorous of mind and of
body ; but the joints retain some painless deformity. In
the year 1869, I published an account of this case, and
of others which appeared to me to indicate that uterine
irritation, chiefly associated with hyperaemiaof the organ,
were capable of reflection upon the joints, with the re-
sult of inducing a form of rheumatic arthritis. The paper
is probably little known to you, and you will pardon me
if I present to you some of its matter and conclusions.
Haygarth, writing in the year 1805, on the "Clinical
History of the Nodosity of Joints," stated that he had
seen thirty-three cases of that condition, all in women.
He regarded the affection as peculiar to women, and as
228
THE MEDICAL RECORD.
[August 30, 1884.
belonging to the climacteric and subsequent periods of
their life. Only three out of his thirty-three cases had
the '* nodes'* during the period of regular menstruation.
Of these, two appeared to be between thirty and forty
years of age ; the third had suffered twelve abortions.
In all, the fingers were chiefly affected. Haygarth sepa-
rated this affection as ''nodosity of joints " from '^ rheu-
matic gout " — a term already in use when he wrote ; and
he considered it to be chiefly a disease of the middle and
higher classes. Curiously enough, when I analyzed my
note-book, I found records of just the same number of
cases — not of nodosity of joints simply, but of rheumatic
arthritis, combined with decided symptoms of uterine
disorder or irritation. I excluded from the list cases in
which there was evidence of uratic deposits, and cases in
which no known uterine complication existed, though
both classes demanded separate attention, as forming
chapters of the history of arthritis.
C5f the thirty-three, twenty-six belonged to the middle
and upper classes, mostly to the former, the remaining
seven to the poorer classes ; seventeen were unmarried^
thirteen were married, and three were widows.
As regards age, ten were between twenty and thirty
years ; eleven were between thirty and forty ; nine were
between forty and fifty ; and three were between fifty and
sixty.
The indications of ovario -uterine complication in the
several cases comprehended marked irregularity of cata-
menia in two ; catamenial flow simply in excess, one ;
catamenial flow very scanty in one j catamenia irregular
with excess in two ; catamenia recently disappeared in
four; catamenia recently reappeared after apparent
cessation, the reappearance coinciding with arthritic
attack, in two ; dysmenorrhoea with excess in eight ; dys-
menorrhoea, with deficiency in four ; constitutional symp-
toms of climacteric present in two ; fibroid of the uterus
with menorrhagia, but not dysmenorrhoea, in one ; cata-
menia regular, relieving pain present at other times in
sacral region, in one ; catamenia excessive, with leucor-
rhcea, in one; profuse leucorrhoea in woman married
several years without pregnancy, one ; woman married
several years without pregnancy, one ; case in which
arthritis occurred on two occasions a week before parturi-
tion, these being the only pregnancies, one ; climacteric
long past, arthritis began then, and has since continued,
one.
In four of the above cases, ovaritis existed ; and it is
important to notice, first, that amenorrhoea is not noted
in any case, second, that the conditions noted are mainly
such as would involve hjrpersemia of the internal genital
organs; third, that marked dysmenorrhoea is noted in
twelve or more than a third of the total number.
The seat of arthritis was various. It affected tlie hands
alone in thirteen cases ; the hands, wrists, and elbows in
three ; the upper extremities in one ; the right hand only
in one ; the right hand and wrist in one ; the hands and
feet in one ; the hands, feet, and knees in one ; the knees
and ankles in one ; both extremities in six ; both extrem-
ities on one side in one ; the ankle and tendo Achillis
in one. From this, it appeared that the hands were more
often affected than any other parts, the metacarpo-pha-
langeal joints being of all joints the most obnoxious to
this form of arthritis. The hands, besides being alone
attacked in the cases, shared the affection with other
joints, and principally with other joints of the upper ex-
tremity, the wrists excepted, in all the rest of the cases,
except two. In three of the cases, where the affection
was limited to one side of the body, or having begun,
continued excessive, on one side, there were ovarian pain
and tenderness on the same side, and a distinct frequency
of neuralgia on the same side.
An inspection of the cases brought out further most
interesting relations. Not only did the arthritis coincide
with ovano-uterine affection; but, in a considerable pro-
portion of cases, paroxysms of arthritis coincided with
menstrual periods. This sort of parallel march was
noted in fourteen cases, in one of which arthritis pre-
ceded menstruarion as its regular herald; in seven
arthritis regularly accompanied ; in two, it followed ; in
two, it boUi accompanied and followed ; and in two
arthritis occurring in the intervals was relieved by men-
struation.
Now, if these had been so many cases of dysmenor-
rhoea, the occurrence might perhaps have been accepted
as an argument for believing the dysmenorrhoea token to
be a part of a general rheumatic process. But, though
the conjunction was reported in seven, it was conspicu-
ously absent in as many cases ; and these are precisely
the instances which do most to prove that the arthritis is
a product of the uterine hyperaemia. With this simple
question, we will deal for a moment, leaving the modus
operandi to be discussed later on.
Among the seven cases referred to as not accompanied
by dysmenorrhoea was that of a lady then fifty-two years
of age. She had had a large family — ^in all twelve— and
it was then as much as five years since she first began to
suffer from arthritis. Before the arthritis troubled her,
she had begun to experience excessive menstrual loss.
She consulted for this a distinguished gynaecologist, who
found the uterus enormously engorged, but otherwise
free from disease. The engorgement was lessened by
treatment, but not by any means cured, and the menor-
rhagia went on. The arthritis first came in the form of
sharp inflammation and swelling of the knuckles of both
hands, rendering them completely useless. It began
usually on the second or third day of the menstrual flow,
and continued as lofig after its cessation. The periods
becoming more frequent and lasting longer as time went
on, she became reduced to a very pitiable state. She
was anssmic, exceedingly feeble, was crippled in hands,
wrists, and knees, and lost her rest by reason of what
she called " fidgets," uneasy but indefinable sensations in
her limbs and abdomen, unaccompanied by pain or
spasm.
Change of air and of scene, baths, tonics, alteratives,
were all used in addition to local remedies, but no relief
was obtained till, as she reached the age of fifty years,
the periods began to be less frequent.
At length, intervals of two or three months occurred,
and allowed her to gain st)rength, when she lost her ar-
thritis and her fidgets, and appeared perfectly healtiiy.
Of late, the periods had been still further apart ; but
still, whenever the catamenia appeared, she was once
more crippled.
The association of the arthritis with this painless men-
orrhagia began clearly at a time when the patient was
weakened and drained of blood. The fidgets illustrated
the irritability of the spinal cord related with imperfect
nutrition, and the arthritis came out as a resultant of two
conditions — uterine irritation and spinal sensitiveness.
I may add that I have seen this lady within the last few
weeks, not as a patient; that the catamenia have entirely
ceased for three years ; that she has had no joint-trouble
since, excepting on one occasion, when it occurred in
conjunction with severe intestinal catarrh ; and that she
is now ruddy, well nourished, active, and cheerful.
A lady, aged fifty-one, the mother of six children,
came to me in 1882 with a gouty-looking inflammation
in the elbows, wrists, hands, and knees. This had oc-
curred a day after the return of the catamenia, previously
absent for twelve months. She had no signs of gout in
the shape of deposits, and her own expression was, that
she felt the attack to be really ** in the nerves." The
period was short, and the arthritis disappeared. But the
catamenia having since returned with unusual freedom
and duration on two occasions, she had each time had
the arthritis severely enough to cripple her. The arthri-
tis came on at the end of the periods, the last of which
was accompanied by abdominal pain, a circumstance
hitherto unknown to her. I am now able to repprt of
this case that the catamenia have ceased, and that the
joint-affection is forgotten.
August 30, 1884.]
THE MEDICAL RECORD.
229
I might multiply my citation to a large extent, for the
idadon is illustrated constantly now that it has once
been recognized.
Hypothesis of reflex causation of arthritis by uterine
irritatiotL — The argument which was founded upon these
cases and others not now quoted, had the following
general bearing : that, seeing this frequent coexistence of
ji certain kind of inflammation of the joints with uterine
byperaemia, seeing also that the joint-inflammation in-
cKBsed in intensity in a very marked proportion to in-
aease of the uterine hyperaemia, and that, also, when the
signs of uterine hyperaemia ceased the joint-aflection
passed away, there was reason to regard the one as caused
by the other. The joint-aflection had in itself no neces-
saiy property of permanency. The uterine affection had
of a necessity a beginning and an end, and the joint-
affection was noticed only during its existence. If, from
sach considerations, it was fair to infer that the dystrophy
of joints was, in some way, brought about by an abnor-
mal condition of the uterus, the intermediate conditions
linking the two had next to be sought for. That there
vas some intimate relation between inflammation of the
joints and uterine conditions more or less approaching
inflammation, had not escaped the acute observation of
the late Dr. Todd. In his Croonian lectures for the year
1843, he had written : '* It is remarkable how frequently
diis afi^ection "• (the symmetrical nodosities of the hands,
called by him "chronic rheumatism of joints") "occurs
in women, and how rarely in men ; and there are many
facts which indicate that, in the former, it may have an
uterine origin, either connected with the puerperal state,
or from a defective or difficult catameniad action." He
was inclined to believe that '' the unhealthy secretions of
the Qterus afforcis material for the production of rheu-
matic matter.*' In these lectures he quotes Sir Heniy
Holland, Sir Charles Locock, and Dr. Rigby as authon-
ties m favor of the opinion that there is some connection
between the sexual functions and the causes and course
of gout and rheumatism.
Another good observer, Dr. Fuller, had spoken decid-
edly as to the fact, that ^* rheumatic gout attacks women
rather than men." *< It fixes,'' he had said, '^ upon the
girl JQst arriving at puberty, whose menstrual functions
are ill performed, and it occurs frequently at the cessa-
tion of menstruation or during the debility which follows
on a miscarriage, or a difficult or protracted labor, more
generally when complicated by floodmg." These authors
Ibond die explanation of the relation which they so
closely acknowledged in the suggestion of a virus, gen-
erated in the uterus, absorbed by the blood, and attack-
ing, in virtue of some elective affinity, the joints.
If we consider the many cases in which acute rheuma-
tism occurs immediately after parturition, in the early
weeks of lactation, we may acknowledge that the se-
quence of morbid phenomena lends much support to a
hypothesis of this kind. We must acknowledge that the
condition of the uterus after parturition provides a large
quantity of septic, inflammatory, and quasi-inflammatory
matters ; that its vascular arrangements are such as to
offer a ready access of these matters to the circulation ; '
and that where these matters are undoubtedly septic and
where they find access to the circulation, in the septicae-
mia or pyaemia which follows, the joints are among the
organs most frequently invaded by the poison so mtro-
daced into the system. But in this, as in other forms,
Ae joints are by no means the only subjects of attack.
The viscera are, at least with equal frequency, the seat
of this secondary affection. In the acute rheumatism
associated with the conditions just mentioned, the serous
membranes, and the lungs, and the veins, are frequent
sufferers from the inflammation which primarily attacks
the jomts ; but they are more rarely affected without in-
tercurrence of a joint-affection, although, in pyaemia, it
is certainly not rare to And the joints spared, while the
viscera show fatal lesions. In the nodosity of the joints,
which I have presented to you as simultaneous with, and
in its variations parallel with, uterine hyperaemia, there
is, so far as I have been able to make out, no correspond-
ing visceral inflammation of either an acute or chronic
kind. If a blood-condition, having some quality of at-
tenuated septicity, were the agent, the viscera ought in
fairness to ^are in the injury. We may remember that
the presence of lactic acid in the blood has been ad-
duced in explanation of the phenomena of acute rheu-
matism, and, perhaps, more particularly of acute rheu-
matism breaking out during lactation. This very neat
hypothesis has been supported by names of great au-
thority, and rests on the observations that the adminis-
trations of lactic acid to men and animals is followed by
joint-affection, and that lactic acid has been found in the
blood during acute rheumatism. The whole theory rest-
ing on these somewhat slender bases cannot, I think,
apply in any way to the joint-affections considered in the
early part of this address, where the only obvious lines
of causation were nervous.
There are not a few considerations which induce me
to oppose to this humoral and chemical view the view of
nerve-agency. Putting aside those peculiarities of per-
sonal constitution which render certain persons prone,
under many circumstances involving febrility, to develop
joint-affection, particularly acute rheumatism, I would
represent that at least a very large majority of the women
having nodosity of the joints, or arthritis deformans, pre-
sent in the first place a marked hyperaemia of the os and
cervix uteri. That these organs have the power, through
centripetal nervous influence, of producing enormous ex-
citement in the spinal cord is the next point which may be
taken. Sometimes the excitement may show itself by pains
in the limbs, sometimes by flushings of the skin, sometimes
by swellings of the breasts. Sometimes, as it appears to me,
the effects of excitement may be reflected along the same
paths, which in primary affection of the spinal cord have
led to affections of joints. Moreover, the state of the
patients under consideration is generally one of debility,
often one of anaemia. It is a matter of daily experience
that in such conditions the reflex excitability of the
spinal cord is increased ; it explodes, so to speak, on the
application of impulses which, in its proper nutrition, it
would transmit. And so both the local and the general
state would conduce to the reflection.
Gonorrhceai rheumatism. — ^There is yet another form of
arthritis in which it appears to me possible to call in the
agency of the nervous system. I speak of gonorrhoea! rheu-
matism, so called. In this disease, as we know, an arthritis
having no differences in its local morbid anatomy from the
lesions already discussed comes on during an attack of
gonorrhoea, often in company with ophthalmia or sclero-
titis. When the gonorrhoea ceases the joint usually gets
well. The arthritis is easily induced afresh by new at-
tacks of gonorrhoea. There are, however, some varia-
tions in progress and relation. The arthritis sometimes
coincides with, sometimes alternates with, the gonorrhoeal
flow. It sometimes persists, particularly in the knees
and ankles, producing chronic dxanges leading to '< white
swelling," or a kind of anchylosis. The affection is only
seen in males. Ricord gave it the name of '* blennor-
rhagic arthritis," whicli is to my mind a far better term
than gonorrhoeal rheumatism. As regards its diagnosis,
he asserted that the only real difference between this
form of arthritis and all the others is to be found in the
cause which gives rise to it. Brodie, EUiotson, Fuller,
and others, have cited cases in which a simple, that is to
say, not gonorrhoeal, urethritis has had associated with it
the same three disorders — arthritis, conjunctivitis, sclero-
titis. It is hard, of course, to prove a negative, but we
have the evidence of the above-named excellent ob-
servers, that they at least accepted, in these cases, the
absence of gonorrhoeal taint as a fact
I have seen lately a gentleman suffering from a third
attack of the kind. He is gouty, lives temperately, but
works very hard. On three occasions he has had severe
purulent urethritis, which he asserts, to be absolutely un-
230
THE MEDICAL RECORD.
[August 30, 1884.
connected with any possible source of gonorrhoea! kind.
This is followed by sharp arthritis, and sometimes by
gouty inflammation of the toe, lasting until the discharge^
which is very obstinate in resisting treatment, is checked.
The patient is a man of the world, and I believe his
statement. His own belief is that all the phenomena are
gouty.
Blennorrhagic arthritis has naturally been attributed to
some specific infection of the system from the urethra,
and consequent infection of the joints ; but if the con-
ciurence of a similar arthritis with non-specific urethritis
be admitted, the theory of a specific poisoning is con-
siderably weakened. If it be acknowledged, again, that
so-called gonorrhoea! rheumatism is a disease only seen in
men, the difficulty of accepting the specific idea is in-
creased.
Women certainly do suffer from gonorrhoea, and I can
conceive no reason why, if they have it, they should not
be poisoned by it in the same way as men are. The
more I think over the matter, the more do I see to sug-
gest a parallel between the nodosity of the joints m
women, so often associated with irritation of the uterine
surfaces, and the blennorrhagic arthritis associated in
men with inflammation of the urethral surface, particu*
larly if the prostatic part of the urethra be affected.
That excitements of the prostatic part of the urethra,
particularly of the floor, have enormous influence upon
the spinal cord, is shown by the phenomena of sexual
intercourse. The widespread indescribable sensations
which attend emission, and the exhaustion which follows,
testify to this. Most of us have, no doubt, been con-
sulted by men, chaste in act, who are tormented by
sexual excitement. They tell one stories of long con-
tinued local excitement, followed by, intense muscular
weariness, or by some severe aching pain in the back
and legs. In some, I have had complaint of swelling
and stiffness in the legs, and of pains in the joints, par-
ticularly in the knees. Conditions of this kind indicate
an effect upon the spinal cord which is very nearly react-
ing in trophic influence upon the limbs. I may relate a
case in which it seems to me that an actual trophic in-
fluence was exerted.
A gentleman, thirty years of age, who had lost his wife
about two years before, came to me with painful affection
of the knees. Both knee-joints were greatly distended
with fluid and were tender, but not much heated. The
condition^ reminded one of the " arthropathie des atax-
iques ; " but no other sign of tabes dorsalis could be
detected then or since. I tried various remedies without
success, and he went to many doctors and many baths,
without obtaining a cure ; though at last with some relief.
Then he married again. Not long after he came to tell
me that he was quite well. He dso told me, upon my
asking him as to his bachelor life, that he had been almost
constanUy harassed by the thorn in the flesh, but that he
had been absolutely chaste, and he himself was of opinion
that marriage had been the means of cure. I hear of
late (some seven years after the second marriage) that his
joints are getting bad again, and at the same time that
his wife suffers from a uterine affection almost altogether
preventing cohabitation. Upon such grounds as the fore-
going considerations afford, I suggest it is possible that
irritation of nerve-cells in the spinaJ cord, carried to them
through channels of urethral nerves, may set up an excite-
ment m those cells giving rise to irritative processes in
the joints supplied by them. M. Charcot's cases already
referred to indicate rather a process of inhibition than
anything else ; of torpor, as he says, of the nerve-cells
under centripetal stimulating coming from joints.
Urinary paraplegia. — In relation with the idea that
irritation is set up in joints by irritation reflected firom
viscera, I am tempted to point to the so-called reflex or
urinary paraplegia as illustrating, possibly, a torpor set
up in the nerve-cells of the cord instead of an irritation
dependent on centripetal irritation coming from viscera.
The name reflex paraplegia, given by Brown-Sdquard,
has been of late replaced by a safer term — ^urinary para-
plegia. But, whichever name we use, we recognize that
an urethral irritation, most commonly dependent on a
stricture, is so joined with paralysis or paresb [of the
lower limbs as to make it probable that the stricture is a
cause of which the paraplegia is an effect The objec
tion — a just one — to the application of the term ** reflex"
lies in the fact that the paralysis can sometimes be traced
to myelitis in the lower part of the cord, sometimes to
neuritis. But in a certain number of cases no lesion of
cord or nerves has been detected, and to such cases,
where the paraplegia and the urethral irritation were the
only coexistences, the term reflex might be applied. I
do not speak here of other reflex paraplegias. I merely
wish to indicate the possibility of some such nerve-relap
tions existing between the urethral surface of man and
the joints, between the uterine surface of woman and
the joints, carried on by the mediation of the nerves and
cord, and to compare them with such relation as we have
been treating of as probably existing between the joints
and muscles through the cord.
Enough, you will say, of the joints and their neurotic
dystrophies. Too little, I reply, for time forbids me to
discuss the neurotic dystrophies of gout.
Neurotic dystrophies of secretion. — I am compelled to
go on to another subject, and to direct your attention
to some neurotic dystrophies of secretiori! Some of the
most striking of these are certainly hard to be under-
stood. So far as I am aware, it is not known why the
breath of a man, who has undergone great and concen-
trated mental anxiety, should suddenly become fetid ; or
why the milk of a woman, whose emotions of fear or anger
have been violently excited, should prove poisonous to
the infant at her breast.
Glycosuria in relation to nerve-influence, — Suggestions,
illustrating the mode in which such dystrophies come
about may not unreasonably be afforded from a consid-
eration of what is known with regard to the production
of glycosuria. Not long ago I reviewed my notes of
cases of glycosuria unattended by diuresis ; such cases
occurring almost entirely in persons over fifty years of
age. Since the time of Bernard's great discovery a long
series of experimental physiologists has been engaged in
working out the influence of the higher centres, and of
the sympathetic in producing glycosuria. Pathological
investigation has brought many f^ood observers to the
belief that true diabetes mellitus is caused by disease of
the central nervous system. It must be admitted that
this point is still far from settled In the non-diabetic
glycosuria of comparatively old people, we may see a
dystrophy coexistent with disorders of various kinds-
disorders, for the most part, more pressing than itself—
in such relation that we may be justified in reducing it to
the rank of a symptom. If it can be ref;arded as a symp-
tom, we may have a reasonable probability of arriving at
a notion of its causation by an examination of its coinci*
dences or its coexistences. As regards the onset of true
diabetes, the frequent antecedence of great emotional
^disturbance of the central nervous system has been recog-
nized by general consent. Dr. Dickenson has collected
a large number of illustrations of this connection in his
work on " Diseases of the Kidneys." In the cases which
I have analyzed, one-third of the whole number told a
story of excessive or prolonged mental work or anxiety
preceding the recognition of glycosuria.
In one, after much emotional excitement, insanity was
at last fully declared. In one, after a long course of stren-
uous mental labor, scarcely intermitted during the nights
of many years, hemiplegia occurred, and apoplexy ended
the chapter. The last two of these cases lead on to
another group, in which glycosuria appeared as a symp-
tom of actual disease of the nervous system.
In two cases there was marked tabes dorsalis, and in
a third locomotor ataxy was present, with additional
signs indicating affection of the whole breadth of the spi-
nal cord. Decided hypochondriasis was noted in two
August 30, 1884.]
THE MEDICAL RECORD-
231
cases. One of the patients was haunted by the dread of^
sjphilidc disease, but manifested no signs thereof what-
ever. In a third group marked signs of nervous disor-
der accompanied the glycosuria^ to wit, tinnitus, vertigo,
sleeplessness in an extreme d^;ree, constant headache,
loss of power, of thought, and memory, numbness in
limbfy sciatica, shingles, prurigo, and marked loss of mus
colar eneigy. In &ee cases the patients were the sub-
jects of a very typical form of angina pectoris. I may
add that I have since seen another illustration of this co-
exjstence. To sum up, there was scarcely a case in which
gI)?C05aria was not associated either with evident disease
of the central nervous system, or with symptoms indicat-
ing great perturbation of the centres of the nerves. A
second stage of observation brings out a new set of rela-
tioos. In more than a third of the cases true gout was
disdncdy present ; in a much smaller number chronic
liienmatoid arthritis. A third of the patients admitted
habitual over-indulgence in alcoholic stimulants.
The multiform relations of glycosuria here exhibited
would lead to the inference that the ultimate causes are
of many kinds. We may recognize the excess of sugar
in the blood giving rise to glycosuria as having at least
a sixfold origin. Putting aside causes consisting in dis-
proportion between the amount of saccharine matter in-
troduced into the system, and the capacity of the liver
for transforming it, or in varying stability of glycogen, or
io diminished use of sugar by the system, we come to the
discussion of the increased decomposition of glycogen
detennined by increased afflux of diastatic ferment. To
pat this in other words, we come to the consideration of
dilatation of the hepatic artery and its branches allowing
of an increased inflow of ferment-containing blood. By
sach kind of intermediate influence it is probable that
inritations and irritability of the nervous system can be
conceived to set up the glycosuria. Irritation of the
hepatic nerves in alcoholism and diseases of the liver,
irritation of the pneuraogastric in the stomach or in the
heart, irritations of the pneumogastric arising in other
peripheric stimulation can conceivably be reflected in
t pathological way, as they are known to be in a physio-
logical way ; and in the most typical of the cases which
I have analyzed I have had presented to me as causa*
tire of glycosuria at the same time signs of deep gastric
(T hepatic disorder, and signs of general nervous irrita-
hilitj.
Gwf and glycosuria, — Gout and glycosuria have been
seen in tolerably frequent association in my cases. Dr.
Gairdner pointed this out many years ago. Dr. Lauder
Brunton has used the term gouty glycosuria. I am
tempted, after much thinking, to ask whether the expres-
sioD " gout of the liver " may not be appropriate ; to ask
whether we may not entertain the idea that, in many
people, there may exist a more or less constant Arterial
hyperemia of the liver, comparable to the acute hyper-
emia of joints, undoubtedly an essential factor of acute
Acute inflampuiiion of diabetes and nerve-influence. —
In true diabetes the occurrence of sudden and very acute
visceral inflammations is common. It is generally found
tiuit, while such complications last, • the urinary sugar
dwindles, or even disappears. An explanation of this
occurrence has been found by some writers in the hy-
pothesis of an increased combustion of sugar as a part
of the pyrexial state. But, seeing that such inflamma-
tions involve the diversion of a large quantity of blood
to the organ aflfected, I venture to suggest that in such
^ersion, rather than in a purely hypothetical combus-
tion, may be found the true explanation. Physiological
experiment has shown that, when sections of the sympa-
thetic leading to vaso-motor dilatation of the hepatic
vessels alone has been made, glycosuria has been pro-
duced ; that, when the section has been made at a point
producing, in addition to dilatation of the arteries of the
^er» dilatation of the vessels of the intestines, glycosuria
has not followed. The inference drawn is to the effect
that so much arterial relaxation was produced in the
supply of organs neighboring to the liver as to stand in
the way of an effective increase in its arterial circulation.
I had an opportunity quite recently of testing the prob-
ability of this hypothesis. The temperature of a diabetic
patient rose suddenly to 104^ Fahr. The most careful
examination brought out no signs of visceral inflamma-
tion during two days, and in the same period the amount
of sugar in the urine stood at the figure registered for
several weeks before. On the third day, the tempera-
ture remaining at the same height, the signs of pneumonia
became apparent, and at the same time the urinary sugar
diminished very considerably. In my gouty cases a
similar train of phenomena has been several times noted
— the sugar diminishing in a very marked degree at the
time of the development of acute joint-inflammation, and
returning immediately on its subsidence.
In trymg to understand the sudden acquirement of a
poisonous quality by the milk of an agitated woman, one
had found a difficulty of this kind— could mere quantita-
tive variations in the afflux of blood affect the quality of
the secretion ? Can it be possible that, in the produc-
tion of the lacteal secretion, may be concerned not merely
increased afflux of the materials of the secretion, but also
varying afflux of ferments determining its quaility, and
capable, by reason of either great deficiency or ^eat ex-
cess, of seriously perverting its quality ? Here is an ad-
mitted neurotic dystrophy, the mechanism of which is
well worth careful investigation ; and from the considera-
tion of glycosuria we may be enabled to glean at least
suggestions as to what the mechanism may be.
T7i€ nervous relations of myxadema. — Let me, leaving
many points which are tempting, go on to say a few
words about another class of neurotic dystrophies, namely,
about those occurring in myxoedema, occurring therem
to such an extent as to constitute the predominant
symptomatology of that disease. We may recognize in
myxoedema three principal lines of nervous abnormity.
Firsty intellectual, consisting in slowness of thought,
in slowness of volition, in loss of memory, in irritability
of temper, in unwarranted suspicions, in delusions, in
actual insanity, or in torpor growing to coma.
Second^ in sensation. General sensation undergoes a
change, to which the term bradyaesthesia is applicable ;
the recognition of impressions made on the surface is dis-
tinctly retarded ; the sensibility to sensations of heat or
cold is blunted ; and there are often noted abnormal
subjective sensations, particularly affecting the sense of
taste and smell.
Thirds the motor powers are disturbed in a singular
way ; all motion is slow ; co-ordination is imperfectly
adjusted ; certain groups of muscles become unduly re*
laxed, and are stimulated to action only by strong exer-
cise of volition. Reflex actions are produced with con-
siderable delay. In some cases evidences of more
lo^dized nervous impairment occur, in particular the
signs of bulbar paralysis. It may be argued, on the one
hand, that this remarkable assemblage of nervous disor-
ders points to the nervous system as the seat of the
original cause of the disease ; on the other, that the
obvious changes in the state of the connective tissues
throughout the body may affect the nervous centres and
put their morbid reactions into the category of secondary
conditions. It is a question, that is to say, whether
myxoedema be a neurotic dystrophy, or whether the dis-
orders of the nervous system are produced by an altera-
tion of connective tissues, having an origin, like that for
instance of lardaceous disease, independent of nervous
influence — chemical, degenerative, inflammatory, or other.
The remarkable atrophy of the thyroid body observed in
this disease, and the relation which is by many regarded
as existing between that body and the sympathetic sys-
tem, have brought some thinkers to the belief that the
disease arises primarily neither in affections of the cere-
bro-spinal system, nor in altered nutrition of the connec-
tive tissues. Those who are induced to take this view
232
THE MEDICAL RECORD.
[August 30, 1884.
have found the explanation in primary alteration of the
sympathetic system ; in alteration of the sympathetic
system somehow determined by the atrophy of the thyroid,
or in alteration of the sympathetic system determined by
chronic apyretic inflammations withm the chest, particu-
larly in the pleura. What can be said is, that in this
disease there can be recognized an enormous dystrophy
of connective tissues ; that the dystrophy has certain
aspects of degeneration ; that, again, in the increase of
nuclei, it has some aspect of over- activity ; and that, so
far, it may suggest the occurrence of a low form of in-
flammatory process inducing degeneration of the tissues
involved ; or that, on the other hand, a degeneration has
induced a very elementary inflammatory process in the
tissues.
The atrophy of the thyroid may conceivably be brought
about by the changes of the connective tissue which we
can see in the other parts of the body, leading, by the
aggressive hypertrophy of that tissue, to pressure on,
and atrophic changes in, immeshed glandular tissues.
But here we must hold our hand, for there is another side
to the question. Kocher and others in Switzerland have
of late years been cutting out enlarged thyroid glands,
and have recorded the sequence upon this operation of
slow development of a condition which, as produced and
described by them, corresponds exactly with myxoedema
as observed in England. The interest of the observation
is intensified by the circumstance that these operators in
making this record were not aware of the observations
on myxoedema, made in this country.
The true function of the thyroid body being undeter-
mined, one may hope that the concurrent observations
may converge in such a way as to throw light on a very
obscure bit of physiology ; but it is hard to resist the
conclusion that, through some nervous channels, the
thyroid body influences the nutrition of the connective
tissues generally, and may, perhaps, also influence the
nutrition of the cerebro-spinal centres.
To put the matter in another way, the great tendency
of existing observations is to class myxoedema among
neurotic dystrophies.
I should have liked, if I could have brought them
within the compass of this address, to have said some-
thing about the neurotic dystrophies of the skin, but
must, however, reluctantly leave them untouched.
Many here will think that I should have said something
about the dystrophies incited by surgical injuries of
nerves. These last, indeed, ofler possibilities of more
exact treatment than any of the dystrophies which have
engaged our attention. The observations of Weir
Mitchell, Brown-S6quard, Hutchinson, and others have
been, in some unconscious fashion, directing my thoughts
to the choice of the subject of to-day's address. Let me
acknowledge this fully ; and let me ask you to under-
stand that I have to-day merely been putting before you
the result of observation and thought set going by the
reading of the works of predecessors and contemporariAu
Each succeeding generation in science gathers the lines
of older and recent vision into some focus more or less
of its own choosing. The wisdom of the choice is to be
judged by the generations still succeeding. What shall
be the outcome here ?
A Rare Human Tapeworm. — Dr. Leidy describes
in The American Journal of the Medical Sciences for July,
1884, the taenia flavopunctata, a rare human tapeworm,
which has now been observed for a second time, both
cases occurring in this country and infesting children.
It is not improbable that the species is more common
than the observations would warrant us in believing, for
from the smallness of the worm and the generally pre-
vailing ignorance of the distinctions in the more com-
mon species, it might readily be passed for immature
portions of these.
CEREBRAL LOCALIZATION— THE CENTRES
FOR VISION.
By PHILIP ZENNER, A.M., M.D.,
aMaKNATI, o.
(Condnued from page 149.) 1
Physiological //«/<».— Fritsch and Hitzig, in 1870, first
made known to the world that irritation or removal of
certain parts of the cerebral cortex was followed by defi.
nite motor phenomena, or the disturbance of the cere-
bral functions. Their experiments made it highly prob-
able that different parts of the cortex have different and
distinct functions. Their results were soon corroborated
' and extended by Ferrier, and since then there have been
numerous contributions of the same kind.
Experiments of Munk. — It is not my object to enter
into any historical disquisition, but rather to give those ex-
perimental researches which bear directly on our subject
I shall, therefore, begin immediately with the experiments
of Munk, which, from the precision and completeness of
their results, have excited universal admiration. We will
consider them only so far as they are concerned with the
sense of vision.
Munk's experiments were made upon dogs and mon-
keys, chiefly the former. The conclusions drawn from
them were : i, in the dog the visual centre is in the
occipital region, the visual area of each hemisphere be-
ing in relation with both eyes, though to a much greater
extent with the eye on the opposite side than with the
one on the same side ; 2, in the monkey the visual centre
is in the occipital lobe, one hemisphere being in relation
with one-half of each retina.
Munk reported his results at various meetings of the
Physiological Society of Berlin, in the years 1877-80.
Each successive report contains the additional knowledge
gained from his latest experiments, and becomes espe-
cially interesting on account of the manner in whidi
former statements are amplified or corrected. There is
something in the gradual development of his views whidi
apparently adds to their weight, and the more easily con-
vinces us of their correctness. In order to give a better
idea of these admirable experiments, I will give a brief
summary of his reports : '
He began by removing small circular segments, fifteen
millimetres in diameter and about two millimetres in depth
from the convexity of the brain (of dogs) in various local-
ities. Only when the part removed was in a limited
area of the occipital region was there any appreciable
impairment of vision. When the lesion was produced in
this region it was followed by peculiar disturbances of
sight. The affection of vision was observed only in the
eye opposite to the injured hemisphere. When the sound
eye was covered, so that he could only use the affected
one ; or, in case a symmetrical lesion had been produced
in both hemispheres when both eyes were uncovered, it
was observed that the animal no longer recognized objects
formerly familiar to him. Thus, he remained uncon-
cerned and quiet when a whip was held before him, at
the sight of which he had previously been accustomed to
wince or run away. A bright light brought suddenly
before the eyes caused no movement, and he remained
impassive in the presence of food until, through some
other sense — taste, smell — ^he became cognizant of its
presence. Yet the dog was not blind, for he avoided
any obstacle in his way. At the end of from four to six
weeks this visual defect gradually disappeared, and ob-
jects were recognized as before.
Munk supposed that the removal of this area in the
cortex did not produce blindness, but that it robbed the
brain of that part wherein were stored the visual images
gained from past experience, leaving the animals, there-
fore, like new-bom, who see, but do not know the mean-
ing of what they see. The fact that after the lapse of a
few weeks they again recognized objects he attributed
> Taken from Functiooen d«s GrosshetanDde. Gewmmrite Mitthdiimgai. ;
August 30, 1884. J
THE MEDICAL RECORD.
233
to knowledge gained from new experience. This condi-
tion, in which animals, while retaining the sense of vision,
had lost the knowledge that vision usually conveys, he
tenned " soul-bHndncss " {seelen blindheit).
Later and more careful observations revealed that
there was in these instances not only this mental blind-
ness, bnt^ at least for parts of the retinse, complete blind-
ness. It was observed after the soul-blindness had dis-
appeared that when pieces of meat were scattered on the
flbor, the dog would find some pieces and overlook others.
In hne( in those animals in which the specified port of
the cortex had been removed there was absolute blind-
ness of the central (the most important) part of the retina
of the opposite eye, while the peripheral portions of the
same retina remained intact. The size of the blind spot
in the retina was in proportion to the extent of visual area
destroyed.
Munk now removed what he supposed to be the entire
visual area of one hemisphere, the cortex of the whole
occipital region. At first the animal made the same im-
pressions as those above described, in the one eye vision
being apparently normal, in the other the so-called soul-
blin£iess. Bat that this conclusion was not quite cor-
rect was shown by closer observations. When the sound
eye was covered objects held in front of the other were
apparently not seen. But if now the object was placed
jost before the covered eye, so that its image fell on the
temporal side of the retina of the affected eye it then
seemed to be observed. Vision was retained in its tem-
poral segment while the rest of the retina was paralyzed
Bot tiiere was for this still sensitive portion the condition
described as soul-blindness — objects were seen but not
recognized. But the animal could very readily be taught
to again recognize the forgotten objects. Thus, when
food was placed where its image fell on the sensitive por-
tion of the retina it was at first left untouched. But when
the animal learned what it was firom his other senses, he
soon recognized it by sight alone. A light held in the same
position left the animal unmoved, but after he had been
silked with it, its mere appearance produced maniies-
tadoosoffear.
While after entire removal of the visual area of one
hemisphere there was thus partial blindness in the oppo-
site eye (the larger part of the retina being paralyzed, a
smaller jMurt on temporal side remaining sensitive to lig^t),
a contrary condition was found in the eye of the same
side. Here central vision was perfect ; but on careful
examination it was observed that there was a small seg-
ment of the retina on the nasal side, corresponding m
sie to die sensitive portion of the other retina, where
light was no longer perceived.
In seven dogs Munk succeeded in removing the entire
visual area of both sides. They all lived several months
(one of them ax months) after the operation. In all of
^em, while the other senses and power of movement re-
mained unimpaired, the sense of vision was lost in both
ejes completely and permanently.
^There could scarcely be a more complete demonstra-
tion of the cortical centres for vision than these admirable
experiments of Munk. It only remains to point out
more precisely the relations of the retina to the visual
area. This Munk succeeded in doing' with a wonderful
degree of precision. His results are as follows : The
outer part of the visual area (about one-third of entire
visual area) is in relation with the outer or temporal part
of retina (about one-fourth entire retina) of the same side.
The larger inner and median part of the visual area is in
relation with the larger inner and central part of the
retina of the opposite side. The outer segment of the
visual area is in relation with the corresponding outer
segment of the retina in such a way that the inner part
of the former is in relation to the inner part of the latter,
the outer part in relation to the outer part of the latter.
The same relationship exists between the other corre-
sponding segments, that is, the outer part of the inner
aod median segment of the visual area is in relation with
the outer part of the corresponding inner and central
segment of the retina, and, again, the inner part of the
one in relation to the inner part of the other. To com-
plete this topographical relationship, it need only be
added that the anterior parts of the visual area are in re-
lation with the superior, the posterior in relation with the
inferior portions of the retina.
Lest die above may not be altogether clear, I will re-
peat the description of relationship of cortex and retina in
Munk's own words : ^ Each retina in its outer lateral
part is devoted to the most external lateral portion of
the visual area of the same side. The much larger re-
maining part of each retina belongs to the much larger
remaining portion of the opposite visual area, and in such
a way that we may imagine the retina projected upon the
visual area with the lateral border of diis larger segment
of the retina corresponding to the lateral border of the
larger segment of the visual area, its most internal border
to the median border of the latter, and, finally, the supe-
rior border of the retina to the anterior, the inferior to
the posterior border of the visual area."
The results of Munk's experiments on monkeys have
already been mentioned. They were made on a smaller
number of animals, and lead to the general conclusion
that the visual area is seated in the occipital convolutions,
each occipital lobe being in relation with a correspond-
ing half of each retina. We thus see that in the monkey
the occipital lobe is in relation with a larger segment of
the retina on the same side than in the dog, and in this
respect is similar to what we will have occasion to ob-
serve in man.
These, then, very briefly given, are the results of
Munk's experiments on dogs and monkeys. Ganser^ ob-
served, after removal of the occipital region in cats,
blindness on the corresponding side of both retinae. The
results obtained by other experimenters, especially Fer-
rier, will be mentioned at a later period ; but we must
now proceed to examine the experiments of an eminent
physiologist, Goltz, who has apparently obtained results
contradictory to diose just mentioned, and who has suc-
ceeded in exciting much doubt as to the correctness of
the present theories of localization.
Experiments of Goltz. — Goltz has made various re-
ports of his experiments, but of his original contributions
only one^ that published in the first volume of the
'< Transactions '' of the last International Medical Con-
gress, is at my disposal. The statements here made are
taken diiefly from that article* A lew of his experiments
mentioned by Wernicke,' not included in the above re-
port, will be added. Goltz* general conclusions are :
Destruction of a large part of the cerebral cortex weak-
ens all its higher functions^ it diminishes the intelli-
gence and thereby the acuity of all the special senses.
But the destruction of no part is followed by the com-
plete or permanent loss of any cerebral function, with
slight modifications all being always alike affected, the
degree depending only on the extent of the injury. In
other words, we cannot say of any part that it is the
centre for vision, hearing, the innervation of certain
groups of muscles, or the like.
The experiments were made on dogs. In the begin-
ning he was accustomed to remove portions of the brain
substance by means of a stream of water, large parts be-
ing washed out at one time. He observed, after thus re-
moving a large part of one hemisphere, hemiplegia on
the opposite side, and blindness in the opposite eye.
But these symptoms were only transitory. Soon the ani-
mal appeared to use one side as well as the other ; and
the eye again saw, though certain disturbances remained.
Altliuugh he avoided obstacles in his way, he no longer
recognized persons, was not frightened when threatened
with a whip, etc.; in short, the condition above described
as soul-blindness. Goltz at the same time observed
similar defects of the other special senses. The dog ap-
* Archiv f. Psychiatrie, Bd. xiii., 1882.
^ Gchimkrankheiten. Introduction to voU.ii*
^34
THE MEDICAL RECORD.
[August 30, 1884.
parently retained the sense of hearing, but was not
frightened at the cracking of a whip as before, etc In-
asmuch as the symptoms were much alike, whatever
part of the brain was washed out, Goltz believed that
the present theories of localization must be incorrect
But for the purpose of examining the question more
carefully, he instituted another series of experiments,
wherein, instead of removing brain substance by means
of a stream of water, he employed a boring-machine,
wherewith he was enabled to remove much more circum-
scribed parts.
His general conclusions are tlie same here as from
the former series of experiments. From small lesions
he observed no permanent injury of intelligence or
special senses, from large lesions (and such were pro-
duced in most instances) the general results already men-
tioned In confirmation of his views he exhibited before
the^International Congress in London a dog in whom he
had removed, at five different periods, from November
15, 1880, to May 25, 1881, large portions from the pa-
rietal and occipital regions of both hemispheres. This
dog could run along in a lively manner, revealing no
evidence of paralysis of any muscles further than a cer-
tain awkwardness in some of his movements. He was not
blind, as evinced by his avoiding obstacles. But he mani-
fested no fear when threatened with the fist or whip, or
when a fiame was brought in front of his eyes. He could
hear, for he turned his head when called and tried to
reach the caller. But he heard unmoved the cracking
of a whip, which formerly produced the liveliest mani-
festations of fear. He could smell, but did not object
to tobacco smoke or chloroform vapor. He could taste,
but would eat the flesh of a dog, formerly very objec-
tionable to him. Finally, his cutaneous sensibility was
retained, though blunted. The dog's intellect was greatly
impaired, and Goltz attributed the various sensory dis-
turbances just detailed to the great lack of intelligence.
It is on experiments and observations of this kind that
Goltz bases his views. Yet, when properly considered,
they by no means have the full significance he attaches
to them.' My present remarks refer to his conclusions
only on the subject of vision. As to the motor phe-
nomena in these instances, they must be explained in
quite a different manner.'
According to the experiments of Munk, the extirpa-
tion of parts of the visual area is attended by permanent
defects of vision, which defects are only detected after
very careful observations. That Goltz made special ex-
aminations for the purpose of discovering whether such
defects were present, whether there were larger or smaller
blind spots in the retinae, does not appear from his report.
If but a small part of the visual area remained, that would
probably be accompanied by sufficient vision to avoid
obstacles, etc., which appeared to be the only evidence of
sight in Goltz' animals, when large parts of the brain
were removed. Only in case he had removed the entire
visual area of Munk without producing complete blind-
ness could it be said that Munk's statements had been
disproven. It is true, Goltz claims to have done this.
But we may be allowed to doubt this statement (at least
so far as Munk's description of the visual area is con-
cerned), for he speaks of the entire removal of the visual
area of the dog presented at thq International Congress,
though a large part of it still remains.
But what Goltz dwells upon specially, as seeming to
disprove former theories of localization, is that in his ex-
periments the removal of the so-called visual centre
caused equal defects in the other special senses, hearing,
smell, etc. As an objection to the correctness of such
* This gtatement and the following ones axe based upon the knowledge of Goltz*
experunenu and conclusbns as found in the report to die International Congress.
As m this rraort he reviews the whole subject, we are po-haps justified in judging
it as it stands. If there be anything in his other contributions which apparently
nullifies anv statement of mine, I regret that such are not within my reach.
> Femer's explanation is probably a correct one, that the lower the animal the
greater the mdependence of the subcortical centres; so that in dogs locomotion is
stUl possible after removal of the cortical oentres of motion, while in the motiker
and man, where the hemispheres havtf a far higher influence, soch mutilation wiU
cause permanent paralysis.
reasoning it must be mentioned that in such instances
large parts of the brain had been removed. Thus not
only were parts of the surface removed, which presuma-
bly belonged to other centres, but the deeper portions
of the brain were extensively injured, and thus fibres
severed passing to various portions of the cortex. That
such lesions should be followed by the impairment of
more than one function is not surprising, but what ought
to have been expected.
But apart from these considerations Goltz' expeii-
ments in some instances are opposed to his own views.
The following illustrations are taken from Wemick^s
summary of Cxoltz' experiments.' A dog, in whom the
cortex of one occipital region was removed, five we^s
after the operation saw only imperfectly with the op-
posite eye, while no other defect was . noticeable. In
another instance, where portions were removed from both
hemispheres, vision was very imperfect while hearing was
apparently normal.
The last instance I shall mention is the dog presented
at the International Congress. This case is the more
worthy of careful study because not only was it publicly
demonstrated, but the post-mortem examination was
made by a commission of impartial judges, giving it the
value not alone of individual but also of general observa^
tion.
I believe in this case there is evidence of paralysis of
parts of the retinae. The do^ did not fix objects with
his eyes, as is usual in lookmg at things ; when called
and attempting to find the one calling him, he moved
aimlessly about ; and in moving about he often struck
against objects on the leffc side, which seemed to indicate
blindness in the left part of the field of vision, and may
be brought in direct relationship with the fact made eviv
dent both by the written description of the post-mortem,
and by the accompanying plates, that the visual area in
the right hemisphere was removed to a much greater ex-
tent than that in the left
We have dwelt sufficiently on the experiments of Goltz.
If, notwithstanding the eminence of the experimenter, we
cannot accept his views, we are influenced not alone by
the results gained by other experimenters, but also by the
critical study of his own results.
Topography of cerebral convolutions. — ^Before leavii^g
this part of our subject I must enter briefly into a few
anatomical details. The object of our present investiga-
tions is to .arrive at a knowledge of the functions of parts
of the convexity of the brain. We have thus far con-
sidered mainly the results of experiments on animals, and
will have next to study pathological changes in man.
But in order that there may be a comparison between
such results we must know that the parts are anatom-
ically homologous, in order to attribute to them like
functions, but in appearance this is not the case. It
will have been observed that in reference to rabbits,
cats, and dogs, I have spoken of the occipital region,
and in man and monkey of the occipital lobes and
convolutions. For the latter can be distinctly mapped
out in man and the monkey, but not in the other animals
mentioned.
In most of the higher mammalia there are to be seen
in the convexity of each hembphere four longitudinal
convolutions which pass from the anterior to the poste-
rior part of the brain, arching over the Sylvian fissure.
These are usually termed the four original convolutions,
the one bordering the longitudinal fissure the first, that
bordering the Sylvian fissure the fourth convolution. In
lower mammalia, as the rabbit, there are only indistinct
sulci on the surface of the hemispheres, and no convolu-
tions distin{:tly mapped out. In the monkey and man,
on the other hand, this four convolution type appears to
have been wiped out through the appearance of new feat-
ures, especially the fissure of Rolando, and the occipital
fissures, thereby multiplying the number of convolutions.
August 30, 1884.J
THE MEDICAL RECORD.
^35
Nevertheless a careful study of their development, and of
hains of different races, where the type gradually changes
to these more extreme forms, enables us to trace a topo-
graphiod relationship between the more highly developed
convolutions of the monkey and man, and the four con-
Tolotion type of other mammalia. It thus appears that
the occipital convolutions are the posterior extremities
of the second and third orif^inal convolutions ; and the
angular gyrus (a part we will have occasion to refer to
again) is a part of the original third convolution.'
I may mention here that our future investigations will
lead to the conclusion that the cortical visual area in man
is mainly in the occipital lobes, the part corresponding
to that pointed out by Munk as the visual area in the
dogi and probably also to that in the rabbit as mapped
out by Monakow.
AGE OF GREATEST RISK FROM CONSUMP-
TION.
By henry B. baker, M.D.,
LANSmC, MICHIGAN.
On page 36 of The Rscord for July 12, 1884, 1 am glad
to find an article, illustrated by a diagram, showing the
death-rate from consumption at several periods of age
from twenty to over seventy years. Some years since I
prepared and published in a volume distributed in Michi*
gan ("The Vital Statistics of Michigan, 1870"^, is-
sued in 1872, a similar diagram relating to the oeaths
returned as having occurred from consumption in the
State of Michigan in the year 1870, 1,451 deaths in all,
in which the increased proportion of deaths to inhabi-
tants over the age of fifty-five years was especially notice-
able. The subject is one .which may justly claim the
attention of the physician as well as the student of vital
statistics. The death-rate of females was much greater than
Aat of the males at ages firom ten to fifty-five years, ex-
cept that at the period from forty to forty-five years of age
the death-rate of women from consumption dropped very
noticeably ; but at ages fifty-five to seventy-five years the
death-rate of males was greater than that of femsdes, from
this disease. The number of deaths of those above the
age of seventy-five years is too small to sive a steady
mrve, but the table, and especially the diagram, shows
well the death-rate of each sex from birth to the age of
seventy-five years. The death-rate from consumption
was then shown to be least at the ages from five to fifteen
jears. The remarks then made in connection with the
subject, show the reason for the fallacy in the popular
new that the death-rate is greatest at ages twenty to
twenty-five or twenty to forty; the number of deaths
being greatest at ages twenty to twenty-five, the fact of
the much greater proportion of inhabitants at those ages
than at the older ages is not generally held in mind.
The Rslation between Nervous Afpections and
Diseases of the Nose. — Dr. Chiari relates three cases
of nervous affections caused by swelling of the mucous
membrane covering the inferior turbinated bones. In
two of these cases tihere was supraorbital neuralgia, which
was entirely relieved after the removal of a number of
nasal polypi. The third patient suffered from bronchial
asthma. Although there seemed to be sufficient cause
for the trouble in an aneurism of the aorta, nevertheless
the aadior determined to reduce a slight swelting of the
mucous membrane covering the anterior portion of the
turbinated bones. This was done by means of the gal-
Tano-cautery, and the result was a perfect eure of the
asthma. Dr. Chiari holds that one ou^ht to search the
nostrils for a possible cause of asthma in every instance,
even though the condition of the heart or lungs would
seem to offer a sufficient explanation of the dyspnoea. —
Deutsche MedicifuU-Zeiiung^ June 9, 1884.
> WcrnickA : Gehirnkraskheiten, vol. i«
gr0j0tt^«BB 0f pSCjedijcal J^cieucje.
Persistent Omphalo- mesenteric Remains^— The
pouch-like formation of intestine occasionally seen pro-
jecting from the lower portion of the ileum, is universally
known as Meckel's diverticuliun. Not that this distin-
^ished anatomist was its discoverer, but to him we owe
not only the almost universal acceptance of his theory
of the origin of the pouch in question, but are also in-
debted to him for calling conspicuous attention to its
importance in the causation of serious disease. In an
article in the July number of The American Journal of
the Medical Sciences^ Dr. Fitz, of Boston, considers this
whole subject . and points out that the view — that most,
if not all well-authenticated instances of duplication of
the intestinal tract, at any part of its course, are the
probable result of the persistence and growth of the re-
mains of the vitelline duct — is rendered highly probable
from what is known concerning the development of the
intestine. Attention is also called to cystic dilatation of
the diverticulum. These retention cySts, as they are
called, may have their cavity continuous or discontinu-
ous with the intestine. Moreover, such cysts of possible
intestinal origin are not limited to the abdominal cavity,
having been observed in the vicinity of the oesophagus,
in the abdominal walls, in the vicinity of the umbilicus.
Dr. Fitz points out that the vitelline duct is com-
posed not only of layers of tissue equivalent to those
forming the coats of the intestine, but it is also accom-
panied by blood-vessels. The relation of these omphalo-
mesenteric vessels or their remains to intestinal strangu-
lation is fully discussed, and the importance of bearing
in mind the congenital nature of certain of the causes of
acute intestinal obstruction is earnestly insisted upon.
Dr. Fitz finds that — i. Bands and cords as a cause of
acute intestinal obstruction are second in importance to
intussusception alone. 2. Their seat, structure, and re-
lation are such as frequently admit their origin from oblit-
erated or patent omphalo-mesenteric vessels, either alone
or in connection with Meckel's diverticulum, and oppose
their origin from peritonitis. 3. Recorded cases of intes-
tinal strangulation from Meckel's diverticulum, in most in-
stances, at least, belong in the above series. 4. In the
region where these congenital causes are most frequently
met with an occasional cause of intestinal strangulation,
viz., the vermiform appendage, is also found. 5. It
would seem, therefore, that in the operation of abdom-
inal section for the relief of acute intestinal obstruction
not due to intussusception, and in' the absence of local
symptoms calling for Uie preferable exploration of other
parts of the abdominal cavity, the lower right quadrant
should be selected as the seat of the incision.
The vicinity of the navel and the lower three feet of
the ilium should then receive the earliest attention. If
a band is discovered, it is most likely to be a persistent
vitelline duct — /.^., Meckel's diverticulum, or an om-
phalo-mesenteric vessel either patent or obliterated, or
both these structures in continuity. The section of the
band may thus necessitate opening the intestinal canal
or a blood-vessel of large size. £ach of these alter-
natives is to be guarded against, and the removal of the
entire band is to be sought for, lest subsequent adher-
ence prove a fresh source of strangulation.
On Opening and Drainage of Abscess Cavities in
THE Brain. — Drs. Fenger and I^ee, in a paper on this
subject in the July number of The American Journal of
the Medical Sciences^ consider the treatment of traumatic
cerebral abscess, and report a case which was success-
fully treated by opening and drainage.
Bergman, in discussing the treatment of cerebral ab-
scess, unhesitatingly sets it down as an axiom that where-
ever there is an accumulation of pus, trephining is
most clearly and indubitably indicated, for the opening
of an abscess in the brain is as necessary as in any
^3*
THE MEDICAL RECORD.
[August 30, 1884.
other part of the body, and we would add even more
80* A correct diagnosis of abscess having been made,
the further difficulty presents itself of locating it with
sufficient accuracy, so as to be able to find it. A num-
ber of cases are on record, in which a correct diagnosis
had been made, the trephine also put on more or less at
the right place^ but the knife or trocar being passed into
the brain, nevertheless missed the abscess. Drs. Fenger
and Lee show by their case that this difficulty can be
obviated by multiple exploratory aspirations, performed at
interstices sufficiently small to prevent any abscess from
escaping detection, even if the trephine opening should
not have been made at the point of the skull nearest the
abscess,
There are on record a large number of cases of cere-
bral abscess in which trephining was performed, pus
evacuated, and temporary relief obtained ; but later re-
lapse followed, and a fatal termination ensued. It is
possible, judging from the success the practice has met
with in the treatment of abscesses in other situations, that
drainage of the cerebral abscess-cavity, with or without
washing out, would have saved some of these cases, by
preventing the reaccumulation of pus aiid the continuous
infection of the surrounding brain tissue, the acute
oedema of which is well known to be, as a rule, the final
cause of death. As far as Drs. Fenger and Lee are
aware, draining and washing out of cerebral abscess-
cavities has heretofore not been tried; that it can be
effected and without any detriment to the patient, is
shown by their case, the treatment of which they hold
strictly conforms to the rational methods of modern sur-
gery m treating abscesses in general; and because of
this, and not because their patient recovered, they re-
gard the case as answering affirmatively the question :
Is it probable that abscesses in the brain can be treated
advantageously on the same principles as abscesses in
other parts of the body ?
Aspiration of the Bladder. — Dr. Hamaide relates
some instances of impervious stricture of the urethra in
which he aspirated the bladder from thirteen to eighteen
times without observing any unpleasant symptoms. He
cites these cases as an additional evidence of the safety
of this procedure, and he maintains that aspiration is
much less likely to do harm than is cadieterization in un-
skilful Ym^d!^— Journal deJii^cinedePariSt No. 21, 1884.
Traumatic Cephalhydrocele. — ^The occurrence of
subfascial accumulation pf cerebro-spinal fluid, in con-
nection with and consequent upon simple fracture of the
vault, is of great rarity. Two cases of this kind are re-
corded by Dr. P. S. Conner, of Cincinnati, in the July
number of TTie American Journal of the Medical Sciences.
So far as he has been able to ascertain, there have been
reported but nineteen similar cases, and three others
where there had been originally a communicating wound
of the scalp which had closed. As £eu: as has yet been
observed, excluding those cases which were primarily
compound, this traumatic cephalhydrocele is met with
only in young subjects. Explanation of this fact is
probably to be found, at least in part, in the great
elasticity of the skull in infancy and early childhood,
permitting of marked depression and Assuring of the
vault without that associated wound of the scalp which
would be likely to occur were ossification complete ; and
in part, also, in the much closer connection of the
meninges and skull in children than in youth and adults.
The decided gravity of these cases is apparent firom
the statistics. Of the eighteen cases of simple fracture
in which the result is known, nine (fifty per cent.) died —
eight of meningo-encephalitis and one of erysipelas and
meningitis ; and of the three in which the fracture was
originally compound, one died (thirty-three and one-third
percent) of cerebral abscess. Even die supposed recover-
ies may be regarded with some suspicion, because of too
early report. Dr. Conner draws the following general con-
clusions : I. Simple fracture of the vault of the skull may
give rise to a collection under the scalp of the cerebro-
spinal fluid ; coming, it may be, only from an opened ven-
tricular cavity. 2. Such traumatic cephalhydrocele may
be developed quickly, or only after the lapse of a number
of days, or even weeks. 3. The condition is one that
has thus fJBLr been noticed only in young subjects. 4,
The accident is quite likely to jprove fatal fi-om lepto-
meningitis or meningo-encephalitis. 5. Operative inter-
ference should be restricted to the removal by aspiration
of a limited amount of fluid ; and such aspiration should
be made only when severe pressure symptoms have
manifested themselves. 6. A similar fluid accumulation
may occur after closure of the external wound of a com-
pound vault-fracture or of a trephining.
Purification of Drinking-Water. — The following
method, proposed by Professor Almen, of Upsala, is rec-
ommended by Husemann : To a quart of water are
added a drachm of a 5 per cent, solution of chloride of
iron, and from i\ to 2 ounces of lime-water. The en-
suing reddish-brown precipitate removes all the floating
particles and from 40 to 80 per cent of the soluble or-
ganic matters. When this precipitate has settled to the
bottom, die water is filtered through sand or fine linen.
— Deutsche Medicinal-Zeitung^ June 5, 1884.
The Etiology of Convulsions in Childrkn.— .
There is a special predisposition in children to convul-
sions, and this is due, according to Professor Kjellbeig,
not to any increased irritability in the motor or sensory
tracts or m the reflex centres, but to the fact that the
brain is unable to exercise any controlling influence
upon the reflex centres. Convulsions whidi occur at
the commencement or during the course of any acute
disease through direct central irritation are symptomatic
Those which are excited reflexly by irritation of the
sensory nerve-endings are sympathetic S)rmptODQatic
convulsions axe due m part to disturbances in the circu«
lation and in part' to changes in the blood. Among
the disturbances in the circulatiany the most common is
a rapidly produced cerebral anaemia. This may be
caused by hemorrhage, a rapid waste of the animal fluids,
or arterial spasm. In other cases it is due to cerebral
compression or anatomical changes in the brain, such as
extravasation of blood, tumors, softening, etc Hyper^
aemia may also cause convulsions indirectly. When an
excess of blood is carried to the brain the cerebro-spinal
fluid in the perivascular spaces cannot yield, but makes
pressure on the smaller capillaries» whereby they are
emptied of their blood, and the real condition is then
anaemia of the brain. The action of venous stasis is
very similar in depriving the brain of its necessary supply
'of arterial blood. There are often changes in the blood
at the same time with these circulatory disturbances.
An elevated temperature is one of the most potent of
these causes, as by it the irritability of the nerve-elements
is increased. The quality of the blood may be impaired
also by the introduction of poisons, either those intro-
duced from without or those formed in the tissues of the
body itself In this category belongs also the change in
the milk of nursing women induced by violent emotion.
Sympathetic convulsions may be excited by almost any
irritation of the sensory nerve-endings, in consequence
either of increased irritability of the nerves or of dimin-
ished power of the reflex controlling centres. In regard
to the presence of worms in the intestinal canal, the
author admits that this may be a cause of convulsions,
but insists upon the necessity of a search for other causes,
since worms may be present and yet have nothing to do
with the convulsions. He believes also that dentition
may be of etiological importance, and does not admit as
valid the objections of those who say that this is a
physiological process, and therefore incapable of pro-
ducing morbid symptoms. Although he does not doubt
the fact of an hereditary predisposition to convulsions in
certain families, he admits his inability to explain it —
Schmidfs JahrbOcher^ May 20, 1884.
August 3o» 1884.]
THE MEDICAL RECORD.
^37
Cortical Lesions of the Brain. — Dr. M. Allen
Starr, of New York, in the July number of like Ameri-
can Journal of the Medical Sciences^ has collected the
American cases of lesions of the central region of the
brain, and carefully studied their localized symptoms.
He finds that disturbance of general sensation — ^in-
dading the sense of touch, pressure, pain, and tempera-
ture, together with the sense of the location of a limb —
may occur either in the form of subjective perceptions
of such sensations without objective cause^ or in the
form of impairment of these sensations. In either case
it indicates a disease in the central convolutions, and
possibly in the adjacent portion of the parietal lobules.
The power of voluntary motion of the muscles of the
opposite side of the body is located in the two central
convolutions which border the fissure of Rolando. Mo-
rions of the face and tongue originate in the lower third
of this r^on ; motions of the arm, in the middle third ;
motions of the leg, in the upper third. Spasms in, or
paralysis of, a single group of muscles may indicate dis-
ease of its motor area. Extensive spasms or paralysis
may indicate a large area of disease in this region, but if
more marked in a single group of muscles than in others
it may indicate a small focus of disease in the motor area
of that group affecting other motor areas indirectly and
coincidently. Paralysis following spasm in one group of
muscles is a characteristic symptom of disease in the cen-
tral region. Disturbance of the power of speech indicates
disease in the convolutions about the fissure of Sylvius on
the left side in right-handed persons, and on the right side
in left-handed persons. If the patient can understand a
question and can recall the words needed for a reply,
but is unable to initiate the necessary motions involved
in speaking, the disease is probably in the third frontal
convolution and in the adjacent portion of the anterior
central convolution. If the patient cannot recognize
spoken language, but can repeat words after another, or
can use exclamations on being irritated, the disease is
probably in the first temporal convolution. If the pa-
tient can understand and can talk, but replaces a word
desired by one that is unexpected, the disease is prob-
ably situated deep within the Sylvian fissure, or in the
white substance of the brain, and involves the association
fibres which join the convolutions just named.
. Right's Disease of Malarial Origin. — Dr. I. R
Atkinson, believing that this subject has not attracted
the attention it deserves, has been led to study with
reference to it all cases of malarial fever coming under
his observation during the late summer and early fall of
the past two years at Bayview Asylum, and the result he
gives in a paper which appears in the July number of
The American Journal of the Medical Sciences. The
conclusions which he reaches are as follows : i. Transi-
tory albuminuria is not uncommon in the course of
malarial fevers, and is due to the intense visceral con-
gestions characteristic of these affections. It only may
endure throughout the height of the congestion, recur-
ring with each return of diis> or it may persist in the
intervals, in which event a higher grade of congestion is
attained, more nearly approaching a condition of acute
inflammation. 2. In a proportion of cases, varying with
locality and type of prevailing epidemic or individual
conditions, inflammation of the kidney occurs, accom-
panied by dropsy and the usual symptoms of nephritis.
3. The usual form of malarial nephritis is the tubal and
diffuse variety. In this the inflammation seems to be
most intense in the vicinity of the glomeruli. 4. Con-
tracted kidney may occur as an advanced stage of ma-
larial nephritis either firom long-continued or frequently
repeated attacks of malarial fever, or from fibrotic changes
such as may ultimately occur in ordinary tubal or diffuse
nephritis. It is altogether improbable that this form of
malarial renal disease ever occurs primarily as purely
interstitial nephritis. 5. These changes may be induced
by any form of malarial fever, though they more com-
monly follow chronic intermittent fever. 6. The ten-
dency of malarial inflammation of the kidney is toward
recovery. But fit>m the persistence of the impaludism
or the intensity of the inflammation, structural changes
may be produced that are characteristic of chronic
Bright's disease, when the gravity of the afiection will
be as that from chronic Brighf s disease from whatever
cause. 7, Treatment should be directed primarily against
the malarial intoxication, more especially in recent cases.
A correction of this will often be followed by a complete,
though often gradual, subsidence of the nephritis. Even
in more chronic cases, the malarial factor in the process
should definitely be destroyed if possible, after which the
disease should be treated as ordinary Bright's disease.
Nerve-Stretching in the Treatment of Epilepti-
form Neuralgia. — Epileptiform neuralgia, or so-called
incurable facial tic, is a disease characterized by neuralgic
paroxysms of great intensity, occurring in one or more
branches of ti^e fifth nerve, and usually, if not always,
confined to one side of the face. The paroxysms seldom
last more than half a minute, and recur mth great irreg-
ularity, sometimes five or six times an hour, and some-
times not more than twenty or thirty times in the twenty-
four hours. They may be determined by a variety of
causes, eating, speaking, washing the face, or any periph-
eral irritation of howsoever trivial a nature. The treat-
ment of this affection has hitherto been eminently unsat-
isfactory. Nearly every known drug has been tried
without efiect, the only one that gave even a measure of
relief being opium in large and repeated doses. Neu-
rotomy, neurectomy, the introduction of hot needles into
the foramina of exit of the different branches of the
nerve, and the extirpation of one of the ganglia con-
nected with it have all been employed, but Imve brought
about only temporary fi-eedom from the paroxysms. In
an article on this subject in The Practitioner for July,
1884, Mr. W. J. Walsham claims to have cured a number
of cases by stretching the affected nerve. Three of
his patients had previously undergone neurotomy or neu-
rectomy with but temporary relief, while nerve-stretching
was followed by the most happy results. The author
gives a brief history of each of his cases, promising; to
publish a more detailed account of them after a sufficient
time has elapsed to satisfy him that the cure is a perma-
nent one. Already, at the time of writing, the patients
had been relieved of their pain for periods of firom tinree
mondis to three years. In order to reach the inferior
dental nerve, the mouth being held open by a gag, an
incision is made through the mucous membrane from the
last molar tooth in the upper jaw to the last molar tooth
in the lower. The finger is now introduced into the
wound and insinuated between the ascending ramus of
the jaw and the internal pterygoid muscle. The small
spur-like projection of bone at the entrance of the infe-
rior dental canal is next felt for and serves as a guide to
the nerve. An aneurism needle with a very short curve
is now passed and hooked around the nerve, which can
be then drawn visibly into the entrance of the wound
The structures in the neighborhood to be avoided are the
inferior dental anery and gustatory nerve. It should
also be remembered that the internal lateral ligament,
which is inserted into the spur-like process of bone, fol-
lows somewhat the same course as the nerve, and might
be mistaken for it In order to avoid this it is necessary
to hitch the point of the needle in the entrance of the
canal, and thence sweep it upward, backward, and out-
ward around the nerve.
Morphine in the Vomiting of Pregnancy. — Dr.
W. C. Roberts, of Albany, Wisconsin, writes that in three
cases of obstinate vomiting of pregnancy he successfiilly
used muriate of morphine per rectum in half-grain doses.
Dr. Roberts asks for the experience of others with mor-
phine given in this way.
238
THE llCEDICAL RECORD:
[August 30, 1884.
The Medical Record:
A Weekly yournal of Medicine and Surgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
PUBLISHSD BY
WM. WOOD & Co., Nos. 56 and 58 Lafayette Place.
New York, August 30, 1884.
SPERMATOPHOBIA AND SPERMATORRHOEA.
If we may except the able treatise of Bartholow, no re-
cent publication has handled with more good sense and
fairness than the little work of Malteot ' a disease which
is oftener to the patient a terrifying phantom of the im-
agination than an actuality, but which, whether fanciful
or real, is certain continually to try the patience and
skill of the busy practitioner.
Malteot has the merit of showing that the '' classical
tableau" of symptoms, so strikingly set forth by Lalle-
mand in his too influential work published in 1840,' and
since then adopted and improved by many well-meaning
writers (to say nothing of the harvest-field which this
" tableau " has been for quacks in all lands), is found,
when subjected to a rigorous criticism, to have little
foundation in fact, being the result of " ignorance of the
pathology of the genito-urinary organs," and a " super-
ficial^^agnosis, devoid of scientific precision." Led
astraj by a preconceived idea, neglecting — what is as-
suredly of the utmost importance in diagnosis — ^the help-
ful guidance of the microscope, these writers, from Lalle-
mand downward, have attributed to seminal losses (which
either did not exist at all, or were ph3rsiological) symp-
toms which '' were the consequence of affections of the
passages, to-day well understood, such as chronic ureth-
ritis, cystitis, prostatitis, or urinary tuberculosis." Those,
moreover, who are familiar with Lallemand's book
know that he dwells much on certain morbid appearances
of the urine — turbidity, flocculence, glaiiy sediments, etc.
— as indicative of the presence of sperm ! Even Trous-
seau, through deference to Lallemand's authority, com-
mitted the same error ; he placed much stress on the
presence in the urine of certain <* granulations, and bril-
liant corpuscular bodies,*' on which Lallemand also in-
sisted.* These " granulations " and " corpuscles " have
been invariably found by Mal6cot to be formed of '* blad-
der epithelium and pus globules, enveloped in a reticu-
lum of fibrine ; spermatozoids were absent."
Certain urethral discharges having been shown to be
not seminal, and of little prognostic value, how shall we
account for the accompanying symptoms which, divested
of the usual exaggerations, are those of spinal erethism
—of so-called *' nervous irritability" or " debility," with
consequent depression of the principal visceral functions ?
> De la Spennatonii^ Doct A. Mal^cot. Pp. 135. Paris, 1884.
' Des Pertes Seminales Invcdimtaires. Montpdtier, x839-4a
* IVoutseau : De la Spermatorrhde. Paris, 1867.
One of three suppositions will explain all of these cases,
so familiar to every physician. Either the neurotic
symptoms are quasi-accidental accompaniments of the
bladder or urethral troubles, being dependent on some
common cause producing functional nervous disturbance,
as overwork — mental or physical — alcoholism, or some
other vice ; or they are the expression of some pathologi.
cal affection of the brain or spine — ^an extremely frequent
antecedent of the ills usually attributed to seminal losses;
or else they are the results of the local catarrhal states,
. through the mysterious but well attested influence of the
emotions and the imagination on the nervous system and
the organic processes. The latter division will embrace
all the victims of what Mal6cot rather infelicitously calls
** physiological spermatorrhoea ; " — ^young men who make
extravagant account of their occasional seminal losses,
and whose habitual emotional firame favors an erethistic
condition of the genital organs, and of whom it may be
affirmed that there is nothing the matter with them but
spermatophobia. This latter word is so good and so
apposite that it might almost be used to indicate a defi-
nite pathological syndrome, with whose outlines every
physician is acquainted. Many of these unhappy per-
sons are veritable hypochondriacs, "always preoccu-
pied with their health, attaching an excessive importance
to the least urethral discharge, whatever may be its na-
ture ; ** fatiguing by their prolixity their medical attend-
ant, who vainly endeavors by reason or by banter to rid
them of their delusion.
A word of caution is here necessary ; these patients
are often real sufferers. If the occasional losses, ure-
thral, prostatic or seminal, are of little or no detriment
per se^ the state of mind known as spermaiophobia b an
actual psycho-cerebral disease, akin to melancholia or the
delirium of persecution. In fact, one of the cases (Obs.
xvi.) reported by Malteot as " imaginary spermatorrhcea"
concerns a patient who was clearly a victim of mental
alienation, bordering on the delirium of persecutim*
Several cases of insanity cited by Lallemand as consecu-
tive to seminal losses are also instances of the same kind,
the insane neurosis, developed to activity, not by sperma-
torrhoea, but by spermatophobia. Another evil is likely
to result from the intense concentration of the attention
on certain organs and organic states, which is character-
istic of this class of patients. By a law of nervous func-
tion, not yet well understood, the very evil which is
dreaded may be engendered, and what Mal^cot caUs
*' physiological spermatorrhoea " may end in the patho-
logical kind. As means to this end we need only to refer
to the well-known efiect, on certain ill-balanced minds, of
the perusal of a class of books, unfortunately too preva-
lent, and sensational advertisements (fi-om which good
newspapers are not always fi'ee), published in the interest
of quackery, and appealing to all who would not wish, in
the flower of their youthful da3rs, to part with their man-
hood and their vitality.
One point has been dearly shown in the treatise of
Mal^cot, namely, that the fiacts of the disease under con-
sideration have been understood and interpreted differ-
ently as they have been studied by physicians or by
surgeons. Surgeons have devoted their attention too
exclusively to the genito-urinary apparatus, regarding the
disease as a local affection and demanding local treat-
August 30^ 1884.]
THE MEDICAL RECORD.
239
mcDt; pb3rsiciajis have emphasized the constitutional
aspect, seeing in spermatorrhoea only a disease of the
nervous system. The latter view seems to be the cor-
rect one. It is now very generally admitted that true
spermatorrhoea as the result of urethral inflammations,
of an over-sensitive urethra in the vicinity of the vera
mMianumy of "atony of the ejaculatory ducts," does not
exist *• To-day the hypothesis of a sort of mysterious
^imatorrhoea, supervening without ejaculation, by par-
alysis, by want of contractility of the ejaculatory ducts,
cannot longer be maintained. The labors of Cadeat and
Robin have shown that while the vas deferens is provided
wi± muscular fibres, the ejaculatory ducts are altogether
destitute of any muscular coat, being constituted of elastic
fibrous tissue. Despite their name, then, they take no
acdve part in the phenomenon of ejaculation. The pres-
ence of sperm in the urethra seems to be due to an
OTeiflow of the vesiculse seminales, too great fulness of
those diverticula overcoming by pressure the resistance
of the ejaculatory canals." '
The division into true and false spermatorrhoea,
adopted by Carlie in « Quain's Dictionary of Medicine,'*
is more sensible than that of Malteot, who considers the
subject under three heads : physiological^ imaginary^
i^ pathological; the two first divisions corresponding
to Quain's false spermatorrhoea. Under the head of
physiological^ however, Mal^cot includes cases which are
really morbid, 1.^., the pollutions are in excess and at-
tended with debility, owing to erethism of the whole
genito-spinal nervous apparatus ; there is no doubt more-
over that this genito-spinal excitement is very fi-equently
the result of abuses of the sexual fiinction. Patients of
this kind are always benefited by marriage and moderate
mdulgence. True spermatorrhoea or loss of seminal
fluid without erection or without sexual desires is a
malady fortunately as rare as it is formidable. It is not
an idiopathic affection, but is dependent on and Sjrmp-
tomatic of certain morbid states of the cerebro-spinal
axis. Venereal excesses and genital afifections are only
predisposing, not efficient causes, and the subjects of this
disease are by inheritance neuropathic. The reflex
shock, of which the pollution is the final expression, may
lead to more or less exhaustion of the nervous centres,
the fright and anxiety occasioned by the nocturnal losses
may have a powerfully depressing influence, but the loss
of semen is of no consequence whatever, it is certainly
not the cause of the nervous disturbance and the pros-
tration.
There are certain morbid conditions of the cerebrum,
which are an efficient cause of spermatorrhoea. Venereal
excesses, as well as involuntary pollutions, are often the
&st symptoms of mental alienation and of general par-
alytic dementia, perhaps from lesion (as Ferrier sup-
poses) of a special sexual centre in the cortex. There
ait certain monstrous aberrations of the sexual appe-
tite described in works on insanity under the heads
necrophily^ lycanthropyy etc.; onanism, satyriasis, and
nymphomania are sometimes noted in confirmed hysteria
and epilepsy. But it is especially in irritative affections
of the spinal marrow that we observe true sperma-
torrhoea ; and Trousseau and Charcot have both pointed
' Joar. de PAnatomie et de la Phytiologie. Pp. xo6. Paris, 1875. Sur quelqucs
P«s de Mroctiire des canaux ^acnlateim. Alio Mal^cot^ loc. dt, p. 41.
out the frequency of this disease in the early stages of
locomotor ataxia. Much, however, is yet needed to
complete our knowledge on this subject.
•'PASTEURIZATION" AGAINST HYDROPHOBIA.
Recent reports fi-om Paris show that M. Pasteur has un-
doubtedly scored another success in his scientific work.
The Commission, consisting of MM. B^ard, Paul Bert,
Buclez, Tisserand, Villemain, Vulpian, and Bouley, ap-
pointed to investigate M. Pasteur's claims for the dis-
covery of a protective vaccine against rabies, has made
its report The members have gone over Pasteur's ex-
periments and found that without question he has been
able to protect dogs against all inoculations with hydro-
phobic virus. A new truth is bom to science, therefore,
viz. : One attack of hydrophobia or of modified hydro-
phobia protects against another. For this alone Pasteur
deserves the greatest credit. But the query next arises.
Will the discovery be of any value? This depends
mainly upon the question whether inoculation with the
vaccine after a person is bitten will fiimish an efficient
protection. It is reported that Pasteur has tried this
already in one case and with success. But the Commis-
sion refirain as yet firom expressing a decided opinion.
They will " continue their labors.*' Meanwhile M. Pas-
teur has suggested a plan of protecting the human race
against rabies in case that the vaccine fails to work after
a person is bitten.
This plan consists in nothing else than the compulsory
"Pasteurization" or protective inoculation of all the
dogs in the country, just as infants are compulsorily vac-
cinated. The project is a very comprehensive one, but
by no means easy to carry out, in view of the large UKm-
ber of dogs and the rapidity with which they multiply.
Besides, society must adjust its protective labors to suf-
ficient ends. Hydrophobia is a fearfiil disease, but a rare
one.
Perhaps one dog in a million gets it In the whole o
the United States there occurred in i860 only 38 deaths
from hydrophobia; in 1870 only 63 cases. In New
York City the number of deaths from rabies between the
years 1855 and 1874 was 57, the annual number ranging
from o to 4. In England the annual mortality has of
late years ranged from 20 to 50. In France hydrophobia
kills about 200 persons a year.
But while the disease is a small element in mortality
generally, it sometimes appears to become almost epi-
demic in activity. It is in such cases and under such
circumstances that "Pasteurization" might perhaps
wisely be enforced.
THE PROPOSED GROSS MEMORIAL PROFESSORSHIP.
We have received some protests against the views ex-
pressed regarding the proposed memorial professorship
to the late Professor Gross. We should be very sorry to
have our meaning and position misunderstood, as evi-
dentiy has been done. No one deserves a greater or
more honorable memorial than the late Professor Gross,
and for this very reason we protested against the found-
ing a professorial chair in a private medical college, as a
petty and inadequate act of commemoration. After the
240
THE MEDICAL RECORD.
[August 30, 1884^
chair is established, only medical students and readers of
the annual catalogue will hear of it. Professor Gross'
life deserves a grander and more conspicuous monument
We regret, therefore, that the committee having the mat-
ter in charge did not make a wiser choice. Already
signs of dissatisfaction are being shown among the physi-
cians in the West Let the committee take advice that
is most sincerely meant It cannot ** boom " a project
to give Jefferson Medical College one hundred thousand
dollars, although that is a most worthy institution. It
can, however, by a very slight change, make its proposed
chair of pathology a public lectureship on pathology or
some allied subject, for the benefit of physicians. Such
lectureships as in England annually commemorate the
names of Harvey, Hunter, Lettsom, Gulston, and others,
would fittingly adorn the memory of America's greatest
surgeon.
THE PARISIAN AND THE BERLIN VIEW OF THE
COMMA-BACILLUS, OR SPIRILLUM.
At the cholera conference in Berlin, of which we give
an account elsewhere. Dr. Koch has described to a sym-
pathetic audience his comma-bacillus, and given his
most cogent reasons for believing it to be the true cause
of the cholera.
Almost at the same time M. Strauss, at the Acad6mie
de M6dicine of Paris, gives to an even more sympa-
thetic audience the reasons why he thinks the comma-
bacillus is not the specific organism of cholera. He states
that, in connection with M. Roux, eighteen autopsies
were made upon cholera patients at Toulon. In the
foudroyant cases the comma-bacillus, or as Koch is now
inclined to call it, the " spirillum," was found abundantly ;
but " in the subacute cases it was impossible to detect
their presence." Further, Strauss says : " In a good
number of cases of cholera one does not find micro-or-
ganisms in the intestinal tunics."
To strengthen his argument still more, M. Strauss
says that Dr. Maddofe, of Tendres, has photographed a
comma-bacillus which he has found in a reservoir of
water ; that M. Malassez has shown him (Strauss) bacilli
of comma shape obtained from dysenteric stools. M.
Strauss had himself seen comma-bacilli in the vaginal
mucus of women suffering from leucorrhoea, and in the
uterine secretion of a woman suffering firom epithelioma
of the neck.
Although M. Strauss' remarks were received with
much favor by the learned Acad6mie, his argument
appears to us to be disingenuous and weak. It contrasts
most unfavorably with the vigorous exposition of his
views made by Dr. Koch, in whom we are more than
ever inclined to feel confidence.
AMERICAN JOURNALISTIC ENTERPRISE.
For four successive issues The Medical Record has
contained reports by cable of the proceedings of the
two most notable medical gatherings of the year. We
have thus been able to present the main features of these
meetings to our readers even sooner than they were
known to the profession in Europe. It will be a matter
of some pride to bur American readers, as it naturally is
to ourselves, that in journalistic enterprise The Record
has so far outstripped all previous efforts. The Record
was the first [medical journal to use the Atlantic cable,
and we can safely say that its cabled reports have fax
exceeded in number and length those attempted any.
where else. Our readers would, we are sure, excuse this
small attempt at self-praise, if they knew the amount of
extra labor, calculation, and expense involved in these
efforts to present promptly and accurately the medical
work of the day.
^exxTB tit ttije "S^jeje^.
The American Microscopical Societt held its an-
nual meeting last week at Rochester, N. Y.
The American Dermatological Association.— The
eighth annual session of the American Dermatological
Association took place this week at West Point, N. Y.
Medical Society of Northern New York.— The
Fall Meeting of the Medical Society of Northern New
York will be held at the City Hall, Albany, Wednesday
October i, 1884.
The Cholera has continued to spread through the
provinces of Southern France and Northern Italy, and
has even invaded Switzerland. Its progress has been of
late more rapid and its manner of attack more violent
Thus in the Western Pyrenees it spread to thirteen places
within a week. In Italy it suddenly attacked La Spezia
on August 2 2d. In three days there had been 79 deaths.
The correspondent of the New York Times telegraphs
that up to August 23d there had been 3,952 deaths from
cholera in Southern France. These deaths were dis-
tributed among one hundred and thirty-one cities and
villages, in fifteen departments. Up to August 15th the
disease had attacked only fifteen places. In the next
week it had spread to fifty-one new places. In Italy the
number of deaths already is about four hundred, and this
number is being increased daily. The number of prov-
inces affected is six.
Suicide op the Late Dr. J. J. Woodward.— It is
known that the late Surgeon Woodward, U.S.A., was in-
sane at the time of his death, and confined in a private
asylum. There seems to be little doubt now that the
unfortunate man met his death by his own hands. An
account states that he had been under care for about four
months, but at no time was violent or in any way trou-
blesome. He generally preferred to be let alone, and
evinced a deHcacy in having any intrusion upon his
privacy. Though of a strong and healthy physique, he
imagined himself of a delicate constitution. He was as
regular as clockwork in his habits, and among the best
patients in the home. On Sunday morning he was passed
on the stairway by one of the lady attendants, who saw
him on the edge of the porch roof. A few minutes later,
before anything could be done to rescue him, he threw
himself off the roof backward, falling on the steps below,
receiving injuries from which he died on the afternoon
of the same day.
Death of Dr. Burq, the Metallo-Therapeutist.
— The death is announced of Dr. Burq, of Paris, aged
sixty-two. Dr. Burq's name has been made very familiar
to the medical world by reason of his persistent efforts to
gain a scientific standing for metallo-therapy. This he
had succeeded in doing, at least in France. Of late he
had been urging the prophylactic value of copper against
August 3Py 1884.]
THE MEDICAL RECORD.
241
cholenu He had just received a mass of testimonials
from miniDg engineers, bronze and copper manufact*
oiers, doctors, and Sisters of Charity in favor of his
copper theory. He even held a letter from a doctor
who said that he had, after gargling his throat with a
solution of salts of copper, sucked with impunity diph-
theritic matter from a child in whose windpipe he had
made an incision. Dr. Burq was rejoicing in the idea
that, owing to M. Bert's influence, the Municipal Council
in future would cause all wood employed in the hospitals
to be steeped in cupric solution.
Death of Dk C, W. Chamberlain. — Dr. Charles
Walter Chamberlain, Secretary of the State Board of
Health of Connecticut, and a member of the National
Board of Health, died in Hartford on August 21st. Dr.
Chamberlain was bom in Providence, R. I., July 22,
1844, and was a son of the Rev. Charles Chamberlain.
He was educated at Brown University, and the College
of Physicians and Surgeons in this city, graduating from
the latter institution in 1871. He made a specialty of
laiyngology, and established himself in Hartford. He
was Secretary of the State Medical Society in 1876, and
contributed to the Transactions of that year two papers
upon throat disease, and in the following year a third
paper on a similkr subject. In 1877 Governor Hubbard
appointed Dr. Chamberlain Examining Surgeon for the
soldiers in the State hospitals. He was also for a num-
ber of years Examining Surgeon to the United States
Pension Bureau, and was well known throughout the
country as a distinguished sanitarian.
The Late Dr« Burq, the Copper Specific, and
Pasteur. — ^The Paris correspondent of the London
Truth writes: ''And now a little benevolent gossip
about the arch-enemies of the Cupric Saviour. Burq,
* fortified' by his medicament, has been since 1849, <1^'
ing eveiy cholera visitation, in the hospitals of the towns
where it was most virulent He faced it at Toulon and
Marseilles, in Paris, Rouen, London, and Eastern France.
He also fietced smallpox in its worst haunts. Pasteur
only studies these maladies at a distance. A little virus
is brou^t to him in a glass tube, and then he operates
with it upon apes, monkeys, dogs, and guinea-pigs. He
preaches ex cathedrdj and all the cowards who are afraid
of losing their worthless lives, and who cannot bear to
think that firir play should be the great sweetener of the
world and reign everywhere, laud him as a benefactor of
the human race and a stamper*out of plague and pesti-
lence. When a contagious disease bums itself out in a
l^ace where some mitigated virus has just produced as
good an effect as Lourdes water, they cry out, ' Great is
Pasteur ! ' He reminds me of Vain-Hope, the ferryman
in the ^ Pilgrim's Progress,' who saved people the trouble
-^wading through the river which lay between the land
I Beulah and the Celestial Kingdom. Poultry-yard
lolera, ovine carbuncle, murrain, rinderpest, smallpox,
ariatina, and every other curse upon dirt and gluttony
e as severe as ever, and yet the notion is abroad that
asteur, through his scapegoat animals, has taken the
ing out of them all. Pasteur, who has not gone to
arseilles to correct or to check the theories he builds
} in his torture-house in the Rue d'Ulm, has got him-
1f appointed French Commissioner to the Health Con-
gress which is to be held at Amsterdam. I don't at all
try to convey the idea that he is a humbug. He believes
in his theories, and has got to look upon himself as a
divinity. When his son-in-law wrote that 'Te Pas-
teurium Laudamus ' (* Monographe de Pasteur par un
Ignorant ') in one volume, the object of the praises him-
self corrected the proofs 1 Pasteur is a priest who lives
by the altar. He has 25,ooof. a year from the State to
enable him to pursue his researches, with lodgings, coal,
and lamplight, and is soon to have a delicious country
residence at Villeneuve I'Etang, where a dogs' Inferno is
being created for him. His mitigated viruses are a
source — and a good one — of income. He has married
his daughter advantageously ; through Brown-Sdquard's
and Paul Bert's manias for vivisection i autrance he is on
good terms with the Opportunists, and owing to his un-
mitigated clericalism he enjoys the friendship of the
dukes and counts at the Academy. If a king starts up,
he will have access to him ; if the republic continues, he
will go on drawing his 25,ooof. a year. His son-in-law
(the author of the 'Te Pasteurium Laudamus ') was, a few
years ago, a secretary to M. de Freycinet. It is on the
cards that he may hereafter receive royal dukes at Albert
Gate House."
Dr. Koch's Berlin Lecture on Cholera and
the Comma-Bacillus. — ^An important conference upon
cholera was held in Berlin, at the Imperial Board of
Health, on the evening of July 26th. There were pres-
ent Drs. Von Bergman, Coler, Eulenberg, B. Frankel,
Gaffky, Hirsch, Koch, Leyden, S. Neumann, Pistor,
Schubert, Skreczka, Struck, Virchow, and WoUfhiigel.
The conference had been called at the instance of the Ber-
lin Medical Society, whose President, Professor Virchow,
explained that it was thought advisable Dr. Koch should
in the first instance give a demonstration of his work
before a smaller body than the whole Society, so that the
proceedings might be fully reported in the medical press.
He mentioned that Herr Director Lucanus and President
Sydow had expressed their regret at being unable to be
present, as well as many others, including Drs. Von
Lauer, Von Frerichs, Mehlhausen, and Kersandt Dr.
Koch first showed various specimens of the bacillus and
their method of preparation (see Berliner Klinische
Wochenschrift^ August 4th). This resembles that for the
tubercle bacillus, viz., drying on a cover-glass and stain-
ing with fiichsin or methyl-olin. Koch then gave a his-
tory of his work while in Egypt and India. His post-
mortem examinations led him to believe that the intestines
were the nidus of the disease. At first his microscopical
examinations were unsatisfactory, but finally he got firesh
dejecta and acute cases, and then discovered the comma-
bacillus.
This, he said, is smaller than the tubercle bacillus, be-
ing only about half or at most two-thirds the size of the
latter, but much more plump, thicker, and slighdy curved.
As a rule, the curve is no more than that of a comma (,),
but soinetimes it assumes a semicircular shape, and he
has seen it forming a double curve like an S ; these two
variations from the normal being suggestive of the junc-
tion of two individual bacilli. In cultures there always
appears a remarkably free development of comma-shaped
bacilli. These bacilli often grow out to form long threads,
not in the manner of anthrax bacilli, nor with a simple
242
THE MEDICAL RECORD*
[August 30, 1884.
undulating form, but assuming the shape of delicate long
spirals — a corkscrew-shape — ^reminding one very forcibly
of the spirochsete of relapsing fever. Indeed, it would
be difficult to distinguish the two if placed side by side.
On account of this developmental change, he doubted
if the cholera organism should be ranked with bacilli ; it
is rather a transitional form between the bacillus and the
spirillum. Possibly it is true spirillum, portions of which
appear in the comma shape, much as in other spirilla —
e,g.j spirilla undula, which do not always form complete
spirals, but consist only of more or less curved rods.
The comma-bacilli thrive well in meat infusion, growing
in it with great rapidity. By examining microscopically
a drop of this broth culture the bacilli are seen in active
movement, swarming at the margins of the drop, inter-
spersed with the spiral threads, which are also apparently
mobile. They grow also in other fluids — e.g,y very abun*
dantly in milk, without coagulating it or changing its ap*
pearance. Also in blood serum they grow very richly.
Another good nutrient medium is gelatine, wherein the
comma bacilli form colonies of a perfectly characteristic
kind, dififerent from those of any other form of bacteria.
The colony when very young appears as a pale and small
spot, not completely spherical as other bacterial colonies
in gelatine are wont to be, but with a more or less irreg-
ular, protruding, or jagged contour. It also very soon
takes on a somewhat granular appearance. As the col-
ony increases the granular character becomes more
marked, until it seems to be made up of highly refhtctile
granules, like a mass of particles of glass. In its further
growth the gelatine is liquefied in the vicinity of the
colony, which at the same time sinks down deeper into
the gelatine mass, and makes a small, thread-like excava^
tion in the gelatine, in the centre of which the colony ap-
pears as a small white point. This, again, is peculiar ; it is
never seen, at least so marked, with any other bacterium.
And a similar appearance is produced when gelatine
is inoculated with a pure culture of this bacillus, the
gelatine liquefying at the seat of inoculation, and the
small colony continually enlarging ; but above it there
occurs the excavated spot, like a bubble of air floating
over the bacillary colony. It gives the impression that
the bacillus growth not only liquefies the gelatine, but
causes a rapid evaporation of the fluid so formed. Many
bacteria also have the power of so liquefying gelatine
with which they are inoculated, but never do they pro-
djace such an excavation with the bladder-like cavity on
the surface. Another peculiarity was the slowness with
which the gelatine liquefied, and the narrow limits of this
liquefaction in the case of a gelatine disc Cultures of
the comma-badllus were also made in Agar-Agar jelly,
which is not liquefied by them. On potato these bacilli
grow like those of glanders, forming a grayish-brown layer
on the surface. The comma-bacilli thrive best at tern*
peratures between 30** and 40° C, but they are not very
sensitive to low temperatures, their growth not being
prevented until 17** or 16° C. is reached. In this respect
they agree with anthrax bacilli. Koch made an experi-
ment to ascertain whether a very low temperature not
merely checked development but killed them, and sub-
jected the comma-bacilli to a temperature of — 10® C,
They were then completely firozen, but yet retained vi»
talitv. oTOwin? in gelatine afterward. Other experiments.
by excluding air ftom the gelatine cultures, or pladna
them under an exhausted bell-jar, or in an atmosphere of
carbonic acid, went to prove that they required air and
oxygen for their growth ; but the deprivation did not kill
them, since on removing them from these conditions they
again began to grow. The growth of these bacilli is ex.
ceptionably rapid, quickly attaining its height, and after
a brief stationary period as quickly terminating. The
dying bacilli lose their shape, sometimes appearing shriv-
elled, sometimes swollen, and then staining very slightly
or not at all. The special features of their vegetation
are best seen when substances which also contain other
forms of bacteria are taken — €.g.^ the intestinal contents
or choleraic evacuations mixed with moistened earth or
linen and kept damp.
A most important statement was that the comma-
bacillus seems to be killed by the bacteria of putrefaction,
and consequently agents that destroy the latter organisms
without the former may really do injury, by removing
from the cholera bacillus an impediment to its growth.
As for destructive agents to the bacillus, he found it killed
by solutions in the following proportions : oil of pepper-
mint, X in 2,000; sulphate of copper, i in 2,500 (a
remedy much employed, but how much would really be
needed merely to hinder the growth of the bacilli m the
intestine!); quinine, i in 5.000; and sublimate, i in
100,000. In contrast with the foregoing measure for
preventing the growth of these bacilli is the striking fact
that they are readily killed by drying. This fact is proved
by merely drying a small drop of material containing the
bacilli on a cover-glass, and then placing this over some
of the fluid on a glass slide. With anthrax bacilli vitality
is retained for nearly a week ; whereas, the comma-bacil-
lus appears to be killed in a very short tinie.
Dr. Koch having found and cultivated the comma-ba-
cillus, and ascertained its distinctive character, next pro-
ceeded to investigate its relation to cholera. In all
there were now about one hundred cases of chol^a in
which the bacillus had been found, while it was never
found in connection with other diseases. Three dif-
ferent views, said the speaker, as to its relation to the
cholera process are tenable, i. That the disease favors
the growth of these bacilli by afifording them a suitable
soil. If so, it would mean that the bacillus in question
is most widely diffused, since it has been found in such
dififerent regions as Egypt, India, and France ; whereas
the contrary is the case, for the bacilli do not occur in
other diseases, nor in the healthy, nor apart firom human
beings in localities most favorable to bacterial life. They
only appear with the cholera. 2. It might be said that
cholera produces conditions leading to a change in form
and properties of the numerous intestinal bacteria--a
pure hypothesis ; the only instance of such a conversion
refers to a change of physiological and pathogenic action,
and not of form. Anthrax bacilli under certain condi-
tions lose their pathogenic power, but undergo no change
in shape ; and that is an instance of a loss of pathogenic
properties, while there is no analogy to support the view
of the harmless intestinal bacteria becoming the deadly
cholera bacilli. The more bacterial morphology is
studied, the more certain is it that bacteria are constant
in their form ; moreover, the comma-bacillus retains its
special characters unchanged through many generations
August 30, 1884.]
THE MEDICAL RECORD.
243
of culture. 3. lastly,* there is the view that the cholera
process and the comma bacilli are intimately related,
and there is no other conceivable relation but that the
bacilli precede the disease and excite it ** For my own
pait," said Dr. Koch, << the matter is proved that the
comma-bacilli are the cause of cholera.'*
Dr. Koch then described his attempts to inoculate
lower animals with the bacillus, and explained the cause
of his Mure in the natural immunity of the animals
against the disestse.
• In advocating the local Indian origin of the disease he
laid : That the virus can be reproduced and multiplied
outside the body is apparent, since the bacillus can be
Qoltivated artificially, and its growth is not affected by
comparatively low temperatures. Probably it does not
grow in streams and rivers, where, owing to the current,
a sufficient concentration of nutrient substance does not
occur; but in stagnant water and at the mouths of drains,
etc., vegetable and animal refuse may accumulate and
afford the necessary nutriment. Thus is explained the
propagation of cholera by the subsoil water, and the in-
crease of epidemics with the sinking of its level, which
lessens the fiow and diminishes the amount of surface
water. Admitting the dependence of cholera upon this
micro-organism, it is impossible to conceive the disease
having an autochthonous origin in any particular place ;
for a bacillus must obey the laws of vegetable life, and
have an antecedent ; and since the comma bacillus does
not belong to the widely diffused micro-organisms, it
must have a limited habitat. Therefore, the occurrence
of cholera on the delta of the Nile does not depend on
its resemblance to the delta of the Ganges ; but the dis-
ease must have been imported there as it is into Europe.
It was once thought that an outbreak in Poland had
a local origin until it was discovered to have been intro-
duced from Russia. Again, about ten years ago, there
was a sudden outbreak at Hamar (Syria), thought to be
an instance of local origin, but erroneously, as shown by
a statement of Lortet, who told Koch, when at Lyons,
that the epidemic had been introduced into Hamar,
where he was at the time, by Turkish soldiers from
Djeddah. All great epidemics of cholera began in South
Bengal, where the conditions for the development and
growth of the bacillus are most perfect
Dr. Koch concluded with a reference to the prospec-
tive practical value of his discovery. It would assist in
leading to intelligent prophylaxis and treatment, and in
making an early diagnosis.
At the close of his lecture a discussion took place,
which we shall report in our next issue.
Pleuro-pneumonia in the West. — A herd of Jersey
cattle infected with pleuro-pneumonia were sold at auc-
tion recently, and the disease was thus disseminated
through several herds in Illinois, and perhaps other
States. The condition of affairs is serious, though incom-
parably less so than if the disease had reached the great
herds of beef cattle of the West instead of smaller herds
of registered cattle.
A Philanthropic Surgeon. — ^The late Sir Erasmus
Wilson was one of the few doctors who are both able
and willing to give. Sir Erasmus distinguished himself
by many benefactions. He founded a chair and a
museum of dermatology, and a chair of pathology, built
a master's residence at Epsom College, and part of a
sea-bathing hospital at Margate. He brought Cleo-
patra's Needle to England at an expense of $50,000, so
that the obelisk may properly be considered a surgeon's
needle, and he gave away a great deal of money in pri-
vate benefactions.
Hog Cholera has been prevailing since last winter in
certain counties of New Jersey.
Druggists' Conventions. — The second annual
meeting of the National Druggists' Association was held
at Milwaukee, Wis., August 25th and 26th. This is the
association which aims to promote the " Campion plan "
for keeping up prices and cutting off the " scalpers."
During the past year it is claimed to have been partially
successful The Association numbers about twenty-five
hundred members.
On August 26th, the National Pharmaceutical Asso-
ciation convened in the same city.
©Mtwarg.
THE LATE SURGEON J. J. WOODWARD, U.S.A.
War Department,
Surgeon.General*s Office,
Washington, D. C, August 20, 1884.
In announcing to the officers of the Medical Depart-
ment the death of Joseph Janvier Woodward, Surgeon
and Brevet Lieutenant-Colonel U. S. A., which oc-
curred near Philadelphia, Pa., August 17, 1884, the
Surgeon-General wishes to offer his tribute of respect to
the memory of the deceased, whose distinguished career
and valuable services for a period of twenty-three ^ears
have shed lustre on the corps, and for whose untmiely
loss feelings of profound regret will be shared alike by
his comrades in arms and b]^ the profession at large.
Dr. Woodward was bom in Philadelphia, Pa., October
30, 1833, and was educated at the Central High School
of that city, graduating with honor as Bachelor of Arts in
1850, and receiving the degree of Master of Arts from
the same institution in 1855.
He p;raduated in medicine at the University of Penn-
sylvaniai, April, 1853 ; entered the Army as Assistant
Surgeon, August 5, 1861 ; became Captain and Assist-
ant Surgeon, July 28, 1866 ; Major and Surgeon, June
26, 1876. " For faithful and meritorious services during
the War" he received the brevets of Captain, Major,
and Lieutenant-Colonel U. S. A.
He was assigned to duty in this Office May 19, 1862,
and from that date until the beginning of the illness which
terminated in his death was intimately identified with its
{MTofessional and scientific work.
While the valuable results of his life's labor are com-
prehended in a long list of miscellaneous publications,
both professional and scientific, too familiar to the corps
to require individual mention, his jpreatest triumphs were
won in the field of microscopical mvestigation in normal
and pathological histology, and in his happy application
of photo-micrography to the purposes of science. In
these pursuits he attained remarkable success, and
achieved an enviable, world-wide reputation, leaving to
science and medicine lessons of undoubted value and
usefulness. Of his strictly professional work the medical
portion of the '< Medical and Surgical History of the
War of the Rebellion " was the crowning achievement.
In the second part of this work he developed the results
of his careful investigations into the nature and pathology
of the intestinal diseases which had proved so fatal in the
244
THE MEDICAL RECORD;
[August 30, 1884,
late war. Here also he displayed his wonderful capacity
for that minute and exhaustive research which forms so
striking a feature of his writings.
As in the case of his co-laborer, Otis, he yields to other
hands the honor of completing his labors.
In addition to his engrossmg professional duties, his
restless activity of mind led him to seek recreation in his
favorite studies — ^physics, art, and philosophy.
Endowed with a retentive memory and of untiring in-
dustry, he acquired a vast store of information whi(£ he
held available for use at will ; fluent of speech, he took de-
light in the expression of his views and opinions both in
social converse and in the arena of scientific debate.
His fund of knowledge, his strong convictions, his
tenacity of opinion, and his quick perception made him
a controversialist of no low order.
With such a record, it is needless to speak of his zeal,
his ambition, or his devotion to his profession, and espe-
cially to the reputation of the corps of which he was so
bright an ornament.
Of a sensitive, highly strung, nervous organization, the
confinement, anxiety, and labor to which he was subjected
in his attendance upon the late President Garfield during
his long illness, proved too much for a mind and body
already overstrained by incessant labor, and precipitated
the illness which finally terminated his life.
At the time of his death Dr. Woodward was a mem-
ber and ex-President of the American Medical Associa-
tion, a member and ex-President of the Washington
Philosophical Society, a member of the National Academy
of Science, of the Association for the Advancement of
Science, of the Academy of Natural Sciences of Phila-
delphia, and of the College of Physicians and Surgeons
of Philadelphia. He was an honorary member of several
American and foreign scientific, medical, and microscopi-
cal societies, and the recipient of many distinguished
honors from learned bodies in this country and abroad.
R. Murray,
Surgeon-General 1/.S.A,
Transactions of the American Gynecologal Soci-
ciETY, Volume VIII. For the Year 1883. New
York : D. Appletou & Co. 1884.
We have not sufiicient space allowed us to attempt a
critical review of this interesting volume. We can only
furnish to the general reader some indications of its con-
tents. We would say, in the first place, however, that
the papers and discussions are quite up to the high gen-
eral average, and express better than do most society
transactions, the views of America's leading specialists
in gynecology. On the whole the papers have a more
general interest than is the case with much other special-
istic work«
A perusal of the volume before us shows that the g3me-
colo^sts continue to entertain a healthy difference of
opinion upon some of the elementary points in their spe-
cialty. For example, Dr. £oimet describes a new oper-
ation for lacerated perineum, and in one article wipes
out all his previous teachings and experience on this sub-
ject We are left finally in doubt whether there is any
perineum, and whether, if it exists, it has any fiinction
whatever. The well-worn subject of dysmenorrhoea is
discussed by Dr. C. D. Palmer, and by Drs. J. R. Chad-
wick and Fordyce Barker. A few, more or less, new
specifics for this trouble are given ; such as apiol, cimici-
fuga, Pulsatilla, coca, and ammonia. Perhaps it may be
found in time that there is no specific for any form of
dysmenorrhoea, but that a great many drugs relieve
equally well the same distresses. We are now told that
such a thing as mechanical dysmenorrhoea rarely exists.
Dr. R. S. Sutton read a paper on *^ Cleanliness in Sur-
gery'* (subsequently read again before the American
Academy of Medicine), in which he introduced the sub-
ject of '* Listerism." Dr. Lusk made an interesting
plea for the spray, but gave no very cogent reasons for
Its retention. Dr. A. Reeves Jackson made an effective
argument against the operation for extirpation of the
cancerous uterus, which he considered useless and tti-
justifiable. Dr. George J. En^elmann denounced the
excessive use of ergot in obstetric practice, and thought
that this drug should only be given in the non-gravid
uterus. He exaggerated the dangers and misuses of
ergot. Dr. Edward W. Jenks described a new mode of
operating for fistula in ano. Dr. Albert H. Smith brought
up the subject of ** Hot Water in Secondary Hemor-
rhages after Pelvic Operations." Hot water is all the
vogue, and gynecology (which is nothing if not fashiona^
ble) commends it in the present volume. Dr. Gk>odell,
to be sure, finds that it is not always potent, and recom*
mends vinegar as an addition.
In the annual address of the President, Dr. Oilman
Kimball, attention is called to the life of Dr. Nathan Smith,
and to the fact that he independently performed ovari-
otomy in 182 1, knowing nothing of McDowell's oper-
ation nine years before.
As regards typographical appearance the volume con-
tinues to be the very dude of medical *' transactions."
Shaksspeare as a Physician : Comprising every Word
which in any Way relates to Medicine, Surgery, or Ob-
stetrics found in the Complete Works of that Writer ;
with Criticisms and Comparison of the Same with the
Medical Thoughts of To-day. By J. Portbian Chesney,
M.D. 8vo, pp. 226. Chicago, III.; St. Louis, Mo.;
Atlanta, Ga. : J. H. Chambers & Co., 1884.
The title of the above work very clearly indicates its
scope and purpose. Beginning with obstetrics, the author
gives ui quotations from every play containing even re-
mote and incidental allusions to that subject It is a
medical concordance of Shakespeare, with comments and
explanations. The author says, no doubt with truth, that
his task has not been a slight one. Whether the result
is worth the trouble, is a question that will be answered
very differently, according to the standpoint of the reader.
For our part we are glad to find that doctors occasionally
have the taste and inclination to wander a little in the
byways and produce some .work outside the beaten paths
of pathology. Dr. Chesney has done his work con-
scientiously, and it fiimishes a volume of curious interest
to the physician. His comments are perhaps the least
interesting, and are at times unnecessaxily discursive and
pedantic ; still, not much other than explanation and a
superficisd exegesis could be expected.
The work is illustrated with a number of curious and
more or less appropriate cuts.
A Text-Book of the Principles of PHvsfcs. By
Alfred Daniell, M.A., Lecturer on Physics in the
School of Medicine, Edinbur^^. London : Macmillan
& Co. 1884.
This book, says the author, was primarily designed as a
contribution to medical education, and as such he hopes
it may be found usefiiL He treats of physics in a very
different manner to that in the older works of fifteen or
twenty years a^o. His book is written strictly fi'om the
modem scientific standpoint, and gives the latest and
best conceptions of matter and the physical forces.
Some idea of the systematic, yet natural and thorough
manner with which the subject is treated, may be
gathered from the titles of the chapters. These are in
their order : Time, Space, and Mass ; Measurements ;
Work and £nergy ; Kinematics ; Kinetics ; Attraction and
Potential; Gravitation; Matter; Solids; Liquids;
Gases ; Heat ; Sound, etc
It would be a ^eat thin^ for medical students if the]r
were thoroughly disciplined in a work like this. We fear,
however, that it would befog the untrained brain of the
majority of them.
August 30, 1884.]
THE MEDICAL RECORD.
245
^evovts Off S^ocUtizs.
THE BERLIN SOCIETY OF INTERNAL MED-
ICINE.
Stated Meetings July 14, 1884.
Hkrr Leyden, President, in the Chair.
(Speciftl Report fer Tkb Msz»cal RacoRD.)
The Society having been called to order by the President,
HiRR Kronecksr exhibited an
APPARATUS FOR THE INFUSION OF SALINE SOLUTIONS
into the general circulation. The speaker stated briefly
the principles of this method, which, though by no means
a new procedure, was still not so widely known and
appreciated as, by reason of its value, it ought to be.
There were several precautions to be observed in em-
ploying this method for restoring the normal fluidity of
the bloody the first and most important of which was to
secure a suitable solution. He had formerly thought it
important to add a certain proportion of soda to the solu-
tion, but had recently omitted the alkali and had ob-
tained equally good results. Experiments on animals
had shown that a solution which was suitable for one
species might be harmful to another, hence it was not
safe to conclude, without further trial, that a mixture
which was well borne by certain animals would be suit-
able for the human subject. Some recent experiments
by Aronsohn and Marckwald had shown that a propor-
tion of -^ part of chloride of sodium to 100 parts of
distilled water (about 56 grains to the pint) caused no
irritation to the mucous membranes or subcutaneous
tissues, and the speaker proposed a solution of this
strength as the one best adapted for intra- venous injec-
tion.
Regarding the proper method of introducing the solu-
tion into the circulation, Herr Kronecker expressed a
decided preference for intra-venous over subcutaneous
injection, as offering the greater certainty that the fluid
will be taken up by the blood stream. But great care
should be observed not to inject the solution too rapidly
or with two great pressure, because of the danger of fill-
ing the heart with water and driving from it all the blood.
Having made a number of observations on this point, the
speaker had been able to set five drachms per second as
the limit beyond which we should not pass in making intra-
venous injections of fluids other than blood. For mak-
ing the injection we need a bottle, graduated to drachms,
to which a rubber tube with canula attachment is fastened.
By holding the bottle at a proper height we are enabled
to force the fluid at any desired rapidity into the veins ;
but as the pressure varies according to the amount of
fiuia contained in the flask, the height at which the
latter is held must be constantly raised during the opera-
tion. In order to obviate the necessity of this, Herr
Kronecker had recently employed a Mariotte flask, by
means of which a constant pressure is obtained, whatever
may be the variation in the quantity of the contained
fluid.
One great advantage possessed by the saline solution
was that it could be disinfected. The air in the flask
could also be kept perfectly pure by allowing it to pass
through cotton saturated with a disinfectant solution.
Herr Leyden thought that the question of saline in-
fusions was a timely one in view of the
EPIDEMIC OF cholera)
in southern Europe. He hoped that the measures which
had been adopted would be eflectual in keeping the dis-
ease out of Germany. But it was only the part of ordi-
nary prudence to make every preparation to grapple with
it ^ould it once gain admittance. He thought that in
Ae event of being called upon to treat cholera the
method of intra-venous injections just demonstrated
would find a ready application.
Herr S. Guttmann thought it would be advisable to
appoint a commbsion to determine just how far trans-
fusion was of value in the collapse consequent upon the
loss of fluids in cholera, and also to settle, as far as mi^ht
be, other points in the prophylajus and therapy of the ms-
ease. Koch's discovery of the parasitic nature of the
affection had as yet led to no practical therapeutic
results, and we now stood in the presence of cholera just
as defenceless as we were a decade ago.
The^discussion then turned upon the
prevention and treatment of cholera.
Herr Fraentzel recalled the fisict that it was only
during the last epidemic in Berlin that attempts were
made to improve the hygienic conditions and that phy-
sicians sought to formulate any dietary rules. Smce
that time considerable advances had been made in these
subjects. Experiments had proven the futility of sub-
cutaneous injections of saline solutions, for the tissties
would not absorb the fluid, and the only result of an in-
jection was the formation of a tumor, which disappeared
only after the lapse of considerable time. He did not
deny, however, that intra-venous injections might prove
more useful.
The speaker regretted the fact that less attention was
now paid to the subject of disinfection than formerly.
He called attention also to the danger from mill-streams
which contained large quantities of filth and decompos-
ing matters, and he hoped that some measures .would be
t^en looking to their purification.
Herr P. Guttmann had made a trial of the infusion
of saline solutions during the epidemic of 1866, but all
the patients so treated died. He did not believe the
cholera would reach Berlin this year, but promised, in
case it did, to make further trials with the method just
demonstrated. He insisted upon the necessity of remov-
ing all cholera patients to a special hospital, since, were
they treated in all the hospitals throughout the city,
there would be created so many additional foci of disease.
Herr Loewenstein did not anticipate any brilliapt
results in the treatment of cholera by saline injecrions.
Restorative measures were needed, and unless it were
shown that saline infusions exerted an analeptic action
upon the heart, he could not place any dependence upon
them.
Herr GuTTSTADT spoke of the danger of rectal injec-
tions in cholera, as any irritation of die mucous mem-
branes was liable to excite a diphtheritic inflammation.
Herr Leyden thought, notwithstanding the general
opposition to saline injections, that possibly, owing to
new methods of preparation and perfected apparatus,
this mode of treatment might eventually be found useful
A cholera commission was then appointed, consisting
of Herren P. Guttmann, Baer, Goltdammer, S. Gutt-
mann, Lehnert, Riess, and Wemich.
Herr P. Guttmann then read a paper upon
ANTIPYRIN.
A number of remedies had recently been made by syn-
thetic processes, which, in suitable doses, possessed a febri-
fuge action. They were all derivatives ofi or closely
allied to, chinolin. One of these substances was antipyrin,
chemically known as dinaethyloxychinicin. It is freely
soluble in water and alcohol, possessing a slightly bitter
taste, and exists in the form of a powder of a whitish
color faintly tinged with yellow. One of its most valu-
able properties is its great solubility (seven grammes of
antipyrin dissolving in three grammes of water), thus ren-
dering it especially adapted for hypodermic use. The
author had employed the remedy in a large number of
cases of typhoid fever, pneumonia, pulmonary phthisis,
measles, scarlatina, and other diseases marked by a high
degree of fever. He had found in every instance that
the exhibition of a drachm to a drachm and a half of an-
246
THE MEDICAL RECORD.
[August 30, 1884.
tipyrin, in half*drachm hourly doses, reduced the tem-
perature curve for at least five or six hours, and some-
times for a still longer period. The drug may also be
given in a single large dose of a drachm, or in fifteen-
grain doses five times repeated, with similar beneficial
effects. The dose for children is seven grains firequently
repeated.
When half-drachm doses are given, the temperature
begins to fall even during the first hour, but reaches its
lowest point at the end of the third or fourth hour. The
minimum reduction observed by the author was i® F.,
and the maximum 7^. The temperature begins to rise
again about an hour after the last dose is taken, but the
ascending curve is so very gradual that it is usually ten
or twelve hours before the remedy need be again exhib-
ited. There are no unpleasant symptoms produced,
with the occasional exception of vomiting. The only
pyretic condition over which antipyrin exerts no effect
is intermittent fever, though even here the paroxysm
seems to be less severe if a full dose of the drug has
been given before its onset.
The febrifuge action of antipyrin is only one-half as
powerful as that of quinine, that is, it requires one
drachm of the former to produce the effect obtained by
thirty grains of the latter. Unfortunately at present an-
tip3rrin costs two-thirds as much as quinine, hence it can-
not be recommended on account of its cheapness. When
it becomes possible to lower the cost of its production,
it will rank as a febrifiige much preferable, in most cases,
to quinine.
Herr Tillmanns had employed antipyrin in a num-
ber of cases with success at the Charit6 clinic. In eight
cases of intermittent fever he had cut short the par-
oxysms by antipyrin, but immediately upon the discon-
tinuance of the remedy the temperature rose again. He
had found the dni^ of especial value in the pyrexia of
phthisis. In typhoid fever the patients expressed them-
selves as feeling much better after taking half-drachm
doses of antipyrin, and the drug seemed also to exert a
controlling effect upon the diarrhoea. The antipyretic
action of the drug was in every case prompt and certain,
and was accompanied, especially in phthisis and pneu-
monia, by a rather profuse perspiration. No injurious
effects were ever observed.
In conclusion, the speaker stated that the results ob-
tained by him were in accord with those of the author of
the paper. He would, however, advise beginning the
administration of antipyrin by small doses (10-15 grains
or less), which could then be increased if necessary.
This caution should specially be heeded in phthisis, as he
had seen rather alarming symptoms of collapse follow the
exhibition of large doses.
On motion, the Society then adjourned.
Irreducible Hernia Cured by Sneezing. — Dr. John
Burke, of this city, sends us the history of a man, aged
sixty, who had suffered for several years fi-om an irreduci-
ble left inguinal hernia. Several surgeons had tried to
get it back, but in vain, and the tumor became as large
as a child's head. One night he was attacked with a fit
of coughing and sneezing, which continued about half an
hoiur, according to his own and wife's report, when he
felt something; give way within him. He heard a gurgling
and the hernia had disappeared. In the morning he sent
for Dr. Burke who found that the mass had gone. The
ring was as large as a silver dollar. There was great pain
and tenderness about the parts and he had local peri-
tonitis. After a few days he recovered. He since has
been fitted with a truss and the hernia has not come
down. Dr. Burke concludes : *' Would it not be well in
some of these cases to give the patient a good pinch of
hellebore to bring on sneezing? Perhaps it may tear away
the adhesions and cause the gut to return. I would ask
your readers if they ever met a case of hernia reduced in
that manner."
THE BIOLOGICAL SOCIETY OF PARIS.
Stated Meeting, July 19, 1884.
M. Paul Bert, President, in the Chair.
(Spedal Report to Thb Mbdical Rjbcord.)
The scientific work of the meeting was begun by M. Ra-
buteau, who made a few remarks upon the
TANNATES IN THE TREATMENT OF CHOLERA.
He prophesied that the workmen in the tanneries near
Bi^vre would escape cholera in case of an epidemic oc>
ciuring there. In the case of a patient attacked by diar-
rhoea m the first stage of cholera, he would begin by
administering a laxative of castor-oil or the sulpho-car-
bolate of soda, and would follow this up by the wine or
tincture of catechu or some other of the anti-cathartics
containing tannin. He would permit the use of apricots,
strawberries, or any fruits containing tannin, but would
forbid melons.
M. Beauregard had been studying the
HABITS OP THE SPANISH FLY,
and related some of the facts which he had discovered in
his investigations. The leaves of the lilac are the favor-
ite food of these insects. The flies lay their eggs in the
ground, digging a burrow some distance below the sur-
face, and there depositing two little spheres each contain-
ing from sixty to eighty eggs. The grubs are hatched at the
end of two weeks. Both the grubs and the flies subsist
entirely on the saccharine juices of plants, and never eat
the eggs of other insects. Cantharidine is present at
every stage of development of the insect. Vesication
may be obtained by using the eggs or the larvae as well
as by using the fully developed fly.
M. RifiMY related some results which he had found to ,
follow upon
EXCITATION OF THE SPERMATIC PLEXUS.
In the course of certain experiments upon the great sym-
pathetic nerve in the Guinea-pig, he had found that irri-
tation of a small ganglion, lying just anterior to the kidney, !
caused a seminal ejaculation, and when continued, excited
an erection. The action was centrifugal, for, if the nerve
were divided, central irritation produced no result.
M. Quinquand gave the results obtained by him in
certain experiments made to determine
THE PATHOGENESIS OF' UR/EMIA. ^
The opinion of pathologists generally of the present day
is that the ursemic symptoms are not caused by the ac-
cumulation of urea in the blood, but the speaker clain^ed
that the experiments conducted by M. Grdhant and him-
self proved that this opinion was incorrect In the frog,
the subcutaneous injection of fifteen grains of urea was
followed by convulsions, tetanus, and death from arrest
of the respiratory movements. The heart continued to
beat several minutes after the cessation of respiration.
In the Guinea-pig, epileptiform convulsions and opisthot-
onus were produced. In the dog, the s^ptomswere
those of coma, and were followed by death in from fifteen 3
to thirty minutes. The dose of urea necessary to pro- 3
duce these results is rather large ; in the Guinea-pig, 75
to 90 grains are required ; in the rabbit, 1 20 to 1 50 grains ; j
in a dog weighing 6^ to 9 pounds, 150 to 180 grains.
The proportion of urea in the blood is, however, not
large, only from three to six parts by weight per thousand.
M. RiCHET said that he had often injected many times
larger amounts of urea in the dog without obtaining any
results. He used the substance in very dilute solution.
M. Quinquand said that with dilute solutions there
were never any uraemic symptoms, an increased secretion
of urine was the only result produced.
M. Frank asked whether the so-called uraemic symp-
toms observed by M. Quinquand might not have been
caused by the irritation of the skin, resulting from the
August 30, 1884-J
THE MEDICAL RECORD.
247
injection of these concentrated solutions, for M. Brown-
S^uaxd had seen like symptoms produced by irritant
JDJections.
^ M. F^Ri presented a communication upon
PARTIAL SOMNAMBULISM.
An hypnotized subject who is cataleptic or lethargic may,
bymeans of friction made over the vertex, be thrown into
a third somnambulistic state. If the friction be made
over one side only the condition is one of hemi-somnam-
bulism. iff instead of general friction over the vertex,
strong pressure be made over certain portions of the
scalp, partial sonmambulism of that region, whose motor
centre in the cortex corresponds to the point pressed
upon, results. Thus one-half of the face, one arm, or one
leg may be affected. It is even possible to cause partial
somnambulism of the upper portion onl^ of the face by
pressing upon that part of the skull lying above a hori-
zontal line prolonged from the level of the eyebrows, and
behind a vertical line drawn posterior to the mastoid pro-
cess. This was the situation of the cranial lesion in a
case of traumatic tic of the eyelids observed once by M.
M. GiBiER then related some experiments upon the
INOCULATION OF RABIES
in birds. He found that the intensity of the virus in-
creased in direct ratio with the number of inoculations
practised. The period of incubation, when the virus
was injected into the anterior chamber of the eye, was
twelve days.
The Society then adjourned
(^owzsvan&enc6.
INTERNATIONAL MEDICAL CONGRESS.
(From our Special^Correspondent)
(COPBNHAGICK, DENMARK, AugUSt x6, X884.
THE SUCCESS OF THE CONGRESS — THE NOTABLES PRES-
ENT— ^THE SPEECHES OF JACOBI AND NOYES — ^AMERI-
CAN ELOQUENCE — DR. SAVRE AND HIS PLASTER
JACKET — HOW CRUDELI TREATED MALARIA — ^VIRCHOW
AND HIS SUBJECT — ^PASTEUR AND HIS IMPRESSED AU-
DIENCE ^THE COLLECTIVE INVESTIGATION COMMITTEE
—SOCIAL ENJOYMENTS — WORK AND PLAY.
You have doubtless received by this time my full cable
despatches of the meeting of the International Medical
Coogress here, and have formed an estimate of what has
been done^ — not only what has been done in a strictly
scientific but a social way. The meeting was [a great
success in every particular. The weather was charm-
ingly pleasant, and all the other accesssories were at hand
to enable the Committee of Arrangements to follow out
their plan within as well as without doors to the satisfac-
tion of every one.
Among the prominent medical men from New York
who were present and took a more or less active part in
Ac proceedings were Drs. A. Jacobi, H. D. Noyes,
Joseph W. Howe, and Lewis A. Sa}Te. Dr. Jacobi
made an impressive and telling address on the eve of the
adjournment, and well represented the cosmopolitan
spirit of the medical profession of America. Dr. Noyes
also made a thrilling speech at the dinner of the Ophthal-
mological Section on Monday, in response to the health
of the American visitors. He was merely a delegate of
a large working community on " the other side " who had
a deep sense of love and reverence for the old countries,
and especially for Denmark, and he made his audience
feel it
Dr. Sayre gave some exhibitions of his plasterof-Paris
jacket, which being novel to most of his hearers attracted
a good deal of attention. If any one who has attended
the recent meetings of the British Medical Association I
for the past few years, or other medical gatherings in
Great Britain and elsewhere, is not now acquainted with
the Sayre jacket, the reasons why it should be used in
all cases, and the way it should be used, he deserves to
be pitied as an ignoramus, or at least an inattentive
listener. Certainly the distinguished surgeon and his
son have spared no pains to such an end, either as to
time, place, circumstance, 'or surroundings. But, as be-
fore remarked, his demonstrations were well received.
The most mteresting subject presented in the addresses
was that on malaria by Professor Crudeli, of Rome.
This has doubtless been published with the cable de-
spatches. The subject was one that interested practition-
ers generally, although some of the views enunciated by
the distinguished hygienist were somewhat striking, if not
heretical in their tendency. The courteous attention of
the large audience throughout the delivery of the address
attested its merit and its widespread applicability to the
wants of his hearers.
Virchow drew a crowd of hearers, more on account of
himself than his subject. He did his best to infuse in-
terest into his theme, and this, considering his impressive
delivery and forcible eloquence, is saying a great deal.
But he was compelled for the most part to confine him-
self to abstruse reasoning on mere theories, and was at
times tiresome and heavy.
Pasteur came before his hearers with the S^iaf of a
star actor in a celebrated part Both he and his subject
were interesting, but the former even more than the lat-
ter. The audience hall was crowded to its uttermost,
and there was infused in his delivery, in his presentation
c^ striking fieicts, and in the apparently modest summing
up of results, a sentimentality which told strongly on his
hearers. But Pasteur is a great man, an original thinker,
a hard worker, and one who knows how to make his work
appreciated. The principal points in his address were
cabled as fully as possible in the rush to get everything
in the shortest time, but perhaps a little more of details
as to experiments performed and their results may be ac-
ceptable just here.
When he had discovered his method of vaccinating dogs
with hydrophobic virus, and so made many dogs insus-
ceptible to hydrophobia, he requested from the govern-
ment a competent committee to judge of his results.
The request was granted by the Minister of Education
(M. Falli^res), who appointed B6clard, Paul Bert,
BouUy, Tisserand, Villemain, and Vulpian, members of
the committee. He sUted that the committee had just
sent its report to the Minister. The following were ito
most important points :
Pasteur gave 23 vaccinated dogs to the committee.
These were compared with 19 non-vaccinated dogs
selected by the committee.
On June ist 2 vaccinated and 2 non- vaccinated dogs
were inoculated by trepanation from a rabid dog.
On June 3d i vaccinated and i non-vacdnated dog
were bitten by a rabid dog.
On June 4th i vaccinated and i non-vacdnated dog
were bitten by a rabid dog.
On June 6th the rabid dog died, and virus was taken
from it and by trepanation inoculated into 3 vaccinated
and 3 non-vaccinated dogs.
On June loth i vaccinated and i non- vaccinated dog
were bitten by another rabid dog.
On June 17th i vaccinated and i non-vaccinated dog
were bitten by one of the non-vaccinated dogs, which
had become rabid after the inoculation by trepanation
on June ist
On June 20th 6 vaccinated and 4 non-vaccinated dogs
were inoculated by injection into a vein.
On June 28th 2 vaccinated and 2 non-vaccinated dogs
were bitten by a rabid dog.
The commission reported that of the 19 non-vac-
cinated dogs 3 out of 6 bitten became rabid, 5 out of 7
inoculated into a vein became rabid, and all the 5 in-
oculated by trepanation became rabid, but among the
248
THE MEDICAL RECORD.
[August 30, 1884.
23 vaccinated dogs not one single case of hydrophobia
occurred.
One of the vaccinated dogs died on July 13th from
diarrhie noire. At once some virus was taken from this
dog and inoculated by trepaning into three rabbits and
one Indian pig. All these four animals are still quite
well, which is a certain proof that the dog did not die
from hydrophobia. The commission, of its own accord,
now intend to vaccinate twenty dogs in order to ascer-
tain results independently of M. Pasteur.
Professor Pasteur finished his address by stating that
animals are proportionately less infected by bites from
dogs than by inoculation. He emphasized that his experi-
ments had only produced results concerning animals, but
that he considered it most likely that if the dog could
thus be made insusceptible of hydrophobia, the source
of this terrible disease in man would be extirpated, and
the question as to prophylaxis both for dog and man
would be solvedt
Sir Wm. Gull's address on the importance of a collec-
tive investigation was well received although it dealt
largely with truisms that were well appreciated by all
progressive men. The adoption of the recommendation
for a National Investigation Committee was a foregone
conclusion. The selection was made from the different
countries as follows, and at the next meeting of the
Congress in Washington, there will probably be formulated
some acceptable working plan. The representatives for
the different countries were : For America — Drs. Jacobi,
Austin Flint, and Billings ; Fngland — Sir James Paget,
Acklan, Gull, Risdon Bennett, Mahomed, and Isambord
Owen ; for Germany — Ewald and Guttman ; Norway--*
Bull ; Denmark — Find and Panum ; France — ^Verneuil,
and Lepine.
It was surprising to note the busy character of the
members in attendance at the different general meetings
and at the sessions of the sections. The attendance in
all was large, and yet each listener was interested, and
all this despite the thousand and one aUurements from
the municipal authorities and citizens generally for
purely social enjoyments. But there was time left for
these. The Tivoli Gardens was the great centre of
attraction. There was dancing, concerts, and other
varieties of light amusement, and thither the majority of
the socially inclined repaired after the hard work of the
day and evening. During the Congress a public lunch-
eon was provided free of expense to the members, while
public dinners were given every day by invitations. All
the museums and hospitals were also thrown open to
the members.
In. my first cable I alluded to a slight confusion in the
programme, but this was only manifest during the first
day, as afterward the affairs of the Congress progressed
like clockwork, with nothing in the way of unpleasant
discussion or obstructive jar to mar the interest and
harmony of the notable eighth session of the Interna*
tional Congress.
OUR LONDON LETTER.
(From our Special Correspondent.}
THE DULL SEASON — BRITISH VERSUS CONTINENTAL SPAS
— ^THEIR LOSS OUR GAIN CHOLERA QUARANTINE
HORRORS — CUSTOM-HOUSE TROUBLES — DEATH OF SIR
ERASTUS WILSON.
London, August 16, 1884.
There is not much stirring just now in medical London.
The medical schools are closed till October. Most of
the societies closed some months ago. All the doctors
who can have followed the example of their patients and
rushed off cither to the mountains, the moors, the
country, or the seaside. Our British health resorts are
more than usually crowded this year, owing to the presence
of cholera on the continent. Many people who have
hitherto paid regular visits to some of the continental
spas every summer have been obliged to Xxy and find a sub-
stitute this year in some of our own watering-places. The
present season therefore promises to be a very profitable
one to the inhabitants of our health and holiday resorts
— most of them are crowded. At many seaside places
bathing begins at four a.m. and goes on actively until the
afternoon; at some, bathers may be observed literally
"from early mom till dewy eve." Undoubtedly many
even of those professedly in search of health are not in-
valids in any sense of the word ; but a certain proportion
of them are, and a good many fees are thus'likely to drop
into the pockets of our own medical men that would
otherwise find their way into those of our forei^ brethren.
The loss to the Continental spas is very senous. Some
rough estimate may be formed of it from the diminution
in the number of circular notes issued this year. One
bank alone estimates that up to now it has issued tliree
thousand notes less than the average of former years.
Multiply this by the average amount represented by each
note, and apain by the number of banks issuing notes, and
the total will be a good round sum.
The cholera is not the only deterrent to foreign travel
The fear of quarantine and its discomfits is a greater
one even. Those who have had to submit to it are not
slow to publish their sufferings in the daily newspapers
as a warning to others. Foreign travel has enough dis-
comforts already without this added. The custom-house
officers are not usually remembered with kindly feelings
by British travellers. Some years ago a relative of the
writer's, who was travelling in Italy in medical charge of
an English family, had an annoying experience. He
carried with him a small medicine-chest On the frontier
the diligence stopped as usual, and the passengers all
alighted to have their baggage examined. The medicine-
chest was seized. In vain its owner protested it only
contained medicines. The officials were inexorable.
Finally he asked them to taste the medicines that they
might be convinced of their nature. The invitation was
not accepted, and the medicines were, after a long parley
in the dusty road, finally allowed to pass. Their owner
afterward learnt that what he ought to have done was
to have given the custom-house officer a " tip " and then
he would have had no trouble.
Sir Erasmus Wilson died last week at his residence in
Kent. He was bom in 1809, and became a member of
the College of Surgeons in 1831, and a Fellow in 1843.
He originally resolved to be a general surgeon, and be-
came Assistant-Surgeon to St Bartholomew's Hospital.
He was the author of the well-known '* Anatomist's Vade-
Mecum,'' which ha« passed through nearly a dozen edi-
tions, the last of which was issued only a few years since.
Twenty years ago it was perhaps the most popular ana-
tomical text-book extant, and has sold well down to the
present time. Not meeting with a success equal to his
wishes in the field of pure surgery. Sir Erasmus (then
simply Mr.) Wilson was advised to take up the skin as a
specialty. This he did with the determination to succeed.
His success was such that his name has become a house-
hold word, and his practice literally became enormous.
Although married, he had no family, and he gave away a
large portion of his earnings. He endowed a chair of
pathology in the College of Surgeons (to which he was
elected as the first professor), and another quite recently
in the University of Aberdeen. The new wing of the
Margate Sea Bathing Infirmary was built with a donation
presented by Mr. Wilson. His gifts to various charities
would take some time to enumerate. I need scarcely
remind your readers that he brought Cleopatra's Needle
to England, an exploit which cost him ten thousand
pounds.
Mr. Wilson never held any skin appointment (except
for a short time the purely honorary one of Consulting
Surgeon to the St John's Hospital for Skin Diseases), so
his experience was drawn from private practice, but as
this was so large he did not feel the want of a hospital
clinic. " 1 see specimens of most varieties of skin dis-
August 30, i884,]
THE MEDICAL RECORD.
249
ease here^ he once remarked to a medical friend, look.
ing round his spacious consulting room. He lived and
practised for many years next door to the late Sir Thomas
Watson. He was President of the College of Surgeons
in 188 1, and he received the honor of knighthood in the
same year. He lived virtually retired during the last
two years of his life at his house at Westgate. He was
the author of numerous works on dermatology.
THE MORPHOLOGICAL STATUS OF THE
CEREBELLUM.
To THB EcrroK op Thb Mkdical Rscoiu).
Sir : Permit me to ask your readers not to interpret my
silence respecting Dr. Spitzka's letter under the above
title (The Medical Record, July 26, 1884) as indicat-
ing either that I have abandoned the view attributed to
me, or that I am unaffected by the objections so ably
advanced by that distinguished anatomist.
I say the view attributed to me^ because Dr. Spitzka
does not refer to the fact that in my discussions of the
segmental constitution of the brain {Science^ March
19, 1881, p. 135; "The Brain of the Cat," "Pro-
ceedings Am. Phil. Soc," August 15, 1881 ; Anaiom-
icai Technology^ November, 1882, pp. 405, 479, 482 ;
"Cartwright Lectures," several places in Lecture I.) I
\as^ provisionally followed Von Baer and others in rec-
ognizing the existence of two encephalic segments can-
did of the " optic lobes."
The matter will be more fully considered in the last
part of the third ** Cartwright," and forms the subject of
a paper entitled " Do the Cerebellum and the Oblon-
gata represent One Encephalic Segment or Two ? " for
presentation at the coming meeting of the American As-
sociation for the Advancement of Science, in Philadel-
phia. If Dn Spitzka could attend the meeting, it would
not only gratify me but further the solution of a difficult
problem. Burt G. Wilder, M.D.
AN UNNOTICED FEATURE OF THE GROSS
ANATOMY OF THE FOURTH VENTRICLE.
To-
: Editor op TuB.BiBMCAL Rxcosoi.
Sir : Observers of cerebral anatomy are familiar with the
fine longitudinal striations which appear to pass from the
anterior half of the fourth ventricle to the aqueduct, to-
ward which they conveige. It is not determined whether
they are the result of shrinkage, through the action of
hardening fluids; they seem to be most pronounced in
those parts of the ventricular parietes where laige cavi-
ties undergo a sudden contraction in passing into smaller
channels, such as the infundibulum and the locality above
mentioned. Bergmaun gave a special name to Uiose in
the latter situation, terming them Psalterium and Or-
ganon pneunuUicuM. In no treatise, ancient or modern,
do I find a veiy distinct appearance, which I have fre-
qaently noted, described In the lateral angles of the
fourth ventricle of a child aged fourteen months I found
OD either side three button-Uke elevations, into which the
striae described by Bergmann were continued, just as the
stick of a drumstick joins its button-like termination.
In another child their existence in the fresh (unhard-
cncd) brain was determined. They are paler than the
rest of the ventricular flow in chromic acid preparations.
At first I supposed that these elevations were infantile
features in the human brain, like ihe crista fornicis of
Wilder, which, so far as I am aware, has been identified
hythat observer only in a child. On examining the
fourth ventricle of the negro Jefiferson, recently executed
in Brooklyn, I found these "hordea,*' as I propose to
designate them, very distinctly marked. On the right
side there were two of these prominences, globular, sep-
arated by a narrow fissure^ the aggregate dunensions be-
ing, antero-posteriorly, a little over one-eighth of an
inch, each measuring transversely a sixteenth. On the
left side there was a single eminence apparently equiva-
lent to a fusion of two such as those on the other side ;
it resembled a long oval hill, running antero-posteriorly,
with its anterior end making a deflection inward. In the
several brains in which I have identified these bodies
they were all situated directly laterad of Ha^forea. In
the negro, most of the strias of the psalterium passed
laterad of them, along the rising ventricular side-wall to
pass into the roof of the ventricle. A few, however,
passed toward the hordea, but without as distinctly con-
necting with them as in the infantile brains. In one of
the latter, the three beautifully distinct hordea (resem-
bling, as their name indicates, so many barleycorns) of
each side had each a string of the psalter running into
them, so as to resemble (as above indicated) three thick-
headed drumsticks lying side by side. In several hard-
ened specimens of the adult brain-isthmus I find these
bodies to be as distinct as in the negro cited, alcohol
specimens, as a rule, showing them less distinctly than
such as had been first preserved in acid, chromic salts,
or glycerine mixtures.
What the significance of these bodies is, whether they
be mere thickenings of the end3m3a or not, I am unable
at present to say. I have identified faint indications of
these bodies in the corresponding situation in the sea-
lion and found them absent in one monkey (cercopithe-
cus), butfnot having examined the entire collection with
reference to this point, am unable to say anything as to
the general absence or presence of the hordea in the an-
imal scale.
I may remark in conclusion, that the general physiog-
nomy— if I may so term it— -of the fourth ventricle in the
negro referred to, was more infantile than that of any
other human brain I have examined. The floor of this
cavity in the child is marked by the deep depression of
the so-called "fasciculus teres*' elevation, the outer bor-
ders of the distinct grooves on the outer side rising up
very steep. In the adult, ordinarily, the floor becomes
generally flatter. The general development of this ne-
gro's brain was good. £. C. Spftzka, M.D.
ENDORSED DIPLOMAS OF THE UNITED
STATES MEDICAL COLLEGE.
To TKB EdUOR op TtaS MXDICAL RacosD.
Sir: Inasmuch as numerous inquiries have been ad-
dressed to the Board of Censors of the County Society
in regard to the endorsement of diplomas by the United
States Medical College, we have been advised to answer
the following recent inquiries through The Record :
I. Is the Eclectic Medical College of Cincinnati, O.,
a reputable institution ?
3. Is a diploma, issued by the above, and endorsed b^
R. A. Gunn, legal qualification for the practice of medi-
cine?
If the writer refers to the Eclectic Medical Institute of
Cincinnati, it is a reputable school and the diplomas are
recognized by the Illinois State Board of Health, pro-
vided the graduate presents a written statement firom the
dean that he has studied medicine three years, and taken
two full courses of twenty weeks each, extending over a
period of sixteen months. The natural inference from
this condition is that diplomas have been issued from
said college to persons who have not met these require-
ments, but that the present management is entitled to
confidence. The Court of Appeals has declared that the
United States Medical College was illegally incorporated,
and such disability never having been removed by subse-
quent legislation, every diploma issued, and every en-
dorsement by R. A. Gunn as dean became null and
void. As a measure of relief to the innocent victims of
this now defunct institution, the Legislature last winter
passed an act legalizing the diplomas issued by the United
States College prior to the beginning of proceedings
against it, April 21. 1883, provided the holders of said
250
THE MEDICAL RECORD.
[August 30, 1884,
diplomas had attended the required courses of lectures,
passed a satisfactory examination, and been regularly
graduated, in other words had not secured a diploma by
the disreputable means believed to have been practised
in some instances.
Very respectfully,
Daniel Lewis, M.D.,
Chairman of Board of Censors.
ELECTROLYSIS IN STRICTURE.
To THK Editor op Thb Mbdical RxooRa
Sir : Allow me a few words in reply to a criticism in the
last Record of my article on the above subject by Dr.
Meier. I do not propose to enter into any controversy
upon this subject, and this will close the discussion on
my part For it is apparent from the doctor's attempted
contradiction of my position, that, in the words of a dis-
tinguished surgeon, "it is useless to argue with men who
persist in making statements in direct opposition to
those who are known to have the largest opportunities
for scientific investigation and experience.''
I claimed that it is impossible to cure organic stricture
by the method of which we have heard considerable in
the last few years, namely, the application of electric
currents so weak as to be scarcely felt That it was not
to be expected from our knowledge of the laws of elec-
tro-therapeutics, and was not endorsed by the standard
authorities. My "arbitrary dictum," as the doctor terms
it, is based upon nearly twenty years' experience in the
study and treatment of strictures and in the use of elec-
tricity. Any one can read the authorities for themselves.
Sir Henry Thompson, Surgeon to University College
Hospital, London, and Fessenden N. Otis, Professor of
Genito-Urinary Diseases in the College of Physicians
and Surgeons, and Surgeon to Charity Hospital, New
York, authors of the most classical works upon stricture
which have ever been written, and who have probably
had the largest experience in this line of any men who
ever lived, totally ignore electrolysis. " Althaus," the
great English authority on electricity, and " Beard and
Rockwell," the American, speak in very guarded and not
favorable terms of the remedy. And so one might go
through nearly the whole list of standard writers, college
professors, and hospital surgeons, who have had the
greatest opportunities for studying and experimenting.
Their ability or honesty cannot be questioned; theu:
position certifies to the one, and their character, writings,
and the absence of biasing motives to the other. 'The
doctor claims that analogous conditions in other parts
are cured in this way. The above remarks apply equally
to this statement also. S. W. Gross, Professor of Sur-
gery in the Jefiferson Medical College, Philadelphia, in a
recent elaborate article in the American Journal of the
Medical Sciences on the " Treatment of Stricture of the
CEsophagus," does not even mention electricity. And
yet my critic has the assurance to deny all this and claim
that the writer, and if him then all who agree with him,
which embraces the great mass of the profession, are not
sufficiently skilful to follow the directions laid down by
the advocates of this method. But that the method itself
is all right is not proven because a certain doctor does
succeed with it anyhow, no matter whether any one else
does or not.
In support of his statements he quotes a few of the re-
ports of the remarkable effects of electricity which have
appeared in the journals. All have heard this same kind
of argument before, can weigh the evidence of both sides,
make the " experimentum crucis" for themselves, and
draw their own conclusions. My experience with dilata-
tion, divulsion, electrolysis, and dilating urethrotomy,
leads me to believe that very few cases of stricture are
permanently cured, except by tearing (divulsion) or cut-
ting ; and the former process has generally been aban-
doned as having no advantages and some disadvantages
compared with the cutting operation. Nearly every
stricture of the straight urethra should be, and can be
cured permanently by cutting. An external constricting
band or a contracted meatus is cut unhesitatingly. ^
puttmg the urethra on the stretch by the urethrotome an
internal one is cut with nearly equal facility with little or
no pain and with almost perfect safety. " Operations con-
fined to the straight urethra are tfj a rule never followed
by constitutional disturbance," but no instruments should
be passed into the bladder at the same time, for
the passage of a sound not unfrequently causes chills
and other constitutional effects. The rationale of cure
is by relieving spasm and congestion, which must exist
more or less about every stricture, to promote a healthy
circulation and absorption of the deposit. Over 1,100
cases without a death, and with only a very few cases of
urethral fever, serious hemorrhage, or inflammation, and
these few in operations on the deep urethra, are reported
in Otis' work. It is not until we pass around the pubic
curve that trouble usually begins. Fortunately the great
majority of cases are in the straight urethra, slight con-
tractions of which the only symptom is gleet, with more
or less spasmodic contractions deeper. ''These cases
are of daily occurrence and often pass unrecognized, the
gleet being treated, the stricture overlooked. Too much
stress cannot be laid upon the importance of exploring
the urethra in every such case, and if the slightest ob-
struction is found, removing it."
H. W. Streeter, M.D.
X04 WcsT Main Stkkbt, Rochester, N. V.
Official List of Changesin theStaiUms and Duties of Officers
serving in the Medical Departnunt^ United States Army,
from August 17 to August 23, 1884.
Crampton, I>ouis W., Captain and Assistant Surgeon.
To report at Creedmoor (L. I.), N. Y., not later than
August 30th, as competitor ; and in addition thereto, as
medical officer of the detachment of competitors. S. 0.
41, Division of the Atlantic, August 20, 1884.
Cochran, J. J., First Lieutenant and Assistant Sur-
geon. Assigned to duty at the Presidio of San Francisco,
Cal. S. O. 81, Division of the Pacific, August 16, 1884.
Birmingham, H. P., First Lieutenant and Assistant
Surgeon. Granted one month's leave of absence. S.
O. 162, Department of the Missouri, August 12, 1884.
Wilson, George F., First Lieutenant and Assistant
Surgeon. Relieved from duty at Fort Walla Walla,
Wash. Terr.y and to take station at Vancouver Barracks,
Wash. Terr. S. O. 120, Department of the Columbia,
August 13, 1884.
Fisher, W. W. R., . First Lieutenant and Assistant
Surgeon. When relieved by Assistant Surgeon Cochran,
to report in person to Commanding General, Depart-
ment of Arizona, for assignment to duty in that depart-
ment. S. O. 81, C. S., Division of the Pacific.
Woodward, J. J., Major and Surgeon.
17, 1884.
Died, August
Official List of Changes in the Medical Carps of the U. S,
Navy, during the week ending August 23, 1884.
Rixey, p. M., Passed Assistant Surgeon. Orders to U.
S. S. Lancaster revoked. To continue on special duty.
Martin, C, Medical Director. To be retired August
21, 1884.
Heyl, T. C, Surgeon. Detached from U. S. S. Inde-
pendence, ordered to U. S. S. Adams.
Ayers, J. G., Surgeon. Detached from U. S. S, Adams,
placed on waiting orders.
Curtis, L. W., Assistant Surgeon. Detached from
U. S. S. Adams, placed on waiting orders.
August 30, 1884.]
THE MEDICAL RECORD.
251
Stephenson, F. B^ Passed Assistant Surgeon. De-
tached from Navy Yard, New York, ordered to C. S. S.
Bache.
Derr, £• Z., Passed Assistant Surgeon. Detached
from C. S. S. Bache, placed on waiting orders.
^edical Stems.
Contagious Disxasxs — ^Wxxkly Statsmxmt. — ^Re-
port of cases and deaths from contagious diseases re-
ported to die Sanitary Bureau, Health Department, for
die week en^ng August 33, 1884 :
WaekBndiiif
Auf^t 16, 1884
Ai^st 23, 1884
Dtaiks.
August 16, 1884
August 23, 1884
I
I
The Vagaries of a Needle. — Under the above
head Dr. John Burke, of this city, writes : " Miss A ,
seventeen years of age, came to my office last October
saffering from an abscess behind her right ear, over mas-
toid process. She had this trouble for four years, and
for ten years she had a discharge from her ear, sometimes
fetid and sometimes not. She was also partially deaf in
that ear. Her mother had tried many ear surgeons, but
the discharge from the ear and the deafness continued.
Now, the abscess had two openings, one above and the
other directly below, about one inch apart Under
ether I laid open the parts to the bone. There was no
Deaosis. Next day a poultice of flax-seed meal was ap-
plied. In three days a common sewing-needle came out
of the wound, not much rusted. History : Ten years
ago the child, being seven years of age, was playing with
a needle in her mouth ; it was swallowed. It caused
some strangulation. It could not be found by the doc-
tors who examined the throat. About four months after-
ward the child was taken with pain in the ear and
otorrhoea, which, notwithstanding good surgical treat-
ment, continued for ten years. For four years she
suffered with an abscess over mastoid process, sometimes
healing, and then suddenly breaking out. On March
ist the needle came out. Since then the abscess has
healed, the discharge from the ear has ceased, and the
patient can hear very fairly in the ear, but not as well as
in the other side. But all pain and tenderness has gone."
Ovariotomy in the Corpulent ; Ovarian Cyst in
A Woman aged Ninety. — Dr. W. P. Giddings, of
Gardiner, Me., sends us the following instructive his-
tories : "On June 26, 1882, 1 removed from Mrs. S ,
twenty-six years of age, an ovarian multilocular cyst,
weighing with its contents flfty pounds. She had been
tapped four times, the last two by myself, removing
respectively 33 and 35 pounds. The abdomen was ex-
cessively pendulous, and after closing the wound there
was a very deep sulcus into which I judge a pint of fluid
noigfat have been poured and retained. Desiring to avoid
the retention and burrowing of pus about the wound, I
placed adhesive strips to within half an inch of the
wound and drew them around toward the spine, then
crossed the wound with adhesive straps supporting it in
the usual way. I had the cicatrix thus supported for
several months, reinforced by the bandage. Recovery
was oninterrapted, and there was gradual retraction of
skin and muscles to a normal state. On June i6th of
the present year, I delivered the lady of a fine healthy
boy of 10 pounds weight, and found the cicatrix of wound
had not yielded in the slightest degree, and during labor
there seemed to be sCs much force exercised by the
muscles as is usual Convalescence rapid and complete.
Case 2 : Mrs. A , ninety years of age, had for eighteen
months noticed a gradual enlargement of abdomen,
and for some few months oedema of feet and limbs,
which had greatly increased, rendering locomotion im-
possible, and confining her to bed. To add to her dis-
comfort, profuse salivation had come on, preventing her
taking food or getting sleep. General dropsy had been
diagnosed, and I was called in consultation. There had
been at times during the past few months quite a
" show.'' I instituted a careful examination and diag-
nosed ovarian cyst of left side with thin fluid. The case
was frankly stated and tapping advised, her extreme age
forbidding the thought of a radical operation. The old
lady, unusually intelligent, with- faculties remarkably well
preserved, submitted at once to the operation, remarking
during it, "Doctor, I enjoy seeing that fluid run;
surgery has advanced since I was a girl.'* This was done
April 10, 1884. At present writing she is well and
hearty, though the cyst is gradually filling. Who has
seen so old a person develop an ovarian tumor ? "
A New, Successful, and Palatable Medicine for
THE Treatment of Tape-worm. — Under the above title
Dr. Howard Pinkney, writing from Sharon Springs, de-
scribes his experience with the oil of the pine needle,
made from the pinus punilio, A hall-boy of the hotel
had sufiered for five years from tape-worm. He had
been treated for four years in New York, but never had
succeeded in getting rid of over four feet of links at a
time. Dr. Pinkney not being able to get any male fern,
pelletierine, or pumpkin seeds, therefore tried the fol-
lowing experiment : "The patient fasted from breakfast,
and at nine p.m. he was given one teaspoonfiil of oil of
the pine needle in half a glass of milk. The following
morning, as there was no perceptible action of the medi-
cine, the dose was doubled. This, the boy said, had a
most agreeable taste. One hour later he took a dose of
castor oil, and in the course of two hours after this he
passed an entire tasnia solium measuring fifteen feet six
inches in length and one-half inch at its broadest part,
gradually tapering down to almost a thread. To be positive
that none remained behind, he was given two teaspoon-
fills more, but no sign of any worm or part thereof
passed. This oil," writes Dr. Pinkney, " contains no tur-
pentine, is fragrant in its odor, and when mixed with milk
very agreeable to the taste. It produces no strangury,
tenesmus, or other unpleasant or distressing symptoms.
The patient can generally pursue his ordinary avocation."
Our correspondent would be pleased to know if any of our
readers have ever read or known of its use in similar cases.
The Cholera Germ and its Destruction. — Dr.
Koch has found large numbers of diflerent kinds of
germs in the intestines and discharges of cholera patients,
and among them one almost new kind which seems peculiar
to cholera. This form, which was not round, or dot-like,
nor rod-shaped, had been previously noticed and described
by Dr. Bristowe, of England, a well known medical
author, as early as 1867. Other more common forms
of germs were found in the dejecta and intestines by
Bohm as early as 1838. Round or dot-like bodies were
detected by Brittain and Swayne in Bristol, England,
in 1849, 2md confirmed by Hugh Bennett, of Edinburgh.
Pouchet, Davaine, and Paccini saw them again in 1854
and 1856. Dundas Thompson and Dr. Hassell, quoted in
the United States Cholera Report for 1873, ^so wrote
about them in 1854, and stated that they thrived most in
warm alkaline fluids, when contaminated with organic
matter in a state of decomposition. The rice-water dis-
charges of cholera were found to be alkaline and very
prone to putrefaction, and acids were first suggested as
germicides and as curative remedies for cholera. In
25^
THE MEDICAL RECORD.
[August 30, 1884.
1866 Dr. MacNaimara, one of the very best writers on
cholera, noticed the same things and was inclined to be-
lieve that the cholera germs died naturally in about three
days. In 1872, Nedwetsky, also quoted in the United
States Cholera Report for 1873, p. 32, ^ave us still more
positive information. He put ten grams of quinine in
two teaspoonfuls of rice-water discharges which were
swarming with germs, and they were not only alive
on the second and third days, but by the fifth day large
masses, or new colonies of them, had formed. He
then put thirty grains of camphor in two teaspoonfuls of
rice-water cholera discharges and found that the germs
lived and thrived. Next he put five drops of strong car-
bolic acid in two teaspoonfuls of nce-water discharges,
but the germs remained alive and active. On the fifth
day he added five drops more of carbolic acid but did
not kill the germs. Then he put first one teaspoonful
and then two teaspoonfuls of tar in two teaspoonfuls of
rice-water discharges, but the germs continued to live,
move and thrive. Then he put ten grains of calomel in
two teaspoonfuls of rice-water discharges, but the germs
continued to live and move among the particles of calo-
mel which had settled at the bottom of the glass ; and by
the fifth or sixth day great numbers and masses of new
germs had formed. Then he put one teaspoonful of
laudanum in two teaspoonfuls of rice-water discharges,
but the germs were alive on the second and third days,
and on the sixth day only a few of them were benumbed.
Next he put one teaspoonful of tincture of nux vomica in
two teaspoonfuls of rice-water discharges, but most of
the germs lived up to the tenth day, and then only a
portion of them were dead and motionless. One tea^
spoonful of chloral was put in two teaspoonfuls of rice-
water discharges, but the germs were not killed.
If there is any value in such careful and ingenious ex-
periments they seem to prove that all these powerful
remedies are useless in cholera. Nedwetsky was in-
clined to believe that they might be useful in cholera
morbus and other allied diseases, and as one-half of the
cases of real cholera recover, that they had obtained a
fictitious reputation. He was destined to be more suc-
cessful with other remedies. He put ten grains only of
tannin or tannic acid in two teaspoonfuls of rice-water
discharges, and in two hours an innumerable number of
germs were found without life or motion. None of them
came to life again up to the tenth day, even after they
were put in distilled water to revive them. Dilute sul-
phuric and nitric acids, made by putting twenty drops of
the strong acids in an ounce of water, and adding two
teaspoonfuls of this to two teaspoonfuls of rice-water
discharges, killed the germs at once. Very dilute mu-
riatic acid, made by putting three drops only of the strong
acid in six ounces, or nearly half a pint of water, killed
the majority of the germs. Chlorine water killed the
germs at ^once. Sulphate of iron in concentrated solu-
tion also killed the germs, and chloroform also. It is
now claimed that all these germs were merely common
germs or bacteria such as cause ordinary putrefaction.
But all the rice-water discharges were taken from well-
marked cholera cases which had been attended by Ned-
wetsky and the others during life and examined after
death. We have apparently gained fixed points in the
treatment of Asiatic cholera, which some are not will-
ing to surrender. Healthy acid gastric juice will destroy
the germs of cholera, and if sufficient of it be present
in the stomach, rice-water cholera discharges may be,
or at least have been, swallowed with impunity. In a
jail in India some experiments were being carried on;
rice-water discharges were put in a very large glass of
water; nineteen convicts accidentally drank of this; in
consequence four or five weak and dyspeptic patients
died of cholera and the rest all escaped without a sign of
disease. Muriatic acid is the base of the acidity of the
gastric juice, and common table salt is a muriate of soda
or a combination of muriatic acid and soda. Sulphuric
acid has a well-established reputation in the treatment of
cholera. Koch has added alum, which is a sulphate of
alumina that kills his germs in a one per cent, solution.
There is no harm in adding a little sulphate of morphine
to these remedies, for opium has much palliative, if not
curative, influence over cholera. Sulphate of copper is
suggested by Koch, who says it will kill his germs in the
very dilute solution of one part to 2,500 of water. And
corrosive sublimate in the proportion of one to 20,000.
But the great difficulty in the treatment of cholera lies in
the fact that huge quantities of alkaline fluids are poured
out into the stomach and bowels ; these have to be
measured by quarts or gallons rather than by pints or
ounces, and all has not only to be neutralized but ren-
dered acid before the germicides will act. If it takes ten
drops of dUute sulphuric acid to kill the germs in two
teaspoonfuls of rice-water discharges, how much will it
require to deal with quarts at least : it would seem that
rather large doses frequently repeated are required ; and
we can judge of the frequency of the repetition of the
doses by the use of litmus paper to the discharges; when
these become acid the doses may be lessened. And now
would also be the time to try the more powerful remedies,
viz., sulphate of copper and corrosive sublimate, if any
one wishes to do it; they will be inoperative, though
alkaline fluids. Lemon juice and vinegar have always
been forbidden in cholera, but acetic acid, the basis of
vinegar, is an efficient remedy.
Rectal Etherization. — Dr. O. Wanscher writes in
the Copenhagen HospUals^Tidende^ of May 28, 1884,
giving an account of the history of rectal etherization
and of the advantages and disadvantages of this method.
He states that in 1847, immediately upon the introduc-
tion of anaesthesia for surgical operations, Pirogoff con-
ceived the idea of administering ether for this purpose
by the rectum. Migendie's experiments upon animals,
however, demonstrated the danger of injecting fluid
ether into the rectum, many of &e animals so treated
passine into a state of dangerous or even fatal collapse,
and Purogoff" was therefore led to experiment with the
vapor of ether passed into the bowels. The method was
described by him in a pamphlet published in St. Peters-
burg in 1847, entitled "Recherches sur T Etherisation,"
and also by Ekstromer who recommended its employ-
ment instead of tobacco clysters in the treatment of
incarcerated hermia. The latter used it also with
success for the relief of renal colic. But upon the in-
troduction of chloroform, Pirogoff, together with most of
the European surgeons abandoned ether, and then rectal
anaesthesia passed into oblivion. The method was re-
vived again by Wanscher, who published an article on
the subject in the Hospitals'7}dende in 1882. The
apparatus used by him, which is nearly identical with
that of Pirogoff, consists of a bottle to which is attached
a flexible tube about two yards in length, and provided
at the other extremity with a nozzle with a stop-cock
attachment. At the end near the nozzle the tube passes
through a flask in which it is looped several times. The
bottle is placed in a vessel of hot water, and the flask is
also filled with hot water in order to prevent any con-
densation of the vaporized ether before it enters the
rectum. By means of the stop-cock it is possible to
administer or withhold the anaesthetic at pleasure, with-
out withdrawing the tube. Dr. Wanscher has induced
anaesthesia by this method successfully in a number of
cases, especially in operations about the head and neck,
and when openings were to be made into the thoracic
cavity for the evacuation of the fluid in empyema.
A Genius to Fail. — Speaking of the causes of failure
in life, Tourgee says : " Trying to carry too big a load,
I don't know about a professional man's failing if he
works, keeps sober, and sleeps at home. Lawyers, minis-
ters, and doctors live on the sins of the people, and, of
course, grow fat under reasonable exertion, unless com-
petition is too great. It requires real genius to fail in
either of these walks of life."
The Medical Re
^^ICAf
A Weekly yournal of Medicine and Surgery
Vol. 26, No. xo
New York, September 6, 1884
Whole No. 722
C^gitml Ji^rticles.
THE MEDICAL HISTORY OF THE CASES OF
THE SURVIVORS OF THE LADY FRANK-
LIN BAY EXPEDITION.
By EDWARD H. GREEN, M.D.,
PASSBD ASSISTANT SURGKON U.S.N. .
As a preliminary to a medical history of the cases of the
survivors of the Lady Franklin Bay Expedition, it is well
to give a brief r^um^ of their mode of life at Camp
Clay, their quarters, rations, etc., so as to better ap-
preciate the condition in which they were found.
On September 29, 1883, Lieutenant Greely landed
with his party at Baird Inlet after thirty days' exposure,
drifting on an ice-floe ; the record left at that time stated
tat party was all well. Having sent an advance detach-
ment ahead, it was found and reported that a cache of
provisions existed at Cape Sabine (fifteen miles further
to the northward than he was at this time). It was
deemed expedient to move the whole command up to
that neighborhood rather than send for the provisions
and winter at Baird Inlet. Finally, on October 25th, they
moved around to a point between Cape Sabine and
"Cocked Hat Island," lat. 78° 45' N., long. 74° 15' W.
The site of their winter quarters was sheltered between
hi^ ridges of mountains, which screened them in a
measure from the northerly and southerly winds. A
fjadti was situated at the foot of the mountain, on either
side of them, about a mile distant They constructed a
house of loose rocks and moss, the walls being 3 feet ki
thickness. The roofing consisted of old canvas stretched
over a boat. The dimensions of the house were 25 feet
long by 1 7 feet wide by 4 feet high, making the cubic
air space 1,700 feet. In this the twenty-five members of
the party Hved all winter, having a cubic air allowance
of about seventy feet for each man. The whole party
could barely squeeze in and lie at length, two or three
being obliged to occupy the same sleeping-bag. The
effects of this diminished air space will be seen later on.
Their hut was but 100 yards removed from the ice-foot
of the Sound, and 200 ^ards to the south of them was an
artificial lake, from which they drew their water-supply
by melting up ice. As the sea-water strained into this
]ake, they were drinking brackish water all the while.
On November ist Lieutenant Greely took a careful
account of his stock of provisions, and found there was
bat a whole ration for each man (estimated as an army
ration, about forty-six ounces solid food per diem) for forty
days. Dr. Pavy and he advised together, and it was
with some reluctance that they determined to divide up
the rations so as to make them last until March ist, put-
ting aside from time to time so that at the end they
would still have ten days' supplies left with which to
attempt the trip to Littleton Island, if the Straits were
frozen over. Dr. Pavy did not think the party could
exist on the ration during the winter ; but the common
voice was to make it go as far as it would, so each man
was given the following daily allowance : Meat and
blabber, 4.33 ounces ; bread and dog-biscuit, 6.5 ounces ;
canned vegetables and rice, 1.40 ounce; butter and
^ci, a75 ounce; soup and beef extract, 0.90 ounce;
berries, pickles, raisins, and milk, i ounce, making the
daily allowance for the four months 14.88 ounces. Dur-
ing the winter the following amount of game was secured,
which added to their stores : two seals, 3rielding about 120
pounds of meat ; one bear, yielding 300 pounds of meat ;
eight foxes, 4 pounds each; and sixty dovekies (Uria
brunnichii), a small bird weighing about a pound.
March ist — Found die party intact with the exception
of Sergeant Cross, who died in January with well-marked
scorbutic symptoms, the only case of pronounced scurv}'
that developed ; and Hans, their Eskimo hunter, who was
lost in his boat while hunting seal^ early in February.
The Straits having been kept open during the winter by a
succession of violent gales, the attempt to cross to Little-
ton Island had to be abandoned, and their ration was
still further reduced to the following allowance : meat 6.8
ounces ; bread and dog-biscuit 3.2 ounces, the rest oi their
stores being exhausted The stores were divided up so as
to last until May 12th. The sun had returned by this time,
after an absence of one hundred and twenty-eight days,
and those employed as hunters caught the sea-fleas or
shrimp, a small Crustacea^ to ^ in. long, consisting of about
four-fifths shell and one-fifth meat. From i to 3 ounces of
these a day — according to the catch — were allowed in addi-
tion to the ration. After the last reduction the party be-
gan to weaken and die ofl* rapidly. About March 24th the
whole party was overcome with asphyxia, and nearly lost
their lives, owing to the atmosphere being surcharged
with carbonic acid ; they had lit their alcohol stove in the
hut to cook a meal, without previously having removed
the rags from the vent-hole in the roof. The remaining
oxygen of the air was soon consumed by the stove, and
the whole party were seized with faintness, vertigo, and
dyspnoea. It was with the greatest difficulty they strug-
gled from their sleepinp;-bags, and stumbled and were
helped into the open air, many fainting away and drop-
ping unconsciously after reaching the open. Being poorly
clad for a temperature such as prevailed outside at the time
(—46** F.), many were frostbitten. The after-effects of
this mishap remained for a long time and weakened many
of them. After May 12th everything like a regular ra-
tion was exhausted, and they struggled on as best they
could, catching the shrimp (which they boiled) gathering
reindeer moss, which when boiled yields a mucilage
(similar to Iceland moss), and boiling up the seal-skin
linings of the^r sleeping-bags (from which a gelatinous
mass was extracted). It was not until they had exhausted
the supply of moss around the camp that they gathered
the black lichen (cr^pe de la roche) growing on the
rocks and boiled that. Dr. Pavy spoke strongly against
its use, as he had the authority of Kane and Hayes that
when eaten it would produce a diarrhoea, which, in their
weakened condition, would be fatal. They had no fuel
for artificial warmth, and barely sufficient to allow for
melting the ice for procuring drinking-water, and to cook
a meal every other day, so that the living temperature of
the hut for the winter was from 5° to 10 F.
They recognized the fact that the nearest they could
approach a state of hibernation the better were their
chances of getting through. Only those employed as
cooks and hunters exerted themselves much, and they
were given a double ration. The rest of them occupied
their sleeping-bags and slept sixteen to eighteen hours
out of the twenty-four. In answer to complaints of
hunger Dr. Pavy's motto was, "quidort dine," which was
philosophical without being filling.
There seemed to be but little acute suffering from the
lack of food, it was only after the introduction of food
into the stomach that the craving became great ; for
254
THE MEDICAL RECORD.
[September 6^ 1884.
days they went without food without actually suffering.
The deaths seemed to take place finally from heart trouble
(hydrops pericardii) ; the feet and face became oedematous ;
for a day or so they would complain of pains over the heart,
have a spasm of pain over praecordia, a slight general
convulsion, and all would be over. Their chief su£fering
during the winter was from constipation; many went
eight to ten days without a stool, and one as long as
sixteen days. The faeces became so hardened and im-
pacted in the rectum that at each operation they were
obliged to dig them out with their fingers, the abdominal
muscles being too weak to extrude the mass; nearly
every one would faint, after having a stool, of sheer ex-
haustion.
When it is considered that for nine months they were
on the ration as detailed, had nothing but brackish water
to drink, no artificial warmth, living in a temperature of
five to ten degrees for the winter, with a cubic air space
of seventy feet pep man, the condition in which the
survivors were found will not be wondered at. There
were but seven out of the twenty-five found alive. These
were A. W, Greely, first lieutenant, U.S.A.; Henry
Beiderlick, hospital steward ; D. L. Brainard, sergeant,
U.S.A.; Thomas Connell, private, U.S.A.; Joseph Elli-
son, sergeant, U.S. A.; Julius Frederick, sergeant, U.S.A.;
Francis Long, sergeant, U.S.A. The four first men-
tioned were taken on board the flagship Thetis and
placed under my care, and with them this paper will
principally be concerned.
On landing at the camp, the condition of the party
was so desperate that a delay of two hours was necessary
to restore them sufficiently to permit their being removed
on stretchers to the boats and taken off to the ships.
Thomas Connell, private, was in extremis, was pulseless,
unconscious, and unable to swallow ; limbs cold and res-
pirations barely noticeable. Auscultating over the heart,
the sounds were heard very indistinctly by propping him
up ; forcing open the jaws, a teaspoonful of brandy was
slowly poured into the back of the throat. The effect of
the stimulant was soon noticeable, as a faint pulse ap-
peared at the wrist ; in ten minutes he could make an
effort to swallow, when more brandy was adminstered,
followed by some warm condensed milk at intervals. The
rest of the party were served with brandy, milk, and
beef essence, and finally transported . to the ships.
The time and space would hardly be allowed me to
give more than a brief detail of the cases, and as they
closely resembled each other, both in symptoms and
treatment, I will confine myself to the case of Lieutenant
A. W. Greely more particularly, alluding to anything
peculiar in the other cases.
June 2 2d, II P.M. — A. W. Greely, lieutenant, U.S.A.,
aged forty. Disease asthenia; on admission fainted
after being carried below in the ward-room and vomited ;
administered ammonia spts. aromat. 6 cc, renewed in
ten minutes ; placed in the berth ; given a teaspoonful
of raw, firesh beefi minced ; clothes were carefully cut off
of him and heavy red flannels, previously warmed, sub-
stituted.
On examination his body emitted a sickly offensive
odor (as of stale urine) ; emaciated to a degree. Skin
hanging from limbs in flaps; face, hands, and scalp
blackened with thick crust of soot and dirt (had not
washed or changed clothing for ten months). Nervous
system : excitable and irritable ; at times almost ir-
rational ; eyes wild and staring ; insists on talking, crav-
ing; news, and demanding food ; complains of no pain.
Digestive system : tongue dry and cracked, heavy brown-
ish-black coat ; ravenously hungry ; abdominal cavity
hollow and lying almost in contact with vertebral column ;
no movement of bowels for six days ; liver dulness ; on
percussion confined to right hypochondriac region. Res-
piratory system : respirations 12 per minute; ausculta-
tion and percussion reveal no abnormal condition of
lungs ; vesicular murmur puerile. Circulatory system :
pulse 52, soft or compressible ; auscultation shows
marked murmur (blowing) in systole over base of heart.
Integumentary system : skin cold and clammy, sickly
odor emanating from it, shrivelled and sallow ; tempera-
ture 97.2° (under tongue). Locomotor system : great
muscular waste ; unable to move or stand without sup-
port; body weight 120 pounds; weight before leaving
Fort Conger in August, 1883, 168 pounds. Urinary
system : no specimen obtainable. Treatment : From n
P.M. till 8 A.M., alternated every half hour, teaspoonful
of raw, fresh beef (minced) with teaspoonful of milk
punch ; enjoined strict quiet ; pulse then rose to 60 per
minute, soft ; temperature 97®.
June 23d. — Nervous system : mind still active and
restless, compelled to allow him some home letters to
read, after which became more composed ; has not closed
his eyes ; talks rationally, but shows loss of memory, as
often repeats himself. Digestive system : had a small
highly offensive stool ; felt quite faint ; afterward passed
considerable wind from bowels; abdomen tympanitic;
tongue still dry and coated. Circulatory system : pulse
slightly stronger, 60 per minute; respiration 12 per min-
ute. Integumentary system : same offensive odor ;
temperature, A.M., 97.8° ; p.m., 98*^. Locomotor sys-
tem : still unable to rise up without help ; muscles
very soft and flabby ; some stiffness and pain in the
joints. Urinary system: urine passed in twenty-four
hours, 1,630 cc, specific gravity 1.014 ; acid, highly
albuminous (^^ tube). Treatment : Continue raw fresh
beef at intervals of an hour, with a raw onion, finely cut
up, added ; also, milk punch, half an ounce every two
hours ; no medication.
June 24th. — No sleep ; mind more tranquil, but too ac-
tive ; great desire to talk and read ; less persistent in
demanding food ; complains of soreness in limbs ; tODflie
presents a moister appearance ; bowels slightly distended
with gas ; no stool ; pulse, 62°, not so thready ; heart
sounds stronger ; still a pronounced anaemic murmur.
Blood examined microscopically shows large increase of
white corpuscles; at first the field (-^ objective) ap-
peared filled with the nucleated corpuscles ; close exam-
ination showed the proportion to be about one to twenty
red ; the red corpuscles show but little disposition to co-
here and run into "rouleaux," and lacked the distinctive
biconcave disk shape ; edges full and round (not ragged).
Urine passed in twenty-four hours, 1,660 cc, highly
albuminous; no casts revealed by microscope; skin
clammy, dirty mottled yellow. Temperature, A.M.,
97.6° ; P.M., 98° ; muscles sore ; slight oedema of hands
and ankles. Treatment : Sponging with tepid water, af-
terward briskly rubbed with 'flannels, and a little lin.
sapo. Small quantity of oatmeal (thoroughly boiled),
four ounces allowed in morning ; beef essence, Liebig's,
one drachm in hot water every foiir hours. Continue
scraped beef and onion ; no medication.
June 2 5 til. — Marked improvement ; mind more tran-
quil ; talks quietly without excitement ; slept two or
three hours naturally, awoke refreshed. Tongue begin-
ning to clean ; had a large dark semi-solid stool ; odor
offensive in the extreme, evidently but little biliary se-
cretion poured into alimentary canal Pulse, 65° ; sodeic
strength ; respiration, 14°, principally costal ; skin losing
clammy feel ; emanation still sour and offensive from it
Temperature, a.m., 98.2° ; p.m., 98'' ; muscles sore, ankles
puffed. Treatment : Shampooing muscles with dry
cloths ; no change in diet ; no medication.
June 26th. — Allowed to sit up in bed and read a little;
slept six hours soundly during the night ; mind tranquil ;
has a loss of memory of words ; tongue cleaning, still a
heavy coat at the back; bowels moved twice; stools
pitchy and offensive ; abdomen tympanitic, considerable
borborygmus ; pulse, 65 ; heart sounds stronger ; mur-
murs still pronounced ; urine passed in twenty-four hours,
1,800 cc ; specific gravity, ioi6; albumen not de-
creased ; no change in condition of skin. Temperature,
A.M., 98° ; P.M., 98.8°. Treatment: Sponging and fric-
tion. Same dietary with tr. ferri muriat., 5 cc L i. d.
September 6, 1884.]
THE MEDICAL RECORD.
255
June 27th. — Still extremely weak; voice stronger;
mind easier; amnesic aphasia marked; appetite still
morbid, always hungry ; considerable flatulency ; no
stool; aspect of skin somewhat improved in appear-
ance ; still dirty yellow (in spots). Temperature, a«m.,
98.4'* ; P.M., 98.8° ; pulse, 66 ; respiration, 14 ; urine albu-
minous (^tube), 1,950 cc in twenty-four hours ; specific
gravity, 1.018; muscles beginning to fill out; very soft.
Treatment : Dietary increased to eight ounces broiled
steak in morning ; continued ferri muriat.
June 28th. — Gaining strength ; dressed and sat up for
a couple of hours, then felt exhausted and returned to
bed; mind quite tranquil; slept well; appetite still mor-
bid; bowels moved; no change* in character of stool ;
liver still inactive. Pulse, 66 ; feirly good tone. Anaemic
murmur not so marked. Temperature, a.m., 98.2^ ;
P.M., 98°. Urine passed in twenty-four hours, 1,860 c.c;
specific gravity, i.oz8; albumen present. Treatment:
Takes food at five stated intervals : 6 a.m., oatmeal,
4 ounces, broiled steak, 8 ounces ; 10 a.m., Liebig's
beef essence, i drachm in teacup of warm water; 2 p.m.,
one soft-boiled egg with milk toast ; 6 p.m., raw minced
beef and onion ; 10 p.m., Liebig's essence of beef. Con-
tinue tr. ferri muriat., 6 cc, t. i. d.
June 29th. — Dressed and assisted to walk in ward-room
a few steps ; muscles soft ; very weak ; limbs filling out ;
body weight, 129^ pounds (gain of 9^ pounds for the
week). Pulse, 68. Urine, 1.650 c.c. in twenty-four hours ;
albumen less. Temperature, a.m. and p.m., normal.
Bowels moved naturally ; stool still pitchy and offensive.
Treatment : Continue the same.
June 30th. — Sleeps naturally and awakes refireshed;
allowed to read and talk ; walks around for an hour or
so with support; limbs filling out; feet oedematous
toward night. Appetite still morbid, unable to be satis-
fied with his allowance ; good movement of bowels ; al-
bumen disappearing ; heart sounds stronger. Tempera-
ture normaL Continue restricted diet and iron.
July ist. — Felt quite refreshed on awaking ; had slept
well during the night ; enjoyed morning meal, and ate
without asking for more. As the sun was shining brightly,
was assisted on deck and sat in the air (well bundled up)
for an hour. Had but little appetite for mid-day meal.
At 4 p.m. a small, dark, offensive stool) strained consider-
ably and was much exhausted afterward (nearly fainted) ;
administered spts. frumenti, | ss. in aqua. At 6 p.m. com-
plained of severe pains in abdominal muscles and over
the region of the liver (pains resembling hepatic colic) ;
considerable febrile disturbance. Pulse, 98. Temperature,
100. 2^ Administered quin. sulph., 3 cc, at 8 p.m.
July 2d. — Feels much prostrated and weak ; muscular
pains and soreness over abdomen and back. Complexion
sallow; appetite poor. Temperature, 8 a.m., 98.8^; 12
M., 99°; 4 p. M., 99.2°. Exhibited hydrarg. chlorid. nit,
3 c.c. at 8 A.M., repeated dose at 2 p. m. Bowels moved
three times, last evacuation watery. Felt weak, but free
of cramps ; headache disappeared. Light diet of oatmeal
and milk. Discontinued tr. ferri muriat.
July 3d. — Still weak ; muscular soreness over abdo-
men; no sharp pains; two loose evacuations from
bowels. Appetite returning. Pulse, 6S, Temperature
normal. Whiskey toddy, | ss. 1. 1 d.
July 4th. — Considerable improvement ; pains have dis-
appeared from muscles, tongue cleaner, complexion bet-
ter. Allowed to sit up to his meals. Urine much improved ;
albumen (^ tube) ; specific gravity 1.022. Resume tr.
ferri muriat, also vin. Portense, | j., t. i. d. before meals.
July 5th. — Gaining strength gradually ; muscles soft ;
knees weak; encouraged to take some exercise daily,
weather permitting, in the open air. Digestion good ; ap-
petite under better control; liver still torpid; regular
movement of bowels ; skin clearing, lost clamminess ;
sleeps well Continue same. From this time forth
gradual improvement. Blood again examined micro-
scopically shows marked diminution of white corpuscles.
On July 8th, no albumen found in urine. On July
1 2th, anaemic murmur very indistinct On July 17th ar-
rived at St Johns. Condition sufficiently improved to
warrant his going ashore for exercise ; muscles still weak
and sore ; filled out rapidly.
July 19th. — Had a slight attack of intestinal indigestion;
was living ashore at the consul's and committed an error
in diet ; suffered for two days.
July 25 th. — Allowed to eat three fiill meals daily, with
certain articles restricted ; encouraged to exercise in
open air. On the trip from St Johns to Portsmouth,
N. H. (July 26th to August xst), ran into damp, moist
weather ; felt much prostrated, and muscles ached. Given
quin. sulph., 18 c.c, every night during the run. On being
transferred at Portsmouth, his body weight was 169 pounds,
representing a gain of 49 pounds in six weeks— 9^ pounds
first weeky.15 pounds second week, 8 pounds third week,
7 pounds fourth week, 5^ pounds fifth week, 4 pounds
sixth week.
Remarks, — Vital depression, as exhibited by the tem-
perature, not marked ; digestion fairly good all the time ;
nervous system soon calmed. Microscopic examination
of blood disappointing ; exhibiting no unhealthy charac-
terjof red blood-globules. Albumen disappearing. Anae-
mic murmur disappearing, showing it to be simply due to
hydraemic condition of blood ; liver not secreting. Large
gain in weight, due to rapid assimilation of food, owing
to a great muscular waste. Large urinary excretion
(1,950 C.C. in one day), due doubtless to almost total in-
activity of sudorific glands.
TREATMENT OF CHOLERA IN INDIA.
By H. MARTYN SCUDDER, M.D.,
LATB MEDICAL MISftlONAKY OF THB AMSIUCAN AKCOT MISSION, INDIA,
CHICAGO, ILL.
For purposes of treatment I would divide the course of
this disease into the following stages : A period of pro-
dromes or prodromic stage ; a first stage, or state of
diarrhoea or chlorine ; a second stage, or stage of inva-
sion ; a third stage, or stage of collapse (algid stage) ; a
fourth stage, or stage of reaction. This last sta^e of re-
action may be succeeded by a typhoid condition, or
cholera typhoid stage, or else may pass directly into a
state of convalescence. In the prodromic stage, mani-
fested by lassitude, mental depression, chilliness, nausea,
and abdominal discomfort, give ten or fifteen drops of
spirits of camphor in dessert-spoonfuls of hot brandy
every hour or two, but be careful not to allow any con-
siderable quantity of stimulants to be taken. When
epidemic cholera is prevalent many are afifected by the
sjrmptoms just described. If the remedies I have indi-
cated are promptly taken, I feel confident many attacks
of cholera will be warded off. It is true that fear of-
ten produces these very symptoms, but the spirits of
camphor in spoonfuls of warm brandy tends to soothe
the fears and dissipate these symptoms, and yet does not
usually disorder the digestion.
As soon as diarrhoea begins, the administration of some
preparation of opium together with aromatics, camphor,
and a little chloroform, is urgently called for. Two parts
of " chlorodyne " to one of spirits of camphor is a very
good combination, thirty drops for a dose. To be re-
peated as required. Another very serviceable prescrip-
tion consists of equal parts of spirits of chloroform, spirits
of camphor, laudanum, aromatic tincture of rhubarb, and
tincture of ginger. Teaspoonful doses every hour or
two according to the urgency of the case until four or
five doses have been taken. In alternation with either
of the combinations, an aromatic sulphuric acid mixture
may be given to advantage. A popular formula is as
follows :
9. Acid, sulphuric, aromat.. . |j.
Tinct. opii deodorat 3 vj. vel f j.
M. Sig. — Twenty or thirty drops in water every
hour or two.
I think it important to administer these remedies
256
THE MEDICAL RECORD.
[September 6, 1884.
hot, unless they create nausea. The hot water, or mor-
phine combined with chloral, should be administered by
hypodermic injection, as the severity of the case may
demand. Either of the following formulas may be chosen
for exhibition every half hour or hour just after a spell
of vomiting :
Q. Chloroform.,
Tinct. capsici,
Tinct. cannab. ind aa VI xxx.
Acid, hydrocyanic, dil TTi xx.
Ether TT[ viij.
Spts. menthae pip TTi xv.
Syrup sassafras comp ad § j.
Sig. — A small teaspoonful every half hour or hour.
9. Spts. ammonia aromatic,
Spts. of chloroform fi& | j.
Tinct of capsicum,
Compound tinct. of cardamom,
Tinct. of ginger aa | ss.
M. Give in the same doses as the above.
A mixture of aromatic powder, gum arabic, and ace-
tate of lead may also be given alternately with either of
these, if desired. In any case a mustard plaster should
be applied over the stomach and abdomen, but not left
on too long ; and, if required, enemata of eight or ten
grains of acetate of lead may be given after each evacua^
tion. I think it is important to bear in mind that some
preparation of opium or morphine, or morphia combined
with chloral, is the chief remedy for cholera, and the
surest agent we can use to arrest the progress of the dis-
ease. When called, therefore, to a case abready in the
stage of invasion, I believe morphine, or morphine and
chloral, should be administered hypodermatically without
delay, in order to get these sovereign remedies into the
system as soon as possible ; for if we can arrest the dis-
ease before the patient beeomes collapsed, his chances
of recovery will be very greatly increased. Caution must
be exercised, however, when this form of treatment is
pursued, for narcotism is easily induced by repeated
hypodermic injections, whereas very large doses of opi-
ates can be given in this disease, by mouth and rectum,
with comparative impunity. The strength of the solu-
tion usually employed for injection is morphine, gr. iijss.
or gr. iv., with chloral hyd., 3 ijss. or 3 iij. to the ounce
of water. Inject twenty or thirty minims.
The hypodermic use of morphine and chloral is, of
course, contraindicated when the stage of collapse has
become well developed. During this stage it is most
essential that the patient should be kept perfectly quiet,
and in the horizontal position. No violent rubbing
should be allowed, but I have found it beneficial to
gently rub the limbs and extremities with hot oil. To
allay thirst let the patient suck ice frequently. Carbolic
acid water or simple acidulated effervescing drinks may
also be given by the tablespoonfuL It is unsafe to
allow the patient to drink any fluid whatsoever in large
quantities. In this stage, especially when the acts of
vomiting and purging have become less frequent and the
algid state well developed, very small quantities of stimu-
lants are useful, but they should be given with great
caution, lest vomiting should be provoked. Stimulating
enemata may also be given, but where the stomach is
intolerant it is often better to inject small quantities
hypodermatically. Experience teaches us, however, that
anything like the free use of stimulants in cholera is un-
called for and exceedingly harmful. I have sometimes
found small doses of both atropia and strychnia, adminis-
tered by hypodermic injection, apparently effectual in
brining about reaction. Amyl nitrite, by inhalation, may
be given, but it seems to exercise very little permanent
beneficial effect. Intravenous administration of milk
and salines may be resorted to, but the reaction thus
produced is not generally of a permanent character, so
that many of those who have given this method a fair
trial have abandoned it.
Of late years, in Southern India, careful experiments
have been carried out in reference to the value of im-
pregnating the atmosphere of the sick room with sul-
phurous acid, by the burning of sulphur. The result
has been that this procedure has been introduced as part
of the treatment of cholera. I have on several oc-
casions carefully tried this plan myself, by subjecting
the inmates of two different cholera sheds to exactly the
same conditions and treatment in every respect, with the
exception that in one the atmosphere of the shed was
kept impregnated with sulphurous acid, and in the other
no^, I have always found that the proportion of recov-
eries was considerably greater in the shed where sul-
phur was burned. I therefore now always proceed to
burn sulphur in the patient's room, as part of the treat-
ment of cholera, and consider it an important adjuvant
The atmosphere should not be so highly impregnated
as to cause the patient or attendants to cough violently.
Sulphurous acid thus applied is not only a useful
remedy, but it is also believed to decrease the liability
to the propagation of the disease, and to its contraction
by the attendant
During the stage of reaction, great care should be ex.
ercised. Vomiting often continues, and the nomial ab-
sorbing power of tibe stomach and intestines is but slowly
restored. Liquid noiirishment by the spoonful should
be most cautiously given; well salted broth and milk,
given as hot as possible, and not too frequently, are the
only forms of food admissible until the enfeebled stom-
ach shows signs of recovering its tone. Peptonized beef-
tea and milk are frequently well borne, if carefully pre-
pared (two or three tablespoonfuls) Each dose maybe
sweetened, if desired. The patient should be made to
lie down, kept perfectly quiet, covered with heated
blankets, and dry heat applied to the surface of the body,
especially to the extremities, by means of hot bottles,
heated flat-irons, etc. In India the administration of
calomel to any extent has lately been discouraged, one
or two small doses may be given if thought best, but not
more. As soon as frequent vomiting commences— or the
stage of invasion becomes established, the combinations
containing opium which have been mentioned, had better
be discontinued, and either of the following mixtures
given in teaspoonful doses at intervals, after a spell of
vomiting.
At the same time, also, morphine, so as not to nause-
ate the patient. If vomiting persists, the following emul-
sion may be given, if deemed best :
ft. Acid, carbolic gr. vij.
Bismuth, subnit 3 ij.
Mucil. acaciae.
Aqua menth. virid a* § j-
Sig. — ^A teaspoonful every hour or two.
But in this stage it is good treatment to let nature do
the work of restoration, and give as little medicine as
possible. We must have in mind, however, that the kid-
neys must be assisted to resume their functions, and for
this purpose mild diuretics, such as potass, nitras, should
be carefully administered. If fever supervenes, it is apt
to be of a typhoid character : a combination of iodine and
carbolic acid then exerts a beneficial effect. A popular
formula is as follows :
ft. Acid, carbolic gr. iijss.
Tinct iodi gtt. xv.
Aquas menth. pip f iv.
M. Sig. — A tablespoonful every two or three hours.
To relieve restlessness and insomnia, potass, bromid is '
often useful
If the attack of cholera is arrested before the patient ,
becomes collapsed, the state of convalescence will prob-
ably be of short duration, and the health soon be re- ;
stored. If, however, the patient is rescued after being .
in a profound state of collapse for a length of time, the
convalescence will generally be protracted.
September 6, 1884.]
THE MEDICAL RECORD.
257
LARGE DOSES OF POTASSIUM OR SODIUM
IODIDE IN SUDDEN DEAFNESS OF SUP-
POSED SYPHILITIC ORIGIN.'
By albert H. BUCK, M.D.,
NBW YORK.
The following very brief histories of cases are offered as
a contribution to the subject of the daily administration —
through a period of several days, or even weeks— of large
doses of potassium or sodium iodide for the relief of sud-
den or rapidly developed deafness due apparently to the
presence of syphilitic lesions in the labyrinth, or in some
part of the auditory nerve outside of this system of cav-
ities, or finally, in those parts of the tympanum which
constitute the movable barriers of separation between
this cavity and those of the labyrinth. I will add that I
have been careful not to introduce among these cases
any in which easil)r recognizable inflammatory lesions,
presumably of syphilitic nature, were observed in the
tjrmpanum, or any in which, from the past history, it
seemed probable that any such middle-ear lesions had
been present at the time when the deafness developed.
I have omitted such cases because nobody is disposed to
doubt the curability of even very marked deafness when
due to syphilitic lesions involving a large part of the
tympanic mucous membrane, and interfering with the
mechanism of the ossicles.' It would, tlierefore not be
Teiy profitable on the present occasion to report any such
cases; particularly as my chief object in making this
communication is to throw a little light, if I can, upon
the prognosis and treatment of what appears to be syphi-
litic disease of the labyrinth, and at the same time to
profit by the experience which other members of the So-
ciety may have had in the treatment of such cases, and
which this communication, I trust, will lead them to pub-
lish. On the other hand, I have not thought it necessary
to exclude one or two cases in which evidences of long-
standing chronic catarrhal inflammation of the tympanum
existed, but in which, at the time of my exammation of
the ear, no signs of congestion or swelHng could be dis-
covered. The profoundness of the de^ness and the
rapid manner in which it developed in these cases, are,
it seems to me, characteristics of syphilitic disease of the
auditory nerve rather than of catarrhal lesions in the
tympanum.
There is still another point to* which I must call atten-
tion. In the majority of the instances enumerated be-
low, the grounds for suspecting syphilis to be the cause of
the deafness seemed to be amply sufficient, but in a few
the evidence in favor of such a conjectural diagnosis was
certainly not strong. Indeed, in one case (Case IV.), there
TO no direct evidence that the patient had ever had this
disease. His remarkable tolerance of the iodide of po-
tassium (slowly increasing doses until finally 360 grains
were taken daily for a period of one week) and the general
resemblance of his attack to those of an acknowledged
syphilitic nature, are the only grounds on which I can
justify myself in placing this case in the same category
with the others.
The literature of this particular subject is scanty. The
attention of the profession was first called to it in 1877
by Dr. Roosa's report of a remarkable case in which,
from a condition of almost total deafness, the patient's
hearing within a few weeks was restored to nearly a nor-
fual condition.' A second, less striking instance, is re-
ported by Dr. Roosa on page 526 of the same work.
Beside these I can find only two other reports which
throw light upon the employment of large doses of po-
tassium iodide in the treatment of labyrinthine deafness,
presumably of syphilitic origin, viz., those of Dr. Samuel
Sexton* and Dr. David Webster.* In some of these
^ A paper read bdbre the American Otological Society, July 15, 1884.
' S«e the Pathology and Treatment of Venereal Diseases, by Freeman T.
and and Robert W.Taylor. Philadelphia: H.C.Lea. i«79.
' Roon : Diseases of the Ear, fourth edition, p. 538.
« American Journal of Otoloj^, toI. iL, p. 30X.
* Aichivcs 01 Otology, voL xii.
Bum-
cases, however, it is not perfectly clear that middle-ear
lesions may not have contributed materially to the deaf-
ness.
From the strict standpoint of scientific inquiry it may
be objected that no trustworthy deductions can be made
from these published cases, or from those which I am
about to report, with regard to the effects of the iodides
upon syphilitic labyrinthine lesions, inasmuch as in all
of them, with a single exception, mercury was adminis-
tered at the same time. The objection is certainly a
valid one; but, as an offset, I will say that, so far as
1 have any knowledge of the subject, no reports of suc-
cess in the treatment of this class of cases have ever
been published previousl}^ to 1877 (Dr. Roosa' s report),
that is, not until after the iodides had been administered
in much larger doses than it had previously been cus-
tomary to administer. From this circumstance, and
from analogous experiences ^on the part of others) in the
treatment of s^hilitic brain lesions, I think that we may
properly ascribe to the iodides whatever curative phe-
nomena have been observed in these few cases of sudden
deafness.
Case I. — Male ; thirty-eight years of age ; first seen
on October 25, 1880. He be^an to grow deaf about
one year previously. Convulsions occurred at the on-
set. He was put at this time under ordinary anti-syphi-
litic treatment. Despite this, however, the hearing stead-
ily and markedly diminished. Patient was very deaf at
time of examination, which revealed no lesions adequate
to explain the deafness. All that I know about the sub-
sequent history of the case is comprised in the following
extract from a letter written by the physician in attend-
ance, Dr. C. McBumey : " Not very long after you saw
the patient he developed mania, became very violent,
and gave an immense amount of trouble in every way.
This mania was doubtless dependent on some syphilitic
lesion, and under the very large doses of iodide (several
hundred grains daily) the mental disturbance disap-
peared. The deafness, however, was only slightly re-
Ueved."
Case II. — Male ; twenty-seven years of age ; patient
seen for the first time on November 12, 1881. He gave
a history of decided naso-pharyngeal catarrh and slowly
increasing deafness since the age of fifteen. Eight or
nine months ago syphilitic manifestations. Ten or
twelve weeks later the deafness, which up to that time
had not been very noticeable, became very marked, and
at the time of my first examination it was so decided that I
could make myself understood only by placing my lips
close to the patient's right ear and fairly shouting into it
what I had to say. In the left ear the deafness was ap-
parently absolute. In the right ear there were evidences
of a former, but now healed, otitis media purulenta (viz.,
a cicatricial reproduction of a part of the membrana
tympani) ; in the left ear the membrana tympani was
simply opaque in appearance and somewhat sunken.
There was decided naso-pharyngeal catarrh, with the
characteristic tone of voice. Eustachian tubes pervious
to air. Hearing not affected by inflations. It not be-
in^ clear to what extent the recent increase of deafness
might be due to the naso-pharyngeal catarrh, I directed
treatment toward the relief of this affection as well as
toward the constitutional syphilis. On the one hand, I
applied a solution of nitrate of silver (twenty grains to the
ounce) to the affected mucous membrane of the naso-
pharynx three times a week ; and for the anti-syphilitic
part of the treatment I recommended daily inunctions of
a five per cent, preparation of Squibb's oleate of mer-
cury, and the internal administration of the iodide of po-
tassium, three times daily, in increasing doses.
On December 8th the patient's gums began to be
noticeably affected, and the inunctions were accordingly
discontinued.
On December 17th he began to complain of great
lassitude. He was then taking daily only thirty grains of
the iodide of potassium and three grains of the sesqui-
258
THE MEDICAL RECORD.
[September 6, 1884,
carbonate of ammonia. As his face also wore a haggard
look, I advised him to stop all treatment for a few days.
On December 27th the iodide of potassium treatment
was resumed ; the sesquicarbonate of ammonia being
omitted from the mixture. Numerous small ulcers visible
on the gums.
December 30th. — Forty-five grains of the iodide of
potassium daily. The local applications to the vault of
the pharynx were discontinued about this time.
January 4, 1882. — Fifty-five grains daily. An eruption
of small pustules has broken out on his face and shoulders.
January loth. — Complains of a "cold in the head."
January 13th. — Sixty-five grains daily. I^e complains
of headache, a sensation of soreness in the back, sore
throat, a very free discharge from the nose, frequent
sneezing, and an occasional attack of coughing. A brief
suspension of the treatment advised.
January 14th. — ^Two decided chills with marked pros-
tration occurred during the night. This morning he looks
pale and haggard, and complains of a sense of discomfort
in the abdominal region. I prescribed a mixture of the
ammonio-citrate of iron and the compound tincture of
cinchona, each dose containing two grains of the former
and one drachm of the latter.
January 17th. — The iron and cinchona mixture soon
produced a decided ringing in his ears, and he discon-
tinued it. All the other unpleasant symptoms, however,
have disappeared, and he feels comparatively well again.
The hearing, too, of late, has noticeably improved. At
times he has been able to understand sentences spoken
in an ordinary tone of voice at a distance of four or five
feet from his right ear. The improvement, however, has
never lasted longer than a few hours, or at most a day,
at a time. To-day I am able, sitting directly in front of
him, at a distance of firom two to three feet, to make my-
self understood by simply raising m^ voice slightly. He
does not appear to read my lips ; m fact they are con-
cealed by my mustache.
January i8th. — At the suggestion of Dr. F. R. Sturgis,
of this ci^, who saw the case in consultation with me, I
prescribed a saturated solution of the iodide of potassium
(i minim, = about i grain). Of this solution the patient
was instructed to take fifteen minims three times a day,
after his meals, and afterward to increase the dose on the
alternate days by five minims. Thus, for example, it was
intended that he should take 45 minims a day on Janu-
ary 19th and 20th, 60 minims on the 21st and 2 2d, 75
minims on the 23d and 24th, and so on.
January 31st — He is now taking 120 minims daily
without any discomfort whatever. Appetite good. A few
insignificant pimples are still visible on his face. During
the coming week he is to discontinue the iodide of potas-
sium, and in its stead to take daily a drachm and a half
of the syrup of the iodide of iron.
February 6th, — Potassium iodide resumed : 120 minims
daily.
February i8th. — One hundred and ninety-five minims
daily. The papular eruption on the patient's face is now
quite noticeable. He is again to discontinue the remedy
for one week, and to take the iodide of iron instead.
A still further improvement has taken place in the hear-
ing. I can now converse with him at a distance of at
least four or five feet ; my pitch of voice being as nearly
as possible the same as when I tested the hearing on
January 17th.
February 24th. — One hundred and ninety-five minims
daily.
March 3d. — ^Two hundred and forty minims daily. No
discomfort whatever from the remedy. Hearing distance
has increased to seven feet. Iodide of iron substituted
for a few days.
March 8th. — Two hundred and forty minims.
March 12th. — ^Two hundred and seventy minims.
March 13th. — Patient is totally deaf this morning, the
result, apparently, of a cold which he contracted last
evening. Marked hoarseness. Right Fustachian tube ob-
structed, and right membrana tympani markedly sunken.
Inflations by Politzer's method and naso-pharyngeal treat-
ment to be resumed. The iodide of potassium to be dis-
continued.
March 20th. — ^The hearing is again as good as it was
on March 3d. Two hundred and seventy minims to be
taken to-day.
March 24th. — ^Three hundred minims.
April 28th. — Three hundred and fort}'-five minims.
May 15th. — ^Four hundred and eighty minims.
May 2 2d. — Five hundred and twenty-five minims.
May 24th. — General malaise. Hearing again quite
poor. Numerous small ulcers on gums, on inner surface
of lips, and on frenum of tongue. Nitrate of silver (solid)
applied to each. The iodide of potassium treatment to
be abandoned.
July 6th. — Patient writes from his home in the countrjr
that the ulcers have healed, and that his general health is
again perfectly good. His hearing, however, remains
poor.
The last report which I received was dated September
nth. The ulcers had reappeared on his gums and lips
toward the end of July, and he had suffered more or less
from " malaria " during this period of nine or ten weeks.
At one time the hearing had been even better than it
was in New York during the previous month of March.
It soon diminished again, however, and was, at the date
of his letter, about as bad as when I first saw him.
Case III. — Male; forty-five years of age ; February 24,
1882. Deafness began to develop four years previously,
and in about two years it had become so marked that it
was only with great difficulty that he could hear what was
said to him. During the past two years the hearing bad
remained unchanged. Syphilitic manifestations twenty-
five years previously. He had also, up to a compara-
tively recent date, used alcoholic stimulants to excess.
Recently he had had some difficulty with his eyesight,
and there had been some paresis of the muscles of the
lower extremities.
Treatment (by Dr. E. D. Hudson, Jr., of this city):
inunctions with a five per cent Squibb's oleate of mercury,
and increasing doses of the iodide of potassium ; begin-
ning with five minims of a saturated solution, to be taken
three times daily, and the dose to be increased by five
minims on alternate days.
On April 6th his gums began to be affected, and the
inunctions were discontinued. Two hundred and eighty-
five minims of the iodide of ix)tassium solution taken
daily. No eruption. No coryza. No discomfort of any
kind.
April 1 2th. — Three hundred and fifteen minims. No
improvement in the hearing.
April 20th. — Potassium iodide discontinued during the
past week, but now to be resumed.
May 4th. — He has taken 315 minims daily during the
past twa weeks, without any unpleasant effects, but also
without any appreciable improvement in the condition of
the hearing.
Treatment abandoned.
Case IV. — Male ; fifty-two years of age ; robust
health ; professional musician (wind instrument) ; No-
vember 2, 1883. Patient had been somewhat hard of
hearing since 1877. In the left ear the hearing power
had been almost, if not quite, destroyed, but witii the
right ear he had been able to hear fairly well — ^well
enough for all ordinary purposes of daily life. On Oc-
tober 27th he began to grow quite deaf in the right ear,
and in less than forty-eight hours he had entirely lost the
hearing in that ear. There was an entire absence of
anything like vertigo, but the tinnitus was very marked,
and extremely distressing. He spoke of it as a terrible
rushing sound in his ear. At the time when I saw him
(November 2d) I was obliged to communicate with him
in writing, as he was apparently perfectly deaf in both ^
ears. Both middle ears and external auditory canals
seemed to be essentially normal. No history of syphilis.
Sq)tember 6, 1884.]
THE MEDICAL RECORD.
259
At first I was disposed to look upon the deafness as due
to the rapture of a blood-vessel and the escape of blood
into the lab^nth. On this supposition I had three
leeches applied immediately to the region of the right
tragus, and advised the promotion of free after-bleeding.
A blister was also applied behind the ear, and four or
fife days later a second one was applied at the same
spot No beneficial effects following these measures, I
prescribed a satiurated solution of the iodide of sodium.
Of this he took at first 30 minims daily, and then
gradoaUy increased the dose, until, from December i8th
to December 24th, he took daily 360 minims. He ex-
perienced no unpleasant symptoms from the large doses
beyond a scanty eruption on his forehead, and some
general malaise toward the end of this period. The hear-
ing, however, was not restored in the slightest degree,
ai2 the tinnitus was not appreciably diminished. Treat-
ment then abandoned.
Case V. — ^Male ; forty years of age ; apparently in
robust health (patieht of Drs. George A. Peters and
Wm. A. Valentine); May 24, 1884. Two days pre-
viously he had experienced decided vertigo, nausea, and
double tinnitus. In a short time vomiting of mucus and
bile set in, and continued, at intervals, for several hours.
He then made the discovery that he had entirely lost the
healing power of both ears. Examination of the ears
revealed no lesions other than those of a chronic catarrhal
inflammation of both tympana. He declared that he
could hear the ticking of my watch in his right ear, but
he was not able to distinguish spoken words.
As the patient had been under my care ten years
previously for syphilitic sore throat with subacute otitis
media, I advised a trial of the mixed treatment described
above.
May 28th. — The vertigo has largely disappeared, and
patient says that he can understand whatPhis wife says to
him in a loud, shrill voice.
On July 7th I learned from Dr. Valentine that little or
no improvement had taken place in the hearing, that the
tinnitus was still marked, and that he could not as yet
walk steadily. Up to that time he had not been able to
take more than 90 grains of the iodide of potassium
daily. It was found Uiat he could take this more com-
fortably than he could the iodide of sodium, which
nauseated him.
July 14th. — Patient has been taking 180 grains daily,
but without any effect upon the hearing. On the nth
the treatment was suspended, as patient's stomach began
to rebel
Soon afterward the treatment was resumed, and before
^e end of the month the daily quantity of potassium
iodide taken by the patient had reached 270 grains. He
had taken this quantity daily for a period of one week,
when it was found necessary to stop the treatment alto-
gether, as his general condition showed that it was doing
him more harm than good It certainly produced little or
no effect upon the hearing power, as it was still found
necessary to communicate with him in writing.
It is not possible to draw any very satisfactory con-
clusion from such a small number of cases. For exam-
ple, the treatment failed to accomplish anything worthy
the name of improvement in all five instances, and yet,
as has been observed in the cases reported by Dr. Roosa,
3nd in those reported by Dr. Webster, essentially the
ame treatment may accomplish strikingly favorable re-
sults. I have compared these cases very carefully with
those reported above, in the hope that I might find out
certain distinguishing features which would enable us to
divide all such cases into two classes, viz., those which
ought be benefited by treatment, and those in which
treatment would almost certainly fail. I have not, how-
ever, been able to find any such distinguishing character-
istics. The only plausible explanation that I can jgive
of the infrequency of our successes is this : A syphiUtic
gonuna in the labyrinth, and especially in the cochlea,
will rarely &il to produce damage from which recovery
is scarcely possible. Treatment may lead to the ab-
sorption of the gumma, but it cannot readjust and render
fimctionally useful those delicate and carefully adjusted
organs which the tumor has disarranged, and perhaps
even destroyed. In the brain excellent compensatory
provision seems to have been made for the pressure
caused by a gumma or other morbid growth; in the
labyrinth, on the other hand, the rigidity of the sur-
rounding walls and the paucity as well as smallness of
the blo<K]-vessels, almost preclude the possibility of com-
pensation. On physiological grounds, therefore, I feel
confident that such 'cures as those reported by Dr. Roosa
and Dr. Webster will always be exceptional. In these
cases we may assume that the pressure had gone only so
far as to suspend for a time the vibratory power of the
cochlear structures, but had not destroyed or even seri-
ously disarranged them. It is also possible that the
gumma may occupy a position in the vicinity of the oval
window and foot-plate of the stirrup, or in that of the
secondary tympanic membrane. A lesion so situated
would be competent to annul the pow^r of hearing, but
it would not necessarily destroy it.
In the next place, it will be obsen/ed that in the fa-
vorable cases the improvement b^gan to show itself as
early as during the second or thiid week of the iodide of
potassium treatment. This would suggest the question
whether it is really necessary to push the doses to the
extreme limits recorded above (viz., 270 gr., 315 gr., 360
gr., 525 gr., and " several hundred grains " daily). This is
a question which cannot be satisfactorily answered until
we shall have accumulated a greater array of evidence.
I am disposed, however, to adopt for the present the
rule of not giving more than from one to two drachms
daily in those cases in which commencing improvement
is observed during the second or third week of treatment.
In conclusion, I will state that in the first years of
practice I must have registered some cases of S3rphilitic
disease of the labyrinth as instances of '' M^ni^re's dis-
ease," and I believe that this error — if error it be — has
probably been committed by other specialists.
HAY ASTHMA— CAN IT BE RELIEVED ? .
By WILUAM JUDKINS, M.D.,
LATB PKOPSSSOS OP PHYSIOLOGY, BTC., ONaNNATI COLLBOB OP BiKDICINK AND
SUXGBtY, aNCUniATI, O.
I FEEL that I should be sadly derelict of duty did I not
give to the profession, and through them to the laity, my
successful treatment of this obstinate and distressing
complaint Though only the record of one case, the
result is so gratifying to the patient, her family, and my-
self; that I feel justified in sending these few lines regard-
ing it, in hope of benefiting others.
Mrs. , aged twenty-eight, married, mother of two
children, the youngest four and a half months old. Has
been subject to an annual attack of ha^ fever for fourteen
years, and frequently with complications of a severe
character. Last year she suflfered an attack of bronchitis
during the latter part of the ^asthmatic stage, that
came near proving fatal. Convalescence slow. This
case first came under my charge in 1880. The attack
that year was aggravated in a measure by pre^ancy.
The only thing at that rime that gave any relief was
'* milk punch,*' in the proportion of whiskey, 2 oz.; milk,
8 oz. The relief obtained from this was only tenaporary,
when more would be administered ; but at no time was
intoxication produced, though the remedy was given for
several days in succession. In 1881 a reputed "hay-
fever resort "—Oakland, Md. — was tried for a part of the
season, but no benefit was derived, the attack being fully
as severe as at any previous time. 1882 and 1883 were
equally as bad, the complication of bronchitis spoken of
above coming on last year, which almost caused death.
This year prophylactic treatment was commenced, some
two weeks before her expected attack, of valerianate of
26o
THE MEDICAL RECORD.
[September 6, 1884.
zinc, gr. i., and pill assafoetida co., gr. ii., combined in cap-
sules, one A.M. and p.m., as recommended by Dr. Morell
Mackenzie, of London. It disagreed with her stomach,
and was discontinued for three days and then again taken
with no bad effect For five days after her usual time
for the appearance of the dreaded affection all was se-
rene. The night of the 20th inst. difficulty of breathing
to a limited extent set in. My attention had been called
to a case of bronchial asthma, who obtained relief from
the use of acid hydriodic, and I immediately ordered my
patient to commence its use early on the morning of the
next day, the 21st. The effect, in conjunction with coun-
ter-irritation in the shape of Rigollof s mustard leaves at
the wrist-joints, was simply magical^ breathing became
more and more easy as she continued the remedies. A
thunder-storm came up that night, twelve hours after
commencing the medicine, and for half an hour she was
somewhat '' stuffed up,'' as she expressed it, but had a
good night's rest. Ever since then she has been easy —
now a week — but is exercising all precautionary measures
against taking cold, for fear of a relapse.
I can truly say that about every remedy suggested and
recommended fi'om the time that Bostock first wrote on
the subject, in 18 19, had been tried, but nothing has
ever given the relief and sense of comfort that this did.
One word more and I am done : the form of administra-
tion was that of the syrup — a teaspoonful every hour or
two, until relief If necessary double the dose. The
syrup, as prepared by Mr. Gardner — Schieflfelin & Co.'s
chemist — was the special brand, though where that is not
accessible, I imagine the regular acid of the dispensatory
on a lump of sugar, gtt. 3 to 5, would be equally as effi-
cacious. The mustard leaves are applied as soon as the
first dose is given.
Since commencing the acid treatment, my brother. Eh*.
C. P. Judkins, has prescribed it in another case, that of
a married lady who suffered intensely with the asthmatic
spaptoms, with perfect relief, that so far has been con-
tmuous, and as in my own patient, bids fair to con-
tinue so.
The capsules were discontinued when commencing the
use of the acid.
ai6 ^cs Strbbt, August 38, X884.
THE DISCUSSION ON CHOLERA AND THE
COMMA-BACILLUS IN THE BERLIN CON-
FERENCE.
We gave last week an abstract of Dr. Koch's lecture
on cholera and the comma-bacillus, delivered at the Im-
perial Board of Health, in Berlin. After describing the
bacillus and its relation to cholera, he spoke of the con-
ditions under which it thrives in its home in India.
Southern Bengal is a flat country, elevated but little
above the level of the sea, and is almost completely
submerged during the rainy season. In order to escape
the flood, the inhabitants build their houses on artificial
elevations, made by piling up the earth taken from the
side of the foundation. It thus happens that beside
every house or group of houses there is a large hole filled
with water. These tanks, as they are called, are very
numerous, there being a thousand or more in the suburbs
of Calcutta alone. The huts of the natives have no
privies attached, and every kind of dirt is thown directly
on the ground, from whence it finds its way naturally,
into the neighboring tanks. A system of sewerage was
introduced m 1865, and at the same time measures were
taken to furnish the city with filtered water brought from
the river some miles above Calcutta. No improvement
in the health of the city was noticed during the first few
years that the canal system was being extended, but as
soon as the pure water supply was obtained, in 1870, the
cholera decreased, and the death-rate from this cause has
not since then surpassed, on an average, one-third of its
former figures. In the suburbs, between which and the
city there is a constant intercourse, but to which the
water supply has not been extended, the cholera is as
prevalent as before. Similar and even more striking
instances of the influence of the water supply were ftir-
nished by other cities and places in India These cases
were cited to show the value of pure water, but Dr. Koch
did not wish to be considered a partisan of an exclusive
drinking-water theory, for he thought that cholera might
be propagated in many different ways in any particular
locality, and further, that each locality had its own
peculiar conditions favorable to the spread of the dis-
ease.
In former times the cholera travelled along the cara-
van routes from India through Persia and £ence into
southern Europe, but now it takes the more speedy way
through the Red Sea and the Suez Canal. There is
little likelihood in these times of the disease coming over-
land, but the danger of its introduction by way of the
Red Sea is becommg greater every year. From Bombay,
which is seldom free firom cholera, to Egypt is a matter
of only eleven days, to Italy sixteen da3rs, and not more
than twenty days, at the most, to the South of France.
As regards the danger of the transportation of cholera in
ships, however, much depends upon the character of the
vessel. Epidemics occur only on those ships in which
large numbers of men are crowded together. In mer-
chant vessels and freighters, although there may be a few
cases of cholera during the first days of the voyage, the
disease never becomes epidemic nor continues for a
long time.
In concluding, the lecturer spoke briefly of the value
of the discovery of the cholera bacillus. In the first
place, it is of the greatest importance to be able to
diagnose correctly the first case of cholera occurring in a
country or in any locality. This, he believed, could now
be done with absolute certainty if the comma^bacillus
were found in the dejections. And fiirther, when the
cause of a disease and its properties are thoroughly un-
derstood, we are in condition to determine with accu-
racy its etiological relations, and also to institute a rational
and effectual mode of treatment. Not the least impor-
tant consideration is the hope, now offered, of discovering
a certain means of prophylaxis.
At the close of Dr. Koch's lecture, Professor Virchow
announced that a second conference would be held on
the evening of July 29th for the purpose of discussing
the various points suggested by the paper.
After the members had re-assembled. Professor Vir-
chow stated that in order to keep the discussion within
bounds, certain questions had been prepared, covering
all the points raised in the lecture, upon which those
present were requested to express their views. The
first question was :
IS CHOLERA CAUSED BY AX INFECTIOUS MATERIAL ORIGI-
NATING ONLY IN INDIA?
This was answered in the affirmative. Herr Hirsch
said that in the Sanitary Conference, held in Vienna in
1874, the members were unanimous in the opinion that
cholera occurs in Europe in consequuence only of the
introduction of the specific poison from India. This
unanimity was the more noteworthy as on other ques-
tions relating to cholera there were many conflicting
opinions expressed by the delegates.
The next question proposed for discussion was :
IS THE INFECTIOUS MATERLAL CONTAINED ONLY IN THE
DEJECTIONS, AND LATER ALSO IN THE VOMITED MAT-
TERS, OR IS IT FOUND ALSO IN THE BLOOD, URINE,
SWEAT, AND EXPIRED AIR ?
Dr. Koch stated that it was his firm conviction that
the cholera poison was present in the dejections only.
In exceptional cases it was found in the vomited mat-
ters, but only when these matters were of intestinal ori-
gin.
September 6, 1884.]
THE MEDICAL RECORD.
261
The two following points were considered together :
IS THE PRESENCE OF THE COMMA- BACILLUS OF DIAGNOSTIC
IMPORT ? AND, IS THE INFECTIOUS MATERIAL OF CHOL-
ERA IDENTICAL WITH THE COMMA-BACILLUS ?
Professor Virchow said that, in regard to the second
point, some elements of absolute certainty were wanting.
On the one hand, no one had as yet succeeded in pro-
ducing cholera in the lower animals by inoculation with
the comma*bacilfais. Dr. Richards had indeed fed hogs
apon intestinal matters taken from cholera patients, and
the animals had sickened and died, but Dr. Koch main-
tained that death in these cases was caused by poisoning
and that the disease produced was not cholera. He
thonght it very desirable that comparative experiments
sboold be made with pure cultures of the conuna-bacillus
and with the cholera dejections, for at present it seemed
possible that there might be some other infectious mate-
rial in addition to the bacillus. On the other hand, the
whole history of cholera, its mode of origin and spread,
seemed inexplicable, except upon the theory of a living
contagium. And among all the micro-organisms found
in Ae cholera stools the comma-bacillus alone could with
any degree of probabiHty be accused of causing the dis-
ease. The question whether there was any other disease
in which tlm particular micro-organism was present
coold not yet be answered with certainty, and indeed, it
might be many years before it could be affirmed or de-
ni^ with strictly scientific accuracy. But for the present
the speaker thought that it was incumbent upon the sani-
tary authorities to act as though the comma-bacillus was
the actual and certain cause d[ cholera.
Dr. Koch remarked that his reason for believing that
the hogs in Dr. Richards^ experiment were poisoned,
was that they died so speedily, within two and a half
hoars. And then every attempt at a reproduction of the
infectious material in these cases failed. He thought,
however, that the experiments told in no way against the
badllns theory; on the contrary, they showed that a
poisonous substance was formed in the intestinal canal
under the influence of the conuna-bacillus. In regard to
a point suggested by Dr. Hirsch, the speaker said that he
had examined sections of the intestinal mucous membrane
taken fiom a man dead of cholera morbus, but had found
no comma-bacilli, although there were swarms of other
miao-organisms present. In answer to a question asked
by Professor Virchow, whether in a doubtiful case, pre-
senting the symptoms of either cholera morbus or Asiatic
dK>lera, but in which simple microscopic examination of
the stools had revealed the presence of countless comma-
hacilli, he would hesitate to make a diagnosis. Dr.
Kodi asserted emphatically that he would not. He said,
however, that it was seldom possible to find the micro-
oiganisms in great numbers in a microscopical examina*
tion of the dejections. In most cases the culture method
is necessary, and this never (ails. This question of an
eariy diagnosis of cholera, he continued, is a very impor-
tant one indeed, for if the first case in any locality be
recognized inunediately, it can be isolated, and thus the
ipiead of the disease be prevented But if the diagnosis
he delayed aniil half a dozen or more cases have occurred,
then all control over the outbreak is lost. Regarding the
difficulties of a general use of this method, he had onl^
tD say that the process of staining the tubercle bacilli,
vioch was now very generally understood, was far more
difficult than was that of cultivating the commarbacillus. In
answer to an inquiry of Dr. Schubert, he said that he had
foood the bacilli present very early in the disease, within
t few hours, and he could state positively that die first
colorless watery stools contained them in great numbere.
Another hypothetical question was proposed, whether in
^ case of a person coming from a cholera district and
presenting symptoms of cholera, but in whose stools no
oomnui-bacilli could be detected, the patient should be
iDowed to go where he would or should be kept under
observation ? To this the speaker replied that the case
ought certainly to be regarded as a very suspicious one.
But this was not exactly a case in point A person,
known to have come directly from a cholera infested
region, who shall be taken ill with symptoms of cholera,
ought to be isolated at once, there would be no necessity
of searching for the comma-bacillus. But to suppose a
case. Cholera is now ravaging the south of France. A
case with S3rmptoms resembling those of cholera occurs
suddenly in a German city, and comma>bacilli are found
in the dejections. Now, die cholera poison is already in
the city, and much more active measures must be taken
than simply to bury the corpse and disinfect the sur-
roundings.
It having been objected that the culture of the comma-
bacillus required a well-appointed laboratory, and the
possession of considerable skill and experience on the
part of the physician, Dr. Koch explained the method
employed by him. The gelatine used could now be
bought in the shops. All that was necessary was to warm
the gelatine, mix it with a flocculus of mucus from the
stools, and then pour it out on a piece of glass. This is
then placed under a glass bell, or, if the latter cannot
be had, between two plates, as was done in the experi-
ments made in Calcutta. It is easy enou^ to obtain
material for examination, for any of the dothes soiled
with the passages will furnish enough mucous flocculi for
the purpose. A special warming apparatus is not neces-
sary, for the ordinary summer temperature was over 1 7^
C. (62.6° F.), which was sufficient for the development
of the badllL
The next two questions proposed were :
DOSS THE INFECnOUS MATERIilL POSSESS A GREAT
POWER OF RESISTANCE, HAS n A STAGS OF PERMA-
NENCE ? AND, IS IT DESTROYED IN A SHORT TIME BY
DRYING ?
Dr. Koch said that his opinion on this point was
based not only upon his experiments with the comma-
bacillus, but also upon the universal experience with
cholera. There was no case known with certainty in
which the poison of cholera had remained latent for a
great length of time, and had then renewed its activity.
Dr. Hirsch related his experience in the cholera epi-
demic which had visited Posen and West Prussia in 1873.
He had seen many cases in which the first persons at-
tacked in a village were women who had washed soiled
clothing brought from infected districts. In several
of these cases the clothes were allowed to remain
some time untouched, before being unpacked and
cleaned.
In reply to a question of Dr. Koch he said that the
clothes in some cases were left for five or six dajrs, long
enough for them to become thoroughly dry. It had been
admitted by the lecturer, he continued, that under con-
ditions of moisture the commarbacillus might remain
latent for an almost unlimited period. Why, &en, was it
not possible, in a place where cholera had been epidemic,
for the bacUlus to romain alive in moist earth or other
damp places during such time as the other conditions
were not favorable to its developn>ent, and then to be-
come active and give occasion to a new epidemic as soon
as a favorable conjunction of circumstances should
arise?
Dr. Koch said that he had admitted the possibility of
such an occurrence, after having found that the comma-
bacillus could endure a very low temperature and could
exist outside of the human body, in potato, gelatine, and
damp clothing, for example, for an indefinite time. He
thought the question a very important one but which the
future only could solve. The ground, the water, and
everything that could offer an asylum to the bacillus
ought to be examined for a long time after the disappear-
ance of cholera firom a place. Such investigations could
not be made in India, because the cholera was always
there, but could be undertaken upon the subsidence of
an epidemic in Europe.
262
THE5 MEDICAL RECORD.
[September 6, 1884.
The next question proposed for discussion was :
CAN THE INFECTIOUS MATERIAL ENTER THE BODY BY
OTHER CHANNELS THAN THE DIOESTIVC TRACT?
The discussion was not confined strictly to this point,
but turned rather upon the question whether the infec-
tious material could be. transported through the air.
Several of those present thought that it might be so
carried, at least for short distances, and instanced the
frequency with which those who handled the bodies of
persons dead of cholera were themselves attacked with
the disease. Dr. Leyden thought it very possible for the
germs to be carried up into the air with fine particles of
moisture during the rapid evaporation of contaminated
fluid.
These views were very strongly opposed by Dr. Koch.
He thought it much more probable that the disease oc-
curring in those who handled the corpses of cholera
patients was due to a want of cleanliness on the part of
those individuals. Their hands became soiled and then
they took food without washing. The physicians and
nurses in hospitals who were careful in washing them-
selves were no more liable to cholera than other people,
uid yet, if the poison were carried through the air, they
ought to be among the principal sufferers. The cholera
bacillus was killed by drying, and it could be carried
through the air only in watery spray or in bubbles; in dust
it could not live. In regard to cases in which the disease
was alleged to have been carried by healthy individuals,
the explanation would probably be simplified were all
the circumstances known. Very possibly food or other
articles were carried firom the house of the cholera
patient, or the apparently healthy individual might have
had a very mild attack of cholera which passed un-
noticed.
IS THE INFECTIOUS MATERIAL REPRODUCED IN THE
HUMAN SUBJECT, OR DOES THIS TAKE PLACE IN THE
GROUND, SO THAT MEN ACT ONLY AS CARRIERS OF FT ?
Professor Virchow asked whether, since the comma-
bacillus was an air-breathing organism, the intestinal
canal could be regarded as a £a.vorable location for its
development
Dr. Koch said that either free oxygen must be pres-
ent in the intestine, or at least such combinations must
be there as would give off oxygen. For we see the
bacilli living in great numbers in the intestine, and yet
they cease to grow outside of the body when deprived of
air. Consequently they must in some way obtain oxygen
in the intestine. Other organisms which require oxygen
for their exsistence, as the oidium laciis for example, are
•often found in quantities in the intestinal canaL
Professor Virchow thought it probable that the bacil-
lus was reproduced both outside and inside the human
organism. At least it was shown that the reproduction
in the ground was possible, but further than that we could
not yet go.
The next question proposed was S
IS A DIRECT TRANSPLANTATION POSSIBLE, OR MUST THE
INFECTIOUS MATERIAL UNDERGO A SORT OF RIPENING
OR GROWTH IN THE GROUND OR ELSEWHERE ?
It was supposed, Dr. Koch said, that a sort of ripen-
ing of the cholera germ was necessary, because the de-
jections were not infectious when first passed. This
latter assertion was based upon an experiment of Thiersch,
but his own opinion was that the clothes were capable
of transmitting the disease at the very instant that they
became soiled.
Three questions were then presented, embracing the
subject of the trasmission of cholera by clothing, rags,
merchandise, food, etc. Dr. Skrzeczka thought it very
reasonable to suppose that the disease-germs could be
carried in rags, for these were packed in large bales, and
if the rags were not thoroughly dried, those in the cen-
tre of the bale might remain moist for an^indefinite
period.
Dr. Koch answered that this question of the possibility
of infection through rags was discussed in the cholera
congresses of Vienna and Constantinople, and nobody
was able to furnish an instance of the spread of the dis-
ease by this means. The rags should, he thought, be
thoroughly dried before being packed. But it seemed to
be of little use to prevent the importation of rags, if
human intercourse was to be allowed The danger of
the introduction of cholera through apparently healthy
individuals, a danger which cannot be guarded against, is
far greater than that of transmitting the disease by rags.
As regards water he said that, as far as his experience
went, the comma-bacilli die in clean water, not imme-
diately, but within a few days.
The remaining questions were :
IS A SPECIAL INDIVIDUAL PREDISPOSmON NECESSARY FOR
THE ACTION OF THE INFECTIOUS MATERIAL ? WHAT IS
THE PERIOD OF INCUBATION ? DOES ONE ATTACK COK-
FBR IMMUNITY FOR A CERTAIN LENGTH OF TIME ? AND,
CAN THE MODE OF ACTION OF THE BACILLI BE RE-
GARDED AS A POISONING ?
Dr. Leyden thought that one attack did confer a de-
ipree of inmiunity against subsequent attacks, yet this
immunity was not absolute, for cases had been reported
in which an individual had suffered from cholera several
rimes during the same epidemic.
Dr. Hirsch stated that in the epidemic studied by
him, in 1873, ^^ period of incubation seemed to vary be-
tween two and four days.
Professor Virchow then closed the diiscussion by
tendering his thanks to Dr. Koch for the lucid report
which he had given of his studies of the comma-badlliis,
and he said that the members would probably be called
together again to discuss these questions, and to impart
any new experiences which they might have gained in re-
gard to the prevention or cure of cholera.
Pernicious Malarial Attacks of Unusual Type.—
The following are the conclusions of a paper read by Dr.
Besnier at a recent meeting of the Soci6t6 de M ^dedne de
VBns {r Union Afidicale, July 26, 1884): i. Certain
chronic diseases or morbid conditions, existing prior to
the malarial attack^ and giving rise in their course to
more or less grave secondary s^ptoms, or manifesting
themselves by repeated functional disturbances, may
sometimes so influence an intermittent fever as to render
it abnormal or pernicious. 2. In such cases the form of
the pernicious attack is in direct relation with the antece-
dent disease. It resembles in its prominent symptoms
one or other of the secondary accidents or the functional
troubles of this disease, but in an aggravated degree, j
The attack b thus more or less masked by the antec^ent
malady and may readily escape recognition. 3. The
morbid states which precede the fever and which impress
upon it their form, may be very slight and compatible
with aU the exigencies of ordinary life. The malaria, on
the other hand, may have been contracted in an infectedre-
gion and may reveal itself for the first time long after the
patient has left that country. The pernicious attack may
thus be more insidious and more sudden in its onset
than are malarial fevers ordinarily. 4. These pernicious
paroxysms owe their gravi^ apparentiy less to the malaria
than to the antecedent disease upon which the malaria
has engrafted itself. They occur with perhaps greater
frequency in non-malarious regions. They yield, as a
rule, readily to quinine, even in moderate doses. The
antecedent affections in the cases studied by Dr. Besnier,
and upon which he based his conclusions, were : arterial
atheroma with encephalic troubles, diabetes accompanied
with albuminuria, and angina pectoris. The pernicious
paroxysms assumed three very distinct types : a delirious,
a comatose, and a cardialgic form.
Septembef 6, 1884.]
THE MEDICAL RECORD.
263
^epfOKts at ^00|yitalB*
ROOSEVELT HOSPITAL, NEW YORK.
Rbportbd by J. K NEWCOMB, M.D.,
HOUSB PHYSiaAN, K008BVSLT HOSMTAL.
The following notes, taken from the hospital records,
narrate the history of
^ CASB IN WHICH ALL THE SIGNS AND SYMPTOMS OF
AORTIC ANEURISM WERE SIMULATED BY AN ENOR-
MOUSLY DILATED HEART
with double aortic valvular lesion.
Thomas K , New York, single, laborer, aged sixteen,
was admitted on August 3, 1881. Father died six years
before of haemoptysis, and mother one year before of
uterine cancer. Patient was temperate, denied syphilis,
admitted occasional masturbation and sexual intercourse.
Had rheumatism three years ago ; developed therewith
pain in epigastric and praecordud regions, and has been
subject to it ever since. For last year has noticed in-
creasing cardiac palpitation and dyspnoea. No oedema ;
vision at times dimmed ; cou^h for past three months
▼ery severe, of late worse mornings and evenings ; muco-
purulent sputa; quite regular night-sweats for past
month; no haemoptysis; occasional vomiting after
meals; some emaciation; bowels usually regular; no
urinary changes noted.
On admission rather poorly nourished, weak and trem-
ulous ; countenance downcast ; face sunburnt, but cya^
nosed; marked dyspnoea, least troublesome in sitting
position ; loose cough, with copious muco-purulent expec-
toration. Cannot sleep on left side ; good appetite ; some
constipation. Urine 1.026 ; acid ; no albumen ; micros-
copic examination negative.
Physical examination, — Heart-«pex, sixth space, one
inch outside nipple line ; impulse strong, heaving, and
raising considerable area of chest- wall. Dulness on level
of third rib from right border of sternum to half an inch
mside left nipple line. Over first and second right inter-
spaces, close to sternum, is an area of dulness ; over it is
felt a systolic thrill and heard a loud, rasping, systolic
muimur, with soft diastolic murmur of lower pitch. A
systolic murmur is heard in carotids and subclavians,
about equally clearly on both sides ; is heard over ster-
num down to level of third right costo-sternal articulation,
where it suddenly becomes softer in character, while at
the same time the diastolic murmur heard in its upper
interspace becomes much louder and sharper ; latter
transmitted down to xiphoid cartilage. At apex is heard
a short, blowing systolic murmur transmitted to left, heard
behind in both vertebral grooves, louder in left, and as
low down as the last dorsal vertebra, A very distinct
doable murmur is heard in the right supra-spinous fossa.
The radial pulse has a rapid rise and fall, with a peculiar
"shot 'Mike effect when hand is elevated above head.
Visible pulsation in all superficial arteries of any size.
Lungs at right apex, markedly exaggerated voice and
breathing, otherwise breathing is feeble everywhere ; sub-
crepitant riles all over chest. A diagnosis was made of
aneurism of ascending arch of aorta with aortic insufficiency.
The patient remained in the hospital for about
eight months. The details of treatment need not be
^one into. Reliance was chiefly placed on digitalis and
iodide of potash, the dosage being varied from time to
time to suit the requirements of the case. A fortnight
after admission he began to have bloody sputa, which con-
tinued for some rime ; later, attacks of spasmodic dysp-
noea came on, which were promptly relieved by small
hypodermics of Magendie's solution. Ten weeks after
admission he began to have nocturnal dyspnoea, with angi-
noid paun in praecordium and left shoulder, running down
arm to elbow. These attacks were sometimes cut short
bf inhalations of amyl nitrite, and later by internal exhi-
bition of one drop of a one per cent, solution of nitro-
glycerine. At other times these remedies seemed to have
no effect whatever. A month later the arm pain was ac-
companied by temporary paralysis of entire extremity.
Four months after admission a marked thrill and visible
pulsation were noted in carotids and over sternum.
The patient was discharged, improved, on April 6,
1882. During preceding two months had had only two
dyspnoeal atUcks. The severity of all the symptoms was
greatly abated, though the physical signs remained prac-
tically the same. After leaving the hospital he resumed
work as an iceman and passed out from under observa-
tion. On June 21, 1884, he again presented himself-
having enjoyed fair health in the interim, excepting
that the cough had steadily persisted. Two weeks be-
fore, he caught cold, increasing the cough, and causing
orthopnoea, with occasional vomiting after couching
severely. He had scanty muco-purulent sputa, pain in
right chest, anorexia, with cramps in belly and calves of
legs. Cardiac action was hurried, averaging 120 per
minute. Respiration 40 and very labored ; evening tem-
perature (mouth), 102.8° ; morning, 99.8° ; urine, 1.030,
no albumen, but hyaline and epithelial casts. Contrast-
ing his present physical condition with that twenty-two
months ago, the following points of difference were
noted : The heart-apex was in sixth space, three inches
below the nipple and five in left of mid-sternal line. On
level of the third rib dulness extended from half an
inch to the right of sternum to one inch outside left
nipple. The area of dulness in the right upper inter-
spaces had extended to third space, and over it was a
visible pulsation with marked purring systolic thrill and
rasping bruit; the finger placed in supra-sternal notch
received a distinct lift at each cardiac pulsation ; there
was a general bulging forward of the entire chest . The
appearance of a localized pulsation over the area of dul-
ness in the right spaces was considered as verification of
the previous diagnosis. He was ordered milk diet with
ten grains of iodide of potash ti.d. His dyspnoea con-
tinued, but was quite well controlled by small doses of
opium. On June 24th had profuse sweating with some
dysuria. Next day anginoid pain in abdomen returned, but
was quieted by six minims of Magendie hypodermically.
Early on the morning of the 27th, while sitting on the
side of the bed in the act of voiding urine, suddenly
he slid down to the floor, grew cyanotic, radial pulse
ceased, respiration became shallow, and ten minutes
later he quietly died.
The autopsy was held eight hours after death, by Dr.
J. West Roosevelt, curator to the hospital No aneurism
was found, though there was general vascular dilatation
in the neighborhood of the heart ; the latter organ weighed,
free of dots, thirty4wo ounces ; there was general di-
latation, the walls being of about normal thickness.
The aortic valve was stenosed, thickened, and insufficient,
one cusp being entirely gone. The right auricle lay
against the chest-wall to the right of the sternum, behind
the first, second, and third ribs. The mitral valve was
thickened, but seemed sufficient, as did also the valves of
the right heart The liver was hard, firm, and con-
gested, the upper part of the right lobe showing a distinct
depression where the heart had rested. The kidneys
were firm, of normal size ; cortex somewhat thinned ;
markings distinct; capsule not adherent; chronic con^
gestion. Both lungs were in a state of pigment indura-
tion. The other points of the autopsy call for no special
remark.
A consideration of the physical condition and situation
of the heart at once accounts for the mistake in diagnosis.
The enormously dilated right auricle, lying just behind
the ribs, gave the percussion dulness, and through its
contents received the direct transmission of the general
impulse occasioned by every systole of this veritable " cor
bovinum." To the eye, ear, and finger the sensations
were those of a true aneurismal sac. Cases of this nature
are unusual, at least to such a degree as was manifested
here. The weight of the heart is by far the largest which
the pathological records of this hospital show.
264
THE MEDICAL RECORD.
[September 6, 1884-
NEW YORK HOSPITAL.
Report of the Case of Yellow Fever in New York.
By FRANCIS M. D WIGHT, M.D.,
MOUSB rHYSiaAH.
No history of the case was obtainable previous to ad-
mission at 10.30 P.M., August 29thy when temperature
was 100.2° ; respiration, 30 ; pulse, 100, weak and irreg-
ular. The patient was well nourished, and there was no
oedema. The skin was intensely jaundiced. The con-
junctivae were injected. The pupils were slightly con-
tracted There was marked nystagmus, general cu-
taneous hypersesthesia, and exaggerated reflexes.
Physictd examination showed slight dulness over both
chests posteriorlv. Respiration in places was tubular
and accompaniea with fine moist r&les. Voice could not
be obtained. Cardiac sounds were inaudible. Palpa-
tion over the abdomen irritated the patient very much,
and apparently caused pain. Examination of the urine
showed its specific gravity to be 1,018, acid in reaction,
dark yellow in color, with about ten per cent by volume
of albumen.
^ Digitalus was administered hypodermically. Shortly
after admission the patient had projectile vomiting. The
vomited matter was very abundant ; was entirely fluid,
and of the color of claret. Microscopic examination
showed it to contain immense numbers of partly decom-
posed blood-cells, free nuclei, and epithelial detritus.
The patient did not respond at all to stimulation. Dur-
ing the night he was restless and irritable, vomiting at
intervals of two or three hours. At 3 A.M., temperature
was 101.6° F. ; respiration, 24; pulse, 100. Two hours
later the patient died. The temperature taken imme-
diately after death was 105°.
The autopsy was conducted by Dr. George L. Pea-
body, and gave the following results : Body was well
nourished, deeply jaundiced, and rigor mortis was well
marked. There was no oedema. The brain and mem-
branes were normal. The peritoneal cavity contained no
fluid; there was no peritonitis. The diaphragm was
normal There were no pleural adhesions. The heart was
normal in size, and bright yellow in color. The endo-
cardium and aorta were deeply jaundiced. The valves
were competent The muscular tissue was pale, yellow,
soft, friable, and contained an abundance of fat The
lungs contained countless hemorrhages, varying in size
from that of a small pea to a small diestnut^ and occur-
ring all through the parenchyma. The lungs elsewhere
were intensely congested and oedematous. The spleen
was about three or four times the size of a normal spleen,
was dark in color and somewhat soft. The kidneys
were normal in size and very yellow. The capsules were
not adherent, the surface was smooth, and the markings
distinct The cortex was somewhat swollen.
The stomach contained nearly a pint of fluid, which
was largely composed of dark-colored blood. The mu-
cous membrane was congested and covered with mucus.
Near the pylorus there was some thickening of the
mucous membrane. There was no ulceration. The
duodenum and upper part of the jejunum were con-
gested and the mucous membrane somewhat swollen.
The common bile-duct was pervious. The intestines
throughout contained a large amount of blood, some of
which was fluid and some &ck, dark, and tarry in color
and consistence. No ulcers were found. The liver was
normal in size. The cut surface was mottled and pre-
sented areas, apparently peripheral, of brilliant red color
with pale yellowish centres of acini which were deeply
jaundiced and contained fat The galUbladder contained
a small amount of dark thick bile.
Microscopic Examination. — Heart : Abundance of fat
was found, both in the form of granules and of small
drops, and to such an extent in many places as to ob-
scure the transverse striae. Kidneys: There was an
abundance of granular fat and drops of fat in the epithe-
lium of the straight and convoluted tubes. Elsewhere
the epithelium appeared swollen and clouded. Liver :
There was much extravasated blood and imbibition of
blood coloring matter in the peripheries of the acini ; at
the centres the cells contained an abundance of fat
"^a^^z&i^ 0t ptiedical jlctence.
Cachectic Purpura. — According to the opinion of
Dr. A. Mathieu, purpura hemorrhagica is not a disease
sui generis, but is merely a symptom of some other mor-
bid condition. He proposes, therefore, to group together
all the various fonns of the afiection under the general
name oi purpura cacheciica^ of which he recognizes three
groups. The first comprises the various forms of hem-
orrhage occurring in pernicious anaemia. In the second
group the purpura appears in the subjects of tuberculosis.
The nervous system plays here an important rdle, so that
the afiection has been called by some purpura ncuro-
pathica or myelopathica. The hemorrhages occurring in
the third division are occasioned by the cachexia of
Bright* s disease. They are a symptom as frequently met
with as oedema. A special form of cachectic purpura,
and one which is closely allied to that of Bri^ht's disease,
is senile purpura. Atheroma of the arteries is a very im-
portant factor in the etiology of this variety. This form
of purpura is characterized by its long duration, its pecu-
liar seat, occurring as it does often on the dorsal surfaces
of the hands and feet, and on the ulnar side of the fore-
arm, and by the shape of the petechiae which are small,
lenticular, and without any areola. It is also worthy df
note that the red globules in this form of purpura, as was
demonstrated by Hayem, are normal in function and pos-
sess the proper amount of haemoglobin. The author
sums up the results of his investigations as follows : l
Cachectic purpura appears in the form of petechiae and
of ecchymoses ; the first are either pilo - sebaceous or
cutaneous, the latter may be very extensive in area. The
papular and erythematous forms are never seen in this
variety of purpura. 2. The first group, that of excessive
anaemia, is characterized by the firequency of oedema
and hemorrhage. In this group may be included pur-
pura of the cancerous cachexia and of the anaemia of
miners. 3. In tuberculosis the purpuric eruption is caused
by the secondary afiections, such as menin^tis, albumi-
nuria, diseases of the liver, etc 4. Purpura is a very fre-
quent phenomenon in Bright's disease, and is to be re-
garded as of evil prognostic import, as it is generally the
forerunner of uraemia and death. 5. In the cachexia of
heart disease purpura may be induced by a variety of
causes, such as albuminuria, pernicious jaundice, arterial
sclerosis, oedema, and embolism. — Schmidt s JahrhiUhcr^
May 20, 1884.
The Value as a Symptom of the Swashing Sound
IN THE Stomach. — Chomel regarded this sound as a
characteristic sign of a morbid condition which he called
indigestion of fluids. He believed that the stomach was in-
capable of absorbing or of passing into the duodenum the
ingested liquids or those secreted within the organ itselil
These liquids accordingly accumulated within the stom-
ach, and their presence was manifested by a succussion
sound on shaking the patient He considered this sound
to be always a pathological phenomenon.' These views
were controverted by M. Andhoui in a note presented to
the Paris Academy of Science (Z' Union MidicaU^ July
12, 1884). He had made a number of experiments upon
dyspeptic and healthy individuals, and had found the
succussion sound always present immediately after the
ingestion of a quantity of fluid. He concluded, there-
fore, that Chomel was wron^ in believing it to be a path-
ognomonic sign of indigestion of fluids, or of any other
gastric disorder.
September 6, 1884.]
THE MEDICAL RECORD.
265
Polyuria in Convalescence from Typhoid Fever.
^The attention of Dr. Spitz having been attracted by
the case of a convalescent from typhoid fever, who
^passed from three to four quarts of urine a day, he was led
to study the subject more closely. He found, to his great
astonishment, that polyuria, sometimes to a remarkable
degree, was present in about half the cases of convales-
cence from tjTphoid. The amount of urine excreted was
usually greater as the fever itself had been more severe.
The urine is of a light yellow color, transparent, without
sugar or albumen, and forming no special deposit. Its
q)ecific gravity varies inversely to the total amount ex-
creted during the twenty-four hours. The polyuria be-
gins at the period of greatest oscillations of temperature
and persists up to the fifth or sixth week of convales-
cence. It would seem to be of favorable prognostic in»-
port — L Union M^dicaic, July 6, 1884.
Hypodermic Injections of Quinine in the Dif-
ferentiation OF Malarlal from Typhoid Fever. — Dr.
Aimibale ArzeU employs quinine subcutaneously in doses
of fifteen grains and more, according to the age and con-
stitution of the patient, as a means of diagnosis between
remittent and typhoid fever. If the disease be malarial
in origin, soon after the injection a noticeable depression
occurs in the temperature curve, which eventuates the
next day, perhaps after another dose of quinine, in com-
plete apyrexia. If the affection be typhoid fever the fall
in temperature is merely temporary. It is necessary to
give the quinine subcutaneously, as the intestinal mucous
membrane is in such a condition that absorption of
remedies administered per orem may not occur. — Deutsche
Medicinal-Zeitungy vol v.. No. 50, 1884.
Treatment of Fractured Patella. — Dr. Van der
Meulen notes that in the space between the two frag-
ments of a broken patella, a clot of blood is formed.
This clot is not organized at once in its entirety, but the
anterior and posterior surfaces are first organized, and
only after some time does the process involve the cen-
tial portion. In this way the two fragments come to be
united by two thin pseudo-membranes. The author
takes advantage of this in his treatment of fractured
patella. From ten to twenty days after the injury he pro-
ceeds to operate. An incision being made over the
patella, the anterior membrane and the unorganized
coaguluml3ring beneath it are removed, but the posterior
membrane is not interfered with, and thus the joint is not
opened. The fragments are then united by platinum or
alver wire suture, care being taken not to include the
inembrane of organized coagulum, but to let it fold upon
itself posteriorly toward the joint cavity. Dr. Van der
Meulen has operated in this manner in three cases of
fractured patella, and has been enabled to obtain ex-
cellent and firm union. — Deutsche Medicinal^Zeitung^
July 21, 1884.
The Diagnosis of Sclatica. — M. de Beurmann
advises, in any case where there is a question of dia^osis
between sciatica and any other painful affection in the
region of the hip, that the patient be placed on the back
and then, the knee being held in complete extension,
flexion be made of the thigh upon the trunk. When this
is done, the patient at once complains of severe pain in
the buttock at the point corresponding to the sciatic
notch. If now the knee be flexed, no pain is experi-
enced upon flexion of the hip. According to Las^gue
this pain is caused by compression of the nerve by the
surrounding muscles, but De Beurmann shows that it
IS due rather to stretching of the nerve trunk by the con-
strained position of the limb. This sign, more valuable
than that of Valleix's tender points, is, the writer states,
constantly present. It is moreover characteristic, for in
other affections simulating sciatica the presence or
absence of pain is not dependent upon the tension or re-
laxation of the nerve, consequent' upon the varying posi-
tions of flexion and extension of the knee. — La France
MUicale^ August 2, 1884.
Treatment of Locomotor Ataxla. — Dr. Mtiller
claims to have had a measure of success in his treatment
of this aflection. The diet, he says, should be strengthen-
ing. Coffee, strong tea, and undiluted alcoholic bever-
ages are forbidden. In the medicinal treatment a pill is
used composed of ^^ grain of nitrate of silver and i^
grain of extract of ergot. The dose is one pill three
times a day, and is gradually increased to three pills three
times a day. After about twenty grains of nitrate of
silver have been taken, the pills are discontinued for three
weeks, when their administration is then resumed in the
same way. The treatment may extend over five or six
months. The author does not believe that the disease
is often of syphilitic origin, aY)d never uses specific treat-
ment unless he can discover unmistakable evidences of
syphilis. Electricity is often useful, but galvanization of
the medulla should be practised as 'weU as that of the
cord. Faradization of the skin by means of the brush
electrode, either alone or combined with galvanization of
the nervous centres, may also be of advantage. The
author condemns hot water or vapor baths as bein^ posi-
tively injurious. Cold baths are also contra-indicated.
The proper temperature for a bath is 84° to 86®, and the
patient should remain in the water for fit>m three to five
minutes only. Massage may prove to be of use, though
data on this point are wanting. Stretching of the longer
nerve-trunks is a dangerous and unwarranted procedure.
For the pains Dr. Miiller makes local applications of a
liniment consisting of veratria, four grains ; chloroform,
half an ounce ; and oil, one ounce. For the gastralgic
crises he uses strong faradization with a brush over the
epigastriuuL Ocuku- paralysis is treated by the continued
current For the relief of vesical spasm, he gives pills
containing one and a half grain of the extract of cannabis
indica. — La France Medicale^ July 31, 1884.
The Weight of the Heart in Cancerous Affec-
tions OF THE Uterus. — It has been stated by Dr.
Artaud that the heart is hypertrophied in cases of car-
cinoma of the uterus, in consequence of secondary in-
flammation of the kidneys. In a series of post-mortem
observations made to verify this assertion {Le Progrls
M^icaly August 2, 1884), Drs. F6r^ and Quermonne
found that such was not the case. As the result of their
investigations they conclude that, not only is hypertrophy
of the heart not the rule in those suffering from renal
lesions consequent upon cancer of the uterus, but that
on the contrary, the heart, as is usually the case in can-
cerous subjects, whatever the seat of Uie lesion, is more
or less atrophied.
A Case of Acttte Iodism. — A gentleman in perfect
health took a dose of fifteen grains of iodide of potassium
in the hope of overcoming the disgust felt for it by his
wife, for whom the drug had been prescribed. This oc-
curred about six o'clock in the evening, and no evil effects
were experienced until eleven o'clock, after he had re-
tired. He was then suddenly awakened by violent sneez-
ing accompanied by excruciating pain in the upper jaw.
This was so severe as to drive the patient nearly frantic.
The upper part of the face was somewhat swollen, and
nasal respiration was impeded, though there was no dis-
charge from the nostrils. The eyes were sufiiised with-
out there being an actual flow of tears. There was also
some nausea and vomiting. M. L^ger, who was sum-
moned about four o'clock, found the patient still suffer-
ing from constant pain, with exacerbations every few
minutes, in the upper jaw and the teeth. This pain was
not increased by pressure upon the infra-orbital nerves.
The symptoms pointed to inflammation of the mucous
membrane lining the two antra, but no cause could be
found to account for its sudden onset, until the patient
mentioned casually that he had taken a dose of his wife's
medicine. The symptoms continued with but slight
abatement until the following evening, and then slowly
disappeared, leaving no sequelae. — Journal de Midecine
et de Chirurgie Pratiques^ July, 1884.
^66
THE MEDICAL RECORD.
[September 6, 1884.
Borax in the Treatment of Contagious Diseases.
— In a communication made to the Academic des
Sciences {L Union MidiccUe^ August 2, 1884)^ Dr. de
Cyon urges upon the members the employment of borax
as an internal disinfectant. It is, he asserts, perfectly
innocuous to the human organism, even when taken in
quantities of half an ounce or more per diem. He op-
poses the notion that a microbidde is the more effectual
in proportion as it is the more poisonous to man. The
efficacy of this substance as a prophylactic against cholera
was demonstrated, the author says, during the cholera
epidemic which ravaged Italy in 1865. At that time not
one of the workmen employed in the seven boracic acid
factories at Larderello was attacked, while in a village
scarcely two miles distant one-third of the inhabitants
died from cholera. Taken in quantities of seventy-
five to ninety grains per diem, the borax would not only
exert a direct action upon the microbes in the intestinal
canaly but would be taken into the blood and destroy the
organisms there present The constipating effect of
borax would be another indication as regards cholera.
He recommends that those exposed to cholera should
wash the mucous membranes frequently with a solution
of boracic acid or borax, and also take about ninety
grains of borax internally each day.
The Induced Current in the Treatment of
PLEURinc Effusions. — Dr. Giuseppe Manzini has col-
lected a number of cases of absorption of the fluid in
chronic pleurisy after the persevering use of the induced
current applied to the thoracic wall In a few instances
there was at first a little fever and a slight degree of in-
flammation, induced apparently by irritation from the
electricity. Although these cases also terminated favor-
ably, the author advises that the treatment be not under-
taken until every trace of inflammatory action has sub-
sided. The action of electricity in causing absorption is
explained : i, by the increased power of contraction in
the intercostal muscles and diaphragm, previously weak-
ened by the hypersemia and oedema, which contraction
exerts a pressure upon the fluid contained in the thora-
cic cavity; 2, by strong irritation of the vasomotor
nerves, which restores to the tissues their absorbing
power. — Deutsche MedicincU-Zeitung^ July 10, 1884.
Malaria and Osteopathies. — Dr. Barberi-Boughini,
in an article on this subject, notes the anatomical and
physiological relations between the spleen and the medul-
lary substance of the bones, and concludes that it is
reasonable to suppose that when the former is affected by
the malarial infection the latter is also involved. He
calls attention to the frequency of non-union or slow
union of fractures in malarious subjects, and mentions
several instances in which he found meUmotic disease of
the medulla of one or more of the long bones in cases of
' h)rpertrophied spleen from malaria. He concludes that :
I. We should recognize the existence of leucocythaemia
due to changes in the various bones. 2. The malarial
poison may act by itself in inducing these changes, or
may be a most powerful coefficient to the expression of
other diatheses not yet determined. 3. Malaria ought
therefore to be regarded as a cause of various osteo-
pathies.— Rivista Clinica^ July, 1884.
The Condition of the Blood in Hydrophobia. —
In an examination of the blood drawn rapidly from the
vessels, especially from the sinuses of the dura mater. Dr.
Romiti {Rivista Clinica, July, 1884) found it to be of a
dark red color and not coagulable spontaneously. The
red globules were rather pale, and when the preparation
was stained by Bizzozero's method, and placed under an
immersion lens, there appeared a mass of granular matter
in which the white globules seemed to be imbedded.
These appearances were similar to those presented by
the blood of persons killed by snake bites.
The Functions of the Thyroid Gland. — In an
article in the Archivio per le Scienze Mediche^ vol. viii..
No. lOy 1884, Drs. Sanquirico and Canalis describe a
number of experiments made by them to determine the
function of the thyroid gland and its value to the economy.
From the results of these experiments the authors draw
the following deductions: i. The extirpation of the
entire thyroid gland in dogs is fatal, whether the spleen
have previously been removed or not 2. Dogs from
whom the spleen has been taken away bear incomplete
thyroidectomy without any apparent ill effects. 3. There
is no functional relationship between the thyroid gland
and the spleen. 4. Only a small portion of the thyroid
requires to be spared in order that the functions proper
to this gland may be actively performed and that there
may be no change in the animal's general condition;
though not yet positively determined, it would appear
that the upper part of the gland is the part that must be
spared in order not to interfere with its necessary func-
tions. 5. The fatal results following complete thyroidec-
tomy cannot be referred to quantitative changes in the
elements of the blood, for the changes observed were
neither constant nor of sufficient gravity. 6. Although
the experiments thus far made have not demonstrated
what the functions of this gland are, they are yet sufficient
to exclude the notion of a haematogenetic action, and
therefore to prove that the thyroid cannot, in this respect
at least, be a substitute for the spleen. Nevertheless we
are justified in assuming that it has an important action
upon the animal, and m all probability in relation with
the nervous centres. The authors have never met with
an absence of the thyroid gland in any of the animals
examined by them, although Tauberhas asserted that the
organ is quite frequently wanting in the domestic animals.
Sub-clavicular Tympanic Resonance in Pneumo-
nia.— In a soldier suffering from acute double pneumo-
nia, Dr. Lav6ran {JO Union M^dicale^ No. 55, 1884) found
a tympanic resonance under the left clavicle. This
resonance persisted from the third day of the disease
until the patient's death. At the autopsy the lef^ lung
was found to be throughout in a state of gray hepatization.
Not being able in this case to admit the theory of Skoda
and others, who explain this phenomenon by the integrity
of the corresponding portion of the other lung, Dr. La-
v6ran concluded that the resonance was that of the
trachea and larger bronchi transmitted through the solid-
ified lung-tissue.
Purulent CoNjuNcrivrris. — In a considerable num-
ber of cases of purulent ophthalmia Dr. Johan Widmark
{Hygieay No. 6, 1884]) was able to demonstrate the
presence of gonococci. The micro-organisms were
generally found in the wandering cells, though they were
also present in the secretion. In some cases of con-
junctivitis of the new-bom the author discovered the
cocci in the epithelial cells. In one case also of oph-
thalmia in the adult they were present in the epithelial
cells in the first days of the disease, but disappeared on
the third day. The author concludes from this that, as
is asserted by Welander to be the case in gonorrhoea, the
gonococci are developed in the epithelium, and only
later penetrate into the subjacent tissues. In every case
Dr. Widmark was able to prove contagion, in adults,
from the presence of the gonococci in the antecedent
urethral discharge, and in the new-bom firom the pres-
ence of these organisms in the vaginal secretions of the
mother. The results of treatment in the new-bom were
excellent, but the disease in the adult was very intract-
able. This difference the author explains by the state-
ment that in the adult there is a layer of adenoid tissue
beneath the conjunctiva which is wanting in the infant
The micro-organisms have a predilection for all glandular
stmctures, and therefore pass deeply down into this sub*
conjunctival layer out of the reach of local applications*
In the treatment Dr. Widmark makes a strong applica-
tion of nitrate of silver once a day, and washes the eye
frequently with solutions of boracic acid and of corrosive
sublimate (jirhnr) employed altemately.
September 6, 1884.]
THE MEDICAL RECORD.
267
The Medical Record
A Weekly journal of Medicine and Surgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Ptjblishsd by
WM. WOOD &. Co.. Nos. 56 and 58 Ufayette Place.
New York, Septemberv 6, 1884.
CHOLERA AND THE COMMA-BACILLUS.
A VERY interesting lecture on cholera, an abstract of
which is given in this and the preceding issue of Thb
Rkcord, was delivered recently by Dr. Koch before an
assembly of prominent physicians and hygienists in Berlin.
The speaker described the minute organism discovered
by him in the intestinal discharges of cholera patients,
and which he maintains is the actual cause and essence
of the disease. This organism has been called rather
inaptly the comma-bacillus, although it resembles a
mark of parenthesis more than it does a comma, and is
probably a spirillum and not a bacillus. Dr. Koch makes
oat a very strong point in favor of the bacillus theory of
cholera and of his claim to have discovered the special
miao-organism that causes the disease. He found the
commapbacillus in every one of nearly a hundred cases
of Asiatic cholera, while its presence could not be de-
tected in cases of cholera morbus and other diseases in
which a search was made. Nevertheless it would be
rash to assert that it is not present in any other disease,
and it may yet be found in other afifections, just as Fried-
lander's pneumonic cocci are said to have been detected
in inflamed tissues other than the lungs. Indeed, Dr.
Klein, a London physician, has recently asserted that he
found micro-organisms, indistinguishable from the comma-
badlli, in the discharges of patients suffering from a
diarrhoea which was epidemic in Cornwall in 1883. As
he made no culture tests, however, his statements can-
not be accepted as conclusive. And more than this, the
crucial test of a theory of this kind is wanting, namely,
inoculation by the infectious material. Various attempts
have been made to induce cholera in the lower animals
by feeding them with matters containing the comma-
badlli, but always without success. Koch says that
animals enjoy a special immunity against the disease ;
but while this may be a sufficient explanation of the
failure of these experiments, it nevertheless leaves the
main question of inoculability untouched.
Although it would be premature without further evi-
dence to regard the problem of the cause of cholera as
ahready solved, the possibility of Koch's solution being
the correct one is nevertheless so great that it may not
be unprofitable to consider some of the sanitary bearings
of his theory.
The lecturer stated that the badllus was found only in
toR intestinal canal and its contents, and never in any of
the other organs or secretions of the body. Further '
than this, it was only in the lower portion of the digestive
canal, the gastric secretion, when normal in character,
being fatal to the life of the micro-organism. This point
is of considerable importance, since, as the bacillus can
gain admission only through the mouth, it must first run
the gauntlet of the stomach before it can reach a locality
favorable to its development. Thus, a healthy individual
whose gastric secretions are normal in quantity and
quality, is far less likely to contract the disease than is a
dyspeptic. This might explain the influence of fear as a
predisposing cause of cholera, since good digestion is so
dependent upon a quiet mind. Hydrochloric acid and
pepsine may yet rank high among the preventives of
cholera.
A still more important statement was that the bacillus
is absolutely dependent upon moisture for its life. There
is no stage of its existence during which it may remain
dormant for an indefinite time, ready for further develop-
ment and reproduction under favoring circumstances.
Once the material in which it is contained be thoroughly
dried, then the comma-badllus is dead and can never
be resuscitated.
If this be so, the question of disinfection becomes a
very simple one. All rags, clothing, or personal effects
of cholera patients need but to be carefully dried, and
they are thenceforth absolutely incapable of carrying
contagion. In the same way letters could be dried, and
the absurd precaution of enclosing them in tarred mail-
bags might then be abandoned. The assertion that the
infectious material of cholera cannot be carried in the
air, but can only be transmitted to distant places by
persons suffering from the disease or by articles soiled
with choleraic discharges, will, if true, lend a measure of
support to the establishment of sanitary cordons, and
demonstrate the utility of quarantine. That the bacillus
can flourish under favoring conditions outside of the
human body, is amply demonstrated by the facts of culti-
vation in gelatine, milk, blood serum, potato, and other
substances. Impure drinking-water would seem to be
one of the most ordinary channels through which the
contagion of cholera is introduced into the intestinal
tract. Dr. Koch cited numerous striking cases showing
the value of pure water in reducing the death-rate from
this disease. He stated also that the comma^baciUus
did not thrive in pure water, but died within a few days.
One of the most valuable results of the discovery of the
cholera bacillus, even though it be proven not to be the
real cause of the disease, provided only that it be pecu*
liar to this affection and not present in any other, will be
the facility thus afforded to a certain and early diagnosis.
The value of this can hardly be over-estimated, for the
first cases usually come singly, and if they can be prompt-
ly recognized and placed under surveillance from the
very beginning, a destructive epidemic may be warded ofil
Whereas, if the first few days be spent in trying to decide
what the nature of the disease is, by the time it is recog-
nized to be cholera it may be too late to check its ad-
vance. Dr. Koch maintains that a simple microscopical
examination of the choleraic discharges is not always
sufficient to base a diagnosis upon, but that by the
method of culture absolute certainty may be obtained.
He looks upon this as a very simple matter, and seems to
think that anybody can do it But he appears to be a
268
THE MEDICAL RECORD.
[September 6, 1884-
little over-sanguine in this respect. It is hardly reason-
able to expect that every physician will take the trouble,
even if he has the time to spare, to acquire the skill
necessary for conducting a trustworthy culture of the
comma-bacillus. But practically, in cities at least, such
a general knowledge of bacteriology is not necessary.
The investigation of doubtful cases could be entrusted to
the sanitary authorities, as is done now in other contagious
diseases.
It is to be hoped that Koch will be able to substantiate
his claims clearly and beyond dispute, for we shall then
be on the high road to victory over this dreaded disease,
and cholera will take its place alongside of small-pox as
one of the former scourges of the human race from which
modem civilization has little to fear.
GASTRIC HYSTERIA, AND THE FASTING GIRL OF
FORT PLAIN.
The necessity of a suitable dietary regimen is seen in
the fact that man, and warm-blooded animals generally,
cannot survive abstinence from food longer than from
seven to ten days ; the period may be somewhat extended
if water be supplied, and it may be very much prolonged
if a minute quantity of nutriment be taken daily.
Cold-blooded animals can endure fasting for a consid-
erably longer time; although some species (notably of
fishes) are characterized by excessive voracity, and all
are dependent for the normal performance of their func*
tions on regular alimentation, it is nevertheless a fact
that reptiles and amphibia have been known to live for
many months without any food whatever. A gentleman,
for whose veracity we can vouch, has reported to The
Record a case of nine months' fasting in a couple of
frogs ; * and an alligator now in our possession has for
more than ninety days refused all sustenance. Such
warm-blooded animals as hibernate during the cold sear
son are examples of a similar kind In all these in-
stances changed conditions in the environment have
caused retardation — sl quasi stagnation of the organic
processes ; assimilation and disassimilation are almost
nil ; animal heat is scarcely above that of the surround-
ing medium ; secretion and excretion are at their mini-
mum.
Although all active manifestations of life are the ex-
pression of change in the protoplasmi matter of life,
necessitating constant waste and repair, yet there are
all grades of vital action (and concomitant molecular
change) ; from the " latent life " of spores and seeds and
grains, of dried rotifers and tardigrades and certain in-
fusoria, which are capable of existing for years in a state
of physical and chemical torpor without maintaining any
relations of exchange with their environment ; to the in-
stances already given of 'Mife ¥dth oscillations" (the
terms are those of M. Claude Bernard), where the con-
dition is not one of absolute torpor and inertness, but
one in which the vital manifestations are at a low ebb ;
to finally — what shall we take as our highest example ? —
to the indefatigable activity which characterizes that
hardest-worked of human beings, a metropolitan news-
paper editor.
There are in man certain morbid conditions which
» Mbdical Rbcoxd, voL xviiL, p. 361, " Fasdng Frogs."
almost reduce the individual to the state of a cold-
blooded or hibernating animal, as far as the ability to
support deprivation of nutriment is concerned. Not to
dwell on certain cases of cancerous stricture of the
pylorus or cardia, where digestion and absorption are
almost, if not quite, impossible, and yet where we have
seen life maintained for many long weeks on the nuiru
five reserves * of the blood and tissues ; there are certain
cases of hysteria characterized by chronic repugnance to
and inability to digest food ; these cases are called by
Huchard and Denian ** gastric hysteria." *
We here say in advance that the intimate nature of thu
disease is still unknown to science. Protean as are the
manifestations, we have not yet ascertained the nexus of
its part$ or the law of its unity. Believing, as we must
do, that it has a definite patho-anatomical basis, we are
forced to conclude that the morbid alterations are princi-
pally molecular, being a disturbance of interstitial pro-
cesses of waste and repair. We are warranted in affirm-
ing that in gastric hysteria there is marked inhibition of
those systemic processes through perverted nervous in-
fluence, the point of departure being a local irritation
which, to the functions of organic life, becomes a para-
lyzing lesion.
In gastric hysteria either the appetite remains normal
or nearly so, but food is vomited shortly after it is in-
gested, from atony of the digestive organs, and failure of
the assimilative processes ; or else the appetite is com-
pletely lost, while organic nutrition is at a stand-still ;
the aversion to food is invincible. In the former class
of cases abstinence is in some sort instinctive, the pa-
tient dreading the distress and vomiting which follow eat-
ing. In the latter class there is also retardation of the
processes of vegetative life, but there is a mental element
which is conspicuous ; as though the dread and disgust
of food were a species of insanity, having a special seat
in the brain. Huchard distinguishes these two varieties
under the names oi gastric anorexia and mental anor-
exia.* The mental anorexia of Huchard has been de-
scribed by Gull, of England, under the name of hysterical
apepsia ; ** an affection chiefly seen in young girls from
fifteen to twenty-three years of age, and characterized by
complete loss of appetite, by emaciation often attributed
to latent tuberculosis, abdominal disease, or tabes me-
senterica, and due especially to central cerebral dis-
turbance." *
Other cases of gastric hysteria are distinguished by
incoercible vomiting, which may be due to hyperaesthesia
of the gastric mucous membrane, to pneumo-gastralgia,
to secretory disturbances of the gastric glands, and to
other causes.
All the neuralgic, spasmodic, paralytic, and other
nervous troubles of hysteria in general, may accompany
this form of hysteria, and be the key and the exponent
of the malady. To cite one of multitudes of illustrative
observations on record, we may refer to the very inter-
esting case reported by Raymond in Vulpian's "Cli-
nique M6dicale," obs. clvi.* The patient was suflfer-
> The term is a fiiivorite oae of the late M. Benurd.
* Huchard: Trait^ des n^vroses, Paris, 1883; Denian: De PHyst^ gM-
trique, Paris, 1883.
* Huchard : Loc. ciL
« Gull : Brit. Med. Jour., 1873. (Quoted by Denian in Hyst^rie Gastrique.)
* Clinique M^dicale de I'Hdpital de la Chants. Obs. Oiniques par fe docL F.
Raymond. 0« Doin, Paris, 1879.
September 6, 1884*]
THE MEDICAL RECORD.
269
jng from ** ovarian hysteria ; " entered the hospital to be
treated for incomplete paraplegia which proved to be
reflex ; while in La Charity had gastric hysteria, vomit-
ing everything ; this was accompanied by choreiform
trembling of the limbs, which lasted for several months ;
both the choreic agitation and the vomiting were very
obstinate ; there was sometimes alternancy of the mor-
bid phenomena, one kind being in abeyance while there
was exacerbation of another kind. The patient left the
hospital unrelieved.
As for the length of time during which life maybe
maintained on such limited quantities of food as are
assimilated in these cases, it is impossible to form an
exact estimate. Dr. Car^^enter relates an instance which
came ander his own observation : '^ A young lady who had
just before suffered severely from the tetanic form of
hysteria, was unable to take food (or three weeks. The
slightest attempt to introduce a morsel of solid matter
into the stomach occasioned violent efforts at vomiting ;
and the only nourishment taken dturing the period men-
tioned was a cup of tea once or twice a day, and on
many days not even this was swallowed. Yet the strength
of the patient rather increased than diminished during
diis period ; her muscles became firmer and her voice
more powerful" *
Willen relates the case of a man who lived sixty days
without taking anything but a little orange juice. Des-
baireaux reports the history of a woman who during
sixty-one days swallowed only one bowl of broth. And
Desportes tells of a woman who during two months lived
on water alone. Denian, from whom we borrow these
not very well attested statements, after remarking the
downess of disassimilation in gastric hysteria^ of which
we have a proof in the minute quantity of urea which is
excreted (in some instances scarcely thirty grains a day),
goes on to observe that " alienists are every day witnesses
of facts of persisted anorexia and abstinence supported
with an immunity truly astonishing." *
The disposition to deceive which characterizes hysteri-
cal patients generally is not absent from the gastric form
of the disease, and the cases of Anna Moore, Sarah
Jacobs, etc., reported by Dr. Hammond in his ^ Fasting
Girls," show us to what bizarre subterfuges these patients
will resort to impose upon family and friends, and com*
pel the belief that absolutely no nourishment of any kind
is ingested.
A notable instance of simulated fasting, which had a
tragic ending, occurred in South Wales in the spring of
1869 {vid^ newspapers of that period, heading '' Fasting
Girl oif South Wales "). The parents made a show of
their child, decking her out like a bride on a bed and as-
serting that she had eaten no food for two years. Some
reckless enthusiasts for truth set four trustworthy hospital
mirses to watch her ; the Celtic obstinacy of the parents
was aroused, and in defence of their imposture (or be-
* cause they had allowed themselves to be deceived) per*
mitted death to take place in eight days. Their trial and
conviction for manslaughter are still fresh in the memories
of inhabitants of that region.*
Whether the same result would follow a rigorous es-
1 Carpenter : Prudidct of HanuM Plqrnology, pi 86. PhaUu, i86a.
SDcniaa : Loe. dc, p. 55-
* Seelbe acoooat ia the Eacydopedki Britaoaica, arlidc DieteCici.
pionage, day and night, of the person and surroundings
of the fasting girl at Fort Plain, is not in our mind at all
uncertain. It would appear that Miss Kate Smusley has
now been for almost six months "lying at death's door
from self-starvation.'' She occasionally ''takes a little
water in her mouth, but does not swallow it, as this
causes convulsions which wrench her stomach most pain-
fully. . . . She recognizes her callers, and carries
on conversations with them, and is perfectly conscious.
. . . Her body is in constant motion, like a machine,
so much so that the bed upon which she lies has to be
supported for fear that it will fall to pieces by the con-
stant vibration.'' Other non-medical accounts of a similar
kind, based on asseverations of members of the family,
are in circulation. We have a medical opinion of the
case from the statement of a local physician whose name
we charitably suppress, and who considers the case ''one
of spinal disintegration, or a species of locomotor ataxy,
or a wasting of the nervous system ! "
It is needless to comment on such an extraordinary
view of a case which, as far as we have been able to in-
form ourselves concerning it, is clearly an instance of
gastric hysteria, and presenting no single element that is
essentially different from other cases of the kind, unless
it be the persistent choreic trepidation, which seems to
be a more obstinate and formidable phenomenon than
in Vulpian's patient above referred to. There would
seem to be a tetanic condition of the oesophageal muscles
at times, making swallowing an impossibility. We can
well believe that Miss Kate Smusley is a great sufferer
and entitled to universal pity; that, however, there is fraud
and imposture in the recital, as it comes to us, there can
be no doubt whatever.
INTRAVESICAL INJECTIONS.
Op the many therapeutic measures in common use for
the alleviation or cure of vesical troubles, few have such
power for good, when rightly used, or such injurious
effects when misapplied, as injections into the bladder.
J^en pense beaucoup de Hen et heaucoup de mal^ said
Guion, when questioned as to their value. Like most
of the therapeutic means in the hands of the surgeon,
whose value cannot be questioned, they are two-edged
weapons — excellent, harmless, and productive of good
results in experienced hands, but dangerous when en-
trusted to the inexperienced and ignorant. Haematuria,
prostatitis, cystitis, and even nephritis are the troubles
arising from misuse of them, troubles depending upon
the technique of the injection, its nature, and its pharma-
ceutical composition.
Intravesical injections may be used in the most diverse
conditions, and to obtain essentially different results;
for a simple mechanical action, or for a modifying
dynamic action on the bladder or its contents, or as
very necessary aids in certain operations upon the
bladder.
Evacuating injections or washes may prove valuable
mechanical aids by acting mechanically on foreign sub-
stances in the bladder, and causing their expulsion.
The substances to be removed may be gravels or frag-
ments of calculi, or purulent or glairy masses which,
on account of their weight or adhesive power, cannot be
-270
THE MEDICAL RECORD.
[September 6, 1884.
expelled by the forces of micturition. It is well known
that in cases of pyluria, the last urine expelled contains
more pus than the first, often consisting of almost pure
•pus ; and the unexpelled contents consist of pus, or at
least urine mixed with pus, which stagnates in the blad-
der, . Now, there is scarcely a surgical principle more
universally admitted than that every suppurating surface
should be placed under conditions favorable for cleanli-
ness and drainage. This is the underlying principle of
detersive vesical injections, which are indicated when-
ever the urine contains pus, and especially when the
pus is secreted by the vesical mucous membrane. So,
also, when the urine undergoes ammoniacal fermenta-
tion, or there are solid blood-clots in the bladder.
As with other measures which are powerful for good,
vesical injections have their contra^indications, of which
pain may be mentioned first. The injection should not
cause any considerable degree of pain, nor should the
bladder be distended by the fluid. After pain, acute
renal lesions contra-indicate detersive injections. We
do not say chronic lesions of the kidneys, because in that
case they would be almost entirely thrown out of vesical
therapeutics.
It would scarcely be considered necessary to say that
metallic catheters should never be used for this purpose,
unless we had seen it done. Furthermore, Desnos has
shown, in his Lithotritie d Stances Prolongies^ that an
evacuating tube should have two eyes, both for lithotrity
operations, and for washing out the bladder. The reason
for this is apparent : the contents of the bladder should
be as much agitated as possible during the injection, and
it is easily seen that a tube with two eyes will create a
double current, which the smgle eye cannot The
double-current canula, formerly much used, is decidedly
disadvantageous on account of the necessarily small cali-
bre, its inability to set up a double current, and the in-
significant attraction at the external orifice. But of all
syringes for vesical injections the hydrocele syringe is
probably the best. Whatever syringe may be used, how-
ever, and however carefully it may be graduated, the
amount of liquid thrown in should only be judged of by
the resistance of the bladder ; and the injection cease at
or before the first manifestation of vesical resistance.
As it is always unwise to empty a distended bladder,
unless the patient is in the recumbent posture, so vesical
injections should always be made while he is lying down.
As to the materials for vesical injections, it may be said
in a general way that nothing should be used which can
possibly do injury, either directly or indirectly. For an-
tiseptic injections solutions of carbolic or boracic acid,
resorcine, corrosive sublimate, and strong tea, are all ex-
cellent Nitrate of silver has been much used in this
country, and is still used in France ; but the less of that
material thrown into a bladder, so much the better for the
patient
THE DEVELOPMENT OF CANCER FROM CICATRICES IN
THE STOMACH AND GALL-BLADDER.
The question whether cancer may have for its starting
point simple ulceration and subsequent cicatrization, has
been fi*equently raised in connection with gastric ulcer.
While Rokitansky and Dittrich merely affirm that there
are cases in which cancer has followed upon ulceration.
Lebert sees in the not infrequent coexistence of gastric
ulcer and carcinoma (9 per cent of his own observations)
more than a chance occurrence. And Leube ascribes
to the presence of an ulcer or its cicatrix a certain pre-
disposition for the development of cancer. In a mono-
graph on chronic ulcer of the stomach, its cicatrization,
and its relationship to cancer, reference to which was
made in these columns in September of last year, Dr.
Hanser has shown that the glandular changes induced by
the cicatricial process occasion a predisposition to can-
cerous growth, and that between the cancerous growth of
the glandular epithelium and its atypical growth in the
course of cicatrization there is but a very slight differ
ence. Dr. M. Heitler, of Vienna, agrees with these
views, and in confirmation of their correctness cites three
cases with autopsies, in which cancer had arisen from
the cicatrix following ulceration. This author further
states that the same thing may occur in the gall-bladder
as in the stomach. In opposition to Frerichs, Forster
and others, who regard the presence of a cancerous
tumor as favorable to the formation of gall-stones, Klebs
and Schiippel regard rather the irritation caused by the
presence of biliary calculi as favoring the development
of carcinoma. Dr. Heitler is led to agree with the latter
by reason of his own experience, jnrhich though limited
to a single case of this kind, he holds to clearly establish
the correctness of the view of Klebs and others. He
asks finally whether, with this experience, the appear-
ance of cachexia (especially when there is unhereditaiy
history of cancer) should not be regarded as an indica-
tion for operative interference.
THE ASSOCIATIONS FOR THE ADVANCEMENT OP
SCIENCE.
The annual meeting of the British Association for the
Advancement of Science, at Montreal, last week, and that
of the American Association, at Philadelphia, this week,
have attracted unusual attention. Both meetings have
been interesting, and have fairly served their purpose of
giving opportunities for social intercourse and mutual
interchange of opinion.
It sometimes occurs that subjects of much interest to
medical men come up in the Sections of Biology or
Anthropology. Such has not been the case this year,
and we much regret the fact It is noticeable that in both
France and Germany there are scientific associations
in which the medical sciences form a prominent part
Such is the case with the French Association for the Ad-
vancement of Science, and the German Society of
Naturalists and Physicians. It would be better if cer-
tain of the medical branches were to ally themselves to
these associations for the advancement of science. Cer-
tainly pharmacology, physiology, pathology, and anatomy
are as legitimate and important sciences as any that at
present receive attention.
INDIANA MEDICAL AMENITIES.
An interesting controversy is going on between the /»-
diana Medical Journal and a Fort Wayne medical con-
temporary. The latter publication is opposed to the
establishment of a Board of Medical Examiners indepen-
dent of the colleges, and to the Indiana Medical Journal
September 6, 1884. J
THE MEDICAL RECORD.
271
being made the organ of the State Society. It intimates
that those medical gentlemen who are not connected
with a medical college are too ignorant to be State ex-
aminers— ^an opinion which has been modestly advanced
by learned professors in our own neighborhood. To this
the Indiana Medical Journal at once applies an argu-
mnium adhominemy quoting from an article by the learned
Fort Wayne editor, who, it is needless to say, is a full-fledged
professor in a second-rate medical school It is shown
that said professor advises the administration of three
grains of quinine and three grains of Dover's powder
every three hours as a " bitter tonic " to a child two
years old. He also gives this dose in the form of a seven-
grain capsule, the whole prescription being written in
idiat might be called dog Latin, and displaying a massive
ignorance of therapeutic knowledge and literary skill.
The Indiana Medical Journal has been making a good
fight for reform in professional education and ethics in
the State of Indiana. It is right in its position as to the
State Medical Examiners, even if its somewhat personal
method of argumentation is not conclusive. Indiana
needs a good independent State Board of Medical Ex-
aminers much more than it needs any of the literary or
educational productions of Fort Wayne.
CONTAGIOUS PLEURO-PNEUMONIA.
Contagious pleuro-pneumonia has already infected
several herds in the West, although the total number
of its victims is still small, not exceeding fAty. Much
to the dismay of the milk-dealers, it has been found to
exist in an unequivocal form also in Brooklyn. The dis-*
ease has been present at several points in the Eastern
States for a long time, and there is no doubt that it was
carried West from some Eastern herd.
The attempts to throw doubt as to the true nature of
^ disease, are simply the expressions of obstinacy and
dubess. The disease is contagious pleuro-pneumonia —
a thing not to be trifled with.
The history of the progress of pleuro-pneumonia in this
country of late years has been a curious illustration of
the advance of scientific knowledge before public opin-
ion. No competent persons (except a few ''inocula-
tionists ") doubt that the only way to treat pleuro-pneu*
nomia is to kill every animal that has the disease, and
quarantine those that have been exposed. This is the
cheapest way in the end, but it has been very hard to
show legislators that such is the fac(. In the State of
New York the Legislature has abandoned its special mar
diinery for dealing with cattle diseases, and there are
now only the State and Local Health Boards. The con-
gressional mind has never been able to comprehend the
situation, although Congress alone is able to purge the
country of the disease.
Pleuro-pneumonia is a most inviting disease for the
pathologist to study. It has a special contagion of per-
sistent vitality, but generally of slow development. It
produces a local disease wherever it fastens itself, but
normally the affected places are the 'bronchi and air lo-
bules. Here we have a bronchitis, peribronchitis, consoli-
dations, hemorrhagic infarctions, and pleural efiiision.
The general features of the disease, however, were de-
scribed in The Record some time ago and need not be
, repeated now.
^etvs 0£ Vbiz fiSK^^k
A Tribute to Marion Sims. — L Union M^icale of
August 1 6th devotes its feuilleton to au account of the
life, work, and character of the late Dr. Marion Sims.
Symmetrical at Least. — In Italy cholera attacks
the peasants, the peasants attack the doctors, and the
doctors attack the cholera. The cholera seems to be
coming out ahead, perhaps the peasants come next.
Dr. Oliver Wendell Holmes celebrated his seventy-
fifth birthday on August 29th. He received the con-
gratulations personally, by mail, and by telegraph of a
large circle of friends and admirers throughout this coun-
try and Europe.
Appointments in the Faculty of Medicine of
Paris. — M. Lannelongue has been made Professor of
External Pathology in the Faculty of Medicine of Paris.
M. Armand Gautier has been made Professor of Medical
Chemistry in the same faculty.
A New Medical Author. — ^A contemporary says:
" Jahrbuch reports the treatment of forty-three cases of
diphtheria with oil of turpentine." Dr. " Jahrbuch " had
excellent results. We are reminded of the Freshman
who inquired at the library for the works of " Ibid."
The Treatment of Dysentery by Corrosive Sub-
limate AND CoLOCYNTH. — Dr. F. Sieber, of Chicago,
IlL, writes us, calling attention to the fact that the method
of treating dysentery advocated by Dr. S. W. Childs in
The Record of August 23d is no new thing, but was de-
scribed in The Medical Record, vol. xiv., pp. 45 and
194.
The Cholera continues to spread in the Pyrenees
villages and has finally reached Madrid, Spain, where it
has caused great consternation* It has also extended itself
still further through Italy, having infected eleven provinces
already. The total number of deaths from cholera up to
September 4th is over 5,000. The cholera is now killing
about one hundred persons a day, if the telegraphed re-
ports are correct.
The Death of Dr. J. Collis Browne is announced
from London. He formerly belonged to the medical
staff of the British Army, and devised the well-known
preparation '' chlorodyne," for the cure of diarrhoea and
similar diseases prevalent in the tropical possessions of
England. Although the remedy was largely imitated and
counterfeited, it is said to have secured great wealth for
its inventor.
A Mild Form of Hydrophobia.— There seems to be
little doubt that the following curious series of events oc-
curred near Eufaula, Ala. On July 25 th a dog on a
plantation bit a mule and several hogs ; nineteen days
later the mule and one of the hogs died with the symp-
toms of tetanus. Within the next week three more of
the bitten hogs died with the same symptoms. The
dead hogs were eaten by some thirty negroes, about half
of whom were within ten or fifteen days attacked with
what Dr. Johnson, the attending physician, calls ^' a mild
form of hydrophobia."
Death of Dr. Robert J. Heinmuller. — ^We regret
to announce the death of Dr. Robert J. Heinmuller, on
272
THE MEDICAL RECORR
[September 6, 1884.
August 30th, at his home in this city, of apoplexy. He
was twenty-nine years of age, and a graduate of the Uni-
versity Medical College. Since 1881 he had been con-
nected with the Health Department, and held the position
of Assistant Sanitary Inspector in the Bureau of Conta-
gious Diseases. He was a member of the County Medi-
cal Society, and of the Physicians' Mutual Aid Associa-
tion. He had been an interne at Bellevue Hospital, and
was for a time well known as a quiz master.
Some Dubious Advice Regarding the Cholera. —
A French doctor being applied to by his mother-in-law
for a receipt to keep off the cholera, recommended the
following prophylactic regimen : Sit for a quarter of an
hour morning and evening in a strong draught. Drink at
each meal a bottle of adulterated wine. Eat two green
melons at breakfast, the same number at dinner. Walk
in the sun with the head uncovered for an hour every
noon. Get yourself into a violent perspiration, then
drink a pitcher of ice-water and sit in the cellar in a
chemise. Drink ice-water every hour that it is hot. Le
culte de Venus matin et soir. If you have any early
symptoms of cholera, don't believe it.
The Danger from Chinese Lepers. — Says The Pa-
cific Medical and Surgical Journal : " Since the founda-
tion of the State of California, thirty-five years ago, Chinese
immigration has gone on, with the introduction of occa-
sional cases of leprosy, and in all those years, comprising
more than a third of a century, only one doubtful case of
leprosy has been found to prove the risk of the disease
extending to the white population. The subject has
more than once been considered by the State Board of
Health, and not a solitary instance has been reported
from any part of the State." It is interesting to compare
this statement with the history of leprosy in the Sandwich
Islands, where the disease has spread so disastrously.
Home Criticisms op the American Institute op
Homceopathv. — The New York Medical Times (homoeo*
pathic, in a measure) charges the American Institute of
Homoeopathy with being a machine-ridden and obsolete
institution which has outlived its usefulness. It calls
upon it to renounce its title or disband, and states what
is now very well known, that *' homoeopathic colleges,"
'^ homoeopathic publishers," '' homoeopathic pharmacies,"
etc., cling to their distinctive name because it is a trade-
mark without which they would become extinct When
the leading homoeopathic (we beg its pardon) journal of
the country talks in this bold way, we opine that the
end is near. Homoeopathy should be taught in all medi-
cal colleges as a branch of historical medicine, or psycho-
logical therapeutics. In that direction matters are rapidly
tending.
A Case op Yellow Fever was discovered in this city
last week. The patient was picked up in an unconscious
condition on the street, and no history of his illness could
be obtained. From his appearance it seemed probable
that he was a sailor. He was taken to the New York Ho^
pital, where he continued semi-comatose, but developed
a high temperature. Symptoms of black vomit, yellow skin,
and subcutaneous hemorrhage appeared. He died the
next morning. Post-mortem examination revealed a yellow,
mottled liver, hemorrhage in the stomach and intestines
as well as in the lungs, enlarged spleen, and yellow kid-
neys. The black vomit, the pronounced yellow staining
of the skin, and the subsequent discovery of gastro-intes-
tinal and pulmonary hemorrhages justify the diagnosis
which was made. For further particulars we refer to the
report of Dr. Francis E. Dwight, House-Physician to the
New York Hospital, on page 264. Since the occurrence
of this case reports of two others in Brooklyn have ap-
peared in the daily papers, but these lack confirmation.
The First Manupacturer op Pepsin. — At the
meeting of the American Pharmacological Association at
Milwaukee, last week, Mr. Henry Biroth, of Chicago, ex-
hibited several bottles of a preparation called " pepsan,"
which he believed to be of historical interest The prep*
aration, he said, was put up in 1853 ^X ^^^ 'Sbexi Owen,
of Chautauqua County, N. Y. Owen lived the life of a
hermit, and was generally spoken of as " Crazy Owen."
When he died his cabin was found to contain several
packing cases filled with bottles of the preparation which
he called ''pepsan," and which he had pat up himself.
Accompanying the stuff were printed circulars quaintly
worded as follows :
Pepsan, for the cure of dyspepsia, jaundice, liver com-
plaint, together with all diseases arising from a disorgani-
zation of die stomach. This, I believe, is the gastric
juices of the stomach of the ox producing the gastric juice
required by man to digest his food. Prepared by Eben
Owen ; by no other, I believe, in this world. Directions
for using : Take a small half-teaspoonful fifteen minutes
before eating in a half gill of cold water. My advice is to
eat light suppers. This is got up under prayer, and will
do good I believe. Ebbn Owen.
.XApril>5.1
Mr. Biroth stated that the so-called ''pepsan" was
vfbaX is now known as '' pepsin," and intimated that the
valuable aid to digestion now known and used by dys-
peptics the world over was originally discovered and
manufactured by " Crazy Owen."
Veratria in the Treatment op Muscular Tre-
mors.— Dr. Feris has employed veratria in a number of
cases of tremor from alcoholism, in convalescence from
t3rphoid fever, and in multiple sclerosis. In every case
the tremor was quickly overcome, but in the last instance
the improvement was only temporary. From his ex-
perience in these cases the author formulates the foUow-
mg conclusions : i. Veratria cures muscular tremor
occurring in alcoholism and in certain nervous affections.
It wiU probably cure all forms of tremor, but is especially
serviceable in that of alcoholism. 2. The effects of the
remedy begin to be manifested within twenty-four hours.
3. In cases in which veratria is of avail it overcomes all
tremor, not only of the hands but also of the tongue, h'ps,
etc 4. The influence of the treatment is prolonged
The author has seen the relief persist for two mcraths;
The dose is four pills per diem, each pill containing
^ milligr. (about ^^ g^^^ of veratria). — Eiznsta CUnica
e Terapeuiicay No. 6, 1884.
iQPoTASH Chlorate in Gonorrhcea. — Dr. J. Milton
{Medical Age, April 25, 1884) states that he has had
excellent results from the internal use of the following
mixture in ordinary cases of gonorrhoea : Potash chlorate
two drachms, boiling water four ounces. Mix and shake
till solution is accomplished; then add potass, acetat
two drachms, spirits of juniper four drachms, camphor
mixture six ounces. M. S. Dose, a tablespoonful twice
daily.
September 6, 1884.]
THE MEDICAL RECORD.
273
3epovts at S^ocUtuB.
THE INTERNATIONAL MEDICAL CONGRESS.
£i^MA Session^ held in Copenhagen^ Denmark, August
10 to 16, 1884.
General Summary of Proceedings.
(From our Special Correspoodent. )
COPBNHAGBN, DSNMAKK, AugUSt Z8, Z884.
On Saturday, August i6th, the president of the Eighth
Session of the International Congress bade adieu to the
members, and in a few simple and evidently heartfelt
words, closed the series of most successful meetings
which have just been held at Copenhagen.
The old French custom, which is expressed by the
words, "Le Roi est mort, vive le Roi," was here im-
proved upon. The reigning Congress was not yet dead
before its successor was decided upon and proclaimed.
After Professor Panum had delivered the closing general
address (see page 203),
ON THE INVESTIGATIONS OF FOOD RATIONS FOR MEN IN
A STATE OF HEALTH AND DISEASE,
the report of the committee upon the invitation
TO HOLD THE NEXT CONGRESS AT WASHINGTON, IN SEP-
TEMBER, 1887,
was read, and, as akeady cabled, adopted.
There were a great number of excellent papers read,
and important discussions held in the diflferent sections,
the results of which will soon be laid before the medical
world.
A VERY LARGE ATTENDANCE.
In a previous letter reference was made to the open-
ly proceedings ; but it was not till the meeting was well
advanced that a reliable estimate could be formed as to
the character and dimensions that the gathering would
mtunately assume. No one, and least of all, apparently,
mose who were organizing the matters here m Copen-
hagen, had the lea.st idea that the Congress would attract
the numbers it had done.
, By Wednesday morning, when the sittings of the sec-
tions were suspended for
THE EXCURSION TO ELSINORE,
the membership had grown to between sixteen and sev-
Mteen hundred, and the number of foreign members
who had been attracted to the great Congress of 1881
had been greatly exceeded This unexpected develop-
ment, so far as regarded the membership of the Congress,
would be sufficient to account for any hitch which might
ocoir m the organizing machinery. Nobody, accord-
ingly, was disposed to be over-querulous by reason of
the fact that
THE LODGING CAPACITY OF THE DANISH CAPITAL
TO felt to be uncomfortably straitened. The least sat-
isactory result was seen m the sectional arrangements,
which will probably make the preparation of the Con-
gress transactions very difficult, if not impossible, of
complete attainment. From the same causes which
were at work in this last respect, representatives of the
several medical journals found it more than usually diffi-
cult to gather up anything like a complete r^sum^ of the
sectional proceedings.
SECTIONAL WORK.
For the English-speaking members, however, interest
centred most largely in the sections of surgery and medi-
cine; and in the case of these two I shall be enabled to
present in The Medical Record sufficiently full and
reliable abstracts of the papers and debates.
hospitalities.
As to the hospitalities and courtesies, these at no time
showed signs of break-down. The private hospitalities
of the Danish physicians will live long in the recollection
of their special recipients. But of the unfailing courtesy,
kindliness, and even exuberant hospitality shown to every
member of the Congress by the king, profession, and
people alike, the memory will only die with the life of
each and every member. The king showed from the be-
ginning to the end of the meeting his warm appreciation
of the intellectual distinction which its presence conferred
on his capital His presence added lustre to the opening
meeting of the Congress, his kindly and generous good-
will gave the members the pleasure, on the Wednesday, of
A VISIT TO ELSINORE,
which will not l>e readily forgotten, and, on the Friday
evening extended to them the honor and enjoyment of
a reception and supper at the palace of Christiansborg,
at which the king and queen, and all the members of the
royal family were present. The dinner given by the
municipality on Thursday evening may be described, for
want of a better adjective, as also right royal in charac-
ter ; and the popular appreciation of the work of the
Congress and its representative men, was completed by
the fete given to the members in the Tivoli Gardens on
the same evening, and by the farewell feast given on the
night of Saturday in the national establishment.
[The scope of the general addresses has been indicated
by summaries which have been sent by cable. In two
of them — those, namely, of Sir William Gull and of Pro-
fessor Panum — as already stated, proposals were made
for collective investigation. Professor Panum's proposi-
tion did not result in any definite action on the part of
the Congress. But in the case of
THE COLLECTIVE INVESTIGATION OF DISEASE
a different course was taken and the following committee
was appointed ; Professors Trier and Lange, of Copen-
hagen ; Drs. Bull, of Christiania; Rauchfuss, of St. Peters-
burg ; Schnitzler, of Vienna ; Pribram, of Prague ; Bou-
chard, of Paris ; Lepine, of Lyons ; Ewald and Bern-
hardt, of Berlin ; Sir William Gull, Professor Humphrey,
and Dr. Mahomed, of England ; Sir Joseph Fayrer, Lon-
don ^India) ; Professor Jacobi, of New York ; Dr. Davies,
of Philadelphia ; Dr. Goutteriez Ponce, of Colombia ;
Professor Despine, of Geneva ; and Dr. Isambard Owen,
of London, Secretary General.]
As to the work of the sections, it has already been in-
dicated that the section on surgery was the one in which
centred the chief interest of the meeting. Here, perhaps,
the most important discussion was that which took place on
THE LISTERLAN SYSTEM OF ANTISEPTICS,
and which, while it showed the continued existence of a
sincere and general acceptance of the principles under-
lying antiseptic surgery and admiration for its author, at
the same time exhibited an immense variety of opinion
and practice as to the methods after which surgeons seek
to follow out their principles.
Interesting and important discussions were held on the
paper of Mr. MacEwen, of Glasgow, on
OPERATION FOR GENU VALGUM,
this particular debate being remarkable for the almost
complete renunciation of their own methods by other sur-
geons in favor of Mr. MacEwen' s ; on the paper of Whit-
spn, of Glasgow, on the treatment of club-foot; on a
paper of Professor Oilier, of Lyons, on the operation of
arthrotomy for tuberculous joint affections ; and on the
subject of extirpation and other operations for the cure
or relief of malignant disease of the rectum, introduced
274
THE MEDICAL RECORD.
[September 6, 1884.
in a remarkable communication by Professor Esmarch,
of Kiel.
In the medical section there was a comparative ab-
sence of large debates on subjects of a very general
interest, except perhaps in the instance of the ques-
tions of
TUBERCULAR PATHOLOGY AND TREATMENT,
and on the
MALARIAL INFECTION IN MAN.
The first-mentioned discussion was noteworthy chiefly
on account of the declaration of Professor Jaccoud, of
Paris, as to the
ALMOST UTTER STERILITY, FROM A CLINICAL POINT OF
VIEW, OF DR. KOCH'S DISCOVERY OF THE BACILLUS
TUBERCULOSIS.
Further observations might, he said, be followed by more
encouraging results; but so far at least the discovery
had borne no fruit in the treatment of the disease.
In the same section some progress was made in the
report of Dr. Austin Flint's committee, in regard to the
question of the establishment of a
UNIFORM NOMENCLATURE OF AUSCULTATORY SOUNDS IN
THE DIAGNOSIS OF DISEASES OF THE CHEST.
The like question of international uniformity of nomen-
clature came up in the section of gynecology and obstet-
rics on the report of Professor Simpson's committee ; and
in this case the section reaffirmed the importance and de-
sirability of the object in view, and reappointed the
committee for further consideration of the question and
report to the next Congress.
Of the other work in this section that which excited
most interest was a prolonged debate on the question of
TREATMENT OF UTERINE FIBROMATA BY LAPAROTOMY,
introduced by a paper by Dr. Koeberle, of Strassburg, and
on kindred subjects of abdominal surgery — the debate
being taken part in by, among others. Professor Eustache,
and Dr. Apostoli, of Paris ; Dr. Margary, of Turin ; and
Sir Spencer Wells, of London.
Of the other sections that of skin diseases perhaps
came next in interest. Here again the question that
most excited debate was that as to the
TUBERCULOUS CHARACTER OF THE LUPUS.
Professor Kaposi, of Vienna found himself practically
alone and unsupported in the negative view of this ques-
tion, as against Professor Doutrelepont, of Bonn ; Dr.
Lelair, of Paris ; Professor Nierser, of Breslau ; and Pro-
fessor Lang, of Insbruck. Of special interest was a com-
munication by Dr. Goldscheider on the
SPECIFIC SENSIBILITY OF THE SKIN.
Prolonged consideration and discussion of different
phases of syphilis was given rise to by a paper by Pro-
fessor Pick on
EXCISION OF THE INITIAL SCLEROSIS IN SYPHILIS,"]
and other communications.
Questions as .to tubercular conditions cropped up in
others of the sections, as in that of pathology and morbid
anatomy, the impulse to the discussion being given by
a paper of Professor Chauveau, of Lyons, on the
IMPORTANCE TO BE ATTACHED TO TUBERCULOSIS IN DO-
MESTIC ANIMALS, CONSIDERED AS A SOURCE OF TUBER-
CULOSIS IN MAN,
and a relative paper by Professor Bang, of Copenha^
gen.
In the same section Sir William Gull and Professor
Comil, of Paris, read papers on
NEPHRITIS AND ITS SPECIAL TISSUE-CHANGES.
In the section of ophthalmology of special importance
was a paper of Professor Holmgren, of Upsala,
ON THE COLOR SENSE ; |
as to which several new and interesting points were
brought forward. Another matter of interest in this sec-
tion was
THE INFLUENCE OF JEQUIRFTY IN GRANULAR CONJUNC-
TIVITIS AND PANNUS;
and of interest were papers on " Latent Squint," by Drs.
Hansen-Grut, of Copenhagen, and Noycs, of New York.
THE SUBJECT OF REf^RACTION
was introduced in a paper by Professor Schmidt-Rimpler,
of Marburg, who detailed a new method of estimating re-
fraction by means of the ophthalmoscope. The subject
was well discussed from a practical point of view by
Noyes, Berry, Juler, Sattler, and others.
THE FEATURES OF THE WORK IN THE SECTION OF LA-
RYNGOLOGY
which were of practical interest were found in papers of
Dr. F. Lemon, of London, on an " Etiological Classifica-
tion of Motor Impairments of the Lar3mx," with a rela-
turc by Dr. Cadier, of Paris, on ** Paralysis and Parescs
of the Larynx.'*
Dr. Lcfferts, of New York, read a very interesting paper
on the " Operative Removal of Foreign Bodies from the
Air- passages."
Dr. Cohen read a paper on " Prognostic Significance
of the Several Local Manifestations Observed in Tubercu-
losis of the Larynx."
In military medicine, Dr. Schmulewitsch's paper was
one of interest ; but some subjects put down in this sec-
tion were discussed in the surgery section by the two sec-
tions jointly, viz., those on antiseptics.
OPERATIVE TREATMENT OF MALIGNANT RECTAL AFFEC-
TIONS.
Professor Esmarch, in his paper on this subject be-
fore the surgical section, laid down the same principles of
treatment for cancer of the rectum as for cancer else-
where. Removal of the disease must be early and entire.
Cases were usually recognized too late, being earlier
treated as piles, and a rectal examination too long de-
ferred. The affection was painless in the early subject
Experience showed that after early and total removal a
permanent cure resulted. The lymphatic glands were
affected late and rarely. Czemy had cases of permanent
recovery, although the disease had existed for three years.
The prognosis was, therefore, good. First, as to principle,
the amputation of the rectum above the limits of the dis-
ease was in every case indicated. The dangers were
hemorrhage — which was to be controlled by care, double
ligature of all vascular parts divided^ — and infection, which
was to be guarded against by irrigation and drainage.
To permit the faeces to pass, a large rubber drain was
needed, surrounded by sublimated gauze. The perito-
neum must inevitably be opened where amputation was
high. Modem methods had reduced the mortality to
twenty per cent., and the troubles resulting from the
operation were insignificant. Suture of the two ends to*
gether was bad, causing gangrene and stricture. The
anus and sphincter were to be leffc, and the coccyx need
not be excbed for space.
Professor Verneuil said he had done his first colot-
omy Uiirty years ago, and his first extirpation fifteen years
ago. He at once found the removal of the disease was im-
possible, the patients objected or refused in many cases to
allow the performance of colotomy. He then found the
September 6, 1884. J
THE MEDICAL RECORD.
275
incision of the cavernous stricture removed all complica-
tioQS and gave all the other advantages of colotomy. The
whole length of the stricture must be split. The incision
was made from the tip of the coccyx by a thermal cau-
tery plunged in to meet the tip of the finger hooked above
the stricture. Through this channel, by a canula, if nec-
essaiy, an toraseur diain was passed, and the rest of
the division completed. No blood was ever lost, and
symptoms at once ceased. No deaths followed.
Professor Tr^lat denied the advantage claimed for
the rectal extirpation, and pointed out the rapidity and ma-
lignity of the recurrence. He quoted one case, which he
said was the type of many, where the removal of the can-
cer early, and when extremely small, was followed by a
speedy and malignant recurrence. In one case he found,
though the operation was normal and extra-peritoneal,
that he had the small intestine in the artificial anus, and
the patient died. He laid stress upon the color of the
mtestine, as the only- part of recognition that did not de-
ceive, being white or grayish white.
Mr. Sampson Gamgee, of Manchester, preferred the
operation of inguinal colotomy, while admitting that the
other operations had their indications, but that no one
could dominate.
Mr. Marshall, of London, in support of the state-
ments of Professor Verneuil, mentioned some cases where
sinuses had been kept open in the peritoneum by tangle
tents.
Professor Volkmann, of Halle, observed that colot-
omy, erven in Mr. Bryant's hands, was a very dangerous
operation, and that the statistics of extirpation were
better than those of the colotomy of Bryant. Cancers, he
said, varied in rapidity and malignity, according to their
locality, and in the rectum they had little tendency to in-
filtrate early and recur soon. Even in desperate cases
he had no return under long periods, in one case not for
ten years. In chronic irritation a barrier surrounded
the infiltrated carcinoma recti. The results of rectot-
omy bad improved, and would go on doing so with im-
proved technique. Asepsis and disinfection were normally
powerfiil when the peritoneum was not opened ; but when
this was opened the dangers were great, and cleansing
difficult But dangerous as extirpation was, it was not
so bad as colotomy, and recurrences were painless and
not troublesome. The comfort of patients was also in-
finitely greater than it was after colotomy, discomfort be-
ing hardly felt save in diarrhoea. The selection of the
cases, he went on to say, was also important, and he did
not operate in any case where he could not reach the
upper end of the disease by bimanual exploration under
anaesthesia. The incision should be both forward and
back to the coccyx, the anus alone being left, and no at-
tempt should be made to unite the upper with the lower
end, which should be stitched well down, and the cavities
at the sides well drained. Extirpation he characterized
as a blessed operation.
Mr. Henry Morris, of London, went over the Eng-
lish reasons for preferring colotomy in the lumbar region.
Professor Kuster said that in extirpation he al-
ways stitched down when the peritoneum had been
opened. He used iodoform in some cases, with tempo-
rary benefit. Cauterization was a proceeding from which
good results were obtained in most of the cases where a
permanent cure could not be expected. He would se-
lect either that or extirpation — ^very seldom colotomy.
Professor Pacquet, of Lille, read a paper on
UNUATERAL HYPEROSTOSIS OF ALL THE BONES OF THE
HEAD,
excision of the upper jaw, and arrest of the hjrperostosis
in all the other bones ; and he showed a preparation de-
monstrating the excision.
Professor Trelat, at the conclusion of the demon-
stration, observed that whatever might be said for the
theory of the operation, the specimen shown to the sec-
tion was one simply of osteo-myelitis.
Professor Pacquet thereupon made some amusement,
withdrew the specimen as having been submitted by mis-
take, and showed another, which he declared to be the
proi^r one.
Dr. a. Van Derveer, of Albany, read a paper on the
treatment of the intermaxillary bone in cases
OF cleft palate
with double harelip.
Dr. Reginald Harrison, of Liverpool, read a paper
on the
treatment of certain cases of prostatic obstruc-
tion BY section of the GLAND.
Professor Volkmann said that drainage through the
perineum, without incision of the prostate, was sufficient,
and that the prostate afterward shrunk.
EXCISION AND ARTHROTOMY IN TUBERCULOUS JOINT DIS-
EASES.
Professor Ollier, of Lyons, read a paper on the
above subject, containing a general examination of the
extent and results of resection and similar operations ia
tumor albus. Dealing with arthrotomy, he said there
were no new operations. It was easy in superficial
articulations and difficult in others. Drainage was often
difficult, but could, however, be effected by canalization of
the joints and foci of the aflfection. If undiscoverable
they must be left. He laid great weight on the use of the
cautery in the operation of arthrotomy. He admitted
that resection beyond the epiphysial cartilages yielded
deplorable results. Arthrotomy was better in youn^
children. Amputation was no shield against the generali-
zation of the tuberculous condition, for the infiltrated
glands were left in every case.
Professor Chiene, of Edinburgh, wished to say a few
words on this subject, on account of the large experience
they had of this condition in the Edinburgh schools.
He divided the cases for operation into two classes, one
with sinuses and open, and one without sinuses and with
unbroken surface. But practically each joint must, he
said, be considered by itself. About four of these joints
— ^the shoulder, elbow, knee, and ankle — there was no
difference of opinion, the general view being that excision,
with the gouge if necessary, was the proper treatment in
the case of the shoulder and elbow ; while in the case of
the knee it was excision or amputation ; and of the ankle
amputation. About the wrist he was undecided. Canali-
zation was, however, useful about the wrist
Professor Volkmann said he spnoke unwillingly, as
the opinions were so irreconcilably different ; that much
mutual study, especially of Professor OUier's paper, was
needful before deciding. He opposed the views of Pro-
fessor Chiene. He believed all scrofulous joint disease,
spinas ventosae, etc., were tubercular, as experiments in
infection and observation of the bacillus proved. In
every case he had found Koch's bacilli. If that were
true, then the treatment was clear. Spontaneous cure
might happen, but the patient was always in danger of
generalization of the condition. Further, all local recur-
rences were due, not to the system, but to remains of the
foci left at the operation. If all were removed, as in
amputation, then the wound never became infected, but,
on the contrary, healed beautifiilly. Let them take the
disease away, stick to no typical resections, but gouge and
cut, and do whatever will remove disease. A joint could
produce general tuberculosis, but this was rather excep-
tional, and he thought the generalization must depend
on other and multiple foci — at least the reverse had not
been proved. Professor Oilier had not mentioned the Ger-
man operation. Arthrotomy was not a distinctive word.
In Germany it signified wide opening of the joint, removal
of the capsule and of the foci of bone tiU nothing re-
mained around but healthy tissue ; and then the reposi-
tion and treatment for cure by first intention, antisepti-
cally. Such operations were often huge. They involved.
276
THE MEDICAL RECORD.
[September 6, 1884.
in the knee, for example, transverse division of the
patella, removal of the disease, or, it might be, the front
and flaps, and an operation as if for extirpation of a
tumor. Professor Oilier said the operations were dan-
gerous, but he (Volkmann) had not found them so.
Professor Oilier also said that the foci could be easily
lefty and he (Volkmann) agreed, but thought that, in
regard to the knee-joint, synovial disease was the most
common.
Professor Tri^lat agreed that most of the affections
of joints, spina ventosa, etc., were really tubercular, and
he was agreed with Volkmann that the tubercular con-
dition could heal spontaneously. He was not so clear
about the diathesis. Its influence varied. It mipht,
indeed, have no influence upon the wound, but it might
certainly determine the development of other local
foci.
Professor Volkmann added that out of two hundred
and fifty cases of excision of the hip he had seen only
five or six where the disease was not tubercular.
Professor Ollier, in his reply, said he thought the
tuberculosis of children differed from that of adults. He
opened largely, so as to see and remove all disease,
divided the ligaments, and cut out foci. He highly es-
teemed the importance of the total removal of the disease,
yet doubted the powers they had to remove it He did
not aim at immediate union.
Dr. Joseph W. Howe, of New York, showed a large
vesical calculus which he had removed by the supra-
pubic method.
Dr. Lauenstein, of Hamburg, gave a demonstration
in Mekuluz's operation for caries of the foot, giving eight
cases with good results, four of which had been com-
pletely cured ; one only required amputation afterward
and one died.
Dr. Sklifossovsky, of Moscow, reported certain Rus-
sian cases.
Mr, MacEwen, of Glasgow, read a paper on
OSTEOTOMY FOR GENU VALGUM,
in which he related his experience with the supra-condy-
loid method.
In the discussion which followed, Professor Ogston,
of Aberdeen, said he had previously operated by a method
which had been called by his name, and it was, he thought,
now time that some conclusions should be arrived at con*
ceming the various existing methods of operating for genu
valgum. There had now been sufficient time given and
sufficient experience of these operations to enable surgeons
to arrive at some definite understanding regarding them.
He had himself operated by MacEwen' s method a con-
siderable number of times, and in such a way as to be
enabled to form a definite opinion on comparison of
these two methods. He had operated on one side of
the body by his own method, and on the other side
by MacEwen's operation exactly as described by its
author ; and he was forced to come to the conclusion
that, for simplicity and good results, MacEwen's opera-
tion was better than those he had himself advocated.
He had not for himself altogether given up his own
operation, chiefly because when one got into the habit
of doing a particular operation, one did not like to throw
it overboard altogether, being so familiar with it. But he
had for some years past told his students that MacEwen's
operation was the best, and he wished to make to that
meeting of the congress a similar announcement. He
would advise every person who wished to osteotomize for
genu valgum to adopt it in preference to his own. Re-
ferringv however, to the statistics which Professor Mac-
Ewen had laid before the congress, he said that he had
found the German surgeons, even those who at first had
adopted his own operation enthusiastically, had now
g|iven it up in favor of MacEwen's, as the better and
simpler operation of the two. That was another reason
for adopting it himself.
Professor Chiene, of Edinburgh, said that after what
he had heard, he thought it right to state that, althoagh
he could not go to £e length of Professor Ogston in
throwing up his own operation entirely, still he would
give MacEwen's operation a fair trial on his return to
Edinburgh. He thought that in all likelihood he would
be able to report as favorably as Professor Ogston had
done concerning it. It was, however, after all, the pro-
fession that were the judges of the merits and demerits
of these operations, and they had seen from the statistics
which had been given in that section, and he also knew
it to be the fact, that his own operation, whatever he
might think of it himself, had not commended itself to
the profession generally.
Professor Schede, of Hamburg, said he had put for-
ward an operation for genu valgum of the tibia which
had gone by his name, and he still practised it in some
cases. But in practising that operation he had not done
so by old ways, especially so often as he had previously
done, but had substituted for his own the operation of
MacEwen, and had by that method obtained excellent
results. He thought in many instances that the tibia
was involved, and he therefore in these cases performed
his own operation. But there was no doubt that there
was a large number of pathological points showing that
the femur alone was involved in a great many cases, and
in some equally so with the tibia. He differed from
MacEwen in this respect that, in doing his operation, he
did not use several chisels, as was recommended in Mac-
Ewen's work on osteotomy, but only one, thinking the
withdrawal of the instrument from the wound was a
serious matter, inasmuch as it sometimes led to a dis-
turbance of the parts, and to a difficulty of reintroduc-
tion of the instrument. But, along with all German
surgeons, he accepted MacEwen's operations.
Mr. Bryant, of London, said he thought the section,
after hearmg what had been said by these diree great men,
would scarcely find it necessary to discuss further the
relative value of these operations. They would all agree
that MacEwen's operation had been proven by the
statistics adduced, and also by the fact that the authors
of the other methods had now practically given them up.
He must say for himself that he had used MacEwen's
operation many times with* very great success, and it was
gaining ground where previously Ogston's operation had
been practised. He was sure the section would endorse
what had been said about MacEwen's operation being
the best one, but he could not sit down without express-
ing the very great pleasure he felt at the manner in which
the other gentlemen had given up what he might call
their pet operations. Professor Ogston had done this
with the greatest possible grace, and he (Mr. Bryant) was
sure the section would award him and the others a vote
of thanks for the manner in which they had acted.
Dr. V. Robin, of Lyons, next read a paper " On a
New and Perfected Method of Osteoclasis for Genu
Valgum," with eighty photographs of patients operated
on after this new system.
Mr. W. Adams, of London, read a paper demonstrat-
ing a series of photographs taken from cases of
dupuytrkn's finger contraction.
He took occasion to correct what he said was in the
books, the anatomically imperfect description of the fascia
and its relation to the tendons of the hands, with a special
view to the pathology of this afiection. His own opera-
tion for the cure of the condition, which he described at
length, he designated as a happy combination of the
tenotomy of Dupuytren first described in 1831 with the
subcutaneous surgery of Stromeyer ; its object being to
deal with the fascia at fault, as well as the tendons. As
to the pathology of the condition he still adhered to his
own view that it essentially depended on a chronic gouty
thickening of the fascia.
In answer to a question as to the return of the condi-
tion after operation, he said that in his own cases he had
found no severe ones of return and bad never seen much
September 6, 1884. J
THE MEDICAL RECORD.
277
tendency to it. The great majority remained free from
it for life.
THE LISTERIAN ANTISEPTIC TREATMENT.
In the absence of Professor Sir J. Lister, of London,
who was to have opened the discussion of the present form
of his treatment. Professor Esmarch introduced the
subject with a paper, f He began by expressing regret
at the absence of Lister, the illustrious master and
teacher of them all. He then went on to describe the
method of treatment now followed in his own clinique.
The aim was the avoidance of suppuration in any case,
and the leaving of the wound undisturbed. This was
best done by a permanent dressing preventing the en-
trance of germs. The postulates were, first, exact
luemostasis ; second, the avoidance of cavities in the in-
terior of the wounds ; third, drainage, artificial ischsemia,
application of multitudes of catgut ligatures on great and
small vessels, and bandage applied before removal of
toomiquet, support of all the deep parts by sutures, curl-
ing in the edges of the skin, and pressure. The drainage-
tube, as preventing healing, was not now used by him,
but openings were left for escape of exudation.
Asepsis was minutely studied The bandage strips
were sterilized by dry heat and sublimate. The spray
was used only before operation, so as to disinfect the air
in the room. During one operation distilled water with
salt only of specific gravity of the blood, was used for
irrigation, but at the end sublimate was employed
Occasionally other antiseptics, as iodoform, were used.
For bandage material, loose, absorbent, soft matter was
needed. Peat was useful in pillows f no Mackintosh), dip-
ped in carbolic lotion. Then immooilization of the parts
was obtained by glass splints till healing by first intention
occured The latter took from eight to ten or fourteen
days to five or six weeks after operations.
Dr. Mostig-Moorhof advocated iodoform treatment
of wounds, and said he operated with no other antiseptic
He used cold water during operations. There was no
irritation and certain asepsis. Iodoform prevented trans-
udation of the white blood-cells. He narrated a case of
traumatic septic gangrene extending above the knee,
where yet the knee-joint was found aseptic at the post-
mortem examination. Iodoform, also, was a substance
that diminished pain.
Dr. Schede said that the principles of antiseptics re-
mained unaltered, though the methods had changed.
After his training in Halle, when called to Berlin, he
found Lister's method perfect in its results. But on suc-
ceeding to Marten, at Hamburg, he had never had perfect
success with Listerism ; he was now unable quite to ex-
clude accidental wound disease from his cases. The
hospital was old, and in many respects undesirably ar-
ranged and situated He tried iodoform without good
results. On the reports as to the substance he had re-
solved to try the sublimate dressing, and now, after ex-
perience, had got with it brilliant results. Erysipelas at
once disappeared, not one case had since occurred under
the dressing in his clinique. There was neither septicae-
mia, pyaemia, nor irritation. Wounds had occurred ; but
they were dry, and showed a great tendency to heal by
first intention. His impression was that it was equalled
by no other plan. He now used a solution of i to 500,
and had no case of poisoning with these strengths.
SoDoetimes, however, there was tenesmus of the rectum.
Children especially tolerated the sublimate wonderfully.
In the final dressing he tried to keep everything dry.
Dr. Mikuucz did not agree with either Moorhof or
Schede. In his clinique, which was much worse than
Schede^s, he had had no erysipelas with iodoform. But
iodoform could not be used alone. Other soluble sub-
stances must be applied where its insolubility prevents
its fulfilling the indications. He disinfected with carbolic
or sublimate solution, and had no spray. In the vagina,
etc., he plugged the canal with iodoform gauze ; in rec-
tum, stitched one side and the upper end of the sphincter.
and had no drain, even where the peritoneum was opened.
Poisoning occurred only from excessive use.
Professor Neudorfer, of Vienna, said the aim of
antiseptic surgeons was the same, but the methods varied,
and must of necessity vary, almost to infinity. Our
knowledge was limited ; they knew that decompositions
occurred, but nothing as to how, how far, or how intensely
they did so. Each surgeon was satisfied with his own
plans and really got good results. But statistics were not
of much value. They must study rather in the direction
of sepsis. Sepsis needed water ; therefore he never used
water in his wound treatment. He used no sponges, but
a dry towel crumpled together to wipe up the blood and
wring it out. The serum of the blood was a matter that
should be studied ; oxidation and deoxidation were im-
portant processes. Therefore he used in his wounds
peroxide of hydrogen and had found singularly good re-
sults.
Professor Buchanan, of Glasgow, said the discussion
of antiseptics without Lister was like the play of Hamlet
with the Prince of Denmark left out. As a representa-
tive of Scotland, the home of antiseptic surgery, a col-
league of Lister, and one who had witnessed his earliest
results, he wished to contribute a few words to the dis-
cussion. He agreed that the principles of antiseptics
were always the same, though the methods might vary ;
and he described the method now employed in Glasgow.
Dr. Schelkley, of America, said the tendency to dis-
ease, sepsis, etc., was different in different races. His
practice had been in the tropics. First he used thorough
Listerism, but never got healing by first intention, but
always slight surface sloughing and healing by second in-
tention ; yet no pus and no fever. He then changed his
plan, ceased to spray, and irrigated during the operation
with salicylic acid or sublimate, and iodoform dressings
or boric lint. Salicylic and iodoform gave the best re-
sults, yet he did not get '* first intention."
Professor KoeberlA, of Strassburg, said that since
1884 he had u§ed only linen to wipe his wounds, and
had had no case of erysipelas among his operations since
then. He claimed to have better results than Schede ;
even his ovariotomies were ail cured.
Professor Plum said that the Danish surgeons agreed
entirely with the German, but he was prevented from
agreeing with Esmarch's plan on account of its cost.
The chief antiseptics were soap and brush, and by simple
means much might be done.
Professor Tr^lat said he had, three years ago, laid
down the following lines : Make the wound of a form suita-
ble for healing by first intention, and perfectly adapted.
Leave no foreign body in the wound, either mechanical
or septic Antiseptics did not exist in some countries —
not on the top of Chimborazo-^and half-educated Ameri-
cans did wondrous operations on negroes. The prin-
ciples of antiseptics were not altered ; the practice was
being perfected. He pointed out the incomparable merit
of Lister, who had given them the principles ; whatever
the methods might become was of little importance. He
(Tr^lat) used the iodoform gauze-— deeply as plugs, and
superficially as required; and made a large cushion
pressed with elastic bandages to the wound, changing
the dressings on the fifteenth day.
Dr. Mostig-Moorhof challenged Mikulicz to say
that he had ever tried a thorough iodoform dressing;
and if not, whence he knew that iodoform required other
antiseptics to supplement its use. At the time that
Schede had tried iodoform there was an epidemic of ery-
sipelas all over Europe, and if he would try it now he
would get better results.
Professor Plum closed the debate with a compliment
to Lister, which was received with great applause.
PHELPS' OPERATION FOR CLUB-FOOT.
Dr. a. M. Phelps, of Chateaugay, N. Y., detailed
cases and showed photographs of club-foot which he
had treated by a new operation, consisting of tenotomy
278
THE MEDICAL RECORD.
[September 6, 1884.
of the tendo Achillis, incision of the sole of the foot op-
posite Chopart's joint, cutting of the tendons and tissues
down to the bone, leaving only the external plantar ar-
tery and nerve. Afterward the foot was fixed in position
by wire hooks of adhesive plaster laced together. It
had been performed in children five years of age or therea-
bouts.
Profbssor Studsgard, of Copenhagen, read a paper
on
THE TREATMENT OF STRICTURES OF THE GBSOPHAGUS.
He had, he said, taken great interest in this question
-and in the statistics of it. Where dilatation failed, gas-
trotomy, he thought, might be had recourse to, and the
stricture dilated even from that. In his practice in cav-
ernous stricture one case had survived for seven, one for
•six, and one for five months after the operation. In four
of stricture from cicatrix, two died arid two survived. In
pressing cases, where the gastrotomy could not be per-
formed in two stages on account of nutrition of the pa-
tient, he thought that a minute opening should be made
at once, and close sutures should be axlopted. Langen-
bach made a capillary puncture for this purpose. He
recommended, as a general rule, that the operation should
be done in one sitting, the sutures not including mucous
membrane. The latter was so loose that there was no fear
•of including it. He referred to a patient upon whom he
had operated for stricture of the oesophagus, probably su-
perficial, two and a half years ago, who now fed himself
by a drainage-tube doubly bevelled at the point, and was
in a perfect state of health.
Professor Hjorth, of Christiania, adduced a case of
stricture from contraction after swallowing an alkali. No
sound could be passed below the cricoid cartilage, and
there was difficult swallowing by slow efforts. Gastrotomy
was performed, with oesophageal catheterism and elec-
trolysis applied at the part and a specially constructed
i>ougie. The positive pole was on the right side of the
neck ; first five, then ten, and finally fifi^een cells were apt
plied, and after an hour the bougie went through suddenly.
Stricture three ctm. long. No bad results followed, and
a repetition of procedure was gone through twelve days
later. The patient could now swallow, and soon flesh and
solids were swallowed, and a No. 19 bougie (Charriire)
went through from below and above. The largest bougies
jiow passed, and the patient was well nourished A fort-
night later he ^Professor Hjorth) closed the gastric
vfistula by a vivincation operation and a bridge trans-
planted b^ glissement. For such catheterism the car-
'diac openmg must be large enough to admit the finger.
The cardiac orifice was found without much difficulty,
especially if a curved staff bougie was first passed up.
To cure the gastric juice digestion of the wound after
the first operation, he found the bismuth dressing valu-
able. He therefore advised gastrotomy and treatment
irom below for oesophageal cicatricial stricture, and sec-
ondly the use of electrolysis.
Professor Verneuil once saw a stricture from alco-
hol There was no malignancy and no caustics in the
xase, alcohol being the sole cause of the condition. He
approved of the conclusion of the operation in one sit-
ting. He sutured closely and opened very minutely,
about the size of a No. to English catheter, and nothing
escaped. The sound was lodged and stitched in, and no
harm ever resulted, the antiseptic dressing being ap-
plied. So long as the patients could swallow, and a fine
sound be passed, dilatation was the proper treatment,
especially by the permanent lodgment of a red nibber
sound ; and the patients could be brought to go about
all their affairs with this sound in, it being withdrawn
when they wished to swallow.
Professor Sch5nborn warned the section against
gastrotomy when the patient had bronchial symptoms, as
these probably indicated the involvement of a bronchus.
He approved of the operation being done in two sittings.
' The piece of stomach fixed in the wound had, however, |
in some of his cases, become spontaneously perforated
from deficient nutrition.
M. Petit, of Paris, gave some very elaborate sta-
tistical details as to 155 operations, with two per cent
cures and twenty-seven per cent, deaths. This was be-
fore antiseptics were employed.
Mr. Thornton, of I^ondon, spoke of one case from
hair swallowing. He proceeded to make a median in.
cision, opening the stomach oy transfixion, the peri-
toneum being protected by packed carbolized sponges.
Removal of the mass was affected, and the stomach
sutures were made in a double row, deep and superficial.
There was subsequently right parotitis and, incision, but
no pus. Left parotitis was treated by belladonna cata^
plasms. He found a sponge had been left in the peri-
toneum, chiefly by localized pain and counting the
sponges. On opening the abdomen to remove the
sponge he found the stomach wound healed.
Mr. Bryant, of London, said he found one row of
sutures enough. He described the minute opening of
the stomach adopted by him. His colleagues in Guy's
Hospital had, in six operations, used clamping, drawing
out the stomach by two rubber-shield forceps, and used
no sutures. One patient subsequently married and had
a child. In her case, two and a half years after the
operation, she suddenly found she could swallow liquids
and solids, such as bread, fish, and minced meat. She
still had the fistula, and Mr. Bryant had advised her to
leave it alone, as she was quite dry, even after a laige
meal.
Professor Sklifporoswskv advised cesophagotomy,
and subsequent dilatation through the wound.
Professor Hjort said fifteen elements were neces-
sary in electrolysis.
M. Ollier advised, in preference to operations,
wherever possible, the use of the minutest whalebone
bougies, one-half mm. in diameter, and the treatment on
the principle which Syme, of Edinburgh, had enunciated
for the urethra, viz., that no case was impermeable. He
admitted this was sometimes excessively difficult, but it
was always possible, and then dilatation was often ex-
tremely easy.
SURGICAL ANifiSTHESIA,
Dr. O. Wanscher, of Copenhagen, in a paper on this
subject, dealt with anaesthesia by irectal insufflation of
ether vapor. PirigofPs first attempts were not attended
with good results. Duping and others tried the method,
but it fell into disuse. Two years ago he (Dr. Wanscher)
a^ain took up the subject, and his experience had con-
vinced him that it should be revived, especially in aid
of other methods, so as to improve the respiratory organs.
There must be preliminary cleansing of the rectum, and
insufflation of the vapor through a warmed reservoir.
He narrated cases.
Dr. Jennings, of London, said that unless the epi-
glottis were drawn forward by a sutur6 put through it, it
fell down during respiration, and unless this were done
tracheotomy should not be performed. In experiments on
dogs with chloroform, the epiglottis was secured forward,
the tongue drawn forward, and the chloroform admin-
istered until the heart stopped, and more was then given
until artificial respiration failed to restore its action.
Then the jugular vein was opened, a canula put in tow-
ard the heart side, and a saline fluid injected, while
bleeding from the peripheral end was allowed to go on.
The dog recovered, but, from the amount of blood lost,
was likely to die. He then injected the quantity of
blood corresponding to the excess of blood lost, and the
animal recovered.
MASSAGE.
Dr. Tubelerdowsky, of Berlin, in a paper on this sub-
ject, said he knew a lady in Berlin who took a pain in her
knee every time her husband had an attack of angina
pectoris.
Dr. David Prince, of Jacksonville, III, read a paper
September 6, 1884.]
THE MEDICAL RECORD.
279
upon ** Palatoplasty with a New Instrument," and demon-
strated his needles.
Professor Moore, of Rochester, N. Y., read a com-
munication on
LUXATION OF THE ULNA IN CONNECTION WITH COLLSS'
FRACTURE.
Id this fracture, he said, there was also an accompanying
displacement of the lower end of the radius. After the
radius gave way the attachments of the triangular cartilage
and internal lateral ligament, acting on the styloid process,
broke it off, or were themselves torn. In continuation of
the force the ulna was shot on, and, penetrating the fascia
and skin, might become compound. He advised reposi-
tion under chloroform, with subcutaneous division, if
needful, in recent cases. In old standing cases he re-
sected the lower end of the ulna. His method of re-
duction was by flexion and pronation over the knee, and
he retained it with finser and thumb. He then laid a
slender splint and rolled bandage, three-fourths of an inch
in diameter, and fixed it by a strip of plaster drawn up as
I tighdy as possible. The hand was allowed to drop, and
! a sling of bandage the length of the plaster strap put over
the spot.
DiL Oscar Wanscher, of Copenhagen, read a paper
on the
TORSION OF LAltGE ARTERIES NEAR THEIR BIFURCATION.
He had, he said, had no cases of his own, but he had ex-
perimented on animals on torsion and refoulement, and
he demonstrated the results.
\ Professor Plum, assuming the chair, thanked the
audience, the presidents, the speakers, and the bureau,
and bade all au revoir d Washington en 1887.
(To be oontmued.)
SHALL ARMY SURGEONS PRACTISE OUTSIDE
THEIR POSTS?
To THs Editor op Thb Mbmcal Rxoobd.
Sir : The accusation of unfairness from one who hides
himself behind the wand of the god of dissimulation, etc.,
falls flat ; and the letter he writes to prove it fails lament-
ably. The mental obtuseness which prevented my
seeing things as some medical officers see them, still
prevents me firom acknowledging the fairness of this ac-
cusation. The '^ extract from a letter'' simply begs the
question.
1 shall be more than glad, if it can be shown that any
statement in my letter is not strictly just and fair. The
"extract" simply proves that the custom of which I
complain dates farther back than I had supposed, from
what had been told me by *' officers and gentlemen " in
die army. That does not make the custom any more
proper, nor does it prove any statement of mine unfair.
I see nothing in this *' extract" to convince any one that
it is fair and honorable for an adequately salaried army
surgeon to employ most of his time in practising outside
his post, when by so doing he is necessarily brought into
competition with physicians who have not the advantage
of an assured and regular income outside of their prac-
tice. I must reiterate, that it is unfair and unjust com-
petition; and no amount of '* extract" is going to alter
that FACT.
The argument that it would be ungracious to deprive
a suffering public from consulting army surgeons looks
pretty, but is unmitigated bosh. If that will apply to
any one branch of the service, it must apply logically to
aU others. Imagine a suffering public seeking legal ad-
vice from the law officers of the Government in ordinary
legal matters. Imagine also the frame of mind of civil
attorneys-at-law et al. under such circumstances.
With all due respect I would submit that the average
army surgeon who does outside practice, is actuated
more by a strong desire for the accruing fees than by
any purpose of " becoming familiar with disease under
all circumstances," etc., however beautiful and lofty such
a purpose might be. I am of the opinion, rather, that the
purpose kept steadily in view is mainly in regard to that
** which relates exclusively to (the army surgeon's) private
interests.*'
Notwithstanding the ^* extract from a letter " with its
specious argument, I am still of the belief that it is not,
and has not been, the general custom for army surgeons
to do or seek outside practice except under exceptional
circumstances, which do not obtain here. If at small
posts ''it has been found much more satis&ctory, for
military reasons, to have the duties of post surgeons per-
formed by a regular medical officer," it would be equally
satisfactory, for civil reasons, that he should confine him-
self to his appointed duties, and not encroach on what I
claim is no legitimate neld for operation. Stripped of all
sentiment, the army surgeon is a public servant and is
paid for his services. If he has plenty of time to devote to
outside practice, then he is paid too much for what
little service he does render, and therefore receives more
than he is justly entitled to ; or if it is proper to practise
in the region about him, to the end that he may not grow
nisty and thereby inflict injury on the service generally^
then it is not proper for him to receive fees for so doing,
since by his own admission he is only striving to main-
tain his standard of excellence.
The attempt in this ''extract" to throw upon us phy-
sicians the odium of trying to prevent army surgeons
from familiarizing themselves with the "maladies pre-
vailing through the country and among citizens generaUy,"
will fail simply because it does not contain the elements
of common-sense.
It will require more proof than is adduced by " Cadu-
ceus*' to convince any one that practising outside of
posts by army surgeons /<?r /ay is proper, while they are
on full salary from the Government.
Very truly yours,
John G. Stanton, M.D.
New London, August ao* 1884.
OBESITY AND THE SEXUAL FUNCTION.
To THB EDfTOK OP T^ BiBDICAL RSOOXH.
Sir : In your issue of this date, at the bottom of the first
column of page 183, I notice an explanation of the fact
that women are more subject to obesity than men which
strikes me as very odd. It is contained in these words :
**The lesser activity of their sexual life." I feel that I am
not alone in failing to understand the meaning of this
phrase. You surely do not mean that men copulate
more frequently than women ; and yet what else can you
mean ? Yours respectfully,
Youthful.
August 16, 1884.
[We refer to the generally accepted fact that women,
as a rule, experience sexual feelings less intensely and less
frequently than men, and to the fact that the mass of re-
spectable women masturbate less and have intercourse
less often than men. — Ed.]
The Rights of a Defendant on Trial for Rape.
— A court in a Western State has recently held that, upon
the trial of a person indicted for rape upon a female
child, evidence is admissible of the answers given by the
girl, two or three days after the alleged injury, to the ques-
tions of her mother, induced by the girl's singular de-
meanor. A hypothetical question put to a physician,
whether in his opinion the facts assumed would constitute
rape, is altogether improper, being a demand for his legal
instead of his medical knowledge. Yet, if he gives a cor-
rect answer, the impropriety of the question is no ground
for a new trial
28o
THE MEDICAL RECORD.
[September 6, 1884.
I^rms MexoB.
Official List ef Changis in the Statums and DuOis of Officers
serving in the Medical Department y United States Army,
from August 23 to August 30, 1884.
Head, John F., Colonel and Surgeon. Granted leave
of absence for four months. S. O. 20 j, A. G. O., Au-
gust 27, 1884.
WooDHULL, A. A., Major and Surgeon. Detailed as
member of Medical Examining Board at U. S. Military
Academy, West Point, N. Y., vice Captain R. H. White,
relieved. Upon adjournment of the Board to return to his
proper station. S. O. 201, C. S., A. G. O.
LiPPiNCOTT, Henry. Promoted Major and Surgeon,
to rank from August 17, 1884, vice Woodward, deceased.
Bartholf, J. H., Captain and Assistant Surgeon. Re-
lieved from duty in Department of the Columbia, and to
report in person to Commanding General, Department
of Texas, for assignment to duty. S. O. 199, A. G. O.,
August 25, 1884.
FiNLBY, J. A., Captain and Assistant Surgeon. The
leave of absence granted him in S. O. 91, C. S., Depart-
ment of Texas, extended two months. S. O. 198, A. G.
O., August 23, 1884.
Taylor, M. £., Captain and Assistant Surgeon.
Granted leave of absence for four months, to take effect
on arrival of a Medical Officer at David's Island, N. Y.,
to replace him. S. O. 200, A. G. O., August 26, 1884.
Gibson, R. J., First Lieutenant and Assistant Sur-
geon. Relieved from duty in Department of the Mis-
souri and ordered to Department of California for duty.
S. O. 202, A. G. 0-, August 28, 1884.
DiETZ, William D., First Lieutenant and Assistant
Surgeon. Relieved from^duty at the Military Academy,
West Point, N. Y. , and ordered to the Department of the
Missouri for duty. S. O. 202, A. G. O., August 28,
1884.
McCaw, Walter D. Appointed Assistant Surgeon,
with rank of First Lieutenant, to date from August 20,
1884.
pcedical Items.
CoiiTAGious Diseases — ^Weekly Statement. — ^Re-
port of cases and deaths from contagions diseases re-
ported to the Sanitary Bureau, Health Department, for
the week ending August 30, 1884 :
Week Ending
Gmm.
August 23, 1884
August 30, 1884
Deatkt.
Xugust 23, 1884
August 30, 1884
Stigmata Maidis in Gonorrhoea. — Dr. Bennett says
that he has had unusual success in the treatment of gonor-
rhoea by fluid extract of com silk (stigmata maidis). To
him the treatment was quite novel, while it has been a
great comfort to the patients, who were entirely relieved
within a week, and very often in three days. He de-
pended alone upon the com silk, and of course made no
error in attributing success to that drug. A half-teaspoon-
ful to a teaspoonful of the fluid extract three times a day
will prove eflectual in male or female. — Therapeutic
Gazette,
" Death owing to visitation of Providence under sus-
picious circumstances," is a coroner's verdict in Muns-
ten
A Curious Freak of Nature. — Dr. Marvin, Rea.
dent Physician of the Saginaw Hospital, East ^naw
Mich., sends us the account of a very curious occurrence!
" A few days ajgo," he writes, " while Dr. Ross, Surgeonl
in-Chief of Saginaw Hospital, was attending a case of ob-
stetrics, he met with a peculiar freak of nature. After
the child was delivered and the umbilical cord severed,
he found a shred of membrane passing into the child's
mouth and seemingly fast there ; on following it to the
vulva on the mother he found it was attached internally.
He severed the shred, and by further examination found
that it passed into the child's moutlf behind the soft pal-
ate and out through the left nostril, and was tied in a
slip-knot around the part that entered the mouth. After
the secundines were removed the other end was followed
to its attachment, which was on the placenta near the
umbilical cord. It was there found it started in a shred
about three Angers in width, and diminished until it was
about one-fourth of an inch wide where it entered the
mouth ; from that point it kept up a uniform width to its
end" Dr. Marvin encloses to us the specimen, so that
we can verify his description.
The Question of the Florida Climate.— Dr. R.
A. Lancaster, of Gainesville, FUu, writes us a letter in
defence of the Gainesville and the Florida climate, sup-
plementing; Dr. Bradner*s letter. After some rather per-
sonal criticism of Dr. Boyland's views, he concludes:
" That many consumptives do die in Florida, however,
all will admit, and I think their physicians are to be cen-
sured for sending them away from the comforts of home
when they are so evidently beyond sdl hope of recovery;
but that Uie lives of many consumptives have been pro-
longed, and many catarrhs and cases of bronchitis of
long standing have been permanently cured, is a fact
that no honest observer will deny. This 'Question of
the Florida Climate ' is one of paramount interest, not
only to the profession, but to countless invalids through-
out the United States. Now, how can the truth be
known when there are so many conflicring statements
regarding it? Would it not be a capital idea for the
American Medical Association to appoint a commission
of unprejudiced and uninterested men, to come and
spend some months in Florida and make an official re-
port of what facts could be gathered, both as to Florida
in general and as to particular localities ? No doubt
physicians of note could be found who, on account of
catarrhs, bronchitis, etc, would be glad to spend a few
months in our genial clime. Will not Dr. John T. Met-
calf, of New York, favor the readers of The Medical
Record with his views of Florida as a health resort ? I
am told that he spent several months in and around
Gainesville some years ago."
The Removal of Bodies from one Burving-ground
TO Another. — The question of the right to remove the
body of a person from one resting-place to another is
frequently up before the courts for determination ; but
an unusually curious instance occurred recently in Brook-
lyn. A gentleman named Gardiner H. Wolcott, residing
in Astoria, died in t88i, and was buried in Greenwood
Cemetery. He was supposed to be intestate, and his
property, amounting to about forty thousand dollars, was
divided up between his heirs. Not long since a will was
discovered directing that his body should be buried in
Greendale Cemetery, Meadville, Pa. An application
was then made to the Surrogate for a sufficient allowance
to carry out this wish, which was opposed by the relatives
of the deceased man, who would be obliged to contribute
their respective shares to meet the expense. The deci-
sion of the Surrogate was to the effect that, as the estate
was divided up, and the relatives opposed the reinter-
ment, the body must remain where it was.
The Medical Record
A Weekly yournal of Medicine and Surgery
Vol. 26, No. II
New York, September 13, 1884
Whole No. 723
©riflitml Ji^rtijcIjeB.
SUCCESSFUL OESOPHAGOTOMY FOR THE
REMOVAL OF FOREIGN BODIES.
By LKROY McLean, M.D.,
SUKGBON TO TROY HOSPITAL, TROV, K". Y.
Ik the number of this journal for April 29, 1876, I re-
corded two cases of oesophagotomy. To those I have
now to add three others, malung in all five oesophagoto-
mies done for the removal of foreign bodies. A summary
of the two cases referred to will, I think, be of interest
in connection with those I am about to report
Case I. Tooih-flaie swallowed during sleep ; cesopha-
l^my; recovery. — Mr. C , of West Troy, N. Y.,
daring sleep swallowed a gold tooth-plate with one cen-
tra] incisor attached. The plate, which was crescent-
shaped, measured from point to point one and a half
inch, and one-half inch from outer to inner edge. On
die outer edge were eight
sharp and irregular projec-
tions which fitted between
the teeth and held the
plate in position (see Fig.
I saw him tl^ee days af-
ter die accident, after many
attempts to dislodge had
been made, and after the
Fig. zJ
conclusion was reached
that the foreign body had
been pushed into the stomach. He was sufifering intense
pain ; neck swollen and inflamed ; all nourishment regur-
gitated ; voice faint and husky. The foreign body could
be easily grasped with oesophageal forceps, but the appli-
cation of much force to dislodge it was deemed impractica-
ble owing to the many points of resistance which the sharp
projections on it offered. The operation was performed
the following day. Incision on the left side three inches
long, extending from top of thyroid cartilage downward,
midway between it and the sterno-cleido-mastoid. Upon
reaching the oesophagus a large-sized lithotomy stafif was
introduced through the mouth and the oesophagus pushed
forward, into which a longitudinal incision was made, the
hnger introduced, and the foreign body with much diffi-
culty removed fi-om its resting-place just below the
cricoid cartilage.
The wound in oesophagus was not closed. For the
first day eneniata of beef-tea were given, and bits of ice
allowed to dissolve in the mouth. After twenty-four
hours was allowed to drink milk, one-third escaping from
wound. Third day, could swallow fluids readily, very
little escaping. Fourth day, ate an oyster, swallowing it
without experiencing pain. Fifth day, sat up dressed ;
could readUy swallow soft solids ; no discharge of fluids
by wound. Sixth day, was out of doors. Twentieth day,
resumed business; wound entirely healed.*
Case II. Tooth-plate impacted in cardiac portion
9f ouophagus eleven months^ causing stricture ; (esopha-
ioiomy ; recovery, — Mr. P , of Gansevoort, N. Y.,
while at dinner dislodged four upper false teeth attached
to a silver plate by striking them with his fork. They
I He is, at this daMC(Jaly, 1884) enjoying good health.
Fig. 3.
were involuntarily swallowed, passing into the oesopha-
gus. The plate was one and a half inch broad, by
about one inch in depth from
front to rear (see Fig. 2).
His physician was summoned,
but did not arrive until evening,
when an attempt was made to
reach the teeth. Instruments
were passed down over ten
inches, but failed to give any in-
dications of touching them, leav-
ing the inference that they might have passed into the
stomach. This was strengthened by a sharp and severe
pain which he felt in the region of the stomach. Within
a fortnight most of the pain and soreness had passed away,
and he was enabled to swallow liquids without difficulty
and most kinds of food with var3ang success. He fre-
quently passed weeks without any marked inconvenience;
at times, however, there would be unusual distress in the
chest, or a return of the difficulty of swallowing. He
first consulted me ^ months after the accident, when I
found that the teeth were still in the oesophagus, eleven
and a half inches from front of upper jaw while the
head was thrown back. An operation was advised : thb
he wished to delay, as he was not sufifering essentially.
For five months nothing was done, when, as he was
having great difficulty in swallowing, I was consulted.
Ab operation was again advised, to which he assented.
7%is was eleven months and seven days from date of cu-
cident. The incision was made on the left side of the
neck, commencing opposite the thyroid cartilage and
reaching to the sternum. The oesophagus was reached
without difficulty, and an opening large enough to admit
the finger made in it as near the sternum as possible.
Passing a finger through the incision and downward a
constriction was felt, below which lay the foreign body
quite out of reach. A polypus forceps was then directed
by the finger down upon the plate, which was soon
brought up, without the teeth, however, they having be-
come detached in the eflFort at removal. The teeth were
voided by the rectum some days after. Wound not closed.
He began to take liquid nourishment by mouth on the
third (3&y. On the thirteenth day walked out of doors.
Owing to a troublesome cough the wound did not close
until the sixth week, at which time he resumed his busi-
ness. He rapidly regained his health, which at this
writing is still excellent.
Case III. An infant swallows a penny ; cesophagot*
omy : recovery, — E. F , aged sixteen months, re-
siding in Lansingburg, N. Y., while playing with an ordi-
ixary nickel cent, put it into his mouth and swallowed it.
The family physician. Dr. Capron, who was immediately
summoned, after carefully examining the child concluded
that the penny had passed into the stomach, and directed
that the stools be watched. On the 27th he was again
called and found that the child was regurgitating most of
the food taken. A probang, with sponge attached at
end, was passed to the stomach. This for a time seemed
to afiford relief. On the 28th and 29th an olive-pointed
probang was passed with no eflfect, the food being per-
sistently regurgitated. I was called to the case on the
30th. The patient was then refusing absolutely to take
nourishment, and was beginning to sufifer from want of
food. The olive-pointed and sponge probang was again
introduced, but as they gave no indication of contact
with the foreign body, a metallic catheter guide (Otis*)
282
THE MEDICAL RECORD.
[September 13, i9Z^
Fig. 3.
was passed. A distinct click was heard as it was moved
up and down within the oesophagus. The sponge pro-
bang was again tried but the penny could not be dis-
lodged, the instrument passing beyond it at each intro-
duction. The point of impaction seemed to be at a
point on a level with the clavicle. On the 31st another
effort was made with a like result As the child was be-
coming rapidly reduced from inanition, an immediate
operation was decided upon.
. With the assistance of Dr. Schuyler, Dr. Capron, and
the Drs. Bucklin, of Lansingburg, the operation was done
at 1 1 A.M. The incision was made upon the left side.
The dissection was exceedingly slow and tedious, owing
to the minute anatomy of the patient. The oesophagus
was nnally reached without tying a vessel. A small
laryngeal brush-holder, to which was
attached an ivory tip, was substituted
for the lithotomy staff in pushing the
oesophagus forward ; with this excep-
tion, the various steps of the operation
did not differ from those in previous
cases. The penny (see Fig. 3) was
found where it had been located pre-
vious to the operation, i.if., on a level
with the clavicle. It was removed with a Gross polypus
forceps. The wound was not closed. The recovery was
rapid and complete. No impairment of voice.
Case IV. A tooth-plate swallowed while asleep ;
removed by oesophagotomy twelve years after ; death,
— J. F , aged thirty-six, of Albany, in August, 1869,
swallowed while asleep a tooth-plate with two central
incisors attached. The plate,
which was of rubber, measured
one and a half inch in width,
and one and one-fourth from
front to rear ^see Fig. 4).
Medical aid was sought at
once, and efforts made at re-
moval. It was finally concluded
that the plate had passed into
the stomach, as he felt greatly
relieved after the introduction
of the instruments. He was then
removed to the city hospital, and kept under observation
for some days ; but as nothing resulted, and as he felt
perfectly well, he left the institution and the city to make
his home in Omaha. For ten years he suffered no pain,
and but little inconvenience, and then only when large
pieces of food were swallowed. During the next two
years, however, the difficulty in deglutition greatly in-
creased, until it was almost impossible to swallow even
fluids. Believing that he could not long survive this con-
dition, he concluded to seek medical advice. Getting
no encouragement in the West from physicians whom
he consulted, he came to Troy seeking the counsel of
his relatives.
I saw him then for the first time. This was twelve
years and two months from time of accident. He was
greatly emaciated. Most of the liquid nourishment (the
only form in which it could be swallowed) taken was im-
mediately regurgitated. His face bore an anxious ex-
pression ; was very solicitous as to the immediate future,
and begged that something might be done for his relief.
Upon passing an olive-pointed probang, an impassable
obstruction was found eleven inches from incisor teeth.
As the instrument gave no evidence of contact by sound,
it was inferred that the foreign body had become en-
cysted, and all efforts at removal in that direction were
abandoned. The operation was done at the Troy Hos-
pital, November 2, 188 1, with the assistance of Drs.
Schuyler and Nichols, and other members of the hos-
pital staff Owing to his extreme emaciation the oesoph-
agus was easily and quickly reached, and opened at
the lowest possible point. By introducing the finger it
was possible to reach the obstruction. It was then
found that, with the exception of a tip of one of the
Fig. 4-
wings, the plate was completely encysted. By the aid
of the finger and an oesophageal forceps, the plate, after
prolonged effort, was lifted from its resting-place.
A single suture was introduced at upper end of ex-
ternal wound, otherwise it was left open as in previous
cases. A nutritive enema with brandy was administered
and the patient put to bed. Then for the first time a
peculiar wheezy and labored respiration, and slight em-
physema in the wound, were noticed. He did not rally
well ; though he was enabled to swallow considerable
milk and brandy (by holding the edges of the wound to-
gether) and retain the enemata, he gradually sank. The
emphysema increased, the respiration became more em-
barrassed, and the exhaustion more pronounced, until
the time of his death, which occurred forty-eight hours
after operation.
The autopsy was made twelve hours after death. The
wound was found to be healthy. There was no evidence
of inflammation of parts at the point of impaction of the
plate. Search was made for the cause of the emphysema
which appeared immediately after the operation. It was
thought that during the removal of the plate firom its
surroundings a slight perforation of the trachea had
occurred, but the most careful search revealed nothing,
however, to confirm this belief.
The conclusion finally reached was, that during a
violent fit of coughing at the time of the administration
of the anaesthetic the expiratory effort ruptured some of
the air-vesicles, the air first escaping into the cellular
tissue between the lobules of the lung, then into the
mediastinum, and from thence to the root of the necL
The presence of dyspnoea after the operation would
seem to strengthen this belief. He undoubtedly died of
exhaustion.
Case V. Tooth^late swallowed while asleep ; eesopK
agotomy ; recovery. — Mr. K , aged thirty-eight,
residing in East Greenbush, N. Y., on April 9, 1884,
retired at 12.30 a.m. About 3 a.m. he was suddenly
awakened by a sharp burning pain in his throat
Springing from his bed he hastily swallowed a glass of
water and felt relieved. Retiring again, the pain soon
retimied with increased violence.
He then for the first time discovered that his tooth-
plate was missing. After a fruitless search in the bed
and upon the floor he concluded he had swallowed it,
and immediately sent for a physician, who, after intro-
ducing an oesophageal probang, assured Mr. K that he
had pushed the foreign body into
the stomach. The plate, which was
of rubber, had four incisor teeth
attached, and measured one and a
half inch from firont to rear, and
one and a fourth inch in width.
I was consulted on the third
day. He complained of intense
pain in the region of the stomach,
which was increased at each act of
swallowing. The expression of
countenance was anxious, his
general appearance that of a per-
son after a severe illness.
Passing an olive-pointed pro-
bang, an obstruction was found at cardiac end of oesopha-
gus, thirteen and a half inches from incisor teeth.
Bringing the instrument in contact with the foreign body,
a metallic click could be distinctly heard.
The exertion of ordinary force failed to remove the
obstruction. Appreciating the liability of injury to the
parts, prolonged and greater effort was deemed unwise,
and an operation — cesophagotomy — ^was suggested to the
patient. To this he demurred, preferring to wait for at
least a few days. Advising him of the danger of delay,
I left him. On the fifth day he entered the Troy Hos-
pital. Since last seen says he has suffered intensely ; is
able to swallow but small quantities of liquid nourish-
ment, which act is attended with increased pain.
Fig. 5.
September 13, 1884.]
THE MEDICAL RECORD.
283
£ffi)rts to dislodge were again made without success.
He was now ready and anxious for an operation, and the
following day was therefore appointed. The operation
yns done at 11 A.M., with the assistance of Dr. Nichols
2Dd members of the hospital staff.
Reaching the oesophagus in the usual manner, from the
left side, it was opened vertically upon a lithotomy staE
The foreign body was found to be quite out of reach of
the finger. It could be readily felt, however, by intro-
dacing a long forceps, but in this manner it could not be
grasped securely enough to admit of extraction.
Unsuccessful attempts were then made to pass beyond
and over the plate loops of silk. Finally, a sponge at-
tached to the probang was carefully passed beyond the
obstruction, and upon removing it the sponge became
engaged, and the foreign body was brought to the open-
ing and removed by the fingers of the operator. The
wound was not closed.
It should be stated, that in carrying the dissection as
Dear the sternum as possible, the anterior jugular vein was
divided It was soon secured, with but little loss of
blood, and without apparent entrance of air. The pa^
tient was put to bed, and a nutritious and stimulating
enema administered soon after. He rallied well. For
the first few hours was allowed to dissolve bits of ice in
the mouth. . Nine hours after the operation he drank, by
holding the edges of the wound together, a goblet of milk.
The temperature then — ^the highest point reached during
convalescence — was iooj-°. The recovery from this
tine was very rapid. On the ninth day he sat up and
ate six oysters, a slice of bread, and one egg. The
wound closed on the eleventh day. Three weeks from
the d^y of operation, he left the hospital, cured. The
following yrevk, he resumed his usual avocation — that of
a toner.
In reviewing the various steps of an operation to reach
the oesophagus by external incision, Professor Cheever*
so well expresses wb^t I want to say that I cannot do
better than quote him verbatim. A more definite or
concise statement has not^ to my knowledge, been pub-
lished. He says : *' It appears, first of all, diat this in-
cision cannot well exceed &ree to three and a half
inches in length. This is about the distance, in average
oecks, from the top of the thyroid cartilage to the ster-
num. If ^e cut above the thyroid cartilage we en-
danger the hypoglossal nerve and lingual artery, in a
deep dissection; and, more important, the superior
taryngeal nerve. The latter crosses the space between
die hyoid bone and top of the thyroid cartilage to enter
die larynx, and its section would destroy the sensibility
of one vocal cord, and one-half of the glottis. Through
a comparatively short incision, therefore, we are obliged
to make a very deep dissection down to the prevertebral
muscles, and to draw various important structiures out
of harm's way as we proceed. First, the carotid sheath,
containing the artery, vein, and pneumogastric nerve,
which approximate closer and closer toward the cesopli-
agus, as we descend the neck. Above and below are
the superior and inferior thyroid arteries ; on the inside
the thyroid gland; below the finger, the S)rmpathetic
.nerve. And, finally, running between the oesophagus
and trachea, to the back of the larynx, the inferior, or
recurrent laryngeal nerve^ the motor nerve of the
laiynx, whose section would paralyze one-half of the
glottis; and the partial division of some filaments of
which, in one case of oesophagotomy, led to a per-
manent alteration of the voice. This nerve, lying upon
the front of the oesophagus principally, is to be avoided
by opening the ^llet toward its posterior part. The
oesophagus is easier found also on the left side of the
neck, as it naturally inclines to that side. And the rule
has been laid down that oesophagotomy should be done
on Ae left side as the place of election, unless we are
sure of cutting down on the foreign body on the right
> Two Cases of CEsophagotomy, etc. Boiton. x868.
side. The deeper dissections being carried on chiefly
with the director, it is possible to reach the oesophagus
not only without injuring any nerves^ except the un*
important superficial branches of the anterior cervical
plexus, but also without tying a vessel. There is, I
believe, but little danger of wounding the recurrent
laryngeal nerve if, before opening the guUet, a lithotomy
staff, or some sucJi curved instrument be introduced by
the mouth, and its walls pushed well forward. This
facilitates the operation by bringing the parts well into
view."
The permanent alteration of voice in Case I. was not
due to the operation, for at the time of my first visit, the
fourth day, I was informed that he had been unable to
speak above a whisper since the day after the accident.
The injury was probably done while making fiiiitless at-
tempts to dislodge.
There is a diversity of opinion as to the treatment of
the patient after the operation.
Boyer, it is said, was the first to advise absolute diet
for a week and the non-employment of elastic tubes to
feed the patient through.
Syme [advocated the early use of the tubes, and the
weight of authority seems to lean in that direction, yet it
is doubtfiil if many have spoken from actual experi-
ence. Cheever believes that the irritation of passing
tubes, however gently, is considerable ; and the risk of
touching granulations, thus lessening'chances of early re-
pair, is very great. I believe this to be true, for a tube
cannot be passed with any degree of accuracy when once
it is {within the oesophagus, making contact with the
wound almost certain. Experience has taught me to
believe that the use of tubes is not essential, and that
there is nothing to contraindicate the administration of
liquid nourishment in small quantities, by the mouth,
within a few hours after operation. The danger of infil-
tration among the long muscles, leading to suppuration,
aft suggested by Cheever, is, I think, ml.
It has occurred to me that the frequent passage of the
escaping fluid through the oesophageal wound during the
process of repair, has a tendency to evert its ed^es. If
this be so, and it seems reasonable, such a condition of
things is to be encouraged.
ON THE PREPARATION AND USE OF OXY-
GEN AND ITS CONGENERS AS REMEDIAL
AGENTS.
By SAMUEL S. WALLIAN, A.M-, M.D.,
BLOOMINGDAUC, N. Y.
Following the appearance of my paper on oxygen, etc,
in The Medical Record of October 27 and November
TO, 1883, I received from every direction a flood of
professional inquiry. To a few applicants I made brief
response by letter.
As the tenor of all was the same, viz., an eager anxiety
for definite practical details in the matter of preparing
and exhibiting the agents in question, and since I found
it utterly impracticable to make satisfactory reponse by
letter to even a few of the many inquirers, I will, at the
urgent request of numerous correspondents, endeavor in
this paper to summarize such practical details as may
assist those practitioners who have not as yet given much
attention to the subject.
Apparatus. — ^Those practitioners who live in or near
large cities may find it more convenient to purchase both
oxygen and nitrogen monoxide compressed in iron flasks ;
suitable contrivances being provided for their proper ex-
pansion, dilution, and dispensation. A constant adver-
tiser in The Record offers to supply "pure oxygen"
and suitable inhaling apparatus for medical purposes,
and the dental depots supply the nitrogen monoxide
compressed so as to be readily portable. If one can
trust to the manufacturer for the absolute purity of his
284
THE ICEDICAL RECORD.
[September 13, 1884,
product, this method of procuring the gases saves a woi'ld
of trouble and vexation ; but as I have had no personal
experience with them I can neither commend nor oon*
demn. The only feasible method for those who live at
a distance from these sources of supply, and the least
expensive for all, is by procuring the necessary apparatus
and manufacturing at one's own <^ce.
For storage I use a meter-holder made of sheet sine
or tinned copper. A convenient size is thirty inches in
diameter by about thirty-two or thirty-four inches in
height — the width of ordinary sheet zinc will do. This
will admit a bell or receiver, corresponding to the gas-
ometer of ordinary city gas works, with a capacity of up*
ward^ of a hundred gallons. In a large practice, or in
hospitals, much larger receptacles may be used, but it is
better to have tevefal of moderate size rather than one
large one, thus enabling the physician to have various
admixtures and dilutions on hand at the same time.
The tank or holder, answering to the well of gas works,
is to be filled with pure water, and should have a tap with
rubber cork, or a faucet, near the bottom for convenience
in drawing off the water when necessary to renew it
To facilitate this operation it is well to place the tank
on a frame or platform eight or ten inches high, and it
should also have a false bottom of wood beneath the
metal one to strengthen it. A broad metal hoop at top,
bottom, and middle is necessary to keep it firm in shape.
The inverted bell or gasometer should have a gas-cock
soldered into the top, through which to admit thie gas,
with ears at opposite sides by which to [suspend or
balance it. For the latter purpose cords, weights, pul-
leys, and a light framework will suggest themselves.
At) approximate scale, estimated in either cubic- inches
or centimetres, as preferred, can be readily arranged 6n
this framework, or on the side of the bell itself for the
purpose of measuring the volume of the gases as manu-
.fJBtctured, comminglbd, or respired.
For any conMderable practice, not less than thale
rte6rvoirs will be found necessary, as well as convenftam.'
lb one should be kept, at all times, a supply of pute
oxygen ; in a second, pure nitrogen monoxide ; the third
may be used for any standard admixture or dilution 'Of
the two, or either of them, as desired.
As an external finish a coat or two of paint, or grain-
ing and varnishing in imitation ^f wood, adds to the
appearance and durability of the ni'^tal reservoirs.
Both the gases usrd must be well washed and purified
as they are evolved. I use a series of four or five wash*
bottles for this purpose, connected by means of glass
and rubber tubing.' Th^se bottles may be procured
ready fitted from manufacturers of glassware through your
local druggist, or you may fit them yourself at less ex-
pense.
For this purpose procure half-gallon or gallon specie
jars, with rubber corks to fit, each cork to be perfor-
ated mth two holes, say three-eighths of an inch in diam-
eter, for the insertion of the glass tubing. Common corks
can be made to answer by carefully cementing them with
fine plaster-of-Paris after the fittings are all in position.
Select the soft or soda glass tubing of about three-
eighths of an inch calibre, and not too heavy. This can be
readily broken into any desired length by first nicking it
on one side with a sharp file and then bend at right
angles, after heating in the flame of a gas-jet or of an
ordinary spirit-lamp. Hard varieties of glass may be bent
by thrusting the ends into a bed of glowing coals for a few
.moments, should the flame heat prove insufficient.
A copper retort with suitable connections for the
. preparsttioa of oxygen can be procured from any dealer
ia chemical apparatus. The size selected may vary from
one to four pints capacity as needed. Common glass
retorts may be used in lieu of copper for generating oxy-
.<«* The following u a hit assortment of tubing for fittingt : Four pieces X^nch
glass tubinjs, thirtv inches long ; four pieces Jji-inch glass tubing, thirty inches
lon^ ; one piece ^-inch rubber tubing, eight feet long : one piece X'lacn rubber
tubing, six feet l^ng.
gen, but the bills for fractured glass and the results of
occasional explosions render them both vexatious and ex-
pensive.
For preparing nitrogen monoxide the same appara-
tus is complete, except that a glass or porcelain fiask
must be substituted for the copper retort. A half-galloa
Florence flask fitted with perforated rubber cork and
long bent glass tube of good calibre, to connect with the
first (or empty) wash^bottle, noakes a very satisfactory
airangement Platinum or gold flasks are perfect, since
they thoroughly resist the action of the chemical used,
but are, of course, expensive. I prefer to use glass for
various reasons, even if there is, as a result, a fractured
flask and a be^>attered floor or table occasionally. In
glass the material can be more closely watched during
the process, and the danger of applying excessive heat
more surely avoided* The first or empty wash-bottle
acts as a safety valve, preventing r.eflow of water into the
flask in case of sudden withdrawal of heat or of an acci-
dent.
Chemicals. — The mat.erials used for preparing pure
■oxygen by the process now under consideration are
potassium chlorate (KCIO,) and manganese dioxide
(peroxide) (MnOj.
The latter, it is hardly necessary to stale, is not chemi-
cally changed during the process, but acts, merely by its
presence. Both chemicals should be as pure as can be
procured, thoroughly dried and finely pulverized previous
to usin^. It is even better to evaporate the water of
crystallization in case of the chlorate, and it must be
very thoroughly rubbed up wiifch the maifganese in a dry
mortar, the most favorable proportions being four or five
of the.potaasium to one of manganese. The exact pro-
portion is not essential , and need not be uniform, oue
part of the former in eight or ten of the latter working
very well. Since it ia so.diflicult to make it fine enough
by hand, and requires so much labor vrithal, I prefer to
buy the pulveri^ chlorate of potassium of the brand
known as "chemically pure."
For nitrogen monoxide, 1 procure simply pure fiised
crystallized: or granulated aounonium nitrate (NH^NO,).
It will not matter which of the three varieties is selected,
so that the. salt* be pure and clean.
Heat decomposes this salt into nitrogen monoxide
(N^O) and water (H,0). If the heat be too ^eat or too
rapidly applied^ fumes of nitrous or hypomtrous acid
(HNO) will be driven over, to be absorbed by the water
in the wash*bottles.
Chemical manipulatums. — To prepare pure oxygen fill
the copper retort half full of the prepared potassium and
manganese mixture, connect securely with the series of
wash-bottles, the last one of the latter to be connected
by a loil^ rubber tube to the gas-cock in the bell or
meter. . Apply heat by means of the sand-bath, a jet of
iiouse gas, a spirit-lamp with several small wicks or ooe
large one, or by a small kerosene stove. No gas is
given ofi* until the whole mass has been heated to a
rather high and uniform degree, at which point the evo-
lution is. sudden and rapid, frequently trying the wash-
bottles and connections severely. The heat should be
promptly diminished at this juncture, to be increased
again as the material begins to be exhausted.
The reaction consists simply in the disengagement of
both equivalents of oxygen from the potassium chlorate,
potassium chloride (KCL) resulting. The flask is to
be disconnected from the wash-bottles promptly when gas
ceases to pass over.
For nitrogen monoxide fill a i'lorence flask (those of
German glass answering best) half full ofammoDium
nitrate ; connect securely with the dry wash-bottle by a
long bent ^lass tube (thirty inches is not too long), and
it is well to wire the cork to the neck with copper or
platinum wire to prevent its being forced out at a critical
moment.
Apply heat gradually at first, preferably by means
of a sand-bath, or very cautiously by means of the same
September 13, 1884.]
THE MEDICAL RECORD.
385
lamp used in the process for oxygen. If the sand-
bath be dispensed with it will be a good precaution to
suspend the flask over the flame by a wire, and keep it
in gentle motion in» order to apply the heat more evenly
and preyent the liability to fracture.
After a few accidents each novice will learn discretion
and acquire the << knack," ao as to make as little havoc
with firs^le apparatus as is possible. With the besjt of
management and the nicest adjustment of all the condi«
tions accidents will sometimes happen, and some taint
of foreign elements will pass oiver into the first two wash*
bottles, which will therefore, more frequendy than the
others, need to be emptied and refilled More care and
watchfulness are required in the preparation of this gas,
and the process is slower than that for oxygen.
Suggestions for administration and for determining
when and idien not indicated, together with approximiate
dosage and condensed reports of a few additional cases
treated, will be given in another paper.
The most difficult part of my task remains, since in no
other form of therapeutic effort is more careAil discrimina-
tion necessary, and in none, are we confronted by a
greater dearth of precedent Ordinarily the diagnosis
fiumishes the indication, and the age, condition, and
temperament of the patient are accredited as safe guides
to the proper dosage.
The agents myw under consideration are potent for
good or evil in a superlative sense, and cannot be so ex-
bibited Nor have we in our libraries half a centiury's
accumulations of litemture on the subject, to which, as
in ordinary cases, we can refer for aid in case of a
One of the first misccmceptions, or misapprehensions^
to be thoroughly uprooted-<--fbr it is always necessary to
unlearn errors before we can comprehend facts— is the
inlerence or impression that since these agents are prin^
dpally used by inhsdation thejr are, on' this accotot,- par-
ticularly adapted, if not practically limited, to the treat-
ment of pidmonary complaints. Nothing could be
farther fixnn the truth, as will appear (com the general
tenor of arguments used and fiscts presented throughout
this series of papers. Oxygen may be now, or may in
time become our chief reliance in combatiDg the strumous
and tubercular, as well as other diatiieaes ; but it is not
and wiU not be because it is taken*directly into the lungs,
tiie apparent principal seat of tubercular mamfestations.
Its specific action is by and through its absorption into
the blood and its direct and rapid distribution to every
tissue dirou^^ut the entire system. It thus becomes, as
nl^ady set finrth with sufficient emphasis, an important
source of supply to the blood, am element of repair and
nmirHian^ already prepared for direct and immediate as*
similation, requiring neither gastric solution nor intestinal
modification in order to become an integral part of the
vital organism. Its eflRects, therefore, must not be com-
pared with those which follow a dose of '' naedicine " in
the ordinary acceptation of that term. Hence, while cer-
tain immediate or acute morbid conditicHis are quickly
removed by its timely exhibition, it cannot be ranked as
« drug to be divided into definite doses and exhibited
promiscuously in all acute and chronic diseases at stated
intervals, as is the case with the ordinary articles of the
Phannacopoeia.
If, therefore^, I were to be asked whether the oxygen
treatment mil ** cure " this or that particular malady or
disease by name, as phthisis, carcinoma, rheumatism,
epilepsy, I should promptly answer, No, it will " cure "
no disease whatever. . If, on the other hand, a profes*
^onal brother should inquire, In what diseased condi-
tions do you consider it particularly indicated ? I sliould
as promptly respond. In every cknmit morM eondHipn
of which it is possible to form a conception.
This may seem an extravagant estimate, but it really is
not, since the question is like asking in what conditions of
die system is it proper to administer nourishment ? It is
merely recognizing the view now coming to the front in
medical philosophy, that, in the language of Ordroneaux,
'* We are to treat it [disease] not as a personal devil en-
tirely, to be exorcised by philters and mummery, but
rather as the perversion of a natural state struggling to
regain its equilibrium.'^ *
Another stereotyped error in connection with the use
of oxygen as a remedy must be eradicated frpm the
average medical mind. It is assumed, on the basis of
an ancient chemical dogma, that this element is pre-emi-
nently a destroyer; that it is the principal, or even sole
office of the oxygen ins(Hred to break down used tissues,
to eliminate refuse material, to *' burn up " waste pro-
ducts ; and that more oxygen means simply and neces-
sarily more extensive waste, more rapid destruction — a
hotter fire ! This is another of the superannuated myths
of science. It is true that living is synonymous with
wasting, disintegration — burnings if you insist on the
misnomer — but to cease to waste, to interrupt disinte-
gration, tQput out the ^^fire^* even for a moment, is to
cease to live ; it is irrevocable death. Nor can repara-
tion, or even primary assimilation, proceed without its
twin process— destruction. Admitting all this as abun-
dantly established by both analogy and observadon,
there is still every corroboratory assurance, in both.cheiD-
istry and physiology, that the element under considera-
tion is less a /^/structive than a ^^^str^ctive agent, less a
detergent than an diment, less a burn^ than a kuUdor^
Again, the underlying idea in all rational .therapeutic
endeavors, aside from surgpk:al conservation of structure
and the temporary palliation of excessive pain, is to
hasten metamorphosis, both destructive andconstrucdve,
smce it is universally recog^nized that destructivet acti<Ai
r— eliminatiQa, depuration — ^is but one and a very essen-
tial part of constructive change. It is the thrusting
aside of obstacles which impede or bar the progress of
true repair and rebuilding.
. On the part of those who have been in the habit of
thinking, teaching, ctnd acting in the old rut^-for rut. it
osAainly is — it will take some time to fiiUy comprehepd,
and will require a considerable effort to frankly adnk
this ; for the rut has long been revered as the regular
way, and in it we have always had, and still have, plenty of
company, and that of eminence the most unquestioned.
Nor is It any novelty, (» in the slightest degree an in-
novation, to assert this. Acknowledged authorities in
physio-diemistry have all along taught it. Jt will be |i
surprise to even well-read and experienced members of
the profes^on to refer freshly, in the fiice pf this asser-
tion, to standard works on physiology . and see how
strong and positive is the evidence to this effect-r-evi-
dence which most of us have all along blundered over,
ignored, or but half comprehended.
*' To describe fully the physiological action of.' oxygen
would involve a description of the processes of respira-
tion, sanguification, nutrition, and tissue-change, for to aU
these, and to life itself, it is essential." *
'^ Preyer showed that a greater saturation from oxygen
inhalation is, a priori^ probable, .... and Demar*
quay proved it by showing that suppurating, indolent, or
unhealthy wounds on the extremities of animals became
quickly florid and hyper^emic when pure oxygen was in-
baled. . . . Allen and Pepys, and later Limousin,
showed that by inhaling an equal quantity of atmos-
pheric air at one time and oxygen at another double
the amount of carbonic acid was expired, and this in-
crease continued for fifteen minutes after the inhalations
had finished."
*' Other observers have reported that the elimination
of uric acid during a course of oxygen inhalation is
markedly lessened, ;>., that more complete combustion
occurs within the system (Schmidt's Jahrb., t i., s. aS,
1865)." •
» Journal of Insanttv, rol. xxix., p. 333.
* Phillips : Mater. M«d. and Tberapcutioi vol. L, p. 3, ed. Wood*i libnury .
Z882.
* Phillipt, op. cit, p. 5.
286
THE MEDICAL RECORD.
[September 13, 1884.
Kollman foand that the quantity of uric acid in an
equal amount of urine was reduced nearly fifty per cent,
by free oxygen inhalation. In one experiment the
amount of acid fell from one hundred and thirty-four to
twenty-five milligrammes.
Gublefs experiments proved that active inspiration of
pure oxygen gas slowed the pulse and respiratory move-
ments, produced a general sense of comfort, did not
cause dyspnoea, and that the pause between inspiration
and expiration could be prolon^d from the ordinary
limit of thirty to as much as ninety or one hundred
seconds after breathing oxygen ; and as a result of his
observations, he asserts that the blood receives the gas
in proportion to its physical capacity for it, rather than in
proportion merely to the vital necessity of hsematosis.
The globules absorb what they need, while any excess
circulates free and enters into combination only as the
haemoglobin loses oxygen in passing through the capillaries.
Quinquaud, by certain chemical tests, which, to make
them reliable, need corroboration, estimated that the
capacity of the blood for oxygen in healty subjects was
quite uniformly two hundred and forty cubic centime-
tres of oxygen to every one thousand grammes of haemo-
globin.
The ' experiments of Buckheim, Klebs, Husemann,
Naoumoff, Beliaieff, Savory, Richardson, Ewald, Hering,
aiid others, have not given us much additional light on
the subject. They were chiefly of that crude, forced,
and unnatural character, too common in physiological
experiments, which &dds so little to our practical knowl-
edge of the "action" of any remedv when property ex-
hibited. For example, what would it profit the patholo-
gist to learn, by cruel experiment on* the lower animals,
or perhaps on some helpless, hospitiil-stranded human
wtetch, that an exclusive diet of absolute alcohol pro-
duced a train of untoward symptoms and speedy death ?
Would we therefore proscribe all the alcoholic mixtures —
brandy, gin, wine, whiskey, etc., etc. ?
Nature doeii not' suggest the use of oxygen in a "pure
lind nascent state," as used by these experimenters, and
I do not consider such use of the -i^nt, unmixed and
undiluted,' permissible, much less advisable, except in' a
few emergencies, and then only to cover the exigencies
of the particular cases as presented. Hence I have
little interest in- the class A experiments referred to.
Tests of the gas as a therapeutic agent must be based on
conditions which do not do viotenceto weU-knawn and well*
proved ncUural laws. The safe guides in this, as in all
therapeutic investigations, are common-sense, the recog-
nition of known facts, and the simple rules of analogy.
Above all, we must "take a hint from nature."
Among the acute or immediate conditions which oxy-
gen and its congeners can be made to promptly, safely,
and surely relieve, may be cited asphyxia^ from drowning,
hanging, or fiiom inhaling carbon dioxide or other Jios^ious
gases ; suspended animation^ from syncope and from
opium or chloroform narcosis ; poisoning, from various
toxic agents ; spasmodic asthma (the paroxysm); ob'-
structed respiration, as in diphtheritis and membranous
croup ; and in cyanosis, from whatever cause.
Of the many chronic conditions which may be con-
fidently attacked, I may specifically mention anamia
(Birch, Demarquay, Da Costa, Dujardin-Beaumetz, et
at.); chlorosis (idem); the cachexice and dyscrasice in
general ; all the indigestions and dependent disorders
(Hill, Beddoes, Birch, Goolden, et aL) ; struma and
tuberculosis (omnescit.) ; empyctmia; cYixomc glandular
enlargements ; intra-thoracic and intrc^pelvic abscesses
and degcnercUions \ epilepsy ; emphysema (palliative) ;
CLsthma (curative) ; the typhoid state ; zymosis, septiccemia,
and paludal poisoning ; neurasthenia, and nearly all
forms of neuralgia.
From this imperfect generalization, it will not be diffi-
cult for the observant medical mind to discern the special
indications and contraindications for treatment in any
given case.
It may be asserted, in general, on rational as well as
experimental grounds, in connection with this treatment,
that those chronic cases show most marked and striking
results which are selected from the gfeat army of house-
prisoners, " delicate " people who, from necesaty, habit,
preoccupation, or negligence, have been long deprived
of wholesome air and everything like active out-door
life ; or who have long suffered from miasmatic location,
sedentary occupations, or unsanitary surroundings ; or
from those who have been too tenderly reared— over-
coddled (and this virtually includes every close resi-
dent of a populous city). To these may be added the
phlegmatic, the "lymph-albuminous," and the lazy~of
whom every community shows numerous examples—
patients witii sluggish circulation, small respiratoiy ap-
paratus, torpid or enlarged livers, fatty heart or kidneys,
and with habitually retarded excretory functions gener-
ally.
As far as individual experience with oxygen goes-- my
first cases were treated sixteen years ago — I have found
thoroughly satisfactory, and in some instances very remark-
able, results in cases of inveterate asthma. As a paUiar
tive of the immediate attack, a mixture of oxygen and
nitrogen monoxide has invariably given instant and happy
relief; and the continued use of the two, variously mod-
ified, has never failed, in my hands, to effect a, to all ap-
pearances, complete and perfect " cure." If more ex-
tended trial proves equally successful, the treatment might
very properly be termed a " specific " in the treatment of
this distressing malady, which so often resists all ordinary
as well as extraordinary measures.
In the severer forms of the indigestions the resulufaave
been scarcely less brilliant Scanty or suppressed secre-
tions are gradually restored, absorption and assimilation
resume normal activity, and the functions of depuration
and defecation, long deranged, obstructed, or interrapted,
are surely, normally, and in a medical sense permanently
restored. *
Hill's first experiments with oxygen (i8so) covered
cases of hydrocephalus, epilepsy, chronic arthritis
(gouty?), paralysis, and morbus coxarius. In each of
these he reported flatteringly encouraging results.
Another, by no means unimportant, but as yet almost
wholly ignored use for oxygen, is in connection with tbe
administration of anaesthetics. On purely rational
grounds, as well as from some years of practical experi-
mentation, I am thoroughly convinced that the dangers
heretofore presumed to be inseparable from the use of
ether, chloroform, and other anaesthetics can be reduced
to a minimum, if not rendered altogether nil, by the
timely, previous, and perhaps occasionally subsequent
exhibition of oxygen. A few inspirations of the gas,
slightly dihited, taken just before inhaling chloroform or
other anaesthetic, while it does not interfere with the de-
gree of anaesthesia produced, effectually prevents the
usual untoward symptoms-^nausea, headache, delirium,
etc. And while not materially abbreviating the stage of
complete anaesthesia, it shortens the recovery stage and
effectually forestalls die S3rmptoms of imminent danger
which so frequently alarm the operator and jeopardize
the life of the patient.
In the use of nitroeen monoxide as an anaesthetic in
short surgical operations, dentistry, etc., the effects are
much more desirable when a certain percentage of pure
oxygen is added.
On this point I would quote a summary of results ar-
rived at by Dr. Klikowitsdi after a series of experiments
in Prof. Botkin's laboratory, at St. Petersburg ( Virchavfs
Archiv) : *
1. Anaesthesia induced by it [nitrogen monoxide] is
closely associated with insufficient oxidation of the blood,
and hence not absolutely free from danger.
2. The association with it of twenty per cent, of pure
oxygen completely removes all possibility of asphyxia,
without interfering with the completeness of the anaes-
thesia.
September 13, 1884. J
THE MEDICAL RECORD.
287
3. By the use of this mixture the heart-pulsations of
healthy subjects are increased, the pulse-wave diminished,
respiration increased in depth but decreased in frequency ;
these effects lasting from three to five minutes.
4. In four cases of weak heart-action, the exhibition of
this mixture produced no unfavorable symptoms. On the
other hand, the pulse increased in strength and decreased
in frequency; these effects lasting from one to two
hours.
5. In cases of disturbed respiratory innervation, the
mixture rapidly removed the symptoms of deficient
blood-oxidation and re|;ulated the respiratory rhythm.
6. This mixture quickly relieves suffering in angina
pectoris, and when pushed, produces very perfect tran-
sient ansesthesia.
7. It is preferable to chloroform as an anaesthetic in
labor.
8. Vomidng and cough of reflex origin are arrested by
a few inhalations of these mixed gases.
(To be continued.)
A PLEA FOR THE ARTIFICIAL FEEDING OF
INFANTS WITH COWS' MILK.'
By JOHN BINNIE, M.D.,
POYNBTTB, WIS.
I ADMIT that nothing is equal to a healthy mother's breast ;
I as truly believe that manv a mother's milk is not so
good as proper artificial feedmg, and I would recommend
irtificial feeding more frequently did I not know the
great liability to carelessness on the part of the niurse in
causing sickness, and even the death of the child. My
experience has been quite extensive, but entirely with
cows' milk, except in two cases, where we added an
infant food. I can say nothing of the various prepared
foods and milks sold by the trade. As I live in a healthy
agricultural district of Wisconsin, among mixed nation-
^ties, I advise the selection of a good healthy cow,
between the age of four and ten years, of mild disposi-
tioD, which has been ^ving milk from four to eight
weeks previous to the birth of the child.
The selection made, she should be cared ibr as follows,
mil fed on good clean grain, and hay free from must Roots,
if any are fed, should be of good quality, and she should
have plenty of good clean water from a living spring or well*
Her pasture sSK>uld be Timothy grass or native grass, free
from weeds ; clover alone is bad. When mixed with
other grasses it will do. She should be cleaned and cared
for like a carriage-horse and milked twice a day. In a
few instances, during the very hot weather, I have recom-
mended milking three times a day. The milking is al-
ways to be done at the same time and by the same
person. This is very important, as those having experi*
ence with cows will readily understand. The milk
should be kept in a cool place, away from v^etableS of
all kinds, or any odors, as milk is exceedingly sensitive
to all such agents. You must caution the nurse to be
especially careful during thunder-storms, as milk mil sour
then do what you will.
Further, I believe some cows are unfit by nature
for feeding infants. In feeding the infant everything
connected with the utensils must be kept scrupulously
dean. Take three or four parts of warm water to one
part of milk, and a little fine white sugar ; bring all to the
temperature of the body. Give the child about two
ounces every two or three hours. This strength is gen-
erally sufficient for the first two or three months, when
you will gradually increase the proportion of milk, so
that by the time the child reaches four months it will
be taking milk and water about equal parts, and an in-
aeased quantity. These are general remarks, and may
*Read beCwe the Columbia Coanty Medical Society, July 31, 1884, held in
Portage.
require changing to suit individual cases. No absolute
rule can be laid down that will be suitable to all cases.
The condition of the child must be the guide. Should
the child appear to be insufficiently nourished, increase
the quantity of milk to water, or use barley-water in
place of simple water, especially so if any tendency to
diarrhoea is present. I have seen cases of diarrhoea from
too much water yield at once to an increase in the pro-
portion of milk and the substitution of barley-water.
You will also get diarrhoea from too great a proportion
of milk, or if the quantity taken be too great ; the physi-
cian must be on his guard to determine which cause is
operating in the individual case. When the food is too
rich, the diarrhoea generally follows immediately upon
some change that has been made in its food, or the
child may become fleshy at first. And this misleads
both the nurse and physician ; they reason that the child
has been doing better since the last change in its food.
In these cases we often see preceding, or simultaneous
with,, the onset of diarrhoea a crop of red raised spots on
the face or extremities, or both, of the child. This, with
the fact that it had increased rapidly in adipose tissue
for a time, should call our attention to its food as being
too rich or too great in quantity. It may call for an
examination of the ^condition of the cow or her pasture.
I believe pure clover very liable to produce this eruptive
condition of the child.
The. dangers from overfeeding, whether by too large
a proportion of milk, or too ^eat a quantity given, are
greater than the opposite conditions, especially so during
hot weather. The cases are rare where the child caii
take pure milk with safety before the ninth month, and
according to my experience not before the year.
I think well of b^ley-water during the heat of summer
and at any time wh^n a tendency to diarrhoea exists> ai^
I doubt not it niight be of service in the opposite con-
dition.
An infant fooKi, added to the inilk as bi^ore pre-,
pAJred, did well in my two cases. As before stated, the
condition of the child is the best) guide. When doing
well, let it alouQ and make as few changes as possible..
Increase very gradually the strength of its food.
I do not allow any solid food until after a number of
teeth are through. Np table-feeding of any kind. I
have seen children fed as above never sick a day^ and as
healthy as any I ever saw nurse a mother. I have seen
the.' opposite from a violation of the rules continue un
til the nurse became more careful. Such carelessness
on the part of a nurse ought not to condemn artificial
feeding. I am fully persuaded that a child can.be raised
with as much certainty of living as when iiursing the
mother, if the necessary care is taken. The causes of
fisulure, as I have found them, are :
1. Want of cleanliness of the utensils.
2. Carelessness in the preparation of the food, as to
the exact proportion of milk and water, at each meal.
. 3. The want . of regularity as to time and quantity of
feeding.
4. Changing from one cow's milk to another, or using
mixed milks of different cows.
5. Allowing the child to nurse or drink too rapidly.
The slower the food can be taken without tiring the child
the better. Making any of the above mistakes may pro-
duce derangement, while some children are permitted to
violate them all and live, thus proving the exception
to the rule.
I have not written this either to recommend or con-
demn any artificial foods, or in any way to detract from
the value of them ; but I have thought there wais a ten-
dency among some of the profession to make the arti-
ficial feeding of infants altogether too artificial, and to
try and supplant milk entirely, or give it, to say the least,
a secondary place. This cannot be done successfully.
We had better devote more time and money to getting
pure fresh milk ; then, if thought best, add your artificid
foods.
288
THE MEDICAL RECORD.
[September 13, 1884.
A CASE OF TRAUMATIC TETANUS CURED
BY THE INTERNAL AND LOCAL USE OF
SULPHATE OF MORPHINE.
By J. W. STICKLER, M.S., M.D.
OKAVGi^ «. J.
On June 4, 1884, I was called to see T J—,
aged eight years. In attempting to cut some hay in one
of the old-fashioned hay-cutters, he brought the knife
down upon his left middle finger, about midway between
the tip and the first joint As the cut seemed to extend
about half through the finger I thought it would be wise to
endeavor to save the part by carefully coapting the cut
surfaces. To do this I inserted a few fine sutures. The
wound, however, did not unite, suppuration causing the
surfaces to separate. As it was manifestly useless to
again attempt to save the end of the finger, I determined
to amputate at the first joint. In this operation I was
assisted by Dr. J. Y. Simpson. The flaps united quickly,
and the boy did very well till June i8th, when he devel-
oped tetanoid S3rmptoms. He had pain along the anterior
attachment of the diaphra^ and in his back, difficulty
in swallowing, and spasmomc contractions of the muscles
about his mouth. His lower extremities were at once
placed in a hot mustard badi, hot poultices applied to
his abdomen, and a mustard plaster to the back of his
neck. He was then given, per orera, nix. of Magendie's
solution of morphine, and wrapped in a blanket. The
following day there were firequent contractions of the
muscles of the face, throat, and trunk ; pain in the epi*
sastric region was quite distressing ; swallowing; of solid
food was difficult, even water excited a mild spasm
of the throat muscles. At this stage of the disease I
asked Dr. Wm. Pierson to see the case, in consultation.
He suggested the application to the part of pooltices
containing morphine (gr. j. each). He was also given
twice daily (9 a.m. and 4 p.m.) twenty-five to thirty-five
drops of Magendie's solution of morphine, per orem, the
dose varving within the limits named, to suit the e#Mr*
gency of the case. Large flaxseed poultices were om-
stantiy applied to his back and abdomen, and he was
carefully shielded from draughts. After beginning thb
treatment there was sufficient opisthotonus to muce it
possible to pass the hand and forearm between the bed
and the patient's back. This condition lasted about
seventy-two hours. The mouth at that time could not
be opened wide enough fo admit the index fin^r. His
food consisted of milk and broths. Constipation was a
troublesome complication, requiring the occasional use
of croton-oil in one-drop doses.
By degrees the rigidity of the various muscles dis-
appeared, the patient being restored by July xst to a
normal condition, so far as the use of the various parts of
his body was concerned.
Malarial Gastralgia. — Dr. N. O. D. Parks, of
Ashton, R. I., writes : *' The following case may prove
interesting as an example of the hydra-headed manner in
which malaria manifests itselfl K. H , a young
married woman, has been subject to severe attacks of
gastralgia since the birth of her first child about ten
months ago, when they occurred for the first time, and
have been hitherto amenable to treatment. She had one
on June 7th, and called in a physican who administered
morphine hypodermically. I was sent for June loth.
She seemed to derive no benefit from morphia, vibur-
num, Hoffmann's anodyne, nor any of the usual remedies,
external or internal, the paroxysms apparently subsiding
of themselves after the lapse of four or five hours, to re-
turn with increased violence, at first every other day, but
finally they recurred every morning, accompanied by vom-
iting, which brought no relief. This periodicity led me
to administer quinine in full doses, which promptly
aborted the attacks. After three days I lessened the
amount of quinine, and prescribed arsenic in small doses,
and she has had no recurrence of the malady."
ON MURIATE OF LIME.
By JOHN C. PETERS, M.D.,
MBW YOBK.
Some time ago Ths Medical Record had a very sugges-
tive article on the *' Uses of the Muriate of Lime." I have
found additional material in the works of the late Dr. I.
Warburton Begbie. In small and repeated doses it pro-
duces increased secretion of mucus, urine, and perspira*
tion ; in large doses it is irritant. Fourcroy and many
physicians of his time (1775-1809), had mudi confidence
in it against scrofula, but especially the celebrated Dr.
Beddoes, who gave it to nearly one hiudred patients, in
doses of ten drops of the saturated solution to young
children, up to two drachms to adults, three or four times
a day. He says there are few of the common forms of
scrofula in which he has not had successful experience
with it He gives the case of a boy, aged seven years,
with a voracious, almost insatiable appetite, protuberant
belly, diarrhoea, emaciation, hectic fever, and nigfat
sweats, who recovered in two months after taking ten-
drop doses, gradually increased to forty ; which he took
with pleasure in small beer or coffee. The purging stopped
first, and then the hectic fever. Also the case ot a young
lady, aged thirteen, with the same symptoms, and in ad-
dition, swelled feet, cough, and difiicult respiration. In
three days, after taking twenty-drop doses, increased to
sixty, the purging stopped ; in nine days the feet ceased
to swell, while tiie hectic symptoms and oou^h disap-
peared in tiiree weeks, foUowed by recovery with great
gain in flesh in six weeks. Dr. Begbie sajrt be has often
cured similar cases, especially the chrooic diarrhoDa of
young children when associated with hectic fever and
tumid belly.
Dr. James Wood says he wonkl feel in some degree
accountable for the sufferings of all thus diseased U he
did not make its virtues known. He used it largely in
incipient phthisis, in all the fonns of scrofula, and in
hectic fever fit>in, or with great dischaqpe^ Dr. logn^
bam found it to possess great (x>wers in discussing tumon
and obstructions of various kinds. The opinions of Dr.
James Sanders have already been given in The Record.
Dr. James Hamilton, professor of midwifay in Edin-
burgh, speaks of it in hig^ terms in scroAila, and Dr.
Antiiony Todd Thompson asserts that he has seen naore
benefit from its continued use than from any other medi-
cine. Dr. John Thomson refers to the three muriate^
those of soda, baryta, and Ume, in scrofiila, but seemed
to prefer cod-liver oil and iodine.
Begbie has used it most successfully in struma, marked
by enlargement of the glands of the neck, after iodine,
iodide of potash, and iron and cod-liver oLL had fail^;
and says it is in his power to assert that many instances
of very great enlargement of the cervical glands have
yielded to its use ; also in glandular swellings of the
axillae and inguinal regions, and of the deep-seated lym-
phatics of the pelvis. It often Requires to be taken for
a considerable time, for weeks or even months, before
its beneficial effects are visibly produced, Usually, how-
ever, in the course of a few weeks there occurs a cer-
tain degree of softening in the glandular tumors, and tb^
component glands of the mass are more easily distinguish-
able. With the gradual subsidence of the enlargement
there is a notable improvement in the patient as to ap-
pearance, appetite, and digestion. If the remedy is
stopped too soon, relapses may occur. He has often
given the medicine with the greatest regularity for one or
two years. He thinks it is best taken in milk, but some
prefer water. It has a mawkish, disagreeable taste, which
is partiy or wholly concealed by milk, but many gnulually
acquire a liking for it and have a great disinclination to
stop it.
Dr. Begbie gives the case of a young woman, with a*
really frightful disfigurement of the neck, who was de-
cidedly improved in three months, and was in a very
satisfactory state in a month more. He refers to two
September 13, 1884.]
THE MEDICAL RECORD.
289
others. In many cases the disorder will return slightly
after the muriate of lime is stopped, but invariably yields
again to the remedy, and then the cure is permanent
In tabes mesenterica, with protracted diarrhoea and ex-
haosting perspirations, the medicine is equally useful,
causing a subsidence of the hectic fever, an improvement
of appetite, a gaining of flesh and strength, and a gradual
restoration to health. In grave disorders of the bowels
it arrests diarrhoea, promotes digestion, and favors nutri-
tion. Also in a class of cases marked by depraved appe-
tite, loss of flesh, pallor, protuberant belly, wasted limbs,
and more or less febrile excitement of an intermittent or
remittent hectic type, with two distinct paroxysms of
fever every day. It checks purging, lessens the fever,
allays the mordinate appetite, and ultimately restores the
patient to health. The red appearance of the tip and
edges of the tongue fades away, and the nausea ceases.
It acts quicker than lime-water.
It has proved useful in lupus exedens and non-exedens,
in local pforiasis, in some instances of ozsna, and in
chronic tonsilitis. The recognized dose is ten to twenty
grains. The -Edinburgh solution has ten grains in every
fifteen drops, which is the average dose for a young adult,
to be given three times a day in milk. Gradually the
doses may be increased to thirty or forty drops. It
lessens the acidity of the urine remarkably. All these
good effects Dr. Begbie has noticed again and again. y*j
ACUTE IMPULSIVE INEBRIETY.
By T. D. CROTHERS, M.D.,
HAKTVORI^ CONN.
This term describes a class of cases who suddenly use
alcohol to great excess, either for a definite period, or
constantly until death or dementia terminates their con-
ickms existence. In many cases they are closely allied
to acute mania, and merge into it, but although of the
same family group, there are distinct differences. Clini-
cally two classes are prominent, and both begin the same
way, but after a time they diverge widely. In one the
use of alcohol is continuous, and only varied by the diffi-
culty of procuring it, and Ac change to opium or other
narcotics. In the other a distiqct free interval of sobriety
follows, usually of definite length, which becomes shorter
as the disease progresses. The latter is of a dipsomaniac
tjrpe, with epileptic tendencies,;and may at last become
what has been" erroneously termed ^alcoholic epilepsy.
Criminality and many strange psychical manifestations
appear in this class. The first class of continuous
drinkers are marked by the early and profound failure
of all the higher brain qualities, dropping quickly from
positions of character and reputation to that of moral
imbecility, and apparent unconscious realization of duty
and obligation to others. My object is to trace some of
the apparent causes and symptoms of the early premoni-
tory stage of this affection. These cases have no par-
ticular stage of moderately drinking, or period in which
wine, beer, bitters, or other of the milder alcoholic drinks
are used. They begin at once with poisonous excessive
doses of alcohol Despite all theories it is an unmistak-
able fact that this condition is an explosion, or the
bnrstmg into activity of a long train of causes unnoticed
before. It is a sign of brain exhaustion, of diseased con-
ditions that have suddenly concentrated into a craving
for the narcotic effects of alcohol. This uncontrollable
desire for alcohol or other narcotics is a symptom of
profound disease and degeneration, which may be regarded
from two points of view, namely, as a congenital or ac-
quired condition.
In ttie first, or inherited group, I find such cases as the
following : A man of good health, temperate, and of repu-
jation, who has insane or inebriate ancestors, but who
MS lived an exemplary temperate life, drinks suddenly
to great excess and never recovers. It may follow some
business, losses or social disasters, and in many cases it
comes on without the slightest reason that is apparent,
like a lightning-fiasl\ in the clear sky. Another case
would be of some hard-working, business, or professional
man, who has given signs of nerve and brain failure f6r
years, then all unexpectedly lapses into profound ine-
briety. An epileptic neurosis or consumptive and hys-
teric diathesis is found to be present.
In other cases signs of brain defects from heredity are
present. Thus a passionate, unreasoning, impulsive brain
power ; or a brain on the borders of delusions and hal-
lucinations ; or a changeable, uncertain brain force, ex-
hibiring many hints of defect will suddenly develop into
inebriety. Some writers assert that in such cases in-
ebriety is merely an outlet for insanity, or insanity in an-
other form, which would appear with certainty in the
natural progress of the case. This would be expected
if a state of moderate drinking was present, but in such
cases absolute abstinence from all use of spirits exists up
to the moment of the outbreak. In some cases these
apparent inherited nerve defects are obscure and un-
noticeable, except from an intimate acquaintance, and
the outburst of inebriety cannot be traced to any pres-
ent exciting cause ; the only fact of significance is that
diey had an insane or inebriate and neurotic ancestry.
A vast realm of clinical and psychological facts stretch
out from this point entirely unknown.
Another group of cases who have a decided neurotic
ancestry, and themselves exhibit marks of it in their
actions and thoughts, become impulsive inebriates from
distinct causes that are traceable. Thus a temperate
man of this class will suffer some great loss of property,
or of relatives bv death ; will meet some unexpected
disaster, which will profoundly impress and change all
his functional activities. After a short incubating period
he will begin to use spirits to great excess, either in
secret or openly. A prominent governor of a great
State, temperate and robust in mind and character, whoste
father was a hard-drinking man, was suddenly over^
wtnkned with sorrow at a social wreck in his family.
Three days after he went to his stable with a case of
brandy, and drank to excess for four days, concealed by
his hostler. From this time he has continued to drink
at intervals, without control of himself or without con-
scious reason, and is now a confirmed inebriate invalid.
In another case of a man of prominence, with an in-
ebriate ancestry, sudden bankruptcy through the dis-
honesty of partners precipitated him into impulsive and
profound inebriety, ending fatally in a few months from
acute pneumonia. In these cases prominent exciting
causes, particularly great strains and profound emotionsu
changes, have fanned into activity a latent neurosis, iHiich
otherwise might have remained dormant.
The same results are seen in cases who suffer from
some acute disease that is profound and prolonged, such
as typhoid fever, malaria, pneumonia, pleurisy, gastritis,
and many other diseases which positively affect the in-
tegrity of the organism, leaving an entailment or condi-
tion of debility from which recovery is very slow. In
such cases, particularly where inebriate heredity is pres-
ent, impulsive inebriety may spring up and go on
rapidly to death. A favoring soil is present, and some
unknown germ cause has developed it. An almost end-
less variety of conditions, involving every form of strain
and drain, of fimctional and organic activities, starting
from a defective brain and nerve soil merge into this
malady. In the acquired form or group the same
conditions are seen without the apparent heredity. It
would seem that all the conditions have grown up from
neglect and the surroundings. A common illustration is
seen in the constantly increasing army of business men
who steadily overwork, and neglect to obey the simplest
laws of health, thus becoming more and more unfitted for
the trials and duties of life. Suddenly, after some great loss
and strain, they become inebriates and drink without any
intelligent reason why they do so. The class who have
used alcohol in moderation for a long time, and suddenly
290
THE MEDICAL RECORD.
[September 13, 1884^
become pronounced inebriates, are very common in all
large cities. Bat the brain-workers, who are intemperate
in almost everything except the ule of alcohol (in this
they are total abstainers^, are furnishing an increasing
proportion of cases of this form of inebriety. A man
who occupies a position as a worker and producer, who
is a power in his circle, suddenly poisons himself with
alcohol, and keeps it up day after day until death brings
relief.
If the causes are not traced to heredity, they will be
found in some condition of bad living overwork, want
of rest, and imperfect nutrition. Psychical traumatism is
apparent in a certain number of these cases. As an
illustration, lately prominent in a distant city. A cler-
gyman, a total abstainer, a man of unusual force of char-
acter and health, saw his daughter dashed down an em-
bankment and killed. The next day after he drank to
intoxication, and is to-day a periodical inebriate of the
worst type. In another case a man of repute was in-
toxicated at the funeral of his wife and never recovered.
In a case under my care a temperate man began to
drink to great excess on the sudden return of his son,
who was supposed to have been killed on the battle-field.
In other instances the mental shock from sudden pov-
erty or unexpected wealth have resulted in this form of
inebriety.
Undoubtedly some profound change and alteration
takes place in the central nerve system, followed by psy-
chical pain and exhaustion, for which nothing but alcohol
brings relief. In these cases a substratum of inherited
degeneration may favor this state, or condition of impair-
ment from disease or other cause, which intensifies the
inebriety, making it more incurable.
Many of these cases of acute impulsive inebriety are
concealed with most extraordinary judgment on the part
of the victim. He has become a periodical inebriate,
and from symptoms he anticipates the approach of the
paroxysm, and conceals himself from observation until
the drink storm has passed. Such cases leave work sud-
denly, and very strangely disappear from the circles of
their acquaintances, and a few days or weeks later return,
paler and somewhat worn, and resume work as before.
This concealment may go on for years, or until death
comes from some acute disease. Frequently sexual per-
versions are associated with this disorder ; then the victim
will be found in disreputable houses far away from home.
Usually this class seek quiet hotels in the interior, or pri-
vate asylums under assumed names. Others appear
boldly in public places and at home, and seem to have
lost all pride of appearance, and when efforts are made
to restrain them from the drink used, resort to any sub-
rstitute, and usually find some form of opium or prepara-
ition of chloral equally satisfactory.
In a certain number this form of inebriety is followed
by paralysis in a year or more, showing that it was but
an early state of other disease. In other cases dementia
appears, and the drink craving subsides. In others opium
and chloral inebriety come on, from which recovery is
rare. The prognosis is unfavorable. The craving for
alcohol may die out, but other diseases will follow. In
many cases acute tuberculosis follows, and in all instances
general failure of all the functions point to the gravity of
this affection.
Prompt, early recognition of disease and diseased con-
ditions are demanded in all these cases. Questions of
vice, will-power, and morals are absurd ; medical means
and remedies are wanted ; for no matter what the case
may be in other respects, it is a distinct neurosis that re-
quires po^tive practical methods of treatment
The quarantine of an asylum or hospital is needed,
where every condition of surroundings can be under
control, and where every source of irritation that is re-
movable can be reached.
The work of restoration involves long time and every
appliance of science and art which can be brought to
build up and strengthen the brain and nerves. If the
case has merged into a periodical condition, the parox-
ysms must be anticipated in the treatment, and all means
used to abort and lessen their intensity.
In some instances these periods return with great ex-
actness, which can be anticipated within a day or hour.
Then the value of hospital treatment and medical aids
are indispensable. Many instances are on record of
persons able to realize the approach of these paroxysms^
and who place themselves under control or in favorable
conditions to pass them with the least injury. One
such instance is that of a temperance lecturer who be-
came an inebriate from the loss of his property, followed
by acute meningitis and inebriety. He lectures on tem-
perance during the free interval between the drink par-
oxysms. These return at intervals of ninety days, rarely
ever exceeding this time more than a day. After a time
he is conscious of the approach of these paroxysms, in
certain nervous symptoms, and goes to jail and is locked
up in a cell for a week, being fed on beef-tea and milk.
Later, he went to a hospital ; then, as the paroxysms
grew less he could be restrained in a private house or
hotel with the door locked and his clothes removed
Now, five years later, the paroxysm still returns, with
the same regularity as to time, and he goes to some re*
tired place where he can be locked in ; has his clothes
taken away, and drinks large quantities of milk, and
uses a bromide prescription of about two hundred grains
a day for two days or more. After a week he fully re-
covers and resumes work again for ninety days more.
Here the quarantine of a hospital is absolutely essential ;
nothing but restraint will enable him to pass this critical
point.
The continuous inebriate of this class needs not only
restraint, but change of surroundings both mental and
physical. He is exhausted, and must be built up ; his
mind must be turned to other channels, and all the sur-
roundings must be stimulating — brain rest, muscle rest,
nerve rest, freedom from all strains and drains — these
are the comer-stones of treatment.
These cases are not dipsomaniacs ; for in nearly all
instances there is no delusion or hallucinations ; the de-
sire for alcohol is the craving for relief ; for a condition
of psychical pain or agony that is most positively checked
by alcohol. If this drug, is not obtainable, other com-
pounds are used. If opium in any form had been at
hand, and its first effects pleasant at the beginning, it
would be used in preference to alcohol. It is not alco-
holism, for the use of this drug is only a symptom of
other and more serious trouble. The desire for alcohol
is fully satisfied when certain effects are obtained.
These cases are unrecognized except in the most vague,
general way. Then simply as drunkards who have oc-
cupied better positions, and are now noted for what is i
termed depravity and great changes of character and '
purposes of life. Physicians who are called to treat
some extreme stage of these cases recognize a realm of
psychological mystery which they are unable to solve.
Thus the case goes on down to death, unknown and
unrecognized, and of course nearly all the means and
remedies that are used intensifying the very conditions
they seek to lessen.
In a summary of what is known, the following may be
stated as a grouping of outline facts :
J^irs/, — Acute impulsive inebriety appears in persons
previously temperate, who have not used alcohol before.
It is marked by profound precipitation and rapid degener-
ation both mentally and physically.
Second: — All cases can be traced to congenital and
acquired conditions, both of which are combined in some
cases. Certain causes are found to be peculiarly ex-
citing, and this form of inebriety follows with great ccr-
tainty. All cases merge into periodical or continuous
drinking.
Third, — In the treatment means of prevention and
means to conduct the case to a successful termination in
recovery should be sought. Quarantine hospitals are
September 13, 1884. J
THE MEDICAL RECORD.
291
essential, together with all other means which science
and art can suggest.
p9urih, — ^These cases should receive thorough medical
study, and all means for relief should be based on such
study and its conclusions.
Wholesale Poisoning by Illuminating Gas. —
An account is given by Dr. G. £. Bentzen, in the
Nffrdiskt MedicinsJU Arkivj vol. xvi., No. i, 1884, of
the poisoning of all the inmates of a house by illuminat-
ing gas. The house was three stories in height and con-
tained sixteen rooms, occupied by six families, but there
was no gas supply and not a single gas-pipe in the house.
There had been a break in the gas-main in the street, and
from this the gas passed through several feet of earth
into the cellar, and was thence diffused through the
whole house in such quantity that every inmate suffered
in nearly equal degree. The author cites the circum-
stance as showing how readily the emanations from the
soil may pass up into the different sleeping apartments
on the several floors of a dwelling.
Embouc Infarction of Muscles. — ^That the mus-
cles, like other organs, are liable to be the seat of em-
tx>]ic infarctions is a subject which is discussed by M.
Girandeau in a recent article, and he thinks that the
rarity of this event is attributable partly to the fact that
the muscles are seldom examined post mortem, and
partly (probably mainly) to the readiness with which
coUaterad circulation is established in cases of blockage
of a muscular artery. It is different in the case of
pyaemia, where muscular metastatic abscesses are fre-
quent ; but in ordinary cases of cardiac disease, where
the viscera show ample evidence of embolism, there are
very few records of muscular infarction. Comil and
Ranvier, admitting this rarity, state that they have met
with two instances, and that they were characterized by
absence of hemorrhage. Girandeau supplies notes of
three cases. The first was a case of chronic mitral
disease with general atheroma. The right sartorius
muscle was found to be ruptured, the broken ends
embedded in hemorrhagic efiusion, and their muscular
fibres granular. The spleen contained two old infarc-
tions. The second case of long standing mitral and
aortic disease, with arterial atheroma, exhibited a firm,
yellow-colored mass in the substance of the pectoralis
major muscle, sharply marked off from the healthy tissue,
and resembling a visceral infarct. The spleen, kidneys,
and brain were also the seat of embolism. A third case,
quoted from Lefevje^s thesis (1867^, was of the same
class, and was further complicated with dry gangrene of
the left foot and leg. In this case a yellowi^ gray mass
of degenerated muscular tissue occurred in the substance
of the vastus extemus muscle. These three cases were,
it will be seen, of chronic heart disease, and Girandeau
asks whether these muscular infarctions could not also
occur in the course of acute endocarditis in young sub-
jects. A priori^ such an event is not impossible ; but
some experiments made by him at Alfort were wholly
native in their result. He concludes that many con-
ditions may be necessary to the production of the event,
among which he enumerates degeneration, roughening,
and inelasticity ^i the arteries ; an enfeebled heart ; and
a more or less marked asphyxial condition, impairing the
autrition qf the muscle. — London Lancet
Ths Gbnesis of Mblanamia. — Professor Marchia-
&va and Dr. A. Celli have recently published a most im-
portant paper {Memorie della R, Accademia del Lincei)
on this subject ^ving the results of experiments and
researches made m the laboratory of pathological anat-
omy in Rome — the title of their paper being, "The
Alterations of the Red Blood-globules in Malarial Infec-
tion, and the Genesis of Melanaemia.'^ It will be inter-
esting, therefore, to learn what were the alterations found
The method used for examining the blood was as fol-
lows : The blood was taken from a small prick in the
finger of the fever patient in different stages of the fever,
the finger being previously washed with alcohol. On the
drop of blood thus obtained a cover-glass was lightly
pressed ; it was then pressed against another glass, and
the two slipped over each other so as to get a thin film
of blood; Uie glasses were then passed through the
flame of a spirit-lamp, so as to dry them. On this prep-
aration one or two drops of an aqueous or alcoholic solu-
tion of methylene-blue, recently filtered, was dropped ;
it was then washed and mounted. By this method the
normal red globules were slightly colored blue, unless
the coloring matter had been washed out too soon.
The protoplasm of the white globules was colored a
pale blue, while the nucleus took a deep color. In an
individual affected with malaria, however, there were
found, in the midst of the normal red discs, other red
globules whose protoplasm was altered, this being very
evident in those discs which were not colored. These
alterations consisted in the presence in the globules Of
small corpuscles, var3dng in number, different in size
and form, which were colored blue with more or less
intensity, but always so much as that they could be dis-
tinguished from the protoplasm of the red disc, whether
colored or not. These corpuscles, passing frt>m the
smallest to the largest forms, are seen as : i. Granules,
generally rounded, which are usually colored a more or
less intense blue, and somewhat resemble micrococci ;
one or more are found in a globule, and sometimes one-
third of the red disc will contain one, two, or more
corpuscles. 2. As corpuscles larger than those just
described, with the appearance of rings in the middle,
which may occupy a third or one-half of the red disc
3. As corpuscles much larger than the first, uniformly
colored, or with spaces of spherical, ovoid, fusiform dr
triangular, which generally contain granules of black
pigment in the centre. The larger masses invade, in
soiyie red discs, all the protoplasm colored by the haemo-
globin, of which only a -v&rj small portion may remain.
With these red discs, thus altered, are found bodies
colored as the masses above described, and containing
pigmentary granules. These bodies evidently represent
the last stage of alteration of the red disc, which is thus
converted into a body deprived of haemoglobin, con-
taining pigment These alterations of the red discs may
be followed in all their stages until the conversion of
them into pigmented masses. When the red disc con-
tains one or more pigmented corpuscles and a certain
portion of its colored protoplasm remains, its normal
elasticity seems to be preserved ; but when converted
into a yellow pigmented body, its elasticity may, or may
not be retained, and the disc will adhere to the cover-
glass without pressure. Such is a general r^sumi of the
microscopic appearances of the blood in malarial sub-
jects, especially during the febrile movement Are these
alterations always found in malarial infection ? In some
cases the altered red discs are few, in others very
numerous ; in others still they cannot be found at all.
But this is true not only in cases of simple intermittent,
but in aggravated cases of malarial infection, and even in
the forms of comatose pernicious fever. Whtn these al-
terations are found the patient always has a peculiar
yellowish earthy appearance, the feebleness is very great,
and convalescence is more slow, and restitution to health
more difficult Important information might be gained
by studying the relations between the degree of alteration
of the blood and the clinical course of the malarial dis-
ease. The examination of the fresh blood from a case of
algid pernicious fever showed the presence of pigmenta^
tion in numerous white globules ; the red discs were not
altered. After coloring by the method indicated, how-
ever^ the corpuscles were found in the red discs. Micro-
scopic examination of the organs and blood after death
showed the described alterations ; the same was true of
292
THE MEDICAL RECORD.
[September 13, 1884.
two other characteristic cases of malarial infection ter-
minating in death. From this it seems demonstrated
that in malarial infection an alteration of the red discs
takes place, running through various stages, and which
commences with the presence of granules and corpuscles,
generally spherical, which are colored by aniline. This
process is continued by the growth of the corpuscles, by
their fusion and the formation of dark pigment in the
form of granules and masses, and terminates with the
reduction of the red discs into a yellowish pigmented
body which is entirely broken up, while the pigment is
freed and is deposited in the various organs. But what
is the nature of this alteration of the red globules?
Without doubt it should be regarded as one of a regres-
sive nature, or better, we may accept Tommasi Crudeli's
view, that it is a necrobiosis of the red disc, which is now
no longer a red globule, but a circulating body incapable
of performing its normal functions. This being admitted,
it may be asserted, as regards the seat of the formation
and the genesis of the pigment of melanaemia : i. That
the pigment is formed in the blood-vessels, and in the
circulating blood ; and, 2, that its origin is the coloring
matter of the red disc, and that it is formed in the pro-
toplasm of this disc. The first conclusion is evident if it
is admitted that the pigment is formed in the circulating
red discs, and it is in accordance with what has already
been shown by Kelsch and Arstein. The second con-
clusion is not less evident, since the dark pigment is de-
posited as the red discs are decolorized, and aJl the stages
of this loss of color and pigmentation may be successively
followed. It should also be stated that in certain cases^
in which there is so great a destruction of the red discs,
there are also found nucleated red discs, macrocytes, and
discs differently colored from those ordinarily found. It
is well known that nucleated red discs are not found in
the normal extra-uterine circulation, except during the first
few days after birth ; but they are very frequently found
in essential and symptomatic anaemia. But hitherto they
have not been described in the acute stages of infection.
Their presence in acute malarial infection, as well as in
the periods of convalescence, is doubtless directly re-
lated to the direct destruction of the red discs, and is a
sure indication that the functions of the haematopoietic
organs are so stimulated by the destruction of the discs
that they are manufactured more rapidly than is neces-
sary, and are thrown out into the circulation before they
have lost their nuclei. These experiments, though not
yet complete, certainly explain the alterations of the red
disc caused by malaria, and go far toward clearing up
the genesis of melanaemia. And although the absence
of these alterations in the red globules does not exclude
malarial infection, their presence proves it conclusively,
as they have been found in no other disease.
Treatment of Laryngismus Stridulus. — In a clin-
ical lecture on this complication of rickets. Professor
Widerhofer (Aligemeine Wiener Medicinische Zeiiungy
July 29, 1884) recommends traction of the tongue during
the attack, to prevent closure of the glottis, or sprinkling
cold water in the face. In the intervals he gives bromide
of potassium, and regards this as almost a specific for
these spasmodic attacks. The remedy must be given in
rather large doses, four grains morning and evening, gradu-
ally increased to eight grains. In one or two da3rs, he
claims, the attacks will have wholly ceased to occur.
Death from Injection of Iodine in Spina Bifida.
— Dr. Woltering relates the following case in the Alige-
meine Medicinische Central-Zeitungy August 13, 1884.
He first operated upon the chUd when she was four days
old, simply puncturing the sac and making pressure with
adhesive plaster and a piece of lead. All went well for
four months, but the parents were careless about keeping
the compress properly adjusted and the tumor reappeared.
It was then determined to use iodine. The sac was
punctured and about two tablespoonfiils of clear spinal
fluid evacuated. One tablespoonful of a solution con-
taining seven grains of iodine and twenty grains of iodide
of potassium to the ounce of water was then injected.
As the sac was filling, it was noticed that the diiid
stopped breathing. The solution was immediately pressed
out again, and every effort made to resuscitate the child.
The heart continued to beat for some time, but, in spite of
artificial respiration maintained for half an hour, death
could not be averted. This case well illustrates fthe
danger of this procedure, immediate paralysis of the res-
piratory centres having followed an injection of only
about Uiree grains of pure iodine.
Tuberculosis of the Tonsils. — It was formerly sup-
posed that tuberculosis of the tonsils never or at most
very rarely occurred. In order to determine the correct-
ness of this supposition, Dr. F. Strassmann {Ceniralblatt
far Chirurgie^ August 16, 1884) has examined these or-
gans in a number of individuals dead of tubercular affec-
tions. In nearly every case of pulmonary phthisis he
found turbercles in the tonsils, while in those who had
died of tuberculosis of other organs these bodies were
healthy. The result of these investigations would seem
to show that the tonsils become infected directly by the
tuberculous matter in the sputa, since they were diseased
only in those cases in which the lungs were affected.
Tuberculosis of the tonsils seldom leads to extensive
caseous degeneration or destruction of the organs. Small
miliary tubercles and few bacilli are found.
Treatment of Pseudarthrosis. — In a monograph
recently published in St. Petersburg, Dr. A. Karmiloff
reviews tfie different methods of treatment of ununited
fracture, and gives the indications for the employment of
each. He regards irritation of the integument by iodine,
blisters, etc., as of no value, except in cases of retarded
consolidation merely. The method of rubbing together
the ends of th^ bone was successful in about 10 per
cent, of the reported cases. It is indicated only in those
cases in which the opposing ends of the bone are thick
and lie in close apposition. This procedure is not al-
ways a safe one, and has sometimes been followed by
very serious consequences. Dieffenbach's method of in-
serting ivory pegs has resulted successfully in 43.5 per
cent of operations on the thigh and arm, and in 80
per cent, of operations on the forearm and leg. The au-
thor, however, believes this percentage is too high, many
failures not having been reported. The method is only
useful when the ends of the bone can be kept firmly in
position, and when the tissues respond readUy to sli|;)it
irritation. Electro-puncture, the subcutaneous mjecuon
of chemical irritants, the insertion of needles into the tis-
sues between the ends of the bone, and the pinning to-
gether of the fragments, are all procedures that the
author regards with some favor, but which he considers
less effectual than Dieffienbach's method. When the
ends of the bone lie near each other, are perfectly mova-
ble and thinned down, and when the tissues seem to have
lost the power of bone formation, Dr. Kamiiloff' regards
resection as clearly indicated. The resected ends are to
be held in close apposition by splints or suture. — Cen-
tralblatifUr Chirurgiey August 9, 1884.
The Cause of Puerperal Septicemia. — In a com-
munication addressed to the Soci6t6 des Sciences M^-
cales of Lyons, M. Arloing (Lyon MidUcU^ August 3,
1884) claims to have isolated the microbe of puerperal
septicaemia. The organisms are micrococci united in
the form of long chains looking at first sight like bacilli
Inoculations of rabbits with cultures of the microbe caused
death with symptoms of septic poisoning. In some cases
fibrinous peritonitis was found after death. He con-
cludes, firom the experiments made by him, that the dif-
ferent forms of puerperal septicaemia are caused by the
same agent, the particular form of the disease being due
to the degree of activity of the microbe. Yet he does
not maintain that this micro-organism is peculiar to the
puerperal state, but only that at this time the conditions
are favorable to its introduction and development
September 13, 1884.]
THE MEDICAL RECORD.
293
SaKROsis IN Plaques following Infectious Dis-
SASES.—According to Dr. Marie, infectious diseases,
such as typhoid fever, small-pox, pneumonia, syphilis,
Qtc, may give rise to consecutive paralyses caused by
scUrose en plaques. The author reports twenty cases
taken from various sources. This view of the nature of
paralysis occurring during convalescence is somewhat
novel and needs further confirmation before being ac-
cepted.— Revista Clinica e TerapeutUa^ August, i884«
Honey as a Remedy for Small-pox. — A physician
of Arequipa, Peru, writes to a local journal in praise of
the virtues of honey in the treatment of small-pox. A
child was attacked with what threatened to be a ver}' se-
vere form of the disease, but to the surprise of all began
to mend within a few days, and passed through a speedy
convalescence without any complications. In searching
for a cause of this unusually rapid recovery, it was found
that the patient, whenever left alone by his nurse, had
helped himself to some honey which was standing in a
jar near his bed. The remedy was then tried in two other
cases occurring at about the same time, and with equally
£ivorable result The writer seemed to think that there
was something more than a mere coincidence in these
cases, and hoped that others would make a trial of this
toothsome remedy in order to prove its efficacy. — La
Or'mUa Midica^ August 5, 1884.
Treatment of Enlarged Prostate. — M. Tripier di-
rects attention to the possibility of reducing prostatic
congestion by £u'adization. One electrode is to be in-
trodyced into the urethra and the other into the rectum.
He has also had recourse to simple intra-rectal faradiza-
tion. The sittings are of five minutes' duration, and the
strength of the current is to be so as to cause no pain.
For hypertrophy of the prostate the author makes use of
suppositories of one and a half grain of iodide of potas-
sium and one-tenth grain of muriate of morphia. — Lyon
MUical^ August 3, 1884.
The Coni>ition of the Ovaries during Men-
struation.— Dr. Meyer has made a number of bimanual
examinations of the ovaries during the menstrual period
to determine vdiat changes they undergo at this time.
In some cases he found an evident increase in size, in
some no change was discoverable. While these organs
are usually of a firm consistence, during menstruation
they are found to be elastic. In some cases the ovaries
were of a more rounded form, in others there were
mequalities on the surface of the organ. Sometimes he
could observe no change in shape, and sometimes there
were changes in both organs, or again in only one. —
Lyon MkOceU^ August 10^ 1884.
The Action of Phosphorus upon the Fcetus. —
Dr. Igacushi Moritzi Miura, of Japan, has been conduct-
ing some experiments on rabbits and guinea-pigs to de-
termine whether phosphorus given to the mother induces
any changes in the fcetus. He found fatty degeneration
of the liver in the mother thirty to forty hours after
poisoning with phosphorus, and the same condition, but
less marked, in the foetus. He found gastro-adenitis in
the foetus as well as in the mother. Hence he concludes
that phosphorus given to the mother can pass through
the placenta and exert its injurious effects upon the fcetus
also. — Centralblatt far Klinische Medicin^ July 26, 1884.
Pernicious ANiEMiA in Children. — Dr. Kjellberg
relates the case of a child five years old who was seized
rather suddenly with headache and general languor. At
the same time the skin became of a pale yellow, waxy
appearance, the lips were pale, and the countenance had
the appearance of suffering, although the body remained
plump. Soon he had dyspnoea on the slightest exertion,
palpitation of the heart, an anaemic murmur was audible
in the vessels of the neck, and there were hemorrhages
into the retina and under the skin. The blood was pale
in color, and the number of red blood-corpuscles fell
away firom 900,000 to 571,000 per cubic millimetre.
Death followed in six weeks, in spite of arsenic exhibited
in moderate dose. At the autopsy there was extensive
fatty degeneration of the heart, the brain was very
anaemic, and the kidne3rs were fatty. There was no en<
largement of the liver, spleen, or lymphatic glands.
This, the author says, is the second case of pernicious
anaemia in childhood that is known in pediatic litera-
tiure. — Centralhlatt fUr Klinische Medicin, July 26, 1884.
Diagnosis of Apparent Death.— The temperature
of the skin in the living subject always rises during con-
traction of the muscle lying immediately beneath, but
after death, even during the time that the muscular con-
tractility to electrical stimulus is preserved, this increase
of heat does not occur. Dr. Max Buch sees in this a
valuable sign by which it can be determined whether life
is extinct. The thermometer is to be placed upon the
integument before and after muscular contraction has
been excited by electricity, and if the mercury does not
rise at the second trial he regards the patient as certainly
dead. — Deutsche Medicinal-T^itung^ No. 37, 1884.
Miliary Aneurism of the Stomach. — Dr. Gallard
has had an opportunity of seeing three cases of haema-
temesis firom the rupture of miliary aneurisms of the
stomach (Deutsche Medicinal-Zeiiung^ No. 37, 1884).
The first case was that of a man, fifty-one years of age,
who was suddenly seized with severe hemorrhage from
the stomach and bowels. He had never suffered from
any gastric trouble. Death occurred in a few days, and
at the autopsy there was found a small tumor the size of
a millet-seed, in which there was a little opening plugged
with a clot of blood. It was ascertained by injection
that this tumor was formed by an enlargement of a branch
of the coronary artery. A month later Dr. Gallard re-
ceived another patient who had suffered for two days from
severe hsematemesis. There was no history of a previous
, affection of the stomach. At the autopsy the same con-
dition was found as in the first case. The third patient
had been seized while upon the street with hemorrhage
from the stomach. He had for a few days complained
of loss of appetite and pain in the epigastrium. The next
nig^t the patient died, and at the autopsy there was seen
a tumor the size of a bean on the greater curvatiure near
the cardiac orifice. There was a perforation at the apex
of the tumor through which the blood had escaped. The
tumor lay directly over a small artery, but attempts at
injection failed. The only case similar to these that has
been reported is one of Dr. Douglas-PoweL But here,
however, there was a tubercular ulceration of the stomach,
so that the aneurism could only be regarded as of sec-
ondary origin.
Antipyrin in Diseases of Children. — Drs. Pen-
zoldt and Sartorius have made a number of trials of anti-
pyrin in the treatment of children's diseases, and report
the following conclusions in the Berliner Klinische
Wachenschr^ of July 28, 1884 : i. Antipyrin is to be
regarded as a very effectual remedy in the pyretic dis-
eases of childhood. 2. In suitable dose it lowers the
temperature several degrees, and the effects continue for
several hours. 3. The pulse rate is never reduced in a
degree corresponding to the fall of temperature. 4. The
effect upon the general condition is usually good. 5.
The only disturbances that it ever causes is occasionally
vomiting. When this occurs the remedy may be given
by the rectum. 6. Antip3nin should be given in three
doses at intervals of an hour. Each dose should consist
of as many decigrammes (one and a half grain) as the
child has lived years. If this dose is insufficient, as may
often be the case in small children, it should be increased
a decigramme at a time until the desired effect is obtained.
When administered by the rectum, a single dose of from
thr«e to six times as many decigrammes as the child counts
years may be given. 7. When the use of the drug has
been long continued the organism seems at times to be-
come tolerant, and then the dose must be increased cau-
tiously.
294
THE MEDICAL RECORD.
[September 13, 1884.
The Medical Record:
A Weekly yournal of Medicine and Surgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD &. Co., Nos. 56 and 58 Lafayette Place.
New York, September 13, 1884.
PROFESSOR VIRCHOW'S ADDRESS ON META-
PLASIA.
We have received from our correspondent in Copen-
hagen the full text of Professor Virchow's address before
the International Medical Congress, and are enabled to
supplement the necessarily brief cabled report by a more
complete abstract of the lecture. After referring to the
older theories concerning the nature of the vital pro-
cesses in health and disease, the author stated briefly his
doctrine of cellular pathology and showed how it opposed
Schwann's theory of the origin of cells from the blastema.
The old theory of the identity of growth and nutrition is
manifestly untenable. The end and aim of nutrition is
self-preservation, while that of growth is increase of cells.
When, in the latter process, two cells are formed from
one, the old cell disappears, and thus we see that the
plastic process, although productive, is, in a certain sense,
also destructive. Thus there is a contradiction between
the nutritive or trophic and the formative or plastic pro-
cesses, which no amount of reasoning upon the materials
affecting nutrition and growth can explain away. Be-
cause the sande matter is used at one time for nutrition
and at Another for the increase of cells, it in no way fol-
lows that the processes in the two cases are identical,
and still less that the cause of both nutrition and growth
resides in this matter. All organic activity, the speaker
insisted, resides within the cells. There is a wide differ^
ence between cellular nutrition and the nourishment of
the individual. The former only begins where the latter
ends. Living tissues may take up materials without
using them in nutrition, as, for instance, the intestinal
epithelium, and the hepatic cells take up fat during the
process of digestion, but they soon give it off again. In
the process called assimilation, in which the cells take
up matters from the fluids and then form them into the
necessary tissue materials, nutrition and growth seem to
approach each other ; but yet there is a distinction. The
formation of tissue materials from nutritive materials is
indeed a sort of plastic process, but the latter term must
be more strictly limited to express the setting forth of
new elements, a formation of new cells. Growth itself
includes two processes, which must be kept distinct one
from the other. There is hypertrophy, an increase in
size of the individual cells, and hyperplasia, a true new
formation whether of cells or nuclei ; the one belongs to
trophic, the other to plastic processes.
But there is another group of processes, more nearly
related to the plastic than to the nutritive, and yet not in
a strict sense plastic, as no new elements are formed
This is what the author called metaplasia, the distinguish-
ing mark of which is the persistence of the cells while the
character of the tissue is changed. Although metaplasia
is the basis of many important pathological processes, it
is not pathological per se. We see it exemplified in the
formation of the bony framework of the body. In order
to a right comprehension of the subject it is necessary to
distinguish between the two processes embraced by the
term ossification. There is first the formation of the
osseous tissue, ossification properly so called, and there
is also the formation of the complete bone, a true organ,
and this is correctly designated osteogenesis. As regards
ossification, it is right to say that the bone is formed as a
rule from cartilage and, at a later stage, also from peri-
osteum. But in osteogenesis there is a further process,
the formation of the marrow, called by the speaker me-
dullification. The marrow was formerly regarded as a
sort of exudation filling up the medullary canal and the
spaces in the spongy portion of the bone. But when the
living bone in its totality came to be studied, it was re-
cognized that marrow is as true a tissue as the bone, the
cartilage, or the periosteum. We find three principal
forms of marrow, the red, the yellow, and the gelatinous.
These three forms, however, represent different condi-
tions of the same thing ; hence the marrow is a change-
able tissue and presents a striking example of metaplasia.
But this tissue is not only metaplastic, it is also of meta-
plastic origin. The greater part of that which fills up the
centre of a fully developed bone was formerly osseous
tissue. This tissue gives up its lime-salts, and the bone-
corpuscles become changed into marrow-cells, their con-
stitution is altered and softened. If this process assumes
an excessive character we call it osteoporosis, and in a
still more advanced degree, osteomalacia. But this is
not the only mode of origin of the marrow, for it may be
formed directly from cartilage. This fact was first dis-
covered by Virchow while studying the development of
the bones forming the base of the skull. He found that
only a small portion of that part of the sphenoid bone
forming the clivus Blumenbachii, which is cartilaginous
at birth, undergoes direct ossification. The greater
portion is transformed directly into marrow. It was here
also that the author was enabled to follow the process of
metaplasia of the small, red marrow-cells into large fat-
cells, the change of red into yellow marrow. The tran-
sition of cartilage into marrow-cells occurs in the same
way as does that of bone into marrow, with this differ-
ence, however, that, while the marrow from osseous tissue
is permanent, the same substance formed from cartilage
shows a marked tendency to ossification. So striking is
this tendency, indeed, that perhaps the majority of ob-
servers regard ossification from cartilage as a secondary
act, the first part of the process being a meduUification.
This is not always the case, however, for an examination
of lateral sections of the epiphyseal cartilage in normal
osteogenesis shows beyond question that the process here
consists in a direct ossification of the cartilaginous tissue.
The development of bone is thus shown to furnish a
striking example of a manifold metaplasia. How little
the simple nutritive standpoint serves to explain this
metaplasia is well shown by the results of the studies
September 13, 1884.]
THE MEDICAL RECORD.
295
made of the formation of the spongy tissue dtring the
last decade. These have shown that the number and
the direction of the bony trabeculae depend upon the
pressure and traction forces working from without. The
spongy tissue arises from a formation, not of the osseous
trabeculae, but of marrow which dissolves out the bone
by a process of metaplasia in some places and, so to
speak, spares it in others. The main part of the process
consists in a medullification rather than in an ossifica-
tion. These examples must have the effect of directing
more attention than was formerly given to the meta<
plastic character of many processes, the exact signifi-
cance of which can only be grasped by regarding them
in this light. Without^such an explanation, indeed, the
etiology of these various processes may be understood
in a general way, but beyond this we could not go. It
is very important, for example, to know that syphilis
may cause sclerosis of the long bones and also osteopor-
osis, but it is of still greater moment to recognize the
&ct that these two conditions may be but different stages
of the same process.
These various metaplasias in osseous tissue are by no
means of equal significance, and even the same form of
metaplasia must be judged differently under differing
circumstances. The secondary formation of marrow
from compact bone substance forms in normal develop-
ment the final stage of osteogenesis, and we may thus
legArd it as a progressive process. But in osteomalacia,
on the other hand, in which medullification surpasses the
normal limits, we derive the impression of a destructive
and regressive process. Wherefore it follows that a
prognostic judgment upon these metaplastic changes
cannot be based upon a simple knowledge of these pro-
cesses, but must rest upon a consideration of all the
circumstances in which the organ is placed.
Professor Virchow then discussed the metaplasia of
appose tissue. The changes here are rather monoto-
nous in character, the fatty being metamorphosed most
frequently into mucous tissue, but the study of them is
not without interest as bearing upon the formation of
some forms of tumor. In this kind of metaplasia the fat
is removed from the cells, but the ceils remain and
generate mucus. This, however, is not distinct from
the cells ; it is not, strictly speaking, secreted, but re-
mains as an integral part of the tissue. The process is
a return of the fatty tissue to the same tissue from which
it is formed in embryonic development. It is not
emaciation, for there is evidently a difference between
simple atrophy of fatty tissue and the formation of mu-
cous tissue by metaplasia. A lipoma may arise from
adipose tissue by partial hyperplasia. Sometimes lipo-
mata present numerous points of gelatinous formation,
and there are even tumors growing from adipose tissue
which are gelatinous throughout their whole extent.
These tumors are called by Virchow myxomata. Since
mucous tissue is normally embryonal, one might say in
a certain sense that myxomata are composed of em-
bryonic tissue ; indeed that tumor, called by the author
myxoma of the villi of the chorion, the hydatidiform
mole, is wholly embryonal. But every myxoma is not of
congenital origin, for besides the primary embryonal
mucous tissue there is, as we have seen, a secondary
tissue of this kind formed in adults by metaplasia, and
from which myxomata are developed by hyperplasia.
The author then spoke of tumors formed from naevi
which may be said to be embryonal tissue, and of
enchondromata arising from little islets of cartilage for-
gotten in the process of ossification, which are certainly
of non-congenital origin. And he took occasion here to
refute the theory of Cohnheim, who regards all tumors
as originating from unchanged embryonic tissue.
Hitherto the argument had been confined to meta-
plasia between tissues of a similar character, but in con-
cluding the author touched briefly upon that occurring
in tissues belonging to different categories. He had
never seen an instance of the formation of connective
tissue from epithelial elements, but was convinced that
the converse does obtain. He did not believe, as is
maintained by some, that the white blood-corpuscles
were capable of producing every form of new tissue, or,
in other words, that they were possessed of the property
of absolute metaplasia, but thought that their powers in
this respect were limited.
Of course, so difficult a problem as the possibility of
metaplasia in the sense of dissimilar tissue production
cannot be regarded as solved because affirmed by even
so high an authority as Professor Virchow. Indeed, the
learned speaker himself disclaimed any such assumption,
and expressed simply his gratification that he had been
instrumental in directing the attention of investigators to
this point, and he hoped that their labors would be
simplified somewhat at the start by an acquaintance
with the less complicated forms of metaplasia which they
had just been considering.
WHAT IS THE CHOLERA MICROBE?
The nomenclature of bacteriology, as is always the case
in every new science, is by no means satisfactory. The
discoverer of each new form of micro-organic life ha&
given it whatever name best suited his frincy, and while
this was doubtless satisfactory to the word*coiner, it re-
salted in a confusion of terms sufficient to appal even
the most stout-hearted tyro in bacterial studies. Cohn
has done much by his dassification to simplify the ques*
tion, and although his system is by no means perfect, it
has been adopted by most of the German writers, Koch
among the rest. Yet the latter seems to have departed
from this nomenclature in one notable instance at least,
in the designation, namely, of the supposed cholera mi*
crobe. He has called it the comma-bacillus. The qual*
ifying word ''comma" was not happily chosen, for it
suggests an organism of curved form with a head and a
tapering extremity, whereas the cholera microbe is of
equal size throughout with no distinction of its extrem-
ities. But more than this, as Koch himself says, the
^* bacillus '' is probably not a bacillus at all, but rather a
spirillum. Indeed, there are many points of close re-
semblance between the spirilla and the microorganisms
found in the dejections of cholera patients.
Dr. Muhlh&user, of Speier, has recently made a study
of spirilla, embodying his results in an interesting article
appearing in Vtrchott/s Archiv^ No. i, 1884. This or-
ganism he describes as existing in the form of a long, fine
thread, twisted into a number of spiral turns. The spi-
rals are of equal size and may vary in number from two
296
THE MEDICAL RECORD.
[September 13, 1884,
to ten or more. There is no appearance of head or tail,
each end of the spiral thread being of equal thickness.
These bodies are possessed of the power of independent
motion^ turning upon themselves like the screw of a pro-
peller. The spirillum seems to be enclosed in a sheath,
like the aids cylinder, which terminates at each extrem-
ity in a cilia4ike prolongation. It is probably to these
cilia that the body owes its power of motion. The spi-
rilla grow by direct increase in length, adding coil upon
coil until the number may reach a dozen or more. The
larger the number of spirals the slower is the motion.
Spirilla are reproduced by fission, and never by the
production of spores. And here begins the likeness be-
tween them and the so-called comma-bacilli. The latter,
Koch insists, are never reproduced by spores, the parent
microbe must be present and alive, otherwise no repro-
duction of organisms can occur. Another point of
resemblance Hes in the weak powers of resistance pos-
sessed by these organisms. Koch says that drying kills
the cholera microbe with absolute certainty, and Miihl-
hauser says the same of the spirillum. The latter is even
killed by sunlight, but seems not to be injuriously affected
by cold, and this fact is also affirmed of the cholera
germ, which has been seen to revive even after having
been frozen. Both these forms of micro-organisms de-
pend upon oxygen for their existence, a peculiarity
which separates them sharply from many other forms of
bacterial life. Muhlhauser saw in some fresh culture-
fluids certain minute shapes which seemed to be straight
and resembled the bacterium termo, but which he found
on closer inspection to be bent, and to be spirilla of but
two coils, thus resembling also in form the cholera germ.
Another peculiarity of the spirilla was that they were
sometimes joined together, end to end, like links of a
chain. Koch also saw this union in the case of the
cholera microbes, two being joined in the shape of an S,
or at times there were longer strings, looking like the
spirals of a corkscrew. Of course, in this case the
resemblance is only in outward form and may be ap-
parent only, but the other points — the absence of spores,
the slight power of resistance to outward influences, cold
alone excepted, and their dependence upon oxygen for
existence — would indicate a near relationship, even
though they may not be members of the same family.
THYMOL IN THE TREATMENT OF CHOLERA.
Professor Bozzolo has written a letter to the public
press in Italy, advocating thymol on theoretical grounds
as a remedy for cholera. If it be true, he says, that
cholera is due to the presence of micro-organisms in the
intestinal canal ; that these organisms are developed in
this part because they find there an alkaline fluid favor-
able to their growth ; and that acids kill them, or at least
hmder their further development, then the problem is to
find a slightly soluble acid, and strongly antiseptic sub-
stance which is, in large quantities, innocuous to the
human organism, and which will pass into the intestines
without sufiering appreciable change in the stomach.
These valuable properties, the learned professor main-
tains, are possessed by thymol. This] substance^ may be
given, he says, without danger, in the dose ^ of three
•drachms a day, divided in capsules containing^seven and
a half grajps each. Judging from the recent telegraphic
reports of the ravages of the cholera in Italy, we are
forced to conclude either that this remedy has not been
tried to any great extent, or else that it has been proven
ineffectuaL
THE PREVALENCE OF TYPHOID FEVER IN NEW YORK.
Some statements have been made in the daily press to
the efiect that typhoid fever is prevailing more than usu-
ally m this city. Such is not the case, however, accord-
ing to the latest reports. There is always some increase
in the disease in the fall, and the mortality statistics show
that the deaths therefrom are one-third greater in the
last quarter of the year than in the first During the
past month of August the number of cases has been
from 24 to 34 per week, and in the first week of Septem-
ber the number reported was 48.
The total number of cases in August was 140, while a
year ago the number in the same month was 344. In
September, 1883, the cases reached a total of 303 for
the month, or 76 per week. So that typhoid fever now
prevails a little more than in 1882, but it is much less
than in 1883.
At the present time, with so many persons returning
from the country, a certain proportion of the cases axe
probably imported. Then the settling again in a house
whose drains and pipes have not been flushed for some time
is a thing not always without danger. A timely caution
from the family physician at present might be of much
service.
THE BAD SANITARY CONDITIONS OF THE GREELY
PARTY WHILE AT CAPE SABINE.
According to Dr. Green's report of the medical history
of the survivors of the Lady Franklin expedition, pub-
lished in last week's Record, it seems that this party
spent their long winter night in a miserable hovel 25
feet long by 17 feet wide and 4 feet high, making the
cubic air space 1,700 feet. In this the twenty-four
members of the party lived all winter, having a cubic
air allowance of about seventy feet for each man. "The
whole party," it is said, '' could barely squeeze in and lie
at length, two or three being obliged to occupy the same
sleeping bag." There were, it appears, certain vent-
holes in the roof, which were sometimes stuffed with
rags, and on one occasion the whole company came near
perishing of asphyxia by the carbonic acid from an
alcohol lamp which was burning in the hut while the
vent-holes were stopped. Doubtless the sufferings and
mortality of the party were augmented by the evil effects
of bad air. It is well known that between four and five
hundred cubic feet of air pass through the lungs daily,
and in the same period about twenty-three cubic feet of
oxygen are absorbed, and that the size of an apartment
in which persons are confined should be such, that
there shall not be less than eight hundred cubic feet
for each person occupying the room. A multitude
of instances illustrative of the fatal effects of neglect
of this precaution are on record, the most notable of
which is that of the " Black Hole of Calcutta," an ac-
count of which may be found in any text-book on phy-
siology. The baneful results of imperfect haematosis
'rom bad ventilation are familiar to all medical readers,
September 13, 1884.]
THE MEDICAL RECORD.
297
and it would appear, by analyzing the morbid phenomena
presented by various members of the expedition, and so
well described by Dr. Green, that the party when found
were suffering almost as much from want of oxygen, and
from accumulation of carbonic acid in their systems, as
from deprivation of food. Add to this that they had
long ceased to bathe themselves or take regular exercise
(except perhaps Long and Brainard, who were the most
healthy of the lot), and that they were extricated from
appalling filth, and the wonder is that there were any
survivors to tell the story.
MENSTRUATION INiWOMEN AND IN ANIMALS.
A Harvard medical student, in the Boston Medical and
Surgical Journal^ Kvigast 28, 1884, has an interesting
article on the phenomenon of menstruation in women
and of heat in animab. According to this writer,
** woman is more different from the man {sic) than the
brute females are from their males, and the reproductive
processes are intensified in her.*' In woman the men-
strual period *' is the period of absent sexual desire, and
is by no means contemporaneous with ovulation.'' '' The
human intelligence has rendered woman sexually inde-
pendent of the heat ; sexual congress is permitted at any
time, and therefore she is subject to a condition not
prevalent in the brute animals ; she is liable to conceive
at any time." This writer goes on to observe that, in
view of the possibility of pregnancy at any time, and the
immediate demands upon her nutritive force which would
come from such an event, '* woman has to be run at a
higher pressure (sic) than is necessary for the needs of
the non-pregnant female." This lucid explanation is
supplemented further on by the statement that, since the
human female " is run at such high pressure, frequent
overflows of nutritive material are necessary in the non-
pregnant women, and these overflows taJce place at
certain periods of genital hyperaemia inherited from the
lower animals, that is, at the menses. That is to say, the
reproductive side of menstruation is emphasized in
woman, the sexual side in brutes."
Despite certain infelicities of style, the present status
of the subject is fairly represented in the article. The
ovulation theory is no longer tenable, as cases are on
recoil of menstruation after double ovariotomy, of ovula-
tion without menstruation, and of menstruation without
ovulation. Instances of conception fifteen days or more
after coitus are numerous. Stedman has reported a case
where " a woman had menstruated regularly to the time
of her death, but whose ovaries were found cystic and
atrophied." It would seem then that there is very strong
evidence against the ovaries being the source of the
menstrual impulse, and the writer asks whether this im-
pulse may not come from the general system. He points
out the fact that fear, horror, and violent emotions, in
general, are known to have an immediate effect on men-
struation in many cases. ^\ The influence of the mammae
is marked. Dr. Campbell cites two cases of premature
menstruation in children caused by mammary inflamma-
tion." Change of climate often suppresses menstruation ;
a sea-voyage often delays or hastens the next period ;
anaemia is a most fruitful cause of amenorrhoea, and so,
alienists have told us, is a mental disease. The writer
takes up the recent, theory propounded by Kindrat and
Williams, and defended by Dr. Chadwick in a former
number of the North American Review ^ that ''menstru-
ation is neither a congestion nor a species of erection, but
a molecular disintegration of the mucous membrane of
the uterus, followed by hemorrhage/' In other words,
the uterine mucus undergoes disintegration and exfol-
iates with each menstrual period ; menstruation is then
a sort of disappointed pregnancy. '' When conception
takes place a process of nine months or more of uterine
increase is gone through, followed by fatty degeneration
and desquamation in the puerperal state. When no con-
ception, the process is completed in a little over a week."
The observations of Moricke and Wyder seem to dis-
prove this view ; Moricke showed, by scraping with a
curette the uterine mucous membrane of his menstruat-
ing patients, that tliere was no destruction, partial or total,
of the mucous membrane, and no fatty degeneration ;
the bleeding, according to him, is due to diapedesis.
Wyder, by a series of careful observations also arrived at
the same conclusion, that in menstruation there is no
denudation of the mucous membrane.
With respect to theories of menstniation this writer
thinks that we are more badly off than we were ten years
ago, when this physiological phenomenon was better ex-
plained than it can be to-day, in the light of all the facts.
^ewB tit tlije "^SeSUt^.
Dr. Van der Veer, of Albany, gave a reception at
his home in honor of Mr. Lawson Tait, of London.
In Memory of Civiale. — ^The municipal council of
Paris has voted to give the name of Civiale to one of the
streets in Paris.
A New Emergency Hospital for Bellevue is soon
to be established in one of the down-town districts. This
will relieve some of the work of the Chambers Street
Hospital
Paris is to Have a Baby Show. — Artists and doc-
tors are to be on the committee of judges, and healthful-
ness is to be considered as well as beauty in giving the
awards.
Claimants to Priority in the Discovery of the
Cholera Bacillus. — ^The number of these is increasmg
weekly. Besides the names of \^t. !Mstowe and Pro-
fessor Pacini, a Polish paper now claims the honor for
Dr. KlodzianowskL The Lancet now brings up Dr. A.
H. Hassall, who claims to have discovered the bacillus
thirty years ago.
The Next International Medical Congress. —
Referring to its next place of meeting the British Medi-
ccU Journal says : " We may be sure that our transatlan-
tic cousins will leave nothing undone to make the next
meeting as successful as the last two, if indeed they do
not succeed in eclipsing former achievements ; however
this may be, the announcement will be received with
great pleasure in this country, where we have learned to
set a high value on the work done by the medical profes-
sion in the United States."
Medical Changes in Berlin. — Owing in part to
the appointment of Professor Schweninger as a member
298
THE MEDICAL RECORD.
[September 13, igg^
of the Imperial Board of Health, the Director, Dr.
Struck, has resigned. Dr. Koch has refused to be his
successor, and has also withdrawn from the Board, being
content with his position as Professor of Hygiene and
Director of the Hygienic Institute. Dr. Julius Wolf has
been made Extraordinary Professor of Surgery, and Dr.
Mendel Extraordinary Professor of Psychiatry.
Ozone and Cholera. — During the cholera epidemic
at Marseilles, ozone disappeared from the atmosphere.
When it reappeared, after a southwest wind, the cholera
mortality fell. It is not easy to produce ozone ; there
are many methods recommended, but they are all mostly
worthless. M. Onimus only admits one method, electri-
fying the oxygen of the air either by a Ruhmkorft*s induc-
tion machine and Berthelot's tubes, or by an ordinary
electric machine ; at the Pharo hospital M. Onimus
adopted the latter method. The ozonoscopic papers
testified that ozone was produced. Its actual therapeutic
properties could not be determined, as the usual treat-
ment was observed conjointly. The mortality was low
in those wards where ozone was artificially produced.
The Elevation of a Quack. — It appears that Berlin
medical circles are much disturbed over the elevation of
Dr. Schweninger, Bismarck's Leibarzt, to a position in the
Medical Faculty of the Berlin University. Schweninger
had no scientific or even social standing amongst the
profession previous to his success with Bismarck, and the
correspondent of the AUgemeiner Wiener Meditinische
Zeitung affirms that if he presented himself for admission
to the Berlin Medical Society now he would be undoubt-
edly rejected.
Schweninger was formerly connected with the Munich
Faculty, but was obliged to leave somewhat under a
cloud. He is claimed to have advertised and applied a
so-called " Schweninger-cure " for obesity, fatty heart,
etc. This " cure/' which he applied to Bismarck, is sub-
stantially that laid down by Professor Oertel in " Ziem-
ssen's Handbuch der Therapie der Kreislaufstdrungen,
Feltherz,'* etc.
Despite the unpleasant pushing forward of the obnox-
ious quack, the Berlin medical journals are forced to keep
very quiet, and it is only through Berlin correspondence
that the true state of feeling is made known.
Death of Professor J. Cohnheim. — We regret to
learn of the death of Professor J. Cohnheim, at the com-
paratively early age of forty-six. He died of gout com-
plicated with some renal trouble. Professor Cohnheim
was one of the most distinguished of the pupils of Vir-
chow, whose assistant, in the Berlin Pathological Insti-
tute, he was from 1864 to 1868. In 1868 he was ap-
pointed ordinary Professor of Pathology at Kiel, and, in
1872 he preceded Waldeyer in a similar capacity at
Breslau. It was there that he made his well-known re-
searches on the changes produced by embolism, and on
the escape of the white blood-corpuscles through the
walls of the vessels in inflammation. In 1876 he suc-
ceeded Wagner in the chair of General Pathology and
Pathological Anatomy in the University of Leipsic, and
held that professorship up to the time of his death.
The AcADfiMiE de Medecine of Paris continues its
session through the summer. At its meeting on August
19th, the subject of cholera was discussed. M. Bouley
read a paper for M. Chauveau on gangrenous septicaemia,
in which it was shown that gangrenous septicaemia in
man is identical with that in animals, and depends upon
a microbe a&obie^ which is probably only the septic vibrio
of Pasteur.
A Place for Cholera to Locate. — One-fourth of
the whole population of the State of New Jersey drink
the water of the Passaic River, taken from a point where
the tide, laden with the sewage of Newark's 140,000 peo-
ple, flows up and meets the downward current bearing
the sewage and factory refuse of 60,000 dwellers in Pat-
erson and other cities on its banks a few miles above.
The city of Passaic now proposes, says the Sanitary En-
gineer^ to add its quota of sewage to the river by estab-
lishing a system of drainage. The water of the Passaic
has been condemned as dangerous long ago. But in
view of a prospective visit of cholera the matter becomes
really serious and of interest. to others than those living
by the polluted river. The establishment of pumping
works on the Passaic above all source of pollution is the
remedial measure urged by our contemporary, and it is
one that has been approved of by competent engineers.
Alleged Successful Inoculatiok of Lower Ani-
mals WITH Cholera. — A cablegram from London says
that Drs. Reitsch and Ricati, of Marseilles, claim to have
successfully inoculated lower animals with the cholera
microbe. The animals died with choleraic symptoms.
Remembering the great ease with which septic pheno-
mena can be produced in certain lower animals, the
reports of successful inoculations must be received with
skepticism until full details are given.
The Paradise of Eclectics. — A writer in the Kan-
sas Medical Journal grows enthusiastic over the present
and future of Eclecticism in Kansas. The Eclectics in »
that State number nearly six hundred. " They do not,"
he says, '^ seek seclusion in rural districts generally, but
occupy lucrative positions in cities and country towns,
and in comparison with other industrial classes they are
thrifty, diligent, have nice homes, pretty wives, sons,
and daughters (so we think), wear good clothes, drive
fine horses, own miles of prairie, bank stocks, meet the
difficulties and enjoy the incidents that go to make up a
busy, active life." The State Society has obtained a
charter for a medical college. ^
The Canada* Medical Association. — We learn
from a correspondent that the annual meeting of this
Association at Montreal, just previous to the meeting of
the British Association, was unusually well attended and
successful. We have received, too late for publication,
the address of the president,|Dr. M. Sullivan, of Kingston.
It was a most able e£fort, and contained a great deal of
solid statistical matter, as well as of practical suggestion
regarding the medical afifairs of Canada.
The Cholera. — ^The cholera has attacked Naples
with a severity far surpassing that with which it visited
Marseilles, or even Toulon. On September 8th diere
were eight hundred fresh cases and three hundred deaths
within twenty-four hours. Some sixteen provinces of
Italy have now been attacked. In most of these, how-
ever, the daily number of firesh cases is not large, varying
from one or two to fifteen or thirty. The disease is
spreading slowly in Spain, but is evidently dying out at
September 13, 1884.]
THE MEDICAL RECORD.
299
Toulon and Marseilles. The total number of deaths
from cholera up to date is about six thousand, which
means that there have, since June, been from twelve
thousand to fifteen thousand cases of the disease.
Reviews and Notices.
Practical Manual of Diseases of Women and Uter-
ine Therapeutics, for Students and Practitioners.
By H. Macnaughton Jones, M.D., M.C.H., F.R.C.S.
I. and E. Examiner in Obstetrics Royal University of
Ireland, Fellow of the Academy of Medicine in Ire-
land, etc. New York : D. Appleton & Co. 1884.
i2ino. pp. 392.
It is seldom that we see a book so completely fill its
avowed mission as does the one before us. It is practi-
ce from beginning to end, and cannot fail to be appre-
ciated by the readers for whom it is intended. The
author's style is terse and perspicuous, and he has the
enviable faculty of giving the learner a clear insight of
his methods and reasons for treatment. Prepared for the
practitioner, this little work deals only with his every- day
wants in ordinary family practice. Every one is com-
pelled to treat uterine disease who does any general busi-
ness whatever, and sjiould become acquainted with the
minor operations thereto pertaining. The book before
as covers this ground completely, and we have nothing
to offer in the way of criticism. The illustrations of dis-
eased conditions and of instruments are numerous and
appropriate.
Diphtheria, Croup, Etc. ; or. The Membranous Dis-
eases : Their Nature, History, Causes, and Treat-
ment ; with a Review of the Prevailing Theories and
Practice of the Medical Profession ; also a Delineation
of the New Chloral Hydrate Method of Treating the
Same, its Superior Success, and its Title to be con-
sidered a Specific. By C. B. Galentin, M.D. Cleve-
land, O.: Printed at the Publishing House of the
Evangelical Association. 1884.
The title of this book sufficiently indicates the object of
the writer in giving it to the world. The author states
that since 1875, when he first began to use chloral in
the treatment of diphtheria, he has given it in over five
hundred well-marked cases of the disease, with a mor-
tality of less than two per cent. Prior to that time, when
employing the ordinary treatment, he had encountered a
mortality of from 25 to 33^ per cent. The chloral is
^ven in small repeated doses with the object of induc^
rng and maintaining a quiet somnolent state. A mod-
erate Jbypnotic effect is, in the author's experience, es-
sential to the best results, as at this point the temperature
and pulse-rate are reduced, and worry, headadie, and
nausea disappe&r. This effect i^ also, he states, an indi-
cation that the remedy has been absorbed into the blood
in sufficient quantity to produce upon it specific effects.
A Treatise on Ophthalmology for the General
Practitioner. Illustrated. By Adolf Alt, M.D.
Chicago, St Louis, & Atlanta: J. H. Chambers &
Co. 1884.
This book, as its title implies, is intended solely for the
general practitioner. Its object, as stated in the preface,
IS to give the general practitioner a clear idea of the
principles of ophthalmology, together with so much only
of its practice as he might be reasonably justified in at-
tempting With this aim in view the author has suc-
ceeded in producing a really valuable work, one which
may be perused with profit by the non-specialist, and
which he will not be forced to lay aside because over-
burdened with details relating to subjects of little or no
use to him. The work contains numerous illustrations
which, though rather coarse in their execution, are yet
sufficiently clear to answer the purpose intended. The
book is neatly printed on good paper and will be found
a valuable addition to the library of the general practi-
tioner.
Fat and Blood : An Essa^ on the Treatment of Cer-
tain Forms of Neurasthenia and Hysteria. By S. Weir
Mitchell, M.D. Third edition. Philadelphia : J. B.
Lippincott & Co. 1SS4.
The author states in his preface that he has, in the pres-
ent edition, rewritten parts of the book, and has added
many practical hints, particularly with regard to the
treatment of obesity and the use of milk. Dr. Mitchell's
method of treating certain classes of nervous invalids is
now well known and has received substantial endorse-
ment on both sides of the Atlantic. For our part, we
believe that the method advocated is an immense addi-
tion to therapeutics, and one whose value is yet not suf-
ficiently appreciated. At the time, we are quite aware
that the proper cases must be selected, and that treat-
ment must be conducted with great care and judgment
The author wisely concludes his book with the expression
of fear lest his method now be misused or misapplied.
Text-Book of Medical Jurisprudence and Toxi-
cology. By John J. Reese, M.D., Professor of Med-
ical Jurisprudence and Toxicology in the University of
Pennsylvania, etc. Philadelphia : Blakiston, Son &
Co. . 1884. i2mo, pp. 597.
Professor Reese is so well known as a skilled medical
jurist thac his authorship of any work virtually guarantees
the thoroughness and practical character of the latter*
And such is the case in the book before us. A very ex-
tensive field is travelled over by one acquainted with all
its parts, and all the main and essential landmarks are
plainly pointed out to the reader. We might call these
the essentials for the study of medical jurisprudence.
The subject is skeletonized, condensed, and made thor-
oughly up to the wants of the general medical practi-
tioner, and the requirements of prosecuting and defend-
ing attorneys. If any section deserves more distinction
than any other as to intrinsic excellence, it is that on
toxicology. This part of the book comprises the best
outline of the subject in a given space that can be found
anywhere. As a whole, the work is everything it prom-
ises and more, and considering its size, condensation, and
practical character, it is by far the most useful one for
ready reference that we have met with. It it well printed
and neatly bound.
Medical German. A Manual Designed to Aid Physi-
cians in their Intercourse with German Patients and
in Reading Medical Works and Publications in the
German Language. By Solomon Deutsch, A.M.,
Ph.D. New York : J. H. Vail & Co. 1884. Pp. 336.
The first division of this book contains an extensive col-
lection of words and phrases that pertain to medicine in
all its branches. The second division consists of conver-
sations supposed to be held with a sick patient, and it
seems to cover every imaginable morbid condition. There
is a very complete German-English index appended.
The book is designed to meet the wants of physicians
who are learning German, and who have to deal with
German patients. In this respect it fills an unoccupied
niche and will prove a most useful publication. It con-
flicts in no way with Cutter's Medical German Diction-
ary, which contains a very much more copious vocabu-
lary. The book is well printed and neatly bound in
flexible covers.
The Theory and Practice of Medicine. By Fred-
erick T. Roberts, M.D., B.Sc., F.R.C.P. With 11-
lustrations. Fifth American edition. Philadelphia :
P. Blakiston, Son & Co. 1884. Pp* 1008. ,
This standard work has now reached its fifth edition,
a sufficient endorsement of its excellence to make the
reviewer feel that his task is a superfluous one. In the
present edition the subjects of diseases of the nervous
system and diseases of the skin have received especial
300
THE MEDICAL RECORD.
[September 13, igg^.
attention, and the chapters bearing thereon have been
rearranged and to a large extent rewritten.
Perhaps the most conspicuous of the valuable features
of the work is its comprehensiveness, the very large field
that it covers within the single volume. If we were to
make any criticism on the other hand, it would be that
too much is attempted, and that the author fails to possess
what might be called the medical perspective. That is
to say, he does not assign his space in strict accordance
with the relative importance of the subjects. The book,
as a whole, is weak in its pathology.
. Nevertheless it deservedly takes a high place among
the standard treatises on the practice of medicine.
An Introduction to Pathology and Morbid An-
atomy. By T. Henry Green, M.D., London. Fifth
American from the sixth revised and enlarged English
edition. With 150 Engravings. Philadelphia : Henry
C. Lea's Son & Co. 1884.
The present edition of this standard work has been con-
siderably revised. The introductory chapter on cells,
and the etiology of disease, and the chapters on tumors,
regenerations, septicaemia and pyaemia, and on vegetable
parasites are entirely the work of Mr. Stanley Boyd*
They are very well written and do the author credit.
The chapter on vegetable parasites in particular is one
of the best presentations of the subject which we have
seen, though it does not differ ^eatly from that in Ziegler.
The chapters on tuberculosis and phthisis would bear
rewriting in the light of modem mycology. Dr. Green's
work is more elementary and less critical than Ziegler's.
It serves all the better, however, on this account, as a
text-book for students*
Sexual Neurasthenia. Its Hygiene, Causes, Symp-
toms, and Treatment, with a Chapter on Diet for the
Nervous. By George M. Beard, A.M., M.D.
[Posthumous Manuscript] Edited by A. D. RocIp'
well, A^M., M.D. New York : E. B. Treat. ^4.
Pp. 276.
To those numerous readers of the late Dr. Beard's wQrk
who admired the charm and suggestiveness of his writings
the present posthumous volume will be examined with
great interest It will be found that the chapters here
given possess the same attractiveness which sCttached to
all the author's writings, and he who begins to read will
be slow to lay down the book before it is finished The
first two chapters comprise an introduction and a discus-
sion of the nature and varieties of neurasthenia. In them
Dr. Beard has stated clearly and succinctly his peculiar
views regarding the nature of nervous exhaustion and its
relation to the functions of the body. He applies here,
also to functional nervous disturbances, the laws of evolu-
tion and devolution, or dissolution, using the same line of
reasoning which Hughlings Jackson employed in a series
of lectures delivered in London last winter.
These first two chapters are decidedly the best in the
book, and furthermore, are among the best pieces of
medical writing ever produced by an American physician.
The remaining chapters contain much that is true with
some that is incorrect or commonplace. In practically
working out his principles. Dr. Beard was sometimes
hasty and superficial. His diet for the nervous is too
fanciful, and his description of the evolution of the sexual
sense amounts to little. His chapter on sexual hygiene
is excellent and correct, but he states what is generally
known and generally accepted.
The illustrative cases deserve attention. They are
many of them most curious histories, and a perusal of
them will give some idea of the peculiar class of cases
which the author attracted to himself.
Though of a philosophic, and as many would say, an
impractical mind, Dr. Beard was a successful therapeutist,
having great resources and thorough confidence in him-
self. The chapter on treatment is instructive, therefore,
but every physician of experience will appreciate that it
was the man behind the therapeutical armamentarium
which accomplished the work.
Dr. Beard's book betrays some signs of incompleteness
and doubtless it would have been added to, and changed
if the author had been spared. As it is, however it
shows well both the faults and merits of the author. And
not the least among the latter is the perfect cleanliness
and absence of pruriency in the manner with which a
delicate subject is treated.
Work and Worry, from a Medical Point of View. By
W. Henry Kesteven, M.R.C.S., L.S.A. London:
Diprose & Bateman, Lincoln's Inn Fields. 1884.
This is a very pleasantly written and suggestive essay on
the evil effects of worry. By work the author means
only that labor which is entered upon and carried through
with heart and mind and soul. And all distasteful and
unpleasant labor he relegates to the category of wony.
Accepting such a definition of terms, we fear there are
few men, however favorably circumstanced, who have
not to undergo nearly as much worry as work in the
course of a day. For no labor, however pleasant in the
main, is throughout and entirely free from antioyances
and disagreeable interjections. Nevertheless^ we can do
much, if we set our minds upon it, to make almost any
kind of labor less unpleasant than it would otherwise be,
and thus go far to convert our worry into work. The
little brochure is quaintly printed and bound, and cor-
responds to its external dress to the style of the author.
PROFESSOR ROBERT E. kOGERS, M.D.,
PHILADBLPHIA, PA.
Dr. Robert Empie Rogers, a prominent physician and
a leading teacher of chemistry, of Philadelphia, died
there on September 6th. He was bom in Baltiniore,
Md., in 1814, and after a careful preliminary education
he studied and was graduated as an M.D. from the Uni«
versity of Pennsylvania in 1836. From 1S44 to 1852
he was Professor of Chemistry at that University, and
assisted his brother, J. B. Rogers, in preparing his edi-
tion of ** Turner's Chemistry," and on the death of that
brother he succeeded him as Professor of Chemistry in
the Medical Department of the University of Pennsyl-
vania, In 1877 he resigned this position, and accepted
a similar one in the Jenerson Medical College, in Phil-
adelphia. He contributed to the JourncU of the Frank-
lin Institute^ took part with his brothers in the geologi-
cal surveys of Virginia and Pennsylvania, and edited the
American reprint of "C. G. Lehman's Physiological
Chemistry," 1855.
JACOB H. STEWART, M.D.,
ST. VADLy MINN.
Dr. Jacob H. Stewart, a prominent physician of St
Paul, Minn., died of apoplexy, August 25th, ult, aged
fifty-six years. He was educated at the Academy in
Peekskill, N. Y., where his father, Dr. Philander H.
Stewart, resided ; he afterward entered Yale College, re-
maining there three years, and finally graduated at the
University Medical College in 185 1. In 1855 ^^ settled
in St Paul, Minn.
In 1 86 1, at the breaking our of the war, he went as
surgeon of the First Minnesota Regiment While attend-
ing the wounded on the Bull Run battle-field he was
taken prisoner and confined in Richmond jai4. Being
paroled, he returned to St. Paul and became examiner
for recruits. He was elected mayor of St. Paul in 1864
and again in 1869, 1871, and 1873. ^^ ^^7^ ^^ ^''^
elected to Congress, and in 1879 ^^ appointed by
President Hayes Surveyor-General of Minnesota. He
leaves a widow and three children, one of whom, Dr.
Jacob .H., is at present perfecting his studies in this city.
September 13. 1884.]
THE MEDICAL RECORD.
301
^jeprartB 0f MocietUs...
EIGHTH SESSION.
Bifida/ Capenhagefty Denmark^ August 10-16, 1884.
REPORTS OF SECTIONS.
(Special Report fior Tkot Mkdioll Rbcokd.)
SECTION ON MEDICINE.
Monday, August iith — First Day.
The section was called to order by the Chairman,
Profsssor F. Trier, who briefly reviewed the forth-
coming work of the members. He regretted the absence
d Professor Grainger Stewart, and announced that the
following gentlemen had been nominated as
HONORARY PRESIDBNTS :
Dre. Bouchard and Jaccoud, of Paris ; L6pine, of Lyons ;
Liebreich, of Berlin ; Liebenneister, of Tubingen ; Bier-
mer, of Breslau ; Pribram, of Prague ; R. Bennett, of Lon-
don; H. Acland, of Oxford; Austin Flint, of New
York ; Tommasi Crudeli, of Rome ; an* Rosenstein, of
Leyden.
SSCRSTARIES :
Dr. Madsen, of Copenhagen, Secretary-General; and
Drs. Lcyfer^ of Wurtzbuig ; Daremberg, of Mentone ;
I. Owen, of London, additional secretaries.
Dr. S. Laachk, of Christiama, then read a paper on
THE YALUK OF RSCSNT RXSRARCHIS ON BLOOI>-GOR-
FDSCLIS IN THB PATHOLOGY OF ANiBMIC AND LBU*
CKMIC DISKASBS.
The speaker said that, owing to tne labors of Vierordt,
Wdckcr, Malasses, and Hayem, we were now in posses-
noQ of a method by which the clinician was enabled to
deteraiine with tolerable exactness, not only the relative
sofflber of the blood-corpuscles, but also the pigmentary
powers of the blood.
It has been determined that, in
AN.AMIA FOLLOWING HBMORRHAGB,
the number of red blood-Kiorpuscles may be reduced be*
bw fifty per cent, without causing immediate death or
rendering impossible a restitutio ad integrum. In the
process of regeneration, the formation of new corpuscles
proceeds more rapidly, as a rule, than does that of the
haemoglobin.
According to the condition of the red blood-globules,
we recogniafie two forms of
CHLOROSIS.
In the first form, pseudochlorosis, there is but little, if any,
change in the red corpuscles. In the second form, the
true chlorosis, these bodies have undergone an un-
doabted, and often very marked, alteration. Here, not
only the coloring properties of the blood, but also the
number of the corpuscles are reduced, the former, how-
ever, in the greatest degree.
Tins division of chlorosis is of practical value, as it is
in the second variety, true chlorosis, that iron exerts its
well-known therapeutical action. In
PERNICIOUS ANiEMIA
the number of red globules may sink below 500,000 per
cul»c millimetre without causing immediate death or de-
stroying all chances of recovery. A peculiarity in this
disease is, that the red corpuscles are on an average larger
and contain more haemoglobin than normal.
While the relations of the white blood-corpuscles in
the above conditions are not constant, their increase in
number is the predominating symptom in
LEUCiBMIA.
Their si^ however, is variable. The red corpuscles
may not be altered, even in advanced stages of the dis-
ease, and the decrease in number, even when it occurs,
never reaches such an extreme degree in the three first-
mentioned afifections. Arsenic exerts a destructive ac-
tion upon the white globules.
Sir RiSDEN Bennett, of London, took the Chair
while Professor Austin Flint, of New York, read a
paper on
A UNIFORM nomenclature OF AUSCULTATORY SOUNDS IN
THE DIAGNOSIS OF DISEASES OF THE CHEST.
At the meeting of the International Medical Congress,
in London, in August, 1881, the following resolution
was adopted by the Section on Medicine :
" Resolved^ That a Committee be appointed to report
on a uniform nomenclature of auscultatory sounds in the
diagnosis of diseases of the chest.''
The following were appointed members of this Com-
mittee ; Professors Austin Flint, of New York ; Ewald,
of Berlin ; D'Fspine, of Geneva ; and Drs. Douglas
Powel and F. A. Mahomed, of London.
At a meeting of the Committee, in London, it was
agreed that ,each member should send his report to the
Chairman, who would compare them and submit the re-
sults of such comparison to the Section on Medicine, at
the meeting of the Congress in Copenhagen. Dr. Flint
placed a
COMPARATIVE TABLE OF THE DIFFERBNT LISTS
where it could be seen by the members, and then pre-
sented his report upon the points of difference and
agreement in these several lists. An approach to uni*
formitywas noticed in them all. The Committee had
evidently not needlessly multiplied terms. Those signs
which were not included in all lists were unimportant,
with the exception of cavernous respiration, which was
wanting in the (merman. There were no essential points
of difference in the nomenclature. The term subcrepi-
tant rSles was wanting in all the lists, and was, ^e
speaker thought, supemuous. No variation existed in
the definition of palpation sounds, but there were sohae
differences in the definition of the percussion sounds.
^ the American list it was stated that prolonged expi-
ration may be high or low in pitch ; the high pitch indi-
cated consolidation. R&les in the French nomenclature
mean either dry or moist sounds ; in the English, only
moist The definition of bronchophony and pectoriloquy
varies in the different lists.
It was suggested by the speaker that the report be
considered a provisional one, and that representatives of
other countries be added to the Committee, to report at
the next meeting of the Congress.
The President returned thanks for the report, and
expressed his approval of the principles upon which it
was drawn up.
The suggestion of Dr. Flint lais to the provisional na-
ture of the report was submitted to the meeting and
adopted.
Several of the members criticised the report, as re-
garded some of its features.
Dr. Flint replied that the report was only intended
to be a provisional one.
Professor Tommasi Crudeli, of Rome, then read a
paper on
malarious INFECTION IN MAN.
The human organism presents different degrees of re-
sistance to the action of the malarial poison. Some-
times this is of very high degree. It may often be he-
reditary in nations, appearing to be the effect of natural
selection. In our day, however, this happy selection is
impossible, at least among civilized races, and has been
replaced by specific degeneration of the inhabitants of
malarious countries. We may, however, oppose this
tendency to degeneration firom the effects of the malarial
poison by means of a simple and inexpensdve prophy*
lactic medication.
The specific ferment of malaria attacks directly the
302
THE MEDICAL RECORD.
[September 13, 1884,
red blood-corpuscles, and causes necrobiosis as the final
result of a series of alterations in the protoplasm of the
cells. These changes are characteristic and pathog-
nomonic as a sign of infection.
Dr. a. Goldschmidt, of Lyngby, Denmark, exhibited
a chart showing the progress of
MALARIAL EPIDEMICS IN DENMARK.
He related briefly the history of these epidemics and
showed their close connection with floods due to irrup-
tion of the sea, or to excessive rainfall.
Dr. Kering, of St. Petersburg, presented a commu-
nication on
CEREBRO-SPINAL MENINGITIS.
He described the etiology, pathology, and symptoms
of the disease. The section on treatment contained no
very novel suggestions.
Tuesday, August i2Th — Second Day.
The Section was called to order by Dr. Bouchard, of
Paris, who occupied the chair.
Professor Ewald, of Berlin, read a paper on the
general management of tuberculosis as influenced
BY recent investigations in experimental pathol-
ogy.
The author reviewed briefly the subject of the tuber-
cle bacillus, and then showed how the theories of Koch
and his followers had influenced the teachings on etio-
logy, diagnosis, prognosis, and treatment.
Dr. J. Grancher, of Paris, then followed with a com-
'munication entitled
THE early diagnosis OF PULMONARY TUBERCULOSIS.
In the pneumonic form of pulmonary tuberculosis,
and in that form which begins with haemoptysis, or with
a violent cough, the presence of the tubercle bacillus is
an all-suflicient diagnostic sign. But in that more com-
mon form, in which the commencement b very insidious
and unaccompanied with expectoration or cough, the
bacilli cannot be detected. They can only be found
after expectoration has be^n, and then the diagnosis
is certain enough without this additional proof.
The most conclusive sign in this early stage is a slight
roughening with lowering of tone of the inspiratory mur-
mur. This inspiratory abnormality is sufficient for a
probable diagnosis when it is distinct, permanent, and
localized at the apex of the lung, and when the patient
is scroflilous or presents an hereditary or other predis-
position to tuberculosis. This change in the sub-clavi-
cular inspiratory sound is found more frequently on the
left than on the right side. It is true, however, that very
slight causes may produce this alteration in the vesicular
murmur, a transitory congestion at the menstrual period,
for example. Hence it is not well to rely upon it too
strongly unless it is permanent, and unless an increased
probability is furnished by the general condition of the
patient.
Dr. Quinlan, of Dublin, presented a note on the
treatment of pulmonary consumption.
The Library of the Royal Irish Academy, in Dublin,
contains a large number of manuscripts in the Celtic
language, treating upon medical subjects. In these,
mention is frequently made of tlie mullein plant as a
remedy in pulmonary diseases. And at the present day
it is largely employed by the Irish in consumption. The
plant is known to botanists as the
verbascum thapsus.
The author had made a number of experiments to
determine its efficacy, and concluded that it possessed
considerable value. It is given in infusion in milk, and
the leaves are smoked for the relief of cough.
Dr. R. Shingleton Smith, of Bristol, read a short
communication on
IODOFORM IN THE TREATMENT OF PHTHISIS.
The drug had acted well in his hands in reducing tern-
perature, and improving the general condition of the
patients.
Dr« Jaccoud, of Paris, concluded the discussion of
pulmonary phthisis with a paper on the
TREATMENT OF TUBERCULOSIS AS INFLUENCED BY KOCH's
THEORY.
He maintained that the discovery of the bacillus
tuberculosis has been singularly sterile in its efiects
upon the treatment of phthisis. He also insisted, in re-
gard to prophylaxis, that precautionary measures against
infection hsid been taken long ago. The main point to
be held in view was to maintain the health of the upper
part of the lung, and so to render it proof against infec-
tion. The good effects of high altitudes were due to
the fresh air and means of exercise. He had himself
pointed out the freedom of such localities from micro-
organisms in the air. As to Koch's theory, he was of the
opinion that it had great nosological interest, but that it
was of no valu^ in a therapeutic sense. Possibly in the
future the discoveries of M. Pasteur may come to be of
some prophylactic importance.
At the afternoon session Professor Austin Flint
occupied the chair.
Dr. W. B. Hadden, of London, read a paper on
MYXOSDBMA AND ITS PATHOLOGY.
This is a disease characterized by a general swollen
condition of the body resembling dropsy, except that
the parts do not pit on pressure. The general expifes-
sion of the sufferers is placid and inert — in a word, cre-
tinoid. The skin is dry and harsh^ perspiration and
sebaceous secretion are absent^ and the hmr, nails, and
teeth share in the general malnutrition. There is wast-
ing of the thyroid gland. The temperature is almost
constantly subnormal. The speech is slow, thick, and
nasal, and the tongue seems too large for the mouth.
An indisposition to all mental and bodily activity is one
of the most striking features of the disease. The appe-
tite is poor, deglutition is often difficult, and defecation
teems to be lundered by a swollen condition of the
rectal mucous membrane.
The disease usually attacks adult women, but it may
possibly commencer during adolescence. It occurs among
rich and poor, and climate and race seem to be without
influence.
As to morbid anatomy, there is always a diminution in
size of the thyroid gland. According to Ord there is
solid oedema of the connective tissues, and a great in-
crease in the amount of mucin ; hence the name myx-
cedema. The author believed that the disease is depen-
dent upon changes in the sympathetic nervous system,
and he thought it not unlikely that the thyroid is in some
relation vnSi the peripheral sympathetic nerve-fibres.
This view, he stated, had recently been borne out by
post-mortem evidence.
An improvement has occasionally followed the em-
ployment of jaborandi.
Professor Brandes, of Copenhagen, then exhibited
A UVING SPEaMBN OF MYXCEDBMA.
The woman was forty years old and had suffered from
the disease for eleven years. The symptoms began with
loss of power in the right hand, followed by a melancholy
sluggishness of the intellect. The urine had contained
but very little albumen.
Sir William Gull said he had published a paper on
CRETINISM in ADULTS
eleven years ago. This was what is now called myx-
cedema, but it is not a new disease. It is merely sporaidic
September 13, 1884.]
THE MEDICAL RECORD.
303
cretmism in the adult. Cretinism comes on at any
period of life and in any degree, and is often not recog-
nized by the physician.
Dr. Ord, he continued, looking on it as a special dis-
ease, looked for a special pathology and termed it mjx*
oedema. The myxoedema in such cases is accidental,
not the essence of the disease.
Dr. Mahomed said that Sir W. GulPs earliest ob-
servations were remarkably confirmed by our latest knowl-
edge of the diseaa^. All the truth about it, however,
was not contained in his remarks. Is the disease a per*
manent one ? He thought it was not necessarily. In
some cases it is not general, but confined to some local
portions of the body. The disease is a perverted nutri*
tion, not necessarily a permanent pervernon.
Many cases have been seen to improve under treat-
ment; one case,, under the speaker's own observation,
dated from two years back. At first there was no albu-
men, but later the urine was highly albuminous. The
patient disappeared for a time, but a few weeks ago ap-
plied for admission. At this time the myxcedema and
cretinism had quite disappeared. There was no albumen
in the urine, but the patient had ascites and general
dropsy. The abdomen was tapped, the patient had
epileptiform convulsions and died in three days. At the
autopsy there was found a thickening of the capsule of
the fiver; the kidneys were not granular, and there was
DO myxoedema of the tissues. The disease had evidently
disappeared.
He related a second case, which was under the care of
Dr. Goodhart some years ago. The patient came into
the hospital lately and died there. She was a withered
old woman, but presented no trace of myxoedema. The
occurrence of mucin in the tissues,, he continued, is
probably accidental, as Sir W. Gull says, and is the result
merely of oedema, as is often seen in oedema from venous
obBtniction, in which he had often seen similar brawny
swelling. It is safe to say in such a disease there is an
affection of the nervous system, but this is probably
secondary, not primary. The sympathetic system is
probably at fiault. He confessed he would not quite like
to see the explanation in simple cretinism or in disease
of the thjrroid gland.
A nuniber of the members then participated in a
DISCUSSION ON TUBERCULOSIS.
Among those who spoke were Professors Paul Gutt-
B»n, of Berlin, A. Pribram, of Prague, and I>r. Croig, of
Brassels. The discussion elicited nothing of any special
interest.
The following day, Wednesday, August 13th, was de-
voted to excursions around Copenhagen, and there was
consequently no work in the Sections.
Thursday, August 14TH — Fourth Day.
Dr. Biermer, of Breslau, presided at the opening
session.
The first paper of the day was read by Professor R.
Upine, of Lyons, and was entitled
CLINICAL observations ON SOME AUTO-INTOXICATIONS.
The different forms of self-poisoning were grouped by
the author under the following heads :
1. Auto-intoxication in diabetics, diabetic coma. Allied
to this is the form of poisoning sometimes seen in pa-
tients suffering from cancer of the stomach.
2. Auto-intoxication of intestinal origin, intestinal
septicaemia. This may occur in strangulated hernia,
artificial anus, and in various other intestinal lesions,
even where there is no obstruction m the gut.
3. Auto-intoxication of bronchial or vesical origin.
. 4- Auto-intoxication as the morbid element in acute
infectious diseases.
The author then spoke briefly of the diagnosis of these
different forms of self-poisoning, and set down the rules
for their hygienic and therapeutical management.
The views advanced in the paper were criticised by
Professor Stadelmann, of Konigsberg, and £defsin,
of Kiel.
A communication was then presented by Professor
Liebermeister, of Tubingen, entitled the
antipyretic treatment of ACUTE INFECTIOUS DISEASES.
He said that a great danger in fevers arose from the
elevated temperature, and it was the problem for the
physician to reduce the pyrexia. The basis of antipyretic
treatment is the direct withdrawal of heat by cooling
baths. In many cases, however, the exhibition of an*
tipyretic drugs is a useful auxiliary.
Professor Bouchard, of Paris, followed with a paper
on the
ANTISEPTIC treatment OF INFECTIOUS DISEASES.
The paper was a presentment of the views of Dr. Warf-
vinge, of Stockholm. He showed that the high tem-
perature is not the essence of the disease, but is only an
important symptom, and consequently is not the main
point for attack in treatment. It is impossible to obtain
a reduction of temperature by cold baths except by re-
peating them with great frequency. It is more rational
to employ internal remedies, which at the same time
reduce the temperature and repress the production of
heat. It is most probable that all infectious diseases are
due to the presence of inferior organisms within the
economy. It is therefore more rational to attack them
as the cause, rather than the fever as a symptom. But
it is known that the so-called antipyretics are also among
our most powerful antiseptics, and this probably explains
their mode of action. Although any possible concentration
of a dni^ within the body is too weak to kill these organ-
isniS) it is probably strong enough to so paralyze them
that they become incapable of exerting their deleterious
effects. The system thus gains time to recuperate, and
finally becomes strong enough to expel the already
weakened micro-c^ganisms.
The writer then gave a r6sum6 of Dr. Warfvinge's
experiments with various antiseptics in fevers. He
regarded phenic acid in the treatment of typhoid fever
with especial favor. Alum he had found of great service
in the treatment of pertussis.
At the afternoon session. Professor LApine, of
Lyons, occupied the chair.
The greater part of the session was occupied by a
DISCUSSION ON COLD BATHS IN FEVERS,
as advocated in Professor Liebermeister's paper. Some
of the speakers animadverted very strongly on the dan-
gers of this method, and expressed a decided preference
for the employment of internal antipyretics.
Dr. Pribram, of Prague, spoke of the value of
ANTIPYRIN.
This was a new remedy, but the results of a number of
experiments by different observers would seem to show
that we possess in this artificially formed substance, an
antipyretic of undoubted worth.
Professor Liebermeister replied briefly to th« criti-
cisms of the cold water treatment, and defended with
some spirit its claims as the best method for reducing
temperature in fevers.
Dr. Brondet, of Paris, read a paper on the
TREATMENT OF INTESTINAL OBSTRUCTIONS BY ELEC-
TRICITY.
He detailed the methods employed by him, and illus-
trated his remarks by a number of cases happily relieved
by this treatment.
304
THE MEDICAL RECORD.
[September 13, 1884,
Friday, August 15TH — Fifth Day.
Dr. Pribram, of Prague, was in the chair.
Professor Rosenstein, of Leyden, presented a paper
on
MALARIOUS infection IN MAN.
This was followed by an interesting paper by Profes-
sor With, of Copenhagen, on
PERrrONITIS RESULTING FROM DISEASES OF THE VERMI-
FORM APPENDIX.
The author said that inflammation of the peritoneum in
the ri^t iliac fossa, known by the name of perityphlitis,
originates most frequently from ulceration and perfora-
tion of the appendix vermiformis. Peritonitis of such an
origin is called appendicular peritonitb. It presents
itsetf under three usually distinct forms or stages, to wit,
adhesive, local, and general appendicular peritonitis.
The first occurs prior to perforation, and the last subse-
quent to this acadent
As regards treatment, the primary indication is to
prevent, as far as possible, all movements of the intestine.
With this object in view, it is necessary to give sufficiently
large doses of opium or morphine, and also to abstain
from the use of laxatives or enemata. The bowels must
be kept confined for many days, sometimes as many as
twenty-four. If this treatment be pursued, the necessity
for f urgical intervention will be greatly restricted.
Frofsssor Austin Funt, of New York, desired to
refer to a point in the diagnosis of perforation of the
inlestine, viz.,
THE persistence OF THE HEPATIC DULNBSS ON PER-
CUSSION,
as a proof that perforation has not taken place. A very
small quantity of air in the peritoneal cavity sufficed to
abolish hepatic dulneas. This might be proved by in-
jecting air through a trocar in tiie dead subject A
tjonpanitic resonance over the whole hepatic region was
not proofs however, that perforation had taken place, for
when the colon is distended, a tympanitic resonance often
extends up to the base of the lung. Another point as to
the
TREATMENT WITH OPIUM,
ajQd allowing the bowels to remiun constipated for a long
time, unless they acted spontaneously. This was long
ago introduced and practised in New York by Dr.Alonzo
Clark, who ascertained that patients could tolerate an
enormous amount of this drug. The dose should be
gradually increased so as to avoid a toxical degree of
narcotism. The rationale of the treatment was com-
plete arrest of peristaltic action, to " put the bowels in
splints." Although cathartics or laxatives were danger-
ous, the rectum might sometimes be emptied by a simple
enema, which did not excite the intestine above a peri-
staltic action.
The paper was further discussed by Drs. Ewald, of
Berlin, and Mahomed, of London.
Dr. J. Grancher, of Paris, followed with a communi-
cation on
SUBACUTE pneumonia.
Subacute inflammation of the lung, so-called spleno-
pneumonia, has no well-defined position in pathological
classification. It is confounded now w^th pulmonary
congestion, and again with the pleurisy which often ac-
companies it as a complication. It differs, however,
from acute congestion and passive stasis as much as
from acute pneumonia and pleurisy. More nearly allied
to broncho-pneumonia, it is yet easily distinguished from
it by its localization in one lun^, its fixedness, as well as
the general character of its clinical features. The mode
of origin, the pain in the side, dyspnoea, fever, and dry
cough are symptoms which resemble more or less those
of pleurisy of medium intensity. But the dyspnoea is
more intense and the fever more active and showing
greater oscillations. The general condition is more
grave than it is in pleurisy. Finally, there is often al-
bumen in the urine. The disease k^ts about five or six
weeks.
The physical signs over the seat of disease are dul-
ness, absence or diminution of vocal resonance, a soft
souffle, broncho-aegophony, and some crepitant r^es on
inspiration. The signs in the neighborhood of the pul-
monary lesion are : below the point and to the left, the
preservation of Traube's space ; on the n^ht, the per-
sistence of the liver in its physiological position. Above
this point, in the sub-clavicular and scapular regions,
there is. a noticeable enfeeblement of the inspiratory
murmur, with tympanism and a permanent or transitory
exaggeration of the vocal vibrations. The opposite long
is healthy.
In subacute pneumonia, pure and simple, puncture of
the chest-walls with the needle of the hypodermic syringe
gives exit only to air and blood. This d^ i« not, how-
ever, always of practical value, as there is often a more
or less extensive pleuritic effusion.
On Friday morning, from 10 to 12 o'clock. Professor
Tommasi Crudbli gave a demonstration at die School
of Technology of microscopic specimens showing the
CHANGES IN THE RED BLOOD-CORPUSCLES IN MALARU
in the human subject In each preparation the healthy
corpuscles were unstained, but in various parti of the
field could be seen other corpuscles containing one or
more nnall colored particles. These particles, he thought,
were probably the germs of a bacillus.
Saturday, August i6th — Sixth Day.
There was but one session .this day. The princq^
Eaper was by Professor Grainger Stewart, of Edm-
urgh, on the
influence of acute INFECnOUS DISEASES UPON THI
kidneys AND their FUNCTIOKS.
The author said that acute infectious diseases were
now believed to be due to the introduction into the sys-
tem of poisonous matters which are capable, under &vor-
able circumstances, of reproducing themselves. These
diseases influence the kidneys in two ways : by producing
organic, and hence grave and permanent, or functional
changes. In considering the
ORGANIC CHANGES
he first described the anatomical alterations. The tub-
ules might be normal in appearance, but were more
usually the seat of lesions varying from a slight cloudy
swelling of the epithelium to the most pronounced in-
flammation, with fatty degeneration and breaking down
of the cells. In some cases the tubules contained nu-
merous parasitic organisms. In the Malpighian cor-
puscles 5ie vascular tufts were compressed by swelling
of surrounding parts. In some cases there was marked
proliferation of the fibrous tissue of the stroma. The
next question was :
WHAT IS THE RELATION OF GERMS TO THESE CHANGES?
It is certain that micro-organisms may be found in
great numbers in the kidneys m certain of the acute in-
fectious diseases, yet the author himself was convinced,
from examinations that he had made in conjunction with
Dr. Stacey Wilson, that fatal diphtheria with albumi-
nuria was not necessarily attended with the presence of
organisms in the kidney. He was also convinced that
well-marked scarlatinal nephritis might run its course
without any organisms being present. It seems most
probable that a poisonous substance is developed in
the course of the disease by which the kidney is irri-
tated.
Sqrtcmber 13, 1884. J
THE MEDICAL RECORD,
305
The third question was :
DO THB INFECTIOUS PROCESSES DIFFER CLINICALLY
FROM ORDINARY NON-INFECTIOUS RENAL INFLAMMA-
TION?
The ordinary symptoms are the same, but, strange to
say, there appeared to be no room for doubt that viru-
lent organisms were often present in the urine of patients
saffering from acute infectious diseases. The author
was unable to explain the fact, and thought it might lead
to a reopening of the question of micro-organisms in the
kidneys, and possibly overthrow the opinions just enun-
ciated by him.
He next considered the question of
FUNCTIONAL ALBUMINURIA,
occurring in the course of acute infectious diseases.
This might result from sli^t changes in the renal struc-
tures which speedily subsided, and were consequently
never the subject of post-mortem examination. In
other cases it was the result of high temperature with
txansudation of albuminous materials through the renal
vessels. Lastly, in some cases it might be due to an
alteration of the blood serum from chemical causes, by
reason of which transudation through the vessels occurred
more readily than in health.
The Section then adjourned at i o'clock.
^jew %nsthxmmte.
A SIMPLE STOMACH-PUMP.
By D. H. GOODWILLIE, M.D.,
NEW YORK.
The accompanying cut represents a simple and efficient
pump for the removal of blood and mucus from the
stomach, to prevent vomiting, after operations on the
nose and mouth, particularly that of staphylorraphy. It
can also be readily used in the bladder or rectum. It con-
sists of a heavy rubber ball of two-ounce capacity, having
an in- valve (I) and an out-valve (O). To this is attached
by a simple hard rubber connection the stomach, bladder,
or rectum tube, of flexible rubber, of diflFerent sizes for
children or adults. The tube at the^other end to be
placed in the vessel of liquid.
When it is to be used, pass the disconnected stomach
tnbe into the stomach. Fill the connected ball and other
tube from the vessel, keep it upright, with the tube down-
ward, connect it to the stomach-tube, and gently force the
required quantity of liquid into the stomach. Then dis-
joint the tubes, reverse the ball, rejoin tubes, and gently
pump out Repeat if necessary.
Its advantages are, that it is simple in structure,|^as
extra large valves, good strength, is always ready, and
easily used.
The Record not Beaten after all. — Dr. L. A.
lUxienstein, of this city, sends a note calling attention to
a case reported by him in the American Journal of Ob-
stetrics. It was that of a polycystic ovarian tumor weigh-
ing one hundred and forty-six pounds. " So,'* writes our
correspondent, ** Dr. C. C. Stockard's case, published in
The Record of August i6th, is not the largest on record,
and New York still holds the champion cup, as far as
laige tumors are concerned.".
A NEW SOFT RUBBER VELVET- EYED TUBE
FOR INJECTING OR MEASURING THE
UTERUS.
By W. THORNTON PARKER, M.D.,
ACTING ASSISTANT SURGEON, V. S. ASMV.
Considerable' attention has been given of late to the
subject of intra-uterine injections. Tlie necessity for
the accurate measurement of the uterus in a great many
gynecological cases requires a safe instrument
All writers on diseases of women recognize the
dangers in the use of the metallic sound.
In too many instances the sound is needlessly
used, and often by rough and unskilful operators.
It is impossible to estimate the injury resulting
from such meddling.
^' The emplo3rment of the uterine sound shouk)
be resorted to with great care and gentleness, and
only when we are Ukely to gain some information
from its use that we cannot otherwise gain.
Several instances have been recorded where the
point has been made to perforate the wall of the ,
uterus. This accident is most likely to happen ^|
when the organ is in a softened state, such as
occurs during the fatty degeneration of sub-involu-
tion following abortion or parturition, or in the
ulcerative stage of cancer. It has been suggested
that the point may have passed along a dilated
Fallopian tube, but although this may explain some
few cases where the point of the sound has been
felt beneath the abdominal wall, there is HtiU
doubt but that in the majority of suck cases perfo-
ration of the uterine wall has actually occurred.*^^
'^ If the uterus be in its normal position^ and
}iie sound he used by a skilful hand^ the opera-
tion is not difficult. But it . is not the healthy
titerus which we are generally called upon to ex-
plofe^^ If the organ be displaced, the difficulties
and dangers attending the employment of the
sound are considerable. . The facts which may be ascer-
tained, by the sound, are these : j, the capacity of the
iilenis; 2, the existence of growths within it; 3, de-
viation of the course of its canal ; 4, differentiation of
displacements from uterine tumors; 5, the mobility of
the uterus. **•
. The great impprtaoce of these facts with reference
to diagnosis is evident, and one would suppose that an
instrument revealing so much would be universally em-
ployed. Such, however, is not by any means the case.
By adepts it is commonly resorted to, but in general
practice will be found many, indeed a majority, who do
not employ W from fear of its results^ the difficulty of its
introduction, and uncertainty as to its revelations.
*' Some remarkable accidents prove the necessity of
exerting the utmost care and delicacy of touch in using
the sound. The point of the instrument has actually
perforated the fundus of the uterus. Two such cases
were observed by Schroeder. In both the sound went
without force sixteen to seventeen centimetres deep, and
its knob was felt through the thin abdominal walls. The
most careful and judicious use of the sound is sometimes
attended and followed by intense pain. Metritis has oc-
curred, and this even when there was no reason to infer
that the wall had been perforated. That fatal accidents
have occurred from the use of the sound can hardly be
doubtful:'^
It has occurred to me that some improvement is re-
quired in our instruments for intra-uterine injection, and
also that some gentler if not more precise method might
be employed in measuring the uterus than that of the
metal sound. The accompanying very simple contrivance
has been devised, which may be found useful in the
operations for which it is intended.
' Edis : Diseases of Women, p. xx. x88i.
3 Thomas : Diseases of Women, p. loo. Fifth Edition^ z8£c.
" Barnes : Diseases of Women, p. 142 et seq.
3o6
THE MEDICAL RECORD.
[September 13, 1884.
This uterine injecting and measuring tube is made of
j^iable rubber somewhat sti£fer than the rubber catheter.
It conespoiids in diameter to the No. 13 Tiemann & Go's
American Scale, aldicmi^ it can be used larger or smaller
in diameter if desired. It. is ten inches long, and fits se-
curely, when needed for injecting purposes^ over the
nozzle of the common hard rubber uterine syringe. For
about six inches it is marked with one-eighth, one-fourth,
one-half, and one inch divisions. There is no terminal
orifice, but there are twelve ** velvet-eyed " apertures to
permit the escape of the fluid for injection obliquely
backward. The tube can be easily and painlessly in-
troduced into the uterus, and by slipping the black hard
rubber ring forward against the os, the length of the
uterine canal can be accurately determined. The tube
being flexible, and the orifices "velvet-eyed," the danger
from injury to the uterus is reduced to the minimum.
The wire provided for use, when used as a measurer^
will be found sufliciently stiff to make the instrument a
very acceptable sound. If this measuring tube can
sometimes be substituted for the more dangerous metal-
lic sound, and with equal accuracy, the object of its
manufacture will have been accomplished.
FoKT Union, New Mbx.
A NEW SPRAY PRODUCER.
By CYRUS EDSON, M.D.,
MRW YORK.
The instrument represented by the accompanying il-
~ lustration is a modification of the
ordinary nasal application, and
has been designed for making me-
dicinal applications to the mucous
surfaces of the nares, pharynx, and
larynx. It consists of a hard rub-
ber tube, about five inches long,
having an oblong bulbous extrem-
ity, divided near its proximal end
by a thread and screw joint.
To use the instrument the bulb
is unscrewed and packed with ab-
sorbent cotton or sponge, which
is then saturated with the chosen
solution. The bulb having been
screwed in place, the instrument
is attached to a compressed air-
receiver and used like a Sass"
tube.
The spray is somewhat coarser
than that produced by the latter
atomizer. A tip is provided for
delivering it in any direction.
To the practitioner who is not
a throat specialist it commends
itself for the following reasons : It
is practically indestructible ; it is
not liable to become clogged ; it
does not require specially con-
structed bottles for the medicinal
solutions. It is an excellent powder blower.
Glass in Pepsin Packages. — Dr. S. E. Campbell^ of
South Bay City, Mich., sends us a note of warning to
physicians who dispense their own pepsin. A medical
student suflering from gastric insufficiency (we have never
met with that trouble in medical students, by the way)
purchased a pound package of saccharated pepsin made
by a New York firm. In taking his dose he noticed oc^
casionally something hard in his mouth. Finally he
sifted the pepsin and found a number of bits of broken
test-tube. We presume that the mixture is not a common
one, but a word of warning is not out of place.
(S^ovKzspon&entz.
INTERNATIONAL MEDICAL CONGRESS
NOTES.
(From our Own Correspondent)
Copenhagen, Denmark, Aupitt 23, 1884.
THE OPENING ON SUNDAY — THE EXCURSION IN THE
MIDDLE 09 THE WEEK — PROFESSOR LANGE, THE SEC-
RETARY-GBNEEAL — HOW HE USED HIS OFFICIAL PO-
SITION IN HINDERING THE PRESS IN OBTAINING
LEGITIMATE INFORIIATION — THE SECRETARIES OF
SECTIONS IN THE R6lE OF OBSTRUCTIONISTS — DIFFI-
CULTIES IN OBTAINING INFORMATION GENERALLY—
THE BANQUET IN THE TENT ANP TSS NOVEL WAY
OF RESPONDING TO TOASTS— BRILLIANT RECEPTIOHS
AND FREE LUNCHES.
In my previous letter, hastily written before the dosing
of the mail, I endeavored to give a general idea of the
great medical meeting here, but I found on looking over
my notes that there are many things which I might have
said but for the hurry.
The choosing of Sunday as the day for the opening
ceremony was not much in accordance with American
or British notions, but I suppose it did not seem outri to
Continentals. It certainly would not have been done in
America or England. Tho singing of a cantata after the
speeches and before the Congress was declared open had
a novel but very pleasing effect
On the whole, those who attended the recent Congress
have no reason to complain of the Danes. Judging of
them by the Congress week, one cannot but pronounce
them a most hospitable nation. Receptions, banquets,
excursions followed one another in rapid succession,
alternating with the more serious work of the Congress.
The idea of giving up a whole day to excursions in the
middle of the week was certainly somewhat novel, but
the result was most enjoyable.
Professor Lange, the Secretary-General, made a
speech at the opening ceremony. He was very nervous,
and spoke so low that no one more than a few yards
from him could hear a word he said, and altogether
made rather a poor impression as an orator. Before
leaving Professor Lange I desire to place on record that,
in his official capacity of secretary, instead of affording
facilities to representatives of the press he either would
not or could not give them any assistance, but ap-
parently endeavored to obstruct them. He speaks
English fluently, so he cannot plead as an excuse that
he did not understand the English-speaking journalists
who applied to him. Several of the secretaries of sec^
tions also were very loth to communicate what they
knew about the proceedings. Some of them excused
themselves by saying they had been away part of the
time. How a complete set of the transactions will be
prepared I am sure I know not.
One of your London contemporaries sent a repre-
sentative accompanied by a short-hand writer. The
former found such insurmountable difficulties in getting
information that, finding his short-hand writer practically
useless, he told him he might as well go off to Norway,
or somewhere else, and take a holiday.
The sections unfortunately did not meet near together,
but in three different places, any one of whidi was
roughly speaking a mile from either of the others. As
the fourteen sections all met simultaneously, your readers
can form some idea of the difficulties of getring infonna^
tion from each.
Passing to more pleasing recollections let me say that
the trip to Elsinore, in which nearly all the members of
the Congress participated, was most enjoyable. The
luncheon in the Kronberg Castle was laid in twenty-two
rooms.
Perhaps of all the scenes in connection with the Con-
September 13, 1884.]
THE MEDICAL RECORD.
307
2res8 the banquet in the tent on the Custom House Quay
^ be the longest remembered by those who were
present. This was on Thursday afternoon. It began at
^ve o'clock and terminated about half-past eight To
^cconmodatt the immense nimiber present — about two
thousand, including visitors — forty-two tables were laid.
To wait on the army of guests one hundred and sixty-
eight servants were provided, who served the successive
courses as the signal was given by ringing a large bell.
The menu was sumptuous, but most unlike an average
London or Parisian dinner. The speeches, too, were
given in a most eccentric manner. The guests were not
aHoired to dine in peace and then enjoy the '* feast of
reason " and " flow of soul " afterward, but they were in-
terspersed between the courses, sandwiched, in fact,
between the viands provided for mere bodily refreshment.
Thej began directly after the soup had been served and
partaken of, and from thence onward to the conclusion
of the meal either a speech, a song, or music diversified
the intervals between the courses. When a speech was
being delivered by an eminent member the dinner was
forgotten and the assembly vacated their seats en masse
and nished to the other end of the immense tent so as
not to lose a word. Venerable and distinguished mem-
bers of the profession were seen running helter-skelter
like so many schoolboys.. I saw one specimen of the
latter genus present by the way — apparently a son of one
of the members present. Sir James Paget spoke to him
and said, " I am very glad to see you, my boy. We shall
all of us remember diis occasion to the end of our lives,
but you, being the youngest of us, will remember it longer
than any of us." Virchow also spoke to him.
Despite the successive interruptions the vast dinner
came to an end at last All then embarked on board
the steamers provided and went by way of the canal to
the Tivoli Gardens. The banks were lined with specta-
tors, who cheered loudly as the Congress passed. Many
boatmen were on the canal and cheered and saluted with
their oars as they passed us. Many of them burnt blue
and red lights. Rockets and other fireworks were dis-
diaiged, illuminations were displayed, and the electric
Hght shone brightly from many vessels and houses. At
Tivoli about forty thousand people had assembled. The
whole formed a never-to-be-forgotten sight. The closing
festival on Saturday was also brilliant.
I must not omit to mention that throughout the Con-
gress firee lunches were provided for such as chose to
partake of them. Free railway passes were also granted
from Copenhagen to the frontier.
Despite a few drawbacks, I think I may safely say,
in conclusion, that all who took part in the Congress of
1884 will remember with pleasure the courtesies and
hospitalities shown them by the Danes in their beautiful
capital, Copenhagen.
Muriate of Ammonia. — It increases the secretion of
mucus from the alimentary canal, and is supposed to render
the blood less plastic and coagulable, without impairing
the structure of the corpuscles. Its habitual use causes
emaciation^ renders all the secretions freer and more
abundant, and exerts an alterative and absorbent action,
especially on the connective tissues, in hyperplasia and
cirrhosis of many organs. It has even exerted some
beneficial influence upon fibrous tumors of the uterus,
and much more upon chronic engorgement of that organ.
Its slow but steady modification of the nutrition of the
connective tissues has been seen in chronic enlargements
of the liver, spleen, prostate, thyroid, and other enlarge-
ments. It cures many cases of gleet and if any internal
remedy will relieve strictures of the urethra, this is the
one most apt to do it It cures some cases of neuralgia
depending upon thickening of the neurilemma, and is one
of the best remedies in fibrous phthisis. If other reme-
dies fiiil, it should be tried in sclerosis of the cord and
hnin depending upon thickening and induration of the
neuroglia.
Official List cf Changes in the SiaHons and Duties of Officers
serving in the Medical Department^ United States Army^
from August 31 to September 6, 1884.
Byrne, Charles C, Major and Surgeon. Relieved
from duty in Department of California, and to report in
person to the Commanding General, Department of the
Platte, for assignment to duty. S. O. 207, A. G. O.,
September 3, 1884.
Town, F. L., Major and Surgeon. Relieved firom duty
in Department of the Columbia, and to report in person
to the Commanding General, Department of Texas, for
assignment to duty. S. O. 207, C. S., A. G. O. Granted
leave of absence for twenty-five days. S. O. 127, De-
partment of the Columbia, August 25, 1884.
Havard, Valery, Captain and Assistant Surgeon.
Relieved from duty in Department of Texas, and to re-
port in person to the Commanding General, Department
of the East, for assignment to duty. S. O. 207, C. S.,
A. G. O.
Hall, William R., Captain and Assistant Surgeon.
Relieved from duty in Department of Texas, and to re-
port in person, on October i, 1884, to the Superintendent
General Recruiting Service in New York City, for duty at
David's Island, N, Y., relieving Assistant Surgeon M. E.
Taylor from duty at that station. S. O. 207, C S.,
A. G. O.
Hopkins, William £., First Lieutenant and Assistant
Surgeon. The leave of absence granted him in S. O. 67,
August 7, 1884, Department of Arizona, is extended one
month. S. O. 204, A. G. O., August 30, 1884.
Official List of Changes in the Medical Corps of the U. 5.
Nuvy^ during the week ending September 6,' 1884.
RixEY, P. M., Passed Assistant Surgeon. From special
duty at Washington, D. C, September 8 th, tp the Lan-
caster, European Squadron.
Oberly, a. S., Surgeon. From the Richmond, August
30th, and wait orders.
Dickson, S. H., Passed Assistant Surgeon. Frona
Arctic Squadron, July 29th. Sick leave August 30, 1884.
pCjedijcal Stems.
Contagious Dissasbs — ^Wkbkly Statkusnt. — ^Re-
port of cases and deaths from contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the week ending September 6, 1884 :
Week Ending
Outs,
August 30, 1884 . .
September 6, 1884
August 30, 1884. .
September 6, 1884
4
2
I
I
Famous Examples of Nervous Exhaustion. — Much
of the world's best work has been done by neurasthenics,
says Beard. George Eliot, Darwin, Heine, Spencer,
Edwards, Kant, Bacon, Montaigne, Joubert, Rousseau,
Schiller, illustrate the possibility of not only living, but of
doing original work on a small capital of reser\'e force.
3o3
THE MEDICAL RECORD.
[September 13, 1884.
The American Laryngological Association Viewed
PROM THE Outside. — ^The Burlington Hawkey e^ in no-
ticing the holding of the sixth annual Congress of the
American Laryngological Association, takes occasion to
thus enlighten the lay public as to the nature of that body
and its functions: '*A laryngological association, my
dear, is, we take it, an association of larynxes. And a
larynx is — well, it is the active principle of yoinr 'Adam's
apple ; ' the lar3mx lives in your neck, third floor front,
between the tongue and the trachea ; it has nine carti-
lages, and looks like an old garden hose%gone to seed.
And its uses are — well, you know when a little mouse
runs across the floor ? Well, your larynx is what you
use then. ' Climb on the table with it ? ' Great Scot-
land, no! Who ever heard of climbing up on a table
with your larynx ? No, girl ; you * holler ' with it
Thaf s what you do with it, and no foolishness about it,
either. And this American Laryngological Congress, we
suppose, is organized to devise some means whereby to
supply a new India-rubber, copper-lined larynx for the
star-eyed goddess of reform, she having shrieked hers
wide open and split it down the back when Morrison
fell."
Chloroform in the Treatment of Tape-worm. —
Dr. Henry K. Gardiner, of Providence, R. I., writes :
" In Vol. 26, No. 4, Medical Record, Dr. J. G. Brooks
reports several cases of tape -worm treated by chloroform,
and claims excellent results. Having a case which I had
previously treated unsuccessfully, I prescribed the fol-
lowing: 9. Chloroform, 3 j.; muc. acaciae, 5 iij. M. Sig,
All to be taken at once after twenty-four hours' fasting,
to be followed in thirty minutes by two drops of croton
oil mixed with bread crumbs. It produced complete an-
aesthesia of the patient in two or three minutes, the
efifects lasting ten minutes; and for some hours after
headache and drunkenness were complained of. The ol.
tiglii was given an hour after taking the chloroform, and
tape-worm expelled entire in about twenty minutes. I
should like to hear of other cases where the action of
chloroform was similar,'*
Internal Use of Nitrfte of AurvL. — Dr. J. F.
Dixon writes to ih^ British Medical Journal: "There
is only slight mention in the text-books, and scarcely
any reference in periodical literature to the internal use
of nitrite of amyl. Its very temporary and ephemeral
action when inhaled has plainly caused therapeutists to
cast about for an agent which produces more continuous
results. I believe that in nitrite of amyl given internally
we have a drug which meets all the requirements of
cases in which it is important to lower the arterial ten-
sion ; and further, that it is free from the uncertainty of
action and the sometimes dangerous results of nitro-
glycerine and nitrite of sodium, which have been em-
ployed apparently as substitutes for it. I have employed
it thus in cases of anginous attacks of a very severe
character. One, complicated with very loud mitral
systolic murmur and nightly angina ; the second with an
aortic systolic murmur, and the third with irritable
action, but no apparent organic lesion. I may say, with-
out going into particulars, for this purports to be the
merest sketch, that in all these cases the relief was of a
marked and abiding character. The dose I employed
was 2^ minims three times in twenty-four hours— of
course, seeing the case twice daily until the action of the
drug was established, when a dose each night was suf-
ficient
Dissensions in the Baltimore Medical Col-
lege.— For some months past, says the Maryland Medi-
cal Journal^ rumors have been afloat of inharmonious
proceedings in the Faculty of the Baltimore Medical
College. We now learn that these have gone so far as
to result in a division, and there are now two faculties,
each claiming to be the rightful Baltimore Medical Col-
lege. One faction, headed by Dr. Bryd, has secured a
building in the eastern section of the city, while the
Munroe party is entrenched in one in the DGnrthem part
of the city. Each has issued a catalogue, and matten
are rapidly coming to a crisis. An early suit, to de-
termine who is legally entitled to the rights and franchises
conferred by the charter, is foreshadowed.
Cerebral Congestion during Mental Work.— Mr.
Beecher once told the late Dr. Beard that after preaching
his head and neck are sometimes so surcharged with
blood that a large seventeen-inch collar is very tight for
him, but in an hour or two the circulation is restored and
no harm results.
Quinine Diminishes Sweating after work upon a hot
summer day, according to Liebermeister and Kemer.
That Florida Climate. — Mens conscia recti is not
much disturbed by slander. We continue to receive
earnest protests from Gainesville physicians regarding the
views on the climate of Florida promulgated by Dr. Boy-
land. We had every reason to believe that the views
expressed were essentially correct, nor do we think that
in a calm discussion it would, be found that he differed
very much from the local physicians. Florida is an ex-
cellent place for many cases of incipient phthisis ; but it
does not benefit all cases. On the other hand, the cli-
mate is often of the greatest benefit in nervous, catarrhal,
and rheumatic troubles. This is the substance of the
matter. Per contra^ Florida is not always Paradise. It
has no cataracts, no rushing streams, and its most ad-
nairing residents refer to mounds of earth sixty feet high
as hills. It will be difficult to prove, therefore, that its
topography is admirably adapted for drainage. How-
ever, we have not the slightest desire to do injustice to
the State or any part of it. We therefore publish a
portion of an account by Dr. N. D. Phillips, of the topog-
raphy of Gainesville, and with this we must close the
discussion. Dr. Phillips says : *' There is a never-failing
stream of limpid water running through the town from
north to south, which stream separates Gainesville from
East Gainesville. From the point where said stream
enters the northern boundary, to where it crosses the
southern boundary of the town, there is a fall of forty-
seven feet The bed of this stream, due east of the pub-
lic square, is thirty-five feet below the general level of
the town on either side, and grows deeper as it mean-
ders among the hills on its way to Alachua Lake, eighty-
six feet below the centre of Gainesville. Due west of
the public square about four hundred yards, is the head
of a deep ravine, also running south, with precipitous
banks, fed by never-failing springs of pure water. The
fall in the bed of this stream is greater than in that of
the stream just mentioned." Another stream is described
arising near the town and emptying into Canapaha Lake.
'' Alachua and Canapaha Lakes both have subterranean
outlets, which outlets are sufficient, although the lakes
are fed by numerous springs and bold streams, to pre-
vent them from overflowing their banks, even in the wet-
test seasons." With reference to the " stagnant water of
which the doctor speaks, it is only necessary to state that
tons of the finest fish are caught from Alachua Lake an-
nually and shipped to cities north of this, and a great
deal of money realized from the business." We are told
that since the leading hotel was built, in 1876, only eight
deaths have occurred within its walls. Gainesville is 213
feet above the St. John's River at Palatka, and Zd feet
above Alachua Lake.
The Forceps in Breech Presentations. — Dr. J. H.
Fruitnight, of this city, writes : '* In connection with the
short notice of * The Forceps in Breech Presentations,'
on page 192 of your valuable journal of the issue of
August 1 6th, let me direct your attention to a paper
written by me on that subject and published so long ago
as July, 1877, in the Virginia Medical Monthly, page
246, and which, so far as I know, is one of the first
articles advocating such use of forceps."
The Medical Record
A Weekly Journal of Medicine and Surgery
VoL 26, No. za
New York, September 20, 1884
Whole No. 724
Chriginal l^trticljes. -
THE RECTUM CONSIDERED AS A RECEPTA-
CLE FOR THE GRADUAL ACCUMULATION
AND RETENTION OF THE EXCREMENTAL
MATTER.
ByWILUAM BODENHAMER, A.M.» M.D.,
NBW YOBX.
Owing to the recent attempts of some authors to sus-
tain with new arguments the theory of Mr. O'Beirne,
that '* the rectum is not a receptacle for the fecal matter,
neither was it ever so designed,** I feel disposed to offer
some arguments in favor of upholding the opposite
theory. The late talented Dr. Bushe, many years ago,
made a very able argument against the theory of Mr.
(yBeime.' It will be perceived, however, that the line
of my argument differs materially in several respects from
that of Dr. Bushe.
As a preliminary to the investigation of this subject,
it is necessary to consider briefly the form, position, di-
rection, dimension, and structure of the rectum, as well
as the effect of that structure upon the accumulation of
fecal matter in its cavity.
The form of the rectum at its commencement, like
that of the sigmoid flexure of the colon, with which it is
continuous, is cylindrical, and it maintains this form
throughout a considerable portion of its extent; but
toward its inferior extremity it becomes large and sac-
cated, forming a terminal pouch, which is dilated from
before backward and the mouth of which is closed by
the internal sphincter muscle, like a purse. This dilata^
tion, or ampulla, in consequence of the peculiar organ-
ization of the parts, is capable of acquiring great size,
and in some instances of long-continued retention of
Heces it has been found to occupy a very large portion
ot the cavity of the pelvis.
The structure of the rectum, like that of other hollow
viscera of the abdomen, is composed of three regular
tanics — ^a serous or peritoneal^ a muscular ^ and a mucous
—which arc intimately blended and united to each other
by cellular tissue. This connective tissue has been dis-
tinguished by some anatomists as an additional coat of
the rectum, thus making this organ to consist of four
tunics, instead of three, and which tissue they have
severally denominated cellular^ submucous, and nervous.
Be this, however, as it may, it nevertheless is most cer-
tainly the connective tissue between the peritoneal and
muscular, and between this last and the mucous coat,
and may be regarded as constituting the framework of
the rectum.
As regards the structure of the rectum, its several
coats are gifted with peculiar functions in health, and
when under the influence of disease each is subjected
to peculiar affections. The muscular coat of the rectum
especially possesses great interest, for in this coat resides
Us contractile power, and to this coat is it indebted for
its properties, both as a retentive and as an expulsive
organ. The muscular coat is composed of longitudinal
and of circular flbres, the disposition or distribution of
which' merits the careful study of the physiologist. The
peculiar arrangement of the longitudinal and circular
* ATceatite on tbe Malformadons, Injuries, and Diseaaet of the Rectum and
Abm, p. as et s«q. 8vo. New York, 1837.
fibres of the rectum, which differs essentially from that
of any other portion of the intestinal canal, has furnished
this organ with the power, to a certain extent, of retain-
ing and controlling its contents. The longitudinal fibres
are much larger and stronger in the superior portion of
the rectum, especially anteriorly and posteriorly, and
they become smaller and weaker as they approach the
internal sphincter ani. By this change or alteration in
the arrangement of these fibres the rectum is enabled,
in its inferior portion or pouch, to retain a larger quantity
of fecal matter. The circular fibres, on the contrary,
are smaller, fewer in number, and more feeble in the
superior portion of the rectum where they are less
needed and where the action of the abdominal muscles
is alone sufficient to propel the contents of this intestine
downward. As the circular fibres, however, approach
the inferior portion of the rectum, they are more numer-
ous and strong where they are most needed, and are
finally blended and constitute the internal sphincter am.
The force exerted by the abdominal muscles in the act
of defecation is chiefly expended upon the superior part
of the rectum, where the antagonists, the circular fibres,
are weakest, and it is exactly in the same ratio in which
this force diminishes in the inferior portion of the rectum
that the contractile power of the circular fibres in this
situation increases. These are facts which cannot be
controverted and must not be ignored in the considera-
tion of this subject.
The mucous coat of the rectum, from its peculiar
structure, is well adapted for the passage over it of ex-
traneous bodies. It is studded with numerous mucous
glands or follicles, from which are derived the mucilagi-
nous fluid which so abundantly lubricates its interior
surface, so as to facilitate the passage of the faeces and
at the same time to protect itself firom mechanical vio-
lence. Without this secretion of mucous, or sonoe such
lubricating substance, it would be almost impossible for
the faeces to be expelled.
The rectum, therefore, being composed of membran-
ous and muscular tissue, is by the first well fitted both to
yield and to expand to a gradual and gentle distending
force, so as to form a perfect recipient reservoir for fecal
matter ; while the contractile power of the latter is well
fitted to obliterate the cavity of the organ and forcibly
eject its contents. This musculo-membranous viscus,
then, demands attention, not only as to its structure, but
also as regards its situation, form, direction, relations,
and connections. The form and direction of the rectum,
as well as the structure of its several coats, and its pecu-
liar muscular equipment as a receptive, retentive, and
expulsive organ, display a most admirable provision of
nature to enable it to perform its numerous offices ; in-
deed, its entire anatomical arrangement evinces a design
far beyond human ingenuity.
The utility of the direction of the rectum will at once
appear evident when we take into consideration that had
this organ been straight, as its name implies, we should
have been constantly subjected to the unpleasant annoy-
ance, especially when in the erect posture, of a dispo-
sition to empty it ; its peculiar direction and formation,
however, happily protect us against this ; and, further-
more, the pouch located at its inferior extremity, allow-
ing a large accumulation of fecal matter to collect,
gives sufficient time to the absorbents of the part to take
up any nutritive particles that might still remain in the
fecal mass. Precisely the same kind of ampulla or en-
3IO
THE MEDICAL RECORD.
[September 20, 18
largement obtains in all canals of this character, at such
parts of them as have normal contractions below them.
In this instance the anal sphincters are the contractors
or constrictors and form the impediment to the further
progress of the fecal matter for the time being.
I would further remark, with regard to the pouch of
the rectum, that Mr. CoUes says, that '^ it is much more
evident in adults than in children ; however, it will be
found in children, except in those of one or two years." *
Some years ago I examined, post mortem^ the rectum in
several children, their ages varying from six to eighteen
months, and in each case I found the rectum of nearly the
same diameter throughout its entire length. No dilata-
tion could be observed toward its inferior extremity in
any one of these subjects. This pouch evidently does
not exist in early infancy, but is subsequently gradually
developed, and is doubtless the result of distention,
caused finally by the retention and accumulation of the
faeces. This begins to take place as the act of defecation
comes under the influence of the will ; for then it is that
the dejections become much less frequent, the faeces in-
crease both in quantity and in consistency, and are suf-
fered to accumulate for a length of time, or until they
provoke by their presence, perhaps, the expulsive move-
ment. In early life defecation is chiefly reflex, but it
gradually becomes voluntary by habit. In children the
fecal dejections take place more frequently than in
adults, being usually in proportion to the number of
meals. This frequency is doubtless owing to the diges-
tion of children being much more rapid, the intestinal
secretions more profuse, the faeces much more fluid, and
the sensibility of the alimentary canal much greater.
It may also in a great degree depend upon the fact that
in childhood the rectum, as before observed, is wholly
uninfluenced by the will.
To the rectum, then, of the adult, and especially to its
capacious pouch, belongs the office of reception, accu-
mulation, and retention of the fecal matter ; while to the
anal sphincters, like sentinels, belongs the oflice of op-
posing its exit for the time being, and finally of giving
permission and of aiding in its expulsion. The rec-
tum, therefore, may with great propriety be denominated
the terminal depdt of the alimentary canal. Indeed, it
is the natural dei>ository of the excrementitious matter
just previous to its final exit from the body, except the
parts are under the influence of certain diseases, such
as dysentery, diarrhoea, etc., when the faeces will not be
tolerated in the organ for a moment, but will be expelled
as soon as the smallest portion presents itself in it.
It must now be observed, however, that the very able
and distinguished physiologist, Mr. O'Beirne, of Dublin,
in 1833, as is well known, positively denied that the rec-
tum was a depdt or receptacle for the temporary lodg-
ment of the faeces. He maintained that the sigmoid
flexure of the colon was the chief receptacle for the fecal
matter while accumulating in quantity suflicient to furnish
a proper stool ; that in health the pouch of the rectum
was always empty of faeces, except immediately before an
evacuation ; and that the upper part of the rectum in-
tervening between the colon and rectal pouch was not
only always empty but firmly contracted by the circular
muscular fibres.'
Now, according to Mr. 0*Beirne, the sigmoid flexure
of the colon is the chief dep6t for the deposit and
retention of the alvine excretions, while the rectum is
the mere avenue for the transmission of such, or the mere
faucet or funnel through which such are rapidly passed
out of the body when called into requisition by the sig-
moid flexure. Hence there is no necessity, according to
Mr. O'Beirne, for the rectal pouch, nor for the anal
sphincters below it, which guard it, inasmuch as his
colonic pouch or receptacle is guarded by the superior
portion of the rectum, which he says is always firmly con-
tracted and acts as a sphincter, and consequently that
^ A Treatise on Surjcical Anatomy^ p. 137. 8vo. Philadelphia, 1831.
- New Views of the Process of Defecation, p. 3 et seq. 8vo. 1 DuUin, 1833.
the power of retaining and controlling the fecal discharge
does not depend upon the anal sphincters.
I, however, hold that the colon and rectum are one
continuous canal, and their junction is not provided with
a sphincter muscle, such as are the anal sphincters. Iq.
deed, Mr. O'Beirne, feeling the absolute necessity of a
recto-colonic sphincter to protect his theory and his
colonic pouch, endeavors to prove that the whole of the
superior portion of the rectum acts in the capacity of
such a sphincter muscle. I, on the contrary, however,
positively maintain that the superior portion of the rectum
is not any more firmly contracted than any other portion
of the intestinal canal not supplied with a sphincter or
sphincters, as any expert can at once verify by the proper
exploration. It is true the faeces are retarded, and con-
sequently detained longer in passing through the coiled
portion of the colon, but this detention there is not
owing to any sphincter or sphincters, but is obviously
owing to the peculiar form, direction, and position of the
sigmoid flexure. It may be admitted that the faeces in
the coiled portion of the colon, as in the caecum, are for
obvious reasons detained longer in passing these points
than they are in passing other parts of the colon, but
this fact alone does by no means constitute these por-
tions of the colon reservoirs for the accumulation of the
faeces, as some authors claim, to the exclusion of the ]
rectum as such.
With regard to the very plausible and ingenious theory,
so ably presented by Mr. O'Beirne, I respectfully beg
leave to differ from it in several respects ; for instance,
instead of the healthy rectum being always empty be-
tween the periods of defecation, as he contends, I am of
opinion that it is never entirely so. I hold that even
immediately after a natural evacuation of the rectum
there is still more or less consistent excrement left in the
superior portion of it ; indeed, it is more in the character 1
of a displacement merely of the fecal matter of the in-
ferior portion of the rectum, in the ordinary calls of
nature in healthy persons, than by a complete evacuation
of the whole contents of the organ ; for it must be ob-
served that besides the contractile power of this part of
the rectum itself the vis d tergo of the consistent natural
excrement also powerfully aids in effecting a dislo<1g-
ment or stool. When the rectum is completely emptied
by an active cathartic, or a stimulating enema, or as in
some diseases, such as dysentery, diarrhoea, the vis d
tergo is for a time absent, and in a person of good
health it requires from two to three days to re-establish
it, by the rectum becoming moderately repleted again
and so making provision for this part of the natural
mechanism by which the consistent fecal matter is ordi-
narily discharged. The rectum, then, which was designed i
by nature to serve the place of a reservoir, is never
entirely empty when in its normal and healthy state, but
always contains some fecal matter in some portion of it,
and it is the inferior portion only that is generally evac-
uated when naturally called to perform this act.
In the exercise of my profession, during a practice of
many years, I have examined the rectum in numerous
instances, some with special reference to this very ques-
tion, and I have scarcely ever failed to discover more or
less fecal matter in some part of the organ. If the
rectum is examined twenty-four hours after an evacua-
tion, the fecal accumulation during that period will
generally be found lodged a little beyond the superior
margin of the internal sphincter, about four inches above
the verge of the anus. With this intention 1 have ex-
amined the rectum in the same individual as often as two
or three times in the twenty hours ; and for thb purpose
I use a bivalve speculum ani, introduce it fairly above the
internal sphincter, open it sufliciently, and then, through
the open blades of this instrument, pass up a No. 2 or 3
English rectal bougie to the superior end of the rectum
and withdraw it, and if it has come in contact with fecal
matter some of it will adhere to the bougie and can be
plainly perceived. In some instances I have found that
September 20, 1884. J
THE MEDICAL RECORD.
3"
the bougie could scarcely be pushed up through the
column of solid excrement, which had evidently been
lodged in the rectum for many hours. This condition of
the solid excrement found in the rectum I have observed
to be more common in females than in males. This,
however, is said not to be the experience of gynecolo-
gists generally, who now, more than ever before, very
properly make use of the rectum for diagnostic purposes.
But I by no means agree with the author, who says that
<< gynecologists by their daily examinations in the vagina
are quite familiar with the fact that the rectums, even of
women of torpid habits, are comparatively seldom found
loaded with faces, but empty and flattened between the
^'agina and the sacrum.'' I have found that if the exami-
nation of the rectum be made just before the usual daily
evacuation the fecal mass may often be detected, even
bj the finger, in ano.
In the dead body I have never found the rectum to
be entirely empty, and it may be observed that in ana-
tomical examinations healthy excrement is just as often
found in the rectum as in the sigmoid flexure of the
colon; indeed, it is sometimes found collected in the
caput coli, which has been considered by some as a fecal
receptacle, and sometimes found at an intermediate point.
This, it appears to me, must be the experience of every
one who has had frequent opportunities of examining
these organs ia the cadaver,
Mr. O'Beirne, in accordance with his theory, has been
compelled to assume as probable phenomena which
do not admit of positive or demonstrative proof ; for ex-
ample, his conception of the manner in which the faeces
are unloaded from or emptied out of the sigmoid flexure
into the rectum is, in my opinion, purely hypothetical. I
dierefore believe that some of his views on this subject
are theoretically wrong. I wish particularly to mention
here that the healthy faeces do not pass out of the coiled
portion of the colon into the rectum continuously, for
they, like in other portions of the intestines, are not per-
petually in motion, but their movement is intermittent.
They neither pass out of the sigmoid flexure at once in
bulk suflicient for one ordinary stool, the result of one
da/s accumulation, as Mr. O'Beirne declares, but pass
into the rectum at intervals in small portions, each por-
tion being the fecal residue of but one meal of the solid
ingesta of the stomach. As each successive portion is
received in the superior part of the rectum, the former
one is propelled forward by the impulse given it from
behind, assisted by the contractile or vermicular power
of the part itself, until it eventually arrives at the inferior
part of the rectum, where it and the portions that follow
in the same manner slowly accumulate, assume shape
and figure, and gradually and gently distend the organ.
As a general rule the excrementitial residue of one day's
aliment taken into the stomach and amassed in the rec-
tam is considered sufficient to provoke the expulsory
movement.
Mr. O'Beirne bein^ continually confronted by the fact
that between the periods of defecation faeces were found
in the rectum, which he had declared to be always empty,
was compelled to notice this, to him, singular circum-
stance, and to account for it. This he does by attribut-
ing it entirely to morbid phenomena, and admitting that
by such even the rectum itself may become the final
reservoir of the faeces in place of the sigmoid flexure. He
says this result is brought about when the whole of the
rectnm, together with the sphincters, is rendered para-
lytic. He is very safe in making this admission, for it is
well known that injuries of the brain and spinal marrow
may and do result in paralysis, not only of the rectum
but sometimes of the coiled portion of the colon, as well as
other portions of the intestinal canal — thus converting
such portions, for obvious reasons, into reservoirs, or stop-
ping-places for the faeces. In compression of the brain the
external sphiacter is almost entirely disabled, and in com-
pression cf the cord the power of the internal sphincter is
also impaired. A morbid condition of the rectum, how-
ever, in a modified degree, may be produced by atony of its
walls, and perhaps this is what Mr. O'Beirne means by the
use of the word paralytic^ that is, merely debility or want
of tone. The rectum, like all other hollow viscera, may be
subjected to paralysis from injuries of the brain and spi-
nal marrow, as has already been observed, or to atony
from undue distention of its parietes by fecal matter, by
gas, or by both, as well as from other causes. But the
question here, however, is not what the rectum may be-
come by disease, such as paralysis, spasmodic or organic
stricture, atony, etc., but is the rectum naturally and in
health a receptacle for faeces ? That is the question, for
it must be understood in this affair that whatever is said
concerning the rectum and its fiinctions or actions, both
directly and indirectly, must have reference only to its
healthy or normal, and not to its morbid or abnormal
condition.
One of the recent and ardent advocates of the theory
of Mr. O'Beirne, after first declaring that the sigmoid flex-
ure of the colon is the proper receptacle for the faeces, and
that the rectum was never designed for such a purpose,
proceeds to account for the puzzling phenomenon of
finding fecal accumulations in the rectum between the
periods of defecation. He declares that whenever faeces
are thus found lodged in the rectum it is entirely owing
to atony of the walls of this organ, by which it is inca*
pacitated or indisposed to forward on through it at
once, without stoppage, the contents of the sigmoid
flexure, hence faeces are permitted to accumulate in it.
The atony of the rectum is brought about, says he, by
the repeated neglect of the calls of nature, by which the
rectum is gradually educated to tolerate that which is
really irritating to it, and it is only the educated or atonied
rectum that ever contains faeces between the periods of
defecation.* The argument of this author, like that of
Mr. O'Beirne, is that the rectum in its healthy state is
always empty between the periods of defecation; and
that this being its normal condition it cannot, therefore,
be a natural reservoir for fecal accumulation; but by
pernicious education, however, which he explains, this
very susceptible or^an may be taught to tolerate in its
natural empty, sensitive, and contnicted cavity, the pres-
ence and the lodgment of fecal matter ; and thus finally
become that which was not designed by nature, namely,
an artificial depository for excrement The whole argu-
ment of this author is to prove that the rectum can be
converted artificially into a fecal receptacle by education,
as if that was the question at issue, but not a single ar-
gument does he give to prove that the uneducated rec-
tum is not normally such a receptacle. This it be-
hooved him to do first, and afterward to account for the
fact of fecal matter being found in the cavity of the rec-
tum.
I maintain that the rectum is. naturally the terminal
dep6t, or last resting-place for the healthy excremental
matter previous to its final evacuation from the body,
and that it tolerates such there for a certain period with-
out being specially educated to do so, for that is its nor-
mal function. This is proved by its anatomical structure,
its peculiar nervous endowment, and by the fact that,
more or less healthy excrement will always be found in
some part of the cavity of a normal and sound rectum.
This, indeed, is the rule ; the reverse of this is the excep-
tion. It is true that, by repeated neglect to respond to
the daily calls of nature to empty the sound rectum, con-
stipation, or a morbid condition of its parietes is sooner
or later induced, by which its sensibility is blunted
and its contractile power more or less diminished, this
morbid condition being of course greatly aggravated by
the repletion, irritation, and excessive distention which
follow ; so that the rectum ultimately becomes capable
of containing and tolerating a much larger quantity of
excrement at any one time than normal, and also of re-
taining it much longer, too, without the natural admoni-
1 Philadelphia Medical Times p. sS^i November x8, 1882.
312
THE MEDICAL RECORD.
[September 20, 1884.
tion to move it. But this morbid state of the rectum,
by whatever cause produced, is no evidence whatever
that it is not a natural receptacle for excrement, previous
to such morbid condition consequent upon artificial
training.
The nisus defacans^ or sensation for the evacuation of
the faeces, takes place in the rectum, where it should, and
not in the sigmoid flexure of the colon, as Mr. O'Beime
and his advocates claim. The coiled portion of the
colon is not under the influence of the will in its move-
ments, but is entirely governed by the automatic operations
of the other portions of the intestines, and which termi-
nate at the inferior portion of the rectum, which portion
we know is under the direction and control of a separate
and entirely different set of nerves. It is doubtless in
this portion of the rectum that the nisus defacans origi-
nates, and it is through these nerves that the sensation is
communicated. The association which exists between the
functions of these different nerves is brought into action
periodically, when in health, by the distention of the
walls of the rectum arriving at a certain stage. This
united action, from various causes, as I have already
shown, may be disturbed, or it may not be in equipoise,
and artificial means, such as cathartics, enemata, or stim-
ulating applications to the lining membrane of the or-
gan, may be required to reproduce the suspended co-
operation.
While some physiologists are of opinion that the un-
easy sensation which arrests the attention of the will to
the act of defecation resides in the rectum, there are
others, however, who believe that it does not take place
solely in that organ, but is often seated in the stomach,
more frequently in the small intestines, and sometimes
only in the imagination. Mr. O'Beime, as before re-
marked, is of opinion that it originates in the sigmoid
flexure of the colon.* My opinion is that this admoni-
tion originates in the rectum alone, the natural reservoir,
in a normal and healthy condition of all the parts con-
cerned, because no portion of the intestinal canal is
supplied as this is with the prop3r nerves to communi-
cate it. When it is experienced in the stomach, in the
small intestines, or anywhere else, except in the rectum, it
must be in consequence of disease of the stomach, or of
such portion of the intestines, or of the brain or nervous sys-
tem. As to the cause of this admonition there are various
opinions. Some allege that it is induced by the mechan-
ical distention of the parietes of the rectum, the result of
accumulated fecal matter, gas, or both, and I am of this
opinion ; others, that it is produced by the mere contact
of the fecal matter, the natural stimulus of the intestines,
with the interior surface of the rectum ; others, again,
that it is caused by the acrimony of the faeces, acquired
by their retention in the rectum. The truth, however, is
that the cause of this sensation is not positively known,
consequently all in relation to it is more or less conjec-
tural. Analogy shows that nature employs a somewhat
similar agency in the case of other hollow viscera pro-
vided with muscular fibres, as the bladder and the uterus.
Mr. O'Beirne's peculiar neurological views on this sub-
ject, his ideas on the peristaltic motion or intestinal ac-
tion, etc., will be fully considered hereafter in a separate
article, on the '* Anatomy and Physiology of the Sigmoid
Flexure of the Colon."
949 Madison Avbmub, Nbw Yokk.
Verges. — Old Dogberry's fellow officer derived his
name from the corruption of verjuice into verges. Ver-
juice is verdjus, or the juice of any green fruit, such as
the acid liquor expressed from wild apples, sour grapes,
etc.
Sickness and Morals. — ''Every man is a rascal as
soon as he is sick," said Dr. Johnson.
» Op. dt., p. t8.
ON THE TOLERANCE OF CORROSIVE SUBLI-
MATE IN SMALL AND FREQUENT DOSES.
By ANDREW H. SMITH, M.D.,
NEW YOWC.
As preliminary to the more extended use of corrosive
sublimate as an anti-zymotic or anti-ferment, it is impor-
tant to settle the question of the safety or danger of ad-
ministering it in such quantities as may reasonably be
expected to act upon the mass of the blood in such man-
ner as to destroy a poison floating in the circulation.
The dangers to be apprehended are, first, local irrita-
tion ; second, mercurial poisoning.
The following observations will help to form an esti-
mate of each of these dangers. It may be premised that
in no- case was the degree of dilution less than one in
ten thousand. The first eight observations were at the
Presbyterian Hospital during my service, and for the
notes I am indebted to the kindness of the house physi-
cian. Dr. Charles G. Wagner.
Cass L — Annie C ; Irish; married; forty years of
age; admitted April 21, 1884. Disease, phthisis pul-
monalis, third stage. Patient had been under observa-
tion three weeks when mercurial treatment was begun.
Temperature had ranged from 100.5° ^o *o3-5**«
May loth. — She was given hydrarg. bichlor., gr. j^
every hour for seven hours. Temperature did not nse
within a degree as high as on the previous evening.
May nth. — Bichloride continued (largely diluted),
gr. ^ every hour for eight hours. Temperature niearly
two degrees lower than on previous night.
May 1 2th. — Bichloride continued. Temperature in
rooming was normal. In the evening it rose only to 100^.
Treatment was continued, and the case remained un-
changed durin|( next three days. On the fourth, patient
had bloody diarrhoea, and the bichloride was stopped
Diarrhoea lasted but one day. Treatment was not re-
sumed.
Case II. — Gertrude M ; Irish ; single ; domestic ;
twenty-six years of age; admitted February 17,1884.
Disease, chronic diffuse nephritis with mitral regurgita-
tion. Patient had been under observation three months
when hydrarg. bichloride treatment was begun. She had
for several weeks been passing a very small amount of
urine.
May 17th. — Patient was given hydrarg. bichlor., gr. ^
every two hours during the day (none at night). The
immediate efifect apparently was to increase the quantity
of urine. She continued to take the drug for four days,
when she had bloody diarrhoea, but no pain in the gums
nor any salivation, the bichloride was suspended and the
diarrhoea ceased after six or seven passages. Treatment
not resumed.
Case III. — Patrick McK ; Irish; single; driver;
forty-seven years of age; admitted May 2, 1884. Dis-
ease, tertiary syphilis, pachymeningitis (cephalalgia).
Patient was put immediately on hydrarg. bichlor., gr. ^
three times a day, with potassii iodidi, gr. xv. t.Ld.
May 15th. — He was put on hydrarg. bichloride, gr. ^
every hour during the day (not in the nightjf. Treatment
continued daily until May 20th, when patient had pain
in the jaws, and gums felt sore, no marked salivation.
Hydrarg. bichloride stopped ; ordered, K,C10,.
Case IV. — ^Julius J ; American ; single ; twent}'-
one years of age ; admitted April 26, 1884. Disease,
chronic diffuse nephritis. Patient had been under obser-
vation in the hospital about three weeks ; was passing
fifty to sixty ounces urine a day, which contained albu-
men and casts.
May i8th. — He was put on hydrarg. bichloride, gr. ^
every hour. This was continued eight days, during day-
time, with no apparent effect on any of the functions.
The amount was then reduced to gr. ^ every two hours,
which he continued to tolerate until June 3d, when it was
discontinued.
September 20, 1884.]
THE MEDICAL RECORD.
313
Case V.-— John O'N ; Irish ; married ; aged fifty-
five. Admitted March 23, 1884. Disease, chronic
diffuse nephritis.
May 15 th. — Patient was put on hydrarg. bichlor., gr.
^ every four hours.
May 20th. — Bichloride increased to gr. ^ every two
hours.
May 27th. — Bichloride stopped. No effects noticed.
Case VI. — Daniel H ; nurse; widower; aged forty-
six; admitted May 7, 1884. Disease, facial erysipelas.
May 7th. — Hydrarg. bichlor. was begun on May loth ;
dose, gr. -^ every hour during daytime.
May 1 2th. — Patient complained of pain in gums and
profuse salivation. Hydrarg. bichlor. stopped. Treat-
ment not resumed.
Case VII. — Dora V ; German; married; aged
thirty-one; admitted March 31, 1884. Disease, phthisis
polmonalis, chronic diarrhoea.
May 2ist — ^Patient was given hydrarg. bichlor., gr. ^
every hour. This was continued until May 23d with no
obvious effect. It was then discontinued.
The following observations were made in private
practice :
Case VIII. — Mrs. H ; puerperal peri-metritis with
malarial complication. Bowels constipated ; -^ gr. bi-
chloride given every hour for eleven hours, then ^ gr.
every hour for seven hours. Griping pain was then felt
in the abdomen and three liquid evacuations occurred in
rapid succession. Bichloride stopped, after which the
diarrhoea ceased spontaneously. No stomatitis occurred.
Case IX. — J. B , aged six years. Malignant
measles with excessive temperature, ^ gr. bichloride
every two hours for three days. No irritation of stomach
or bowels, no soreness of the mouth. The urine, which
at first was very scanty, was increased to double the
normal quantity. It contained no albumen.
Case X. — M. S , six and one-half years of age ;
diphtheria following scarlet fever. Patient took ^ gr.
bichloride hourly, with very few omissions, day and night
for a week, and the same quantity during the day with
two or three doses during the night for several suc-
ceeding days. Chlorate of potash and tincture of the
chloride of iron were given at the same time. The
mouth was not affected and there was little or no irrita-
tion of the stomach or bowels. The urine was increased
to seventy ounces, but fell to the normal amount when
the drug was discontinued. It did not contain albumen
during this time, though a very slight albuminuria was
afterward developed.
Case XL — Miss H. G , fifty years of age, con-
tracted kidney anasarca of legs ; urine much decreased
in quantity, but of high specific gravity, no nausea or
other uraemic symptoms. One-twentieth of a grain in
four ounces of water immediately produced gastric dis-
tress followed by vomiting. A second dose three hours
later resulted similarly, and the patient declined to pur-
sue the treatment further.
From an examination of these histories it will be seen
that in five of the eleven cases, the bichloride given in
quantities of from ^ to ^ of a grain, and at intervals of
one or two hours, produced no ill effect. Of the other
six cases diarrhoea with griping occurred in one, bloody
diarrhoea in two, and ptyalism in two.
The bloody diarrhoea occurred in one case after seven
hourly doses of ^ grain the first day, and eight hourly
doses on each of the four succeeding days. In the other
case the drug was given in the same dose but at intervals
of two hours throughout the day, and the bloody dis-
charges occurred after four days. In both instances the
diarrhoea ceased immediately on the withdrawal of the
medicine.
Stomatitis occurred in one case after five days' use of
the bichloride in hourly doses (during the day) of ^
grain, and in the other case after two days.
In one case an idiosyncrasy caused gastric distress
and vomiting immediately upon taking ^ grain, and
this recurred when the dose was repeated some hours
afterward.
In one case of phthisical diarrhoea ^ grain every hour
for two days neither increased nor diminished the diar-
rhoea, producing in fact no obvious effect.
In two cases of children under seven years of age
doses nearly equal to those given to adults were remark-
ably well tolerated.
In three cases, one of chronic diffuse nephritis, one of
scarlet fever and diphtheria, and one of measles, the drug
produced a marked diuretic effect.
In one case of phthisical hectic the temperature was
apparently reduced in a marked degree by the bichloride.
ON THE PREPARATION AND USE OF OXY-
GEN AND ITS CONGENERS AS REMEDIAL
AGENTS.
By SAMUEL S. WALLIAN, A.M., M.D.,
BLOOMINGDALK, N. Y.
(Continued firom page 9S7.)
Methods and appliances for clinical exhibition, — As
will be inferred, the use of these agents, although not
necessarily restricted to these, is more especially adapted
to office and hospital practice. For a complete office
equipment in every considerable practice there should
be at least three separate reservoirs. One should contain,
at all times, pure oxygen, ready for instant use in cases
of emergency ; a second may contain pure nitrogen
monoxide, and a third such modified admixture as is
found best adapted to the class of cases under treat-
ment One or more additional reservoirs will at all
times be found a matter of convenience, and in
undertaking the treatment of a variety of cases in an
extensive hospital or general office practice, quite essen-
tial. These should be arranged so as to be readily
connected when desired. They may be placed in a suit-
able hall, closet, or private room adjoining the office,
and connected with the latter either by ordinary gas-pipe
or by rubber tubing. The latter may be neatly covered
with rep or other suitable material, as a matter of taste.
The mouth-piece or inhaler may be of glass or hard
rubber, and it is to be connected with the reservoir
through covered rubber tubing and a glass bell, or a
small-sized wash-bottle half filled (with simple water, a
solution of caustic soda, or of any medicated solution
desired), through which the gas is drawn in brilliant
bubbles. A number of these bells or wash-bottles being
kept on hand, each patient, or at least each class of
patients, may thus be provided with an appropriate and
separate solution.
In regard to proportions, a mixture very much used
by me is composed of O two volumes, N^O two volumes,
and common air (to be drawn fi-om a pure source) fonr
volumes. In cases of extreme vascular torpor and func-
tional inactivity a stronger mixture will be indicated,
as O two volumes, N,0 one to two volumes, and com-
mon air one volume. Such a mixture is almost as effi-
cacious, in emergencies and extreme cases, as pure
oxygen ; it is far better for ordinary use, and will answer
every purpose in case of a sudden demand for the pure
gas. Delicate patients will require the weaker mixture
from the start, and after a few days of the more active
treatment, very few cases will require any stronger. I
would again most emphatically repeat what I have
already several times asserted, that a majority of experi-
menters with oxygen and congeners have failed and will
continue to fail of good results on account of using the
agents in too concentrated form.
For a limited practice, in which one quality of gas
must be made to serve a variety of patients, a com-
promise mixture of equal volumes of O, N,0, and common
air is as strong as should be used. This will be suffi-
ciently potent for the severer cases, and must be cau-
314
THE MEDICAL RECORD.
[September 20, 1884.
tiously administered to susceptible patients and those
in anything like a critical condition.
Time and frequency of administration. — Except in
emergencies, the treatment should not be given either
on an empty stomach or after a prolonged fast. In a
majority of cases the mid-meal hours between break-
fast and dinner are most favorable. It is well to avoid
giving any active treatment within an hour of any prin-
cipal meal, or at any time when there is present an
unusual degree of fatigue. Mere weakness or nervous
prostration do not, however, contraindicate, but are
usually relieved by oxygen.
In cases complicated with persistent or periodic neu-
ralgia, it will be advisable to supplement the regular
daily sitting with a few inhalations just before retiring ;
and in these, as well as in extremely " nervous " or in
hysterical cases, this evening exhibition should consist
of as much as fifty per cent. N,0.
As a rule, in ordinary chronic cases one treatment
per diem is all that is advisable ; in many cases it is all
that is allowable. This should be carefully borne in
mind by the inexperienced, since it is quite easy, and I
had almost said natural, to overdo in the matter of
dosage, in the anxiety of both physician and patient to
see palpable signs of immediate improvement.
Methods, dosage, and intervals. — When feasible, let
the patient stand erect, throwing the shoulders well back
and as thoroughly as possible expelling the residual air
from the lungs before inspiring the gas; then with a
steady effort slowly inspire from the mouth-piece until
the lungs are as full as they can be readily filled. Let
the inspired gas be retained as long as convenient with-
out discomfort, then slowly and deliberately expired.
There should be an interval of from five to twenty
minutes, according to the nature of the case, before a
second inspiration is given, and during this interval the
patient may walk about, sit, or recline, as he seems most
inclined.
In ordinary non-critical cases, accompanied with ven-
ous stasis and general functional torpidity, from four to
six inspirations, comprehending two to four gallons, may
be given at each daily stance ; but this limit should sel-
dom be exceeded. Many cases will present in which two
full inspirations will be all that should be exhibited during
the twenty-four hours. In this regard the practitioner
must be constantly on the alert, and must use the most
careful discretion.
A systematic record should be kept of each case
treated, beginning with a summarized history, a thorough
physical examination, an examination of the urine, noting
pulse- and respiration-rates, capacity of lungs, etc. The
quantity per diem and specific gravity of the urine, as
observed at stated intervals daily in critical or important
cases, and at least weekly in all, during treatment, will
furnish suggestive data from which to regulate the qual-
ity and quantity of gas to be exhibited.
If there be a tendency to haemoptysis, oxygen is not
necessarily contra-indicated, but evidently should be ad-
ministered with more caution. I have not hesitated to
advise the treatment in these cases, if not otherwise
contra-indicated, and have never witnessed any untoward
results ; but the lungs should never be forcibly inflated,
nor should the inspired gas be so long retained. As a
further precaution, which, however, I am incUned to think
is superfluous, it should be nmcb diluted at the outset
and gradually increased in strength with the progress of
the case. I have even thought the use of the gas, with
due precautions, has eventually lessened the liability to
hemorrhage.
In acute cases, as of asphyxia from any cause, alarm-
ing dyspnoea, cyanosis, suspended animation, narcosis,
severe paroxysms of asthma, etc, no definite rules can
be formulated. The indications must be gathered in
each instance from the nature and progress of the case,
and the judgment of the practitioner must in all cases
supersede all rules.
In cyanosis and asphyxia there is little danger of push-
ing the treatment too rapidly or too far, short of posi-
tively relieving the patient. The immediate demand is
for oxygen, and it may be given, freely and constantly,
until the imminent crisis has been passed and the urgent
symptoms are relieved.
A practical suggestion. — In its incipiency every "new"
treatment is called on to perform miracles, since at first
only the most inveterate and apparently incurable cases
will seek its aid. I would therefore utter this warning,
and suggest that no such cases be received except with
the express stipulation that the treatment shall be punctil-
iously followed for a definite period of, say, not less than
two, three, or four months. It will be worse than throw-
ing away time or than i)lacing pearls before swine to per-
mit the grand army of physical vacillators to spasmodically
attempt the treatment, foolishly expecting that it will ac-
complish greater wonders than the touch of Midas' wand,
and fully believing for a day that it is the latest " wonderful
discovery" among patent nostrums. These will follow it
for a few days or weeks, and will insist upon giving it up
long before it has accomplished any definite or perma-
nent good. They will be only a block of stumbling to
its success with others, and will give you no end of annoy-
ance by their irrational and short-sighted criticisms.
Better decline to treat not only hopeless incurables, but
all who will not stipulate to give the treatment a fair and
thorough opportunity to accomplish tangible and perma-
nent results. I would insist on this, even though it
might appear to savor of the methods of the advertising
charlatan. Thus, it would be a stroke of business pru-
dence to charge each patient a maximum fee by the
month for the first month, and minimum or perhaps grad-
uated fees for subsequent months of treatment, since this
will encourage perseverance on his part, and since the
first month covers the period requiring most watchful
care and intelligent adjustment of all the conditions.
Adjuvants, — As regards concurrent treatment by means
of drugs, this must be left to the discretion of each practi-
tioner, guided by the exigencies of each particular case.
It must not be omitted whenever it rationally appears to
be either synergistic or complementary. To reject any
source of aid in treating maladies is to raise (or lower)
any method of treatment to the questionable rank of a
hobby.
Theoretically iron is an oxygen carrier, and in some
instances it may be given with advantage during an
oxygen course; but if the patient's diet be sufficiently
varied so that it shall contain the earthy salts in due pro-
portion, there will be little need for increasing the chalyb-
eate element.
To this end, even though it may seem pedantic, I
would distinctly urge, in connection with an oxygen
course, the daily use of those cereal and other preparap
tions known to be rich in phosphates and other needed
elements, as oatmeal (coarse), white wheat (crushed or
cracked), whole wheat flour, some of the principal ele-
ments of which are wanting in a majority of modem
dietaries.
In connection with the use of oxygen the question of
alimentation is of far more than usual significance. In
all cases the diet should be thoroughly sustaining, and in
some it should be abundant, even to the extent of forced
feeding. Bearing this well in mind, no specific rules
need be suggested. The necessity for an intelligently
selected variety in diet suggests itself when we reflect
that the subtle and powerful agent to which we are sub-
jecting our patients rapidly permeates every molecule of
matter in even the remotest tissues of the body. It ac^
celerates at once the process of liberating worn material
with retained and septic excretions, as well as that of
rebuilding or repairing weakened structures. For all
this work — destruction and reconstruction — ^liberal sup-
plies of fresh material are in constant demand, and must
be supplied with the food.
In ail cases complicated by chronic gastric catarrh or
September 20, 1884.]
THE MEDICAL RECORD.
315
torpid states of any of the viscera, the somewhat over-
done fashion of hot-water drinking, to the extent of two
or three pints per day an hour before meals, will be
found a valuable adjunct. If simple hot water be voted
flat, hot lemonade or hot soda-water may be substituted,
as indicated. The washing away of morbid products set
free by the treatment is also quite an essential factor ;
hence, in addition to the hot- water drinking, the warm
full bath, or a course of systematic bathing with massage,
with also frequent local lavements, hot douches, etc.,
should not be omitted. These are invaluable adjuvants
to any treatment
The regulation of the general sanitary and hygienic
surroundings of each patient need not be adverted to.
The judgment of all intelligent practitioners will suggest
this. One exception may be remarked in connection
with this treatment : Deprivation in the matter of out-
door air and physical exercise, whether from negligence,
necessity, or indifference, will not be so serious a draw-
back as in case of ordinary treatment, since superoxygen-
ation to some extent supplies the lack. But blind faith
in the treatment should not be allowed to exclude such
aids as may be derived from any and all adjuvants.
I append reports of a few additional cases treated,
hoping that other experimenters in this promising field
may be prompted to give to the general profession the
results of their efforts, and that in due time we shall not
be, as now, literally without a literature on the subject.
Case VI. — Miss E. A. W , aged thirty-one;
superintendent of a fur manufactory, the confinement
and dust of which is very irritating. Strumous habit, but
family history negative. Is anaemic, despondent, and
complains of a constant cough ; areas of dulness over
right lung, with persistent bronchial irritation and bron-
diial catarrh.
April 20th. — Placed this patient on a mixture of equal
volumes of O, N,0, and common air. Lung capacity
bat 130 cubic inches, although a woman of more than
average stature and weight Advised daily exercise in
the open air and nutritious diet.
April 30th. — No apparent improvement ; cough rather
worse ; expectoration very profuse, and sputa containing
fetid cheesy (tubercular ?) matter. Treatment continued.
May loth. — Appetite rather better, and sleeps more
regularly; otherwise no visible improvement. Cannot
secure out-door exercise to any extent. Treatment
changed to O two volumes, N,0 and atmospheric air,
la one volume. Lung capacity 150 cubic inches.
May 2oth. — Lung begins to clear up, but no outward
signs of improvement. Patient much discouraged, and
only consents to continue the treatment on my positive
assurance that she has made some progress. Lung
capacity 160 cubic inches.
May 30th. — Now reports her general health as very
decidedly improved ; cough perceptibly better ; her
former sallow ("bilious") complexion has cleared up,
and is now fairly ruddy. Eats and sleeps well, and en-
joys a buoyancy of spirits unknown for years.
June loth. — Reports herself "cured,'* and is loud in
her praise of the treatment. Says she had no faith in
it in the start. Her cough is almost entirely gone ;
respiratory murmur audible all over both lungs, and /las
gained twenty pounds in flesh. Lung capacity 195 cubic
inches. Treatment discontinued, patient going to the
country for a vacation.
August 8th. — She returns for additional treatment.
Took a severe "cold'* en route from the country, and
her bronchial trouble returned. Severe passive conges-
tion of both lungs, annoying cough with muco-purulent
expectoration. Pulse, 94. At the first sitting she in-
hales two full inspirations of O one volume, N^O one
vohinle, and common air two volumes. Within five
minutes her pulse falls to 84, and the immediate dyspnoea
is decidedly relieved.
August 20th. — Some cough yet, but great general
improvement is evident Severe bronchial irritadon per-
sists, and, continuing the oxygen treatment, a local spray
is added. 9. Potas. chlor. 3j. ad aqua ^iv.; alternat-
ing every other day with IJ. Fl. ext. hyosc. 3 ss. ad
aqua § viij. per steam atomizer. Complains of pectoral
and intercostal myalgia, for which ordered a stimulating
lotion and tonic regimen.
August 29th. — Notable improvement is evident
Bronchial difficulty is much relieved ; myalgia gone, and
not much cough left Treatment interrupted.
September 20th. — Treatment resumed every other
day, improvement having continued since last record.
October loth. — This patient now considers herself
well, but is advised to leave the factory and live more
out of doors, if possible.
Saw this patient six months later, and although she
has not left the unwholesome factory she continues well
Case VII. — L. P. N , aged twenty-five; theo-
logical student; nervous temperament; family history
good, but is a confirmed dyspeptic, and has spermator-
rhoea of several years' standing, nocturnal emissions occur-
ring almost every night Over the latter he is despondent,
even to desperation. Fears he is going into a " de-
cline." Studies hard far into the night, preaches, be-
comes very excitable ; after which he suflfers from pro-
tracted insomnia. Has consulted a number of physicians
here and elsewhere, but without benefit. Is now trying
movement-cure, but thinks it weakens rather than
strengthens him.
April 13th. — Begins the use of a mixture composed of
0 one volume, N,0 two volumes, and common air two
volumes. Lung capacity 160 cubic inches ; countenance
expressing haggardness and hopelessness ; urine loaded
with oxalates.
April 20th. — Already reports a marked change in his
appetite and digestion. Says his food no longer dis-
tresses him.
April 30th. — Nocturnal emissions have entirely ceased !
He sleeps and eats well, and does not give way to ex-
citement as formerly. Lung capacity increased to 190
cubic inches. Feels greatly encouraged.
May loth. — Improvement has been constant and
rapid since last report. Appetite and digestion excel-
lent. Has gained in flesh, feels fresh and buoyant, and
no return of emissions. In short, this patient is quite
himself, and attributes the change wholly to the oxygen
treatment. Lung capacity 200 cubic inches. No fur-
ther treatment deemed necessary, and patient passed
from observation.
Case VIII. — E. W , aged forty- nine; insurance
agent— one of the toughest of his kind ! Could talk a
graven image into taking a policy, if he had time. Mixes
his family history so much with Parr's tables and the
" actuaries' experience " that I cannot make much of it.
Is suffering from a chronic " cold on his lungs," which
1 diagnose as bronchitis — sub-acute, with some pulmo-
nary congestion. Has a very harassing cough, is quite
dyspeptic, constipated bowels, harsh, dry skin, haggard
appearance.
April 8th. — Placed him on the use, daily, of the stand-
ard admixture of equal volumes of O, N,0, and com-
mon air. Lung capacity 150 cubic inches. Urine heavy
with chlorides, etc.
April 1 6th. — Decidedly relieved; coughs less, raises
more easily, sleeps and eats better. Treatment contin-
ued, increasing the proportion of O. Lung capacity 180
cubic inches.
April 25th. — Patient says he is pretty much "cured,"
and that the treatment has benefited his general health
more than all the tonics, bitters, and "blood renewers"
he has ever taken. Has a more natural appetite than
for twenty years, and is quite relieved of his habitual
constipation.
May 8th. — Reports himself " well ; " no cough, respi-
ration free and natural, all his bodily functions well per-
formed.
Saw this patient six months later ; no relapse.
;i6
THE MEDICAL RECORD.
[September 20, 1884,
Case IX. — Mrs. L. F. L , aged forty-seven, mar-
ried ; one child, aged twenty. Family history shows
rheumatism in her mother (arthritis, both subacute, and
deformans), who is still living. Father dead. Brothers
and sisters enjoy very fair health. Some twelve years
ago had a miscarriage at three months, from which she
made a poor recovery. Her account would indicate that
the secundines were retained for several weeks, and
finally expelled, with a spasmodic effort, and in a very
fetid condition ; pelvic cellulitis supervening and event-
uating in chronic abscess (intra-pelvic), which four
years ago found exit through a tortuous sinus and
reached the surface in the right labia majora. Free in-
cision was made, and the immediate or superficial ab-
scess cavity was syringed repeatedly with tincture of io-
dine, carbolic acid, and glycerine. It healed but soon
filled again, and a careful exploration with flexible probe
proved its origin to be as above stated, the seat of the
original abscess being, apparently, in the vicinity of the
right ovary.
During the past three years patient has suffered from
lumbo-sacral neuralgia and wandering arthritic pains.
Six months since her neuralgia culminated in a painful
and disabling sciatica of the left side. After exhausting
all the domestic remedies to be had or heard of, try-
ing salicylates, manaca, lotions, and anodynes without
limit, she came to me in sheer desperation. I found her
anaemic, suffering paroxysms of excruciating pain, which
extended from the hip to the ankle ; bowels constipated
and moved only by enemas, dysuria a frequent symptom,
appetite wanting, and much gastric distress accompany-
ing the process of digestion. Tonics, iron, stimulants,
counter-irritation, the deep injection of chloroform, and
in some of the worst paroxysms, of morphia and atropia,
as also the constant current, were all thoroughly tried,
and afforded some temporary relief. However, these
remedies severely aggravated her stomach troubles, in-
ducing intense cephalalgia and almost unendurable nau-
sea ; and on omitting them the paroxysms returned with
even greater severity.
As a last resort I advised a persistent trial of the
oxygen treatment ; and for the purpose of making the
test a thorough one, took the patient into my own
family. Her complexion is quite sallow, and skin,
especially on her hands, covered with patches of ** salt
rheum," which has persisted for thirty years. She suf-
fers from periodic attacks of rheumatic headache, and
her countenance is a petrified epitome of seriousness and
distress.
February ist. — Prepared a mixture of O two volume.^
N,0 two volumes, and diluted this with twenty per cent,
of^common air. Of this, two full inspirations to be taken
at 10 A.M. and the same on retiring. Lung capacity 100
cubic inches. The first few doses of the mixture pro-
duced such complete muscular relaxation and semi-
insensibility that she sank helplessly to the floor unless
supported ; no unpleasant sensations or effects superven-
ing.
February loth. — Sciatica still recurs, but less fre-
quently and with less severity.
February 20th. — Appetite improves ; complexion a
little clearer ; no dysuria except after the use of ano-
dynes ; discharge from the abscess less profuse and less
fetid.
February 28th. — No further discharge from the ab-
scess ; digestion constantly improving ; sciatica decidedly
modified. Lung capacity 140 cubic inches.
March 5th. — Headaches less frequent and less severe ;
lameness almost wholly overcome ; complexion rapidly
improving. Patient eats, sleeps, and walks better, and
shows a buoyancy of spirits unknown for years. Lung
capacity 150 cubic inches. The treatment is continued
with some interruptions, changing the proportions by
adding twenty per cent, of common air and increasing
to four full inspirations at each sitting, twice per
diem.
March 12th. — Improvement steadily continues in all
directions.
March 20th. — Is gaining flesh quite perceptibly, but it
is as much a gain of quality as quantity. Paroxysms of
headache rare and light ; sciatica persists, but is mild.
'* Salt rheum " gone ; skin smooth as a child's,
April ist — She declares she is ready to ** certify" to
any kind of statement I may ask as to the efficacy of
the oxygen treatment. Avers that it has made her "a
new woman," etc. Wants to go home. I express my
conviction that the treatment should be continued much
longer to ensure permanent results. She goes home,
promising to return soon, especially if any old symptoms
reappear.
April 24th. — Has worked considerably about the house
and garden since last report. General health continues
good, but sciatica returns in mild form. Again place
her on four inspirations daily of equal volumes of 0,
N,0, and common air. Lung capacity 200 cubic inches.
May 3d. — Steady improvement since last report. Sings
with good voice, which she has not done for years;
walks and rides without pain or extra fatigue ; also does
considerable light work about the house. Her complex-
ion is now clear and fairly ruddy ; headaches slight and
infrequent. No sciatica, no eczema.
May 1 8th. — ^Treatment suspended. This patient has
astonished her friends — and her physician I
September 15th. — Continues to this date free from
all her former complications, with the exception of oc-
casional disturbances of a physiologically weak heart.
These are, however, chiefly or wholly attributable to her
own indiscretion in the matter of over-exertion. She
has attended to active household duties ever since treat-
ment was suspended.
THE USE OF THE GREEN LEAVES OF THE
DATURA STRAMONIUM IN THE CURE OF
PAINFUL JOINT AFFECTIONS.
By HAL C. WYMAN, M.D.,
PROPSSSOR OP PHYSIOLOGY AND HISTOLOGY, MICHIGAN COLLBGK OF MSDiaNt,
DBTKOIT, MICH.
It may seem unwise to speak of the use of a remedy that
can be had only at one season of the year, yet such a
remedy I have found so invaluable and wide in its range
of usefulness that I am constrained to risk criticism by
reporting the success I have bad in the treatment of vari-
ous painful joint affections with the green leaves of the
datura stramonium. I have now under my care, in the
wards of the Michigan College of Medicine Hospital, a
young woman, aged twenty-two, who is recovering from
an attack of acute rheumatic inflammation of the right
knee-joint, that illustrates the advantage of treatment
with the fresh stramonium leaves. She was attacked
three months ago with rheumatism of wrist and ankle-
joints upon opposite sides. Under treatment with sali-
cylates the swelling disappeared from these joints and re-
appeared in the right knee, where it remained until I
began the use of the leaves. In the meantime, blisters
and iodine ointment externally, iodide of potash, colchi-
cum, and alkalies internally were tried without avail
Large and frequently repeated doses of morphine were
required at night to relieve pain and produce sleep. She
began to enjoy freedom from pain, and to sleep, and the
joint to improve, immediately the joints and parts con-
tiguous were enveloped in layers three or four leaves deep
of the freshly picked leaves of the datura stramonium—
thornapple or Jamestown weed, as it is sometimes called.
This application* has been continued for two weeks. In-
ternally she has taken infusion of quassia only. She has
developed good appetite. The joint has become ftiobile
and supple, and swelling is almost entirely gone.
A feeble, nervous boy, aged ten, had psoas abscess
caused by carious dorsal vertebrae. He slept badly and
cried and worried with pain in the hip and lumbar region.
September 20, 1884.]
THE MEDICAL RECORD.
317
Morphia internally interfered with digestion. His friends
could not be prevailed upon to use it thoroughly by in-
unctions. I directed that a sufficient number of the
fresh leaves of the stramonium be gathered daily from a
neighboring vacant lot and applied to the hip and lumbar
region, and held in place by a bandage. Freedom from
{MUD was an almost immediate result.
I could mention numerous cases of acute inflammation
of the large joints of the body where great pain, on attempt-
ing motion, was a prominent symptom that have occurred
in my practice during the summer season. I have been in
the habit of using the fresh stramonium leaves in these
cases, and with the most happy results, so far as the relief
of pain is concerned. In the season when it is impossible
to obtain the fresh leaves I have tried, but without success,
to obtain the same results by inunctions of stramonium
ointment.
The plant from which the leaf is obtained is now
so common in the United States that one need ex-
perience little difficulty in getting a sufficient number of
the leaves fresh every day for use in any case of inflamed
joint, where it is desirable to check pain and give physi-
ological rest. It is my custom to keep the inflamed and
painful joint enveloped in the leaves for a period of
twenty-four hours, when fresh leaves are to be applied.
In some instances I have used the bruised leaves in the
foroi of paste or cold poultice, but do not think any par-
ticular advantage has resulted from this method of appli-
cation. All that seems to be necessary to relieve the
pain in an inflamed joint is to invest it with a layer of
leaves thick enough to shut out the air, and prevent sur-
face evaporation. Profuse perspiration from the skin
over the joint follows, and pain and swelling usually
vanish.
.An experience of twelve summers with this remedy
convinces me that with its help there is less frequent
occasion to resort to the various immobilizing appar-
atus in the management of joint troubles than during
the winter, when it is impossible to procure the fresh
leaves, and that my summer cases make better recoveries
—more useful joints — because of the greater opportunity
given by the treatment without fixation apparatus for the
exercise of the physiological conditions under which
joints exist.
Opium-smoking as a Therapeutic Measure. — Dr.
Thudichum regards opium-smoking as a valuable remedy
in colds, hay fever, chronic neuralgia, and hypera&sthesia,
when these affections are rebellious to the action of
quraine in large doses (Schmidfs Jahrbucher^ No. 4,
1884). It is also useful in attacks of coughing in phthisi-
cal patients. The author thinks there is no danger of
the patient becoming habituated to the practice, and
says that those only who suffer from incurable affections
are unable to cure themselves of the habit. The aqueous
extract is used and the smoke is to be deeply inhaled.
Dr. Thndichum regards the stories which have been told
of the victims of opium-smoking as highly colored fables,
bat this is probably because he lacks experience, other-
wise he would not so unhesitatingly recommend such a
dangerous remedy.
Experimental Research Relating to the Etiology
OF Tuberculosis.-— Geo. M. Sternberg, M.D., F.R.M.S.,
Major and Surgeon, U.S.A., in a paper read before the
Section of Biology of the American Association for the
Advancement of Science, stated that he had repeated
Koch's inoculation experiments, and was able to confirm
liiiu as to the infectious nature of tuberculo3is. Also as to
the presence of the bacillus discovered by him, in tubercle
nodules in the lungs and in tuberculous glands of inocu-
lated rabbits and guinea-pigs (inoculated with sputum,
containing the bacUlus, from a phthisical patient). The
experiments of Formad of Philadelphia, by which he
claims to induce tuberculosis in rabbits by the introduc-
tion into the cavity of the abdomen of finely powdered
inorganic material, have also been repeated with an
entirely negative result, so far as the production of
tuberculosis is concerned. The conclusion is therefore
reached that the bacillus of Koch is an essential factor
in the etiology of the infectious disease, tuberculosis.
Intermittent Fever Excited by Intestinal
Worms. — Dr. Rousseau relates in L Union MddicaU^
No. 30, 1884, the case of a young woman, nineteen
years old, who was attacked with an intermittent fever of
very severe type. The attacks recurred at frequent in*
tervals for over a year, during which time the patient
became emaciated and suffered severely in her general
condition. Quinine and other antipyretics were tried
repeatedly without effect. Finally several ascarides
were passed, and an anthelmintic treatment being then
ordered two hundred and twenty-nine worms were passed
in four months. The intermittent attacks at once ceased
and did not recur.
Paraldehyde as a Hypnotic. — Dr. C. Rank for-
mulates the following conclusions based upon a number
of experiments with this remedy : i. On account of its
unpleasant odor and burning taste, paraldehyde is un-
suited for general use, especially in private practice ; 2^
in physical diseases it exerts no hypnotic effect, at noost
its action is only sedative ; 3, parsddehyde is efficacious
in nervous insomnia, in mental excitation, and especially
in delirium tremens; 4, this drug cannot replace
chloral or morphine, at least in the treatment of physical
disorders. — Deutsche Medicinal-Zeitung^ Avif^st 11, 1884*
Exanthem following the Use of Antipyrin. —
Dr. Paul Ernst reports, in the Ceniralblatt fur Klinische
Medicin of August 16, 1884, two cases of an eruption
caused by the internal administration of antipyrin. The
two patients were a boy and a woman, aged respectively
ten and sixty-seven years, yet the eruption was so nearly
alike in both cases that there could be little doubt that
the same cause was at work. The exanthem consisted
of little irregularly rounded pimples lying close together,
and in some places confluent so as to form patches of
greater or less extent, between which the skin was nor-
mal, thus giving a marbled appearance to the surface.
After about five days the eruption began to fade and to
assume the character of a.brownish pigmentation, and in
the old woman there were some faint evidences of des-
quamation. Traces of the eruption were still visible at
the end of two weeks. The exanUiem was thickest over
the body, and on the extremities the extensor surfaces
were more covered than the flexor. In the boy there
was some oedema of the face, but in neither case was
there any eruption on the head or neck, although the
palms of the hands and soles of the feet were not spared.
There was some itching in the case of the woman, but
the boy did not complam of this. The eruption ran its
course and disappeared, although the administration of
the antipyrin was not interrupted. The writer explains
this by supposing that the system acquired a tolerance
for the drug. On this account he advises a continuance
of the remedy where its use is indicated, despite the
eruption. In a postscript Dr. Ernst states that he has
observed three other cases of an exactly similar nature.
OsMic Acid in Epilepsy. — Dr. Wilderniuth has
given osmic acid in a number of cases of epilepsy oc-*
curring in his practice during the past two years (0»-
tralblatt fur Klinische Medicin, August 16, 1884). It
was given, in combination with potassium, in pills, con-
taining each T^g^ grain of the salt. The largest amount
given in one day was \ grain. He used it in ten invet-
erate cases, and saw no result in seven, in two the at-
tacks were less frequent, and in one a prompt improve-
ment and final cure was obtained. The drug caused no
unpleasant symptoms of any kind.
3i8
THE MEDICAL RECORD.
[September 20, 1884.
The Medical Record-.
A Weekly yournal of Medicine and Surgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published bv
WM. WOOD & Co.. Nos. 56 and 58 Ufayette Place.
New York, September 20, 1884.
THE WAVE THEORY OF MENSTRUATION.
So rapid has been the progress of scientific investigation
and destructive criticism that there is now no English or
American text-book which presents correctly the state of
scientific opinion regarding the physiology of menstrua-
tion. It is still generally stated that menstruation is a
miniature pregnancy, in which there is a disintegration
and throwing off of the mucous membrane. It is known
now, however, that such statements do not express the
truth, but that the denudation is only partial, and that
the blood escapes mainly by diapedesis and by rupture
of engorged vessels. This view, that the uterine mucous
membrane is characterized by a monthly '* deciduosity,"
has been laid aside.
In the same way the old theory of Pfltiger, that men-
struation and ovulation were almost, if not quite insep-
arable phenomena, the irritation of a ripened follicle ex-
citing reflexly uterine congestion, has also been disproved.
The iaxX that after removal of the ovaries menstruation
may continue, furnished a sufficient refutation of this
previously very satisfactory explanation of the menstrual
process.
If, however, it be true that menstruation invariably
ceases after removal of the Fallopian tubes, some in-
genious person may yet be able to rehabilitate in a
measure the reflex hypothesis of Pfliiger.
At the meeting of the German Naturalists and Physi-
cians in Freiburg, February, 1883, Professor Hegar re-
viewed and showed the insufficiency of the various
theories of menstruation. Since that time Arthur Farre
and I^opold {Archivf, Gynecologies Bd. xxi.) have con-
tributed further evidence as to the independence of ovu-
lation and menstruation.
In a recent issue of Volkmann's Klinischer Vortrdge
(No. 243), Dr. Carl Reinl, a pupil of Hegar, discusses
the theories of menstruation, and contributes the results
of some careful experiments relating to what may bt
called the wave theory of menstruation.
Professor Goodman, of Louisville, some six years ago,
advanced the theory that the vital activity of woman
ebbed and flowed rhythmically, the length of the wave
being the duration of a menstrual epoch. Various inves-
tigators (Putnam- Jacobi, Stephenson, Rabuteau, Hen-
nig, and Von Ott) have contributed some facts which
apparently show that just before menstruation the vital
powers of woman are at the highest, and that with the
appearance of the menses there is a gradual fall, with, in
some cases, a secondary rise.
The measures of this alleged increased vitality have
been the state of the heart circulation, the temperature,
and the excretion of urea. It has generally been found
that the temperature has been higher, the blood-pressure
greater, and the excretion of urea larger in amount be-
fore menstruation than during or directly after it
ReinVs observations cover the subject of the relation
of the heat production to the menstrual epoch. Records
were made of the temperature in eighteen cases. Eight
of these were healthy women ; on three ovariotomy or
oophorectomy had been performed, while the remainder
had some form of uterine or ovarian trouble. In the
healthy patients he established the existence of a tem-
perature curve, which reaches its highest point just previ-
ous to menstruation ; it then gradually falls during men-
struation, and for some days thereafter. In a certain
proportion of cases during the first half of the intermen-
strual period it falls below the normal.
In the pathological cases Reinl still found marked
evidences of the temperature wave. Even when men-
struation occurred every two or three weeks the appear-
ances of menstruation corresponded with the top of the
curve. Perhaps the most significant £act, however, was
that in the castrated women, when no menstruatbn
occurred, the form of a periodically returning temperature
wave could still be made out
The observations which have thus apparently estab-
lished the fact of a menstrual wave are most interesting
and not without practical significance. It will still be
questioned, however, whether because the pulse is harder,
the skin hotter, and the urea excreted greater, therefore
the vital powers are above their average of activity.
MALARIA AS A DEFENCE IN A SUIT TO RECOVER RENT.
The defence of poor plumbing to a suit to collect rent
is a common one, and it often seems to be the opmion
that defects of this kind causing sickness are suflicient in
law to prevent a recovery on the part of the landlord.
So generally is this defence brought forward, that it
shows there is a deep-seated idea that this is an excep-
tion to the ordinary rule of contracts. There may be
defects in the roof, or the furniture may not be up to the
standard promised by the landlord, but such defences
are not often urged in a suit for rent It is only when
malaria shows itself that the tehant feels himself justified
in leaving the house or in refusing to pay his rent
There seems to be no reason, however, for this gen-
eral belief in the power of malaria to change the settled
rules of law. When a man hires a house and examines
it, he cannot, in general, refuse to pay rent because
malaria then existed or is afterward produced because of
poor plumbing. He takes the house as it is, and while
he may be unfortunate in his selection, he will not be
allowed to leave, and certainly there is no rule of law
which will allow him to continue in the house and yet re-
fuse to pay rent.
In the case where there is a positive guarantee on the
part of the landlord that the plumbing is in good order
and no malaria exists, there seems to be a little confu-
sion in the decisions, but die general opinion is, that i(
September 20, 1884.]
THE MEDICAL RECORD.
319
notwithstanding the guarantee, the tenant examines the
bouse and is apparently satisfied by accepting the lease,
he cannot afterward refuse to pay rent. In case the
tenant relies on the landlord's statements and makes no
examination of the condition of the house, the decisions
are in favor of allowing him to leave the house, and no
rent can be recovered.
An interesting case was decided not long since in this
dty which seems to give the tenant rights under the
Health laws to leave his house and refuse to pay rent
The following is the statement of the case : '' In a suit
for rent claimed to be due from a tenant of a suite of
rooms in an apartment house, it appeared that the de-
fendant's wife and servants were taken sick by inhaling a
malarial or poisonous gas in the apartments occupied by
them; that this unhealthy condition of the apartments
was [owing to the [defective condition of the general
plumbing work of the house, of which the landlord was
notified by orders received from the Board of Health,
requiring him to have changes made in the plumbing
work, and which unhealthy condition could have been
removed if he had complied with those orders ; that the
defendant waited for two weeks, and finding that nothing
was done on the part of the landlord, left under the ap-
prehension that he was imperilling the health of himself
and fiunily by remaining.'' Under these circumstances,
the judge who tried the case decided that this was what
is called in law a constructive eviction, and the tenant
could not be forced to pay rent during that portion of his
lease subsequent to the removal.
The decision has recently been affirmed by the Gen-
eral Term of the Court of Common Pleas, and unless re-
versed by the Court of Appeals, which is unlikely, will
be the law in the future. It may be said in general that
the policy of the law is becoming more favorable to
tenants in some particulars, but the main principles of
contract law will always apply to leases.
WHEN SHOULD POISON LABELS BE USED?
A CASB has recently occurred in Philadelphia which
raises a nice question as to what prescriptions should be
labelled '* Poison." The Pennsylvania stotute, and that
of almost every other State, is to the effect that <' No
apothecary, druggist, or other person, shall sell, . . .
by retail, any morphia, strychnia, . , , except upon
the prescription of a physician or on the personal ap-
plication, . . . and in all cases of such sales the
word ' Poison ' shall be carefully and legibly marked or
placed upon the label," etc.
In the case referred to a physician ordered pills con-
taining one-twentieth of a grain of strychnia for a pa-
tient ; a number of persons (not previously adjudged
lunatics) believing that such diminutive pills could con-
tain nothing prejudicial to health, undertook to see who
could swallow most of them in ar given time.. The
youngest of the party took fourteen, representing seven-
tenths of a grain, and died. The erudite corotier, after
holding an inquest of great length, has instructed his
jury to find the dispensing clerk responsible for the
death of the girl in not labelling the pill-box " Poison." ,
Aside from the fact that from the manner in which
tile case has been conducted, it looks very like a case of
libel, the question arises, Are all prescriptions contain-
ing a poison to be labelled " Poison " ? or shall only
those prescriptions containing the drugs mentioned in the
statute be labelled as poison ? The statute in the Penn-
sylvania books is clearly deficient, as it only includes
morphia, strychnia, arsenic, prussic acid, and corrosive
sublimate. Certainly it would be absurd to require the
apothecary to label pills containing one-twentieth of a
grain of strychnia " Poison," and at the same time allow
him to sell an ounce of tartar emetic or one grain of
atropine to any person without the cautionary label.
Yet this is clearly what the law would allow, and we do
not see how he could be prosecuted for it. But it is
equally absurd to require him to put the fpoison-label
on every prescription containing a poison ; for in this
case it would be the exception when a prescription
would not be labelled as poisonous. Brown-S^quard's
neuralgic pills, Dalby's carminative, Mitchell's tonic pills,
Dover's powder, and fully one-half of the prescrip-
tions sent out by physicians would be illustrated with
the skull and cross-bones. Such is clearly not the pur-
pose of the law, and it would be not only absurd but
puerile, especially when pills are dispensed, as no one
could take two pills by mistake for one ; and though the
law has a good deal of presumption, it has no right to
presume that the physician is prescribing for a patient
whose friends are without proper mental balance. Had
the prescription in question called for gr. v. of strychnia,
and f^xiiss^ of water, in teaspoonfiil doses, the drug*
gist would very properly, as he says, have labelled it as
poisonous, because a careless person might take a table-
spoonfiil of it, or else, as many people do, might turn
the bottle up to the mouth and guess that the proper
amount had been swallowed. As an example of the
absurdity to which this hair-splitting construction of the
law would be reduced, the druggist in question gives the
following, taken from his file : ** Eight suppositories, each
containing half a grain of aqueous extract of opium. Use
one " (here the opium contains morphia, and the label
must be used) ; and adds, '^ If some lunatics will banter
each other as to how many of these they can insert into
their respective rectums, they will also be subjects for
inquest." But the manifest absurdity of the coroner's
construction is still further seen when it is remembered
that scores of patent medicines are sold without the
poison-label ; in fact, we do not remember ever to have
seen such a label on a patent-medicine bottle. Yet we
have known a woman to die within two minutes after
taking a triple dose of a patent cough-mixture, without
previously shaking the bottle. Nor have paregoric or
any of the many soothing syrups cautionary labels. The
Philadelphia coroner may not be much of a mathemati-
cian, but he has evidently not foi^otten the reductio ad
aksurdum.
MULLEIN LEAVES IN PHTHISIS.
At the late meeting of the International Medical Con-
gress at Copenhagen, Dr. Quinlan, of Dublin, read a paper
in which he advocated the employ of mullein leaves in
phthisis, claiming extraordinary success in the treatitoent
of this disease by the free use of a decoction in milk of
this plant, or rather wtidy for it is one of the most com*
mon of our native weeds, growing by the roadside and in
320
THE MEDICAL RECORD.
[September 20, 1884.
neglected fields. Mullein is known to botanists as the
verbascum thapsus, and has honorable mention in the
Codex of France under the name of Moline, bouillon
blanc ; entering into the composition of the quaire fleurs
pectorales. The mode of preparation is to infuse an
ounce of the dried leaves, or the equivalent of the fresh,
in a pint of milk, to boil for ten minutes, and then to
strain. This infusion is administered warm to the patient,
with or without a little sugar. The whole pint is given
in two doses during the twenty-four hours. The hot de-
coction is said to be very easing to consumptive coughs,
so that during its use the ordinary cough mixtures may
be dispensed with. Its power of checking phthisical
looseness of the bowels is said ^ to be very marked. In
early cases, according to Dr. Quinlan, the mullein milk
appears to act very much in the same manner as cod-
liver oil, than which it is much more palatable. A large
number of cases of pulmonary consumption have been
treated in St. Vincent Hospital, Dublin, exclusively on
mullein, and it is said that crowds of patients have been
attracted to this hospital by the wonderful results which
have been obtained from this singularly^simple treatment.
In phthisical coughs great relief is said to follow smoking
dried mullein leaves in the same manner as tobacco. Dr.
Quinlan showed at the meeting of the Congress cigar-
ettes made of mullein leaves, which are said to be very
pleasant to smoke. It is asserted that in pretubercular
and early cases of pulmonary consumption mullein ap-
pears to have a distinct weight-increasing power, and to
be an excellent palliative to the cough in the later stages,
besides being the very best remedy to antagonize loose-
ness of the bowels.
Wood, in the U. S. Dispensatory, speaks of mullein
leaves as '^ demulcent and emollient,'' and as reputed to
possess " anodyne properties which render them useful in
pectoral complaints."
THE NEXT MEETING OF THE INTERNATIONAL MED-
ICAL CONGRESS.
It is a matter of gratification and pride that the Inter-
national Medical Congress has decided to hold its next
meeting in this country. The American profession, how-
ever, cannot too soon be made to feel that it has ac-
cepted no small responsibility, and that it must put forth
especial effort in order to acquit itself well. So far as
American hospitality and the ability generously to offer
it are concerned we have little to fear. But that the
literary and scientific contributions come up to the high
standard heretofore observed in these Congresses is a
matter of more concern. Unquestionably American
physicians can respond successfully in this direction if
the effort is made, as there is little doubt will be the case.
We trust that our readers will begin at once to consider
whether they wish to take part in the Congress, and if so,
to see that they bring to it something worthy of the occa-
sion. Three years is none too long to expend in such
preparation.
Naturally, the character of the papers read at the
Congress in question will depend greatly upon the judi-
cious work of the organizing committee. There should
be no effort spared to get our most representative men
and no ill-timed charity in selecting the wheat from the
great amount of chaff that will surely be offered. No
papers shoild be accepted that do not bear the stamp of
originality and merit.
Some practical difficulties will, we fear, be met with by
reason of the climate of Washington, where the Congress
is to be held. In July and August the heat is liable to
be intense, and to unfit even the most enthusiastic for
scientific work or social enjoyment It would be im-
possible probably to get many European physicians from
their work so early as May or June. In September there
might perhaps be cooler weather.
Still we do not think that climatic objections will be
insuperable, especially since the hotel accommodations in
Washington are so ample, and the Potomac has almost
always a cool breeze. Three years from now, however,
we shall advise our prospective European visitors to
bring the lightest clothes and to be prepared for the
most liberal diaphoretic activity.
THE GROSS MEMORIAL AGAIN.
The sting of death is sometimes in the imbecility of
posthumous admirers. The Chicago Medical Journal and
Examiner has made a siurprising display of unpleasant
feeling as regards the position of The Record toward
the proposed Gross Memorial Professorship. We have
not seen so near an approach to billingsgate in a medical
journal for a long time.
We confess that we do not understand the cause of the
JournaPs outburst. We honor the memory of the late
Dr. Gross ; we urge that his memory have a fit memorial
His is the greatest name in American surgery ; we pro-
test against its being buried in a ''memorial professor-
ship " in* a private (as distinguished from a State) medi-
cal school. Medical history furnishes no such project
as that which is now being set before us. We advise
against it because the plan is unwise and will not arouse
the sympathy of the profession. We urge in its place
that there be founded a memorial laboratory or a lecture-
ship similar to those by which celebrated physicians of
London have been honored. Every doctor in the coun-
try, with a spark of generosity in him, will gladly forward
such a plan, and it will succeed. But to set up as a
memorial to a great man a didactic professorship for
the yearly benefit, not of doctors, but of students, a com-
monplace, utterly local and never-to-be»foiigotten invest-
ment is ridiculous 1
The Journal is mistaken in arguing with so much point
and courtesy that The Record is "untruthful," '* jealous,"
" spiteful,'' and " sordid." It is simply a question of
properly and successfully rendering homage to a dis-
tinguished name. We believe thoroughly that Jefferson
Medical College took up the matter in good £sdth and io
perfect unselfishness. We do say, however, that it was
not only unwise but in bad taste for it to organize a
scheme which will help itself as much as it honors Gross.
We have the " efiroAtery " still to reiterate that the above
expresses the views of most of the profession.
Uatie Journal still believes that our interpretation of
the general feeling is not correct, we refer its editor to
Gaillard's Medical Journal^ the Medical Age^ the De-
troit Lancet, the Cincinnati Lancet and CHniCy the Indi-
ana Medical Monthly^ the Peoria Medical Monthly y widi
other journals yet to come.
September 20, 1884* J
THE MEDICAL RECORD.
321
It is said that Lord North's third wife was of so in-
flammable a temperament that for three days before the
wedding she had to be kept packed in ice. We would
in all courtesy suggest that a similar course would be
advisable for the editor of our valued contemporary pre-
vious to his ventures in polemics. Being cooled to below
the point of unmannerly vituperation, he may see that
possibly all is not guile in New York, and that we may
be quite sincere in urging the views we have presented.
We certainly trust that there will be no quarrel over
the matter. It would require very little change to secure
perfect unanimity in working for the honor of the la-
mented Gross.
As bearing upon the general question, we append the
following from a well-known Jefferson Alumnus in the
western part of this State. The writer puts the case
with fairness, and is responsible for his facts :
Your views on the subject of the proposed memo-
rial to the late Professor Gross meet with a hearty re-
sponse from many of the alumni of Jefferson Medical
College. As a member of the Auxiliary Committee, ap-
pointed to solicit contributions, I find that most of the
old " Jeff." men whom I approach are unwilling to help
in any movement which will, at the expense of the alumni,
only give another prize to be electioneered for in
the Board of Trustees of the College. All old Jeffer-
son men know what a close corporation said Board is,
and when they remember that neither Professor Pan-
coast nor Professor Gross, out of their large estates, left
a cent to the school which so long honored them, it
would seem that these great men saw nothing in the
spirit which animates the Trustees to warrant giving
them the disposal of any endowed chairs. The last
three appointments to professorships in Jefferson were
made notoriously for the following objects — first to con-
ciliate Philadelphia society, and, second, to drains students
from the West It is high time that the alumni of a
college, who in after life do so much for its benefit,
should have some voice in the management. Let the
Alumni Associatibn have the election of one-half the
Board of Trustees, or a confirmatory vote on profes-
sional appointments, or the nomination to the Trustees
of names to fill vacancies in the teaching body, if they
are to be expected to aid the College in the means for
higher education. I am as fond of my alma mater as the
next man, and look with pride at the signatures on my
diploma, but I cannot avoid the chagrin which comes
over me every year as I peruse the annual announce-
ment, and see the miserable subterfuges which are in-
serted therein to appease the clamor for higher stand-
ards and yet avoid any rock which will lower the fees of
the Faculty. Such an instance is found in the last an-
nouncement, in which the preliminary examination re-
quired by the laws of certain States is offered only to
those who intend to locate in those States, instead of be-
ing required of all students. The auri sacra fames has
its seats in the councils of all our educational institu-
tions, but the alumni of Jefferson will not, as a body,
respond to that thirst until a change comes over the
spirit of those who control its affairs.
A Jefferson Man.
The Fort Plain Fasting Girl. — Dr. Darwin Pot-
ter, of Fort Plain, N. Y., has examined the alleged fast-
ing girl of that place. He finds the case to be one of
very much the kind we had stated. The claim to having
Casted for one hundred and eighty-eight days is made
preposterous by the girFs well-nourished state. She has
chorea, and is, as we suggested, undoubtedly hysteri-
cal.
%«mi& 0f tiut tSftejeli.
The Rhinelander Case. — The recent investigation
into the mental condition of William C. Rhinelander by a
commission appointed by the Court of General Sessions
has attracted a great deal of attention on the part of the
community at large. It was begun for the purpose of
enabling Recorder Smyth to decide whether Rhinelander
should be called upon to plead to an indictment for as-
sault upon John Drake, a lawyer of this city. It was
alleged that Rhinelander was insane and more fit for an
asylum than a trial in a court of law. The investigation
continued for a number of weeks during the summer
before the commission, consisting of Drs. Detmold and
Nolan and Edward Patterson, a lawyer. The testimony
was conflicting and Rhinelander vigorously contested
the idea that he was insane, claiming that he desired and
ought to have a criminal trial. The commission have
just reported to the Recorder, Drs. Detmold and Nolan
holding that he is insane, and Mr. Patterson that he is
not. Under the law the Recorder can adopt either report
he chooses, and he is now engaged in examining the
voluminous testimony produced, in order to arrive at
some conclusion.
The Death of Dr. Robert J. HEiNMttLLER. — ^At a
special meeting of the members of the Fourth Division
of the Health Department of the City of New York,
held September 2, 1884, the following resolutions were
adopted :
Whereas^ We have learned withjdeep sorrow and re-
gret of the death of our late colleague. Dr. Robert J.
Heinmiiller ; therefore, be it
Resolved^ That in the death of Dr. Heinmtlller, this
Department has lost one of its most faithful and efficient
officers, and we, his associates, a friend whose many
noble qualities of mind and heart had endeared him to
each and all of us ; and the orofession has lost one of its
most promising young members.
That we tender to the family of the deceased our
deepest sympathy in their great bereavement.
That a copy of the proceedings of this meeting be sent
to the family, and to the medical journals for publication.
J. B. Taylor, MfD.,
J. B. Lenehan, M.D.,
George S. Conant, M.D.,
J. N. McChesvey, M.D.,
J. C. Conover, M.D.,
Committee.
The Cholera. — On September 14th, the cholera at
Naples showed evident signs of abating. On the i6th,
there were only 470 new cases and 167 deaths. The
total number of deaths at Naples, up to the day men-
tioned, is estimated to be about 3,700. This would
represent between eight and nine thousand cases, since
the mortality has been, on the whole, rather below its aver-
age. In other parts of Italy the cholera continues to keep
its hold, but makes no alarming progress. Reports are
sent in from thirteen different provinces, but the total
number of cases ranges between one and two hundred,
with a mortality considerably less than fifty per cent.
In France there continues to be occasional sporadic
322
THE MEDICAL RECORD.
[September 20, 1884.
outbreaks. Some cases are still reported from Toulon
and Marseilles, In the Eastern Pyrenees there are forty-
seven places where the disease has appeared. In all
France it is estimated that there have been 5,200 deaths
in 207 cities and villages.
Cholera is reported from half a dozen Spanish towns,
but in none of them has the disease made great ravages,
if we may trust reports. At date of writing, indeed, there
have not been 200 deaths from cholera ih all Spain.
On the whole, the epidemic appears to have spent its
force. We may estimate that it will leave with a record
of 10,000 deaths and two or three times as many cases
of sickness.
The Academie de Medicine, of Paris, has appointed
a cholera commission, consisting of MM. Brouardel,
Marey, Rochard, Proust, de Mussey, Fauvel, Legouest,
and Besnicr.
Protesting against Compulsory Vaccination. — A
despatch says that over 3,000 people at Leicester, Eng-
land, have been summoned for defying the vaccination
law, the feeling against which is very bitter all over
England.
Giving Commissions on Dental Patients. — We are
not aware that there is an Odontological Code of Ethics,
written or unwritten. Bat whether there is or not, there
ought to be some moral prohibition put upon the prac-
tice by certain dentists of offering a percentage on all
patients sent. The practice seems to be to circulate
cards among physicians announcing that '* we allow you
twenty-five per cent, of all money received from patients
whom you send us."
The English Army Surgeons, about two thousand
in number, are to change their uniform from scarlet to
blue.
A Testimonial to Dr. H. D. Schmidt. — We learn
from the New Orleans Medical and Surgical Journal
that the friends of the eminent pathologist, Dr. H. D.
Schmidt, have»organized for the purpose of procuring and
presenting a testimonial portrait of him to Charity Hos-
pital. The presentation was to have been made the first
Monday in September. Dr. Schmidt xs facile princeps
the pathologist of the South, and deserves this act of ap-
preciation from the profession.
The Will op the Late Dr. John G. Adams. — Dr.
Adams, by his will, bequeaths $5,000 to the Presbyterian
Hospital for a free bed for the sick poor of the Fifth
Avenue Brick Church ; $2,500 to the Bridgeport Protes-
tant Orphan Asylum and Hospital ; $500 each to the
Physicians* Mutual Aid Association and the New York
Training School for Nurses. His medical library is be-
queathed to the New York Academy of Medicine. Dr.
Adams revokes in a codicil a bequest of $5,000 to the
New York Academy of Medicine.
Cholera and Tobacco. — There seems to be a belief,
among the newspaper section of the city at least, that
tobacco has some prophylactic power against cholera.
The Times correspondent who visited Toulon and Mar-
seilles kept tobacco in his mouth while in the infected
districts and hospitals. Mr. George Augustus Sala has
asserted that in past epidemics tobacco-smokers have
had some exemption from the disease. Now experience
has shown that acid solutions prevent the development
of the cholera germ, and that this organism cannot easily
pass through an acid stomach into the intestine. But
the use of tobacco promotes a flow of alkaline saliva
which is swallowed, thus preparing a flowery path for the
bacillus to enter.
Prof. Mallet, M.D., LL.D., Ph.D., has been ap-
pointed to the chair of Chemistry in Jefferson College, as
successor to the late Professor Rogers. The school, in
selecting Dr. Mallet, has successfully pursued its policy
of taking the best men obtainable for its professorships.
Trouble among the Homoeopaths at Washing-
ton, D. C. — ^The homoeopaths, or at least certain persons
practising under that trade-mark in Washington, D. C,
are complaining that the trustees of the Garfield Me-
morial Hospital give them no share in its management
To offset this, the managers of the " National Homoeo-
pathic Hospital" (that is to be) have issued an appeal to
the homoeopathic societies throughout the country to
assist in a grand national fair to be held in Washington
in December next.
A Homoeopathic Fraud Exposed. — ^Wbile on the
subject of homoeopathy, it may be of interest to note the
following case of poisoning recently, reported in the Aus-
tralasian Medical Gazette : *' A homoeopathic practitioner
named Giinst was called in to attend a young woman
suffering fi-om sleeplessness and neuralgia, for which he
prescribed morphia and quinine. His explanation is that
by some bungling in the use of Hahnemannic symbols, the
powder ordered actually contained ten grains of hydro-
chlorate of morphia and five grains of quinine, and as the
directions given to the patient had been to take the pow-
der at once, the unfortunate woman was killed. This
accident of the poisoning, however, is not the main point
of interest now. In the evidence given by Dr. Giinst at
the inquest, he explained that what he intended to order
was half a grain of morphia, and this admission at once
puts the treatment out of the compass of homoeopathy."
The Code of the Nebraska Doctor. — ^The Omaha
doctors are being greatly slandered or they are in a bad
way. A correspondent from that city asserts that the
code of ethics is " Every man for himself and the devil
take the hindermost." This code is recommended, how-
ever, by a Western exchange as being devoid of all possible
hypocrisy at least.
The Missouri State Medical Society is accused,
like the New York Society, of being overrun with special-
ism. There is fault on both sides. Papers are wanted,
and specialists generally are the most ready to write.
Let the general practitioner assert himself, therefore, but
also let the organizing committees help him a little more
than is now the case.
Pasteur in Wax. — A foreign exchange states that
there has been placed in the Musie Grivin a represen-
tation in wax of Pasteur, with his assistants engaged in
the act of inoculating a dog against rabies. Wax works
have become the modern barometers of fame.
The Important Fact is being circulated that Mr.
Blaine is homoeopathic in his medical beliefs. However
this may be, he seems a big pill to some people.
September 20, 1884.]
THE MEDICAL RECORD.
323
£xcisiON OP THE Pylorus for Malignant Disease
was performed by Dr. Randolph Winslow, of Baltimore,
recently at the University Hospital. The patient was a
woman, forty-two years of age, who had suflFered for over
a year and was much emaciated. She died of shock a
few hours after the operation. So far as we can learn,
this is the second operation of the kind in this country.
Both have been unsuccessful
Doctors in Denver. — The Denver Medical Times
says, that about twenty new doctors have located in
Denver v^ithin the past three months. The ratio of
doctor to inhabitant now is one to two hundred and fifty.
Denver has also one medical college, twenty-five to thirty
professors, and five or six hospitals.
%i^w:\s xrf ^ocijctiieB,
MEDICAL SOCIETY OF VIRGINIA.
Fifteenth Annual Session, held at Rawley Springs, Va.,
September o, 10, and 11, 1884.
(Special Report for Thb Mkdical Rbc»kd.)
Tuesday, September 9TH — First Day.
The fifteentli annual session of the Medical Society of
Virginia convened in the main room of the hotel at Raw-
ley Springs, Rockingham County, Va., at eight o'clock on
Tuesday evening, September 9th, the President, Dr. J.
Edgar Chancellor, of Charlottesville, in the chair.
The meeting was opened with prayer by Rev. Dr.
Robert C. Mattlack, of Philadelphia.
Dr. M. G. Ellzey, of Washington, D. C, in behalf of
the management of the Springs, delivered an address of
welcome, in the course of which he warmly greeted the
delegates, and referred to the fact that the doctors of
Virginia could better recommend to their patients the
mineral waters of the State after personal inspection of
them at the native springs.
Dr. J. E. Chancellor, President, for the Society,
made a few appropriate remarks in reply, and in behalf
of the members present thanked the Springs manage-
ment for the hospitable welcome they had already re-
ceived.
Dr, Robert I. Hicks, of Fauquier County, then read
the address to the public and the profession, entitled
HYGIENE IN RELATION TO THE PRIVATE FAMILY.
He began by showing the important relations existing
between individual sanitation and the public health. He
briefly described the investigations of Pasteur, Koch,
and Devaine, in connection with the germ theory, ex-
plaining the microbes, bacilli vibrios, and spores found
by these observers in different forms of disease, and
warned his hearers not to be too ready of belief as to
these micro-organisms producing disease, as they may be
simply accompanying the disorders in question. After
this question is fairly settled, there yet remains the most
important thing to be done, 1.^., how to best destroy
them. He enumerated the different hiding-places of
these germs, and showed that by destroying the condi-
tions that make and support them we can in that way do
best in practical hygiene. He said that while these
agents do exist, and their existence is as yet unavoid-
able, it is a further fact that we are responsible for
them to a much greater extent than we are willing to ad-
mit. Many are chargeable to ignorance and reckless-
ness. He showed how some of the preventable diseases
are produced simply from people not having a knowledge
of the primitive points of practical hygiene. Public leg-
islation, while in every way desirable, can do little else
than establish general quarantine laws against the great
plagues, but, except in a general way, it cannot enter
into the private house, it cannot reform the domestic
habits, it cannot enforce purity in a private well, and as
these things involve the life and health of the family,
they must be attended to from within. As nations are
but aggregations of individuals, as is the individual so is
the nation. Toulon and Marseilles are now paying the
terrible penalty of individual uncleanliness.
The happiness, longevity, and often the success itsell
of man, is largely dependent upon an intelligent recogni-
tion of the laws of health. Misery, disease, and failure
in life are the penalties paid for their violation. Penalties
extending beyond one generation are frequently the re-
sult of personal neglect. Our present knowledge of
pathology shows us that diseases are often perverted life
processes, and are therefore more easily prevented than
stamped out when once begun.
Dr. Hicks showed a firm belief in the preventability of
consumption, and did not think it hereditary to anything
like the commonly accepted extent Out of one hundred
cases in New York only twenty-six per cent, were hered-
itary, the remainder (seventy-four per cent.) are charged
to damp air, insufficient food, poverty, and filth. He
wished to impress upon his hearers the fact that tubercle
is not a new formation dependent upon hereditary taint^
but is merely an alteration of normal nutrition, a de-
graded tissue resulting from neglect of trivial complaints
in connection with a disregard of ordinary sanitation.
He illustrated these and other points by cases drawn
from his private practice. He classed Bright's disease,
dyspepsia, gout, etc., as preventable diseases, due fre-
quently to personal habits. No organ can continue
sound and be the constant carrier of morbid products.
The remedy for this class of complaints consists in change
of habits, moderation, etc. The subject of the location
of the family house and its bearing upon the health of
its inmates was taken up and carefully discussed, the
point being also illustrated by cases under his own obser-
vation. He pronounced pure air antiseptic, showing, by
well-chosen illustrations, its influence on animal life. He
thought that from 1,200 to 2,000 cubic feet of air must
pass through a room every two or three hours to make it
healthy for one individual. The addition of one other
person impairs its purity and renders it unfit for use. It
becomes not only unhealthy but unclean. He took up
the subject of ventilation, and gave some practical hints
regarding it. He called the attention of his hearers to
the fact that dry heat was the only perfect disinfectant, ex-
treme cold having failed in that direction in many in-
stances. The importance of light, both to the well and
sick, was touched upon, and practical examples were
given from his own observation. He then showed, from
cases in his own practice, how typhoid fever, diphtheria,
and some other diseases were often caused by the pres-
ence of old rubbish, bad water, and filth. He believed
that certainly in decaying animal matter, and probably
also in decaying vegetable matter, are found the germs
that produce zymotic diseases. The thorough destruction
of these matters insures the destruction of the germs. As
one person, by bad personal habits, may not only pro-
duce disease in himself but pass it on to others, the in-
nocent suffering with the guilty, each individual should
feel the great responsibility resting upon himself. He
concluded by showing the economical side of the sanitary
question, proving how much could be saved by personal
attention to the first principles of hygiene, and demanded
a higher grade of education for the children of to-day in
matters pertaining to individual and home sanitation.
At the conclusion of Dr. Hicks* address the Secretary
read the names of forty-four physicians who applied for
admission into the Society, ^y vote the list was referred
to the proper committee.
THE SERIOUS ILLNESS OF HONORARY FELLOW DR. R. S,
PAYNE,
of Lynchburg, having been announced by a mem-
ber, the Secretary was directed to telegraph to him the
324
THE MEDICAL RECORD.
[September 20, 1884.
resolutions of sympathy adopted by the unanimous vote
of the Society.
The nomination and election of officers of the Associa-
tion were then taken up.
The evening session was devoted to a consideration of
THS PHYSICIANS TO BE APPOINTED UPON THE BOARD OP
MEDICAL EXAMINERS.
The State is divided into ten congressional districts and
the bill provides that the State Medical Society shall
nominate three men from each district, and two from the
State at large. These names will be presented to the
Governor, and, if satisfactory to him, the physicians named
will constitute a Board for the examination of every
doctor who desires to practise medicine in Virginia after
January i, 1885. The following named gentlemen were
selected by the Society as
EXAMINERS.
From the State at large — Drs. William C. Dabney, of
Charlottesville, and F. D. Cunningham, of Richmond,
were unanimously elected. First Congressional district
—Drs. W. W. Douglas, of Richmond' County, O. B.
Finney, of Accomac County, and S. W. Carmichael, of
Spottsylvania County. Second district — Drs. Thomas B.
Ward, of Norfolk, L, Lankfold, of Southampton County,
and Jesse H. Peek, of Hampton. Third district — Drs.
R. Lewis, of Richmond, C. R. Cullen, of Hanover
County, and O. Crenshaw, of Richmond. Fourth dis-
trict— Drs. Hugh Stockdell and J. H. Claiborne, of
Petersburg, and Dr. William J. Harris, of Black's and
White's, Nottaway County. Fifth district—Drs. Rawley
Martin, of Pittsylvania County, William L. Robinson,
of Danville, and T. B. Greer, of Franklin County. Sixth
district — Drs. H. Gray Latham, of Lynchburg, Harvey
Black, of Blacksburg, and Oscar Wiley, of Roanoke
County. Seventh district—Drs. William P. McGuire, of
Winchester, J. H. NeflF, of Rockingham County, and
Hugh T. Nelson, of Albemarle County. Eighth district
— Drs. Alexander Harris, of Jeffersonton, C. C. Conway,
of Orange County, and Bedford Brown, of Alexandria.
Ninth district—Drs. S. W. Dickinson and R- D. Huffard,
of Smyth County, and Robert J. Preston, of Washington
County.- Tenth district — Drs. Merriwether, of Amherst
County, Z. G. Walker, of Rockbridge County, and H.
Patterson, of Highland County.
Wednesday, September ioth — Second Day.
Dr. William C. Dabney, of Charlottesville, as chair-
man, read the
report of the COMMnTEB ON MEDICAL LEGISLATION,
in the course of which he referred to the work done
during the meetings of the Legislature in the past few
years, closing with showing the success the committee
met with in the last legislature, an act providing for a
Board of Medical Examiners having been then passed.
Although the bill finally passed was not exactly what the
profession desired, still it was far in advance of no act
at all for the protection of the people of the State. The
committee was discharged with the full thanks of the
Society.
Dr. L. B. £dwards, of Richmond, then read for Dr.
H. T. Nelson, of Charlottesville, the report on
advances in anatomy AND PHYSIOLOGY,
and after making excellent references to what had been
done in this line in the past few years, he began his re-
port by showing the newer discovered morphological
components of the blood, and referred to the late exam-
inations of this fluid made by German and Italian scien-
tists, mentioning their beliefs in thrombosis, etc.
The next subject taken up was the physiology of diges-
I'on, and the writer spoke of the newer theories concern-
ing peptones. All the tissues of the body contain some
digestive power, according to one observer. Albumen
and peptone are identical, if we are to believe some
authorities. According to Dr. Frank, of New York,
animals fed on peptones were nourished in the same man-
ner as if fed on albumen. The favorable views of Dr.
Jacobi on peptone feeding were quoted with great praise.
The subject of the intracranial nerve-system was taken
up, and the writer confined his remarks mainly to the
sensory portion of the encephalon, taking occasion to
remark that there had not recently appeared any addi-
tions to our existing knowledge of the cerebral motor
centres and their connections. He closed by expressing
the hope that his paper might have some practical bear-
ing upon alimentation in disease, and might encourage
more general study of cerebral pathology, a more per-
feet knowledge of which must ultimately increase the
longevity of our race.
The President, Dr. J. E. Chancellor, then delivered
his annual address, taking as his subject
A BRIEF REVIEW OF THE ORIGIN AND HISTORY OF
MEDICINE.
After a few introductory remarks he began by con-
gratulating the Society upon the great and growing inter-
est so evidently manifested in' the yearly meetings, as
evidenced by the large attendance last year, and the sdll
larger attendance of members this year, about one hun-
dred and twenty-five being | present The character of
the papers presented had also improved of late years.
He mentioned especially the great work done by the So-
ciety members, in securing, since the last session, a par-
tial recognition of the rights of the profession, by Legis-
lative enactment, in the passage of the Anatomy Bill
and the act establishing a State Board of Medical Ex-
aminers, but also said that, gratifying as this fact may be,
there yet remains much to be done by the proper authori-
ties. With his words of greeting he said was mingled
the always sad duty of presenting to the Society the tid-
ings of the work of death among the membership during
the past year. It had seemed to have been a year of tin-
usual mortality, among the elder members espedallj.
Six or eight of the charter members have died since the
last meeting, and several of the younger Fellows. Three
of those taken from the Society's work were ex-presidents,
and one a distinguished professor in the Medical College
of Virginia. The speaker paid a brief tribute to the
memories of the departed members, and referred in
touching terms to the memory of our beloved Honorazj
Fellow, Dr. J. Marion Sims, calling him the Moses of
our profession, as well as the father of gynecology in
America.
He then passed to the consideration of his subject
proper, saying that the central and all-absorbing thought
of the world of medicine was progress — scientific prog-
ress^ the development of a more advanced medical
education, and a higher standard for graduation. The
advance in medical science has been so rapid, and the
glamour thrown around the medical study of to-day was
so great, that there was danger that the work in its de-
velopment done by the earlier fathers of medicine would
be overlooked He would like to call a halt in this, and
ask the members present to review with him briefly the
origin and history of ancient medicine. He then pro-
ceeded from his standpoint to show that with the crea-
tion of our first ancestors the necessity for the healing
art originated, and he proceeded to unfold, step by step
with the progress of ages, its growth into a science. He
first took up the medicine of the patriarchs, following it
up through centuries to the sacerdotal S3rstem or that of
the priesthood, and in what manner these had led to the
present distinctly professional system. He plainly showed
that medicine had an organized existence nine hundred
years before Hippocrates — the generally accepted "Father
of Medicine'* — and perhaps even beyond tliis. He
quoted Herodotus to show the expedients commonly re-
September 20, 1884.]
THE MEDICAL RECORD.
325
sorted to in the earlier days of science, the recording of
cases treated, and remedies used, by writing on the walls
of ancient temples, etc The president then went on to
describe the systems of medicine. He began with the
Ayar Veda, or sacred revelations of the Hindoo system,
and then spoke of the Greek system, fully elaborating
the subject. The Roman and Israelitish systems of
medicine were fully brought into review, and the entire
portion of the paper relating to these systems showed
great research and much familiarity with the matters re-
ferred to. He also gave an interesting account of the
Ebus papyrus, found at ancient Memphis about ten years
ago. He referred to this "hermetic book of medica-
ment " now to be seen at Leipsic, and said that it showed
diagnoses made, remedies suggested, and systematic
treatment of diseases about 1600 B.C. He then traced
the origin and progress of medicine in Egypt, and how in
after years it was first introduced into Rome, bringing it
down to the time of Hippocrates. He spoke of the
origin of the medical school at Alexandria and those of
Cridnos, which gave rise to the Cridnerian lectures, etc.
After this he took up the history of those men who were
roost prominent under the different systems of the practice
of medicine in the olden time.
He referred to the importance of properly organizing
and of selecting the proper men who should be placed
apon the Board of Medical Examiners for the State, to
be appointed during the session, urging the society mem-
bers to make it a thoroughly independent body. He,
although praising the work of the committee, did not by
any means look upon the act constituting a Board of
Examiners as it now stands, to be exactly what the pro-
fession desired, and suggested the appointment of a
committee to recommend amendments to the bill as
seemed necessary. He took up the subject of the State
Board of Health, and showed how ridiculous such a
board was made by the fact that no money is given it by
the State to do any work with, it consequently being with-
out efficiency, and in fact a nullity. Lastly, he lu-ged that
steps should be taken to secure, as soon as possible, a full
history of the deceased medical men of the State of Vir-
ginia, as it certainly was the duty of the present genera-
tion to rescue from oblivion the galaxy of illustrious
names which have been emblazoned upon the honorable
page of medicine in Virginia.
Thursday, September iith — Third Day.
The morning session opened at 9.30 o'clock, Thurs-
day, and the regular business of the Society was pro-
ceeded with. After the reading of letters from non-resi-
dent honorary fellows, etc., and work of like nature. Dr.
J. M. Toner, of Washington, was unanimously elected an
honorary fellow of the Society.
Dr. S. B. Morrison, of Rockbridge County, presented
resolutions of
RESPECT TO THE MEMORY OF DR. J. MARION SIMS,
one of the most prominent fellows, which were unani-
mously adopted by a rising vote.
Dr. S. B. M(^8on then read his report on
ADVANCES IN OBSTETRICS AND DISEASES OF WOMEN
AND CHILDREN.
He began by running over the case of pregnant women,
and not only referred to the familiar truths of obstetrics,
but from his own practice illustrated many of his points.
He protested against too much interference with the
physiological process of child-bearing, and thought that,
as a mle, the less duty the accoucheur felt called upon to
perform the better for the patient He instanced the
ease with which the Indians of this country went through
this most natural work. He referred to the use and
abuse of ergot and chloroform, and fully mentioned the
proper method of employing massage and expression.
Forceps, he thought, were invaluable, and he pronounced
decidedly in favor of the use of the instrument. He be-
lieved fully in Denman's rule, that when the ear of the
child can be plainly felt in the lower strait the forceps
should be employed. Uterine haematocele in pregnant
women was touched upon, and the reader presented a
case from his own practice illustrative of this condition.
He referred to the common occurrence of gynecological
disorders, and in reporting some of his own cases illus-
trated the points made in his paper.
He particularly made reference to the fact that an
early treatment should be employed in instances of the
kind, and laid down the rules he was in the habit of
adopting in like cases. Batte/s operation he thought
would not stand the test of time. He was very desirous
that a school for nurses should be established in Virginia.
On conclusion of the paper, several members made a few
remarks concerning the views presented.
Dr. John Clopton, of Williamsburg, presented, through
another member, his paper upon
ADVANCES IN PSYCHOLOGY. AND NEUROLOGY,
which was simply an apology for not preparing a full
report.
Dr. George D. Harrison^ of New York, by invita-
tion, read a paper upOn
the modern treatment of wounds.
He considered the subject very fully, detailing the work
of micro-organisms on the living tissue. He made a
clear statement of the necessary procedure to produce
an antiseptic condition of wounds which had taken on
suppurative action. His method in operations was, first
to keep the wound in an aseptic condition until the dress-
pgs were applied, and second, to put on the dressings in
such a manner that the wound will remain aseptic. He
detailed all the processes of cleanliness which were to be
employed in such instances; how the instruments,
sponges, operator's hands, drainage-tubes, sutures, etc.,
should be treated to render them aseptic. Lister's full
dressing was described. He was favorably inclined toward
the use of iodoform. He said that, according to Von
Minewarter, the healing process after the use of the Lis-
ter method was decidedly shorter in point of time, and
that he fully believed in the same mode. He thought
the day of that terrible bugbear of surgery, septicaemia,
was about past, and that if operators would fully adopt
the clean method of treating wounds favorable results
would be more frequent. He concluded by paying an
eloquent tribute to those men of great scientific renown,
Pasteur and Lister.
Dr. Hunter McGuire made some practical remarks
upon wounds and their treatment, and gave most excel-
lent advice concerning cleanliness in operations in private
practice.
Dr. G. S. Stone, of Loudon County, Dr. S. B. Mor-
rison, of Rockbridge County, Dr. J. H. Neff, of Harrison-
burg, Dr. Wm. L. Robinson, of Danville, Dr. J. E.
Chancellor, of Charlottesville, Dr. I^. Lankford, of
Southampton County, Dr. Alban S. Payne, of Atlanta,
Ga., Dr. R. Tatum, of Harrisonburg, Dr. Jessie Ewell,
Sr., of Prince William County, and Dr. H. M. Patterson,
of Highland County, discussed the subject.
The next paper read was presented by Dr. Alexander
Harris, of Jefferson ton, Va., on
the medicinal properties and therapeutic applica-
tion OF the waters of FAUQUIER WHITE SULPHUR
SPRINGS, VA.
The reader purposed to give a careful and rational
explanation of the medicinal properties and therapeutic
application of this water through its chemical constitu-
tion. The springs being at such an elevation — about
seven hundred feet above sea level — the hygienic sur-
roundings of the hotel and grounds are unsurpassed, this
being plainly evidenced by the fact that the writer has
not been called upon to treat a case of zymotic disease
which had its origin on the premises during his thirty-five
326
THE MEDICAL RECORD.
[September 20, 1884.
years' connection with the springs. The water is remark-
able for its lightness and possesses a very strong sul-
phurous taste and smell. The quality of lightness enables
Che patients residing at the springs to ingest nearly twice
as much in quantity than if it were an ordinary freestone
water. The experience of Dr. Harris and others has
shown the water to be primarily diuretic, diaphoretic, or
purgative, and secondarily alterative and tonic. It gives,
when first tasted, a perceptible stimulant eflfect, in some
cases causing a sense of fulness of the head, in some few
cases going so far as to produce headache. The reason
for the remarkable therapeutic properties possessed by
this water can be readily seen by a careful examination
of an analysis of it. There are nearly three grains of
iron phosphate, lime, and magnesia in the gallon, and it
can be understood how the tired brain is rested and the
overworked nervous system is built up by the use of
these waters. The reader then compared the analysis of
this water with the analyses of 1 78 of the most important
and best known natural mineral waters of this country
and Europe, and showed how rarely the ferric phosphates
were to be found in those waters — there being only two
of this number which have an^ of this salt in solution,
namely, the water under discussion (containing two
grains to the gallon), and the Newbury (two-fifths of a
grain per gallon). It can be readily understood how
broad a range of therapeutic application the Fauquier
White Sulphur waters possess in those cases of chronic
diseased action dependent upon loss of nerve-power.
Not only did Dr. Harris draw upon his own record of
practice for illustrative cases, but referred to Burke's
work on the Virginia Springs for a number of instances
where these waters had done so much good. The use of
this water, according to Dr. Harris, is especially valuable
in dyspepsias of neurotic origin, in dropsies, in certain
instances of neurasthenia, etc.
The third day's afternoon session began at three o'clock
Thursday, nth inst., with the report of Dr. H. W. Clark-
son, as chairman of the delegation from the Society to
the last session of the American Medical Association.
The committee appointed to report upon the
THERAPEUTIC VALUE OF RAWLEY SPRINGS WATER,
made a return through the chairman. Dr. T. M. Miller,
of Frederick County. In his paper he entered into a
full analysis of the water, and compared it with that of the
most noted and best visited springs of this and other
countries. The especial point in Rawley water which
renders its therapeutic properties so valuable is the large
quantity of protoxide of iron placed in complete solution
by the excess of carbonic acid contained therein. The
iron being rapidly appropriated by the red corpuscles of
the blood, the anaemic patient who uses the water is
soon put into a condition where proper assimilation
takes place. The water abounds in carbonates, not only
of iron, but also of all the common alkalies to the ex-
clusion of the sulphate.
Dr. F. M. Robertson, of Charleston, S. C, by in-
vitation of the Society, also read a paper upon the same
subject, the medicinal virtues of Rawley Springs water,
in the course of which he very highly extolled its eflFects.
Drs. George \ \ arrison, of New York City, and F. M.
Robertson, of Charleston, S. C, by unanimous vote of
the Society, were made non-resident Honorary Fellows.
Dr. Chancellor then yielded the chair to his successor.
Dr. S. K. Jackson, of Norfolk, and was unanimously
elected an Honorary Fellow of the Society.
The following summer resorts extended invitations to
the Society to hold its session of 1885 at their hotels ;
Rawley Springs, of Rockingham County ; Alleghany
Springs, of Montgomery County.
It was decided by vote to meet at Alleghany Springs
in the fall of 1885.
A unanimous vote of thanks for the extreme kindness
and hospitality extended this year to the Society by the
Rawley Springs management was passed, the manage-
ment entertaining the members free of all hotel charge
during the session.
Dr. Hunter McGuire then presented his paper upon
intestinal obstruction — its differential diagnosis.
He began by relating some illustrative cases, which
showed the necessity of making, as far as possible, an
early and positive diagnosis, for the purpose of operating
if necessary. Yet he had seen patients recover entirely
with but little or no treatment. He gave the different
modes of production of this condition, and showed how
operative treatment often offered great prospect of re-
covery. The paper was mainly confined to the diag-
nosis of this difhculty. He had seen a patient die in
thirty-six hours, and had also seen others which recovered
thoroughly after a complete condition of obstruction.
He laid down, as a rule, the fact that no purgative should
be given at first. This he considered one of the most
important points to be remembered. He looked upon
opium as the sheet-anchor in these cases. He criticised
most unfavorably several of the older methods of treat-
ment. He showed when he thought was the proper
time for opening the abdomen, namely in certain cases,
in thirty-six hours after the proper medicinal treatment
had been faithfully tried.
etherization by the rectum.
Dr. William H. Coggeshall, of Richmond, Va., then
read a paper upon this subject, and showed that the
method was by no means a new advance in therapeutics,
but simply a revival of the process of Pirogoff, who em-
ployed it in 1848, a year after the discovery of ether an-
aesthesia. The writer traced the employment of the
rectal process down to about thirty years ago and showed
that no clinical record had been made of its use since
then, until M. Mollidre wrote his first paper for the
Lyons Mhdicale^ in March last, explaining that Dr. Axel
Iversen, of Copenhagen, had called his attention to it,
and referred to six successful cases by this method. Dr.
Coggeshall presented the details of &fty cases where rec-
tal anaesthesia had been employed, this number being
all he could find fully detailed in the American medical
journals of this year, one or two occurring in his own
practice. He found from examination of the cases re-
ported that by this process the preliminary stage of ex-
citement in anaesthesia is certainly of shorter duration
than when the vapor is inhaled. There is also less vom-
iting, but it may occur at an unexpected time during the
operation. The question as to whether the return to
sensibility after this method is quicker than when inhala-
tion is used he thought to be doubtful. The great ele-
ment of danger, however, and the reason why rectal ether-
ization will never come into general use, is because of
the liability of the mucous membrane of the lower bowel
to take on inflammatory action from the presence of the
ether vapor. Two fatal cases were given by the writer
out of the fifty reported, making four per cent, of deaths.
He gave the fullest instructions for the employment
of this method when it was required, as in face and
mouth operations, and described his own form of home-
made apparatus for rectal anaesthesia, which could easily
be improvised by any doctor even away from the city.
The several important points insisted upon for the use
of ether vapor per rectum were as follows : The lower
bowel should be thoroughly cleansed by enemata before
the introduction of the rectal tube ; the connecting-
jetnts of the tube and tubing must be perfect ; the tub-
ing should be about two feet long ; the water-bath should
be kept as nearly as possible at the ?ame temperature —
120® to 140° F. ; the rectal tube should be withdrawn
when insensibility is complete ; the nates should be held
tightly together by an assistant ; the possibility of sud-
den peristalsis occurring during the operation should be
provided for. The doctor concluded by advising only
those to experiment with this method who could afibrd
to take some risk.
September 20, 1884. J
THE MEDICAL RECORD.
Z'il
The Society by vote thanked Dr. Coggeshall for his
painsuking collection of cases of this method.
Dr. Wiluam G. Rogbrs, of Charlottesville, then, as
cbainnao, read the report of the committee appointed
last session to secure legislation against the practice of
druggists refilling prescriptions containing narcotic poi-
sons without the renewal order by a physician. Al-
though the Committee worked hard for it the bill was
not passed by the Legislature last winter.
The evening session opened at 7.30 o'clock, Dr. Sam-
USL K. Jackson, President, in the Chair, with the read-
ing of an excellent paper by Dr. M. A. Rust, of Rich-
mond, on
TYPHOID FSVBR.
The reader went rapidly over the pathology of the dis-
ease, showing the tissue changes he believed to occur.
He spent some time in defining this particular fever, and
made a strong protest against calling the fever which is
now, and has been, endemic in Richmond, a form of
'*tjpho-malarial fever," as he thought that such a combi-
nation did not exist. He looked upon it as a special
grade of enteric fever, which might be called a by-name
for typhoid. He thought the special germs producing
malarial fever and typhoid fever never became blended
in any one case — ^in fact that it was impossible for such
blending to occur. He endeavored to show that typhoid
fever was a distinctly defined disease, whether severe or
light in character, having a truly personal character of
itself which could never be mingled with that of any
other. His treatment for this disorder was mainly cold
sponge bathing, sulphate of quinia, bismuth, beef-tea,
and wine, and he had great faith in milk as the main ar-
ticle of diet. He recommended that the milk be always
boiled for use.
Dr. Alban S. Paynb, of Atlanta, Ga., non-resident
Honorary Fellow, next read a paper on
CEREBRO-SPINAL MENINGITIS.
He began by saying that as he had so often met with
cases of cholera morbus and cholera infantum which
could not be differentiated from cerebrospinal meningitis,
he would make a few remarks upon the disease known
as cholera infantum. His remarks concerning menin-
gitis were very apt, and were attentively listened to by
the members. He had found the monobromide of cam-
phor to be very valuable in treating these diseases. He
blisters the nape of the neck with croton-oil, and usu-
ally gives a hot mustard bath. Quinine should be given
at night or morning, and he was in the habit of giving
chlor-anodyne to control pain.
Dr. I. S. Stone, of Loudon County, then read a paper
upon the use of
MASSAGE AND ELECTRICITY IN HYSTERIA AND ALLIED
DISORDERS,
from the point of view of the general practitioner. He went
over some of the forms of hysteria and neurasthenia, and
related his success in sevend such cases. He was a firm
believer in the theory and practice of Dr. Weir Mitchell,
and thought he had in several instances improved in some
degree the methods adopted by that celebrated specialist
He showed how the ordinary country practitioner could
successfully handle this class of cases, and illustrated the
points mentioned by two or three very severe cases of
nervous disease. Seclusion, he thought, was one of the
best helps in treatment, especially in female patients, as
the constant attendance of visitors to see and talk with
the patient that " has such strange symptoms and so
bodiers the doctors,'' certainly does an enormous amount
of injury. He beheved in the vahie of a skim -milk diet
in these cases, and he also used quantities of raw beef
made into a broth, after the method of Weir Mitchell.
At ia3o o'clock the Society was invited by the Raw-
ley Springs management to a very handsome complimen-
tary banquet 'Hie embossed menus were engraved and
printed for this special occasion, the tables were deco-
lated with flowers, etc., and the wines were excellent It
was a remarkable affiaiir to have been gotten up, off in
the country^ eleven miles from the railroad.
Friday, September i2TH — Fourth Day.
The fourth day's session convened at 9.30, Friday
morning, by Dr. J. N. Upshur opening the discussion
on
MALARIAL FEVER,
by reading a paper prepared on the subject by Dr. R. B.
Storer, of Richmond. The writer began with a history
of miasma, presenting, up to the present year, all that is
known on this branch of the subject He then went
into the causation of this condition, and referred especi-
ally to the fact that in Richmond, for the past ten years,
whenever the streets have been torn up for the purpose
of putting in new culverts, etc., fever has invariably fol-
lowed the excavations. He also mentioned the fact that
in that city there are certain portions where fever has
followed the introduction of water from a certain part of
the water-supply canal, when the other districts of the
city have been entirely free from it. He showed that
this was the case even where chemical analysis and
microscopical examination failed utterly to show any-
thing wrong with the water.
Dr. J. N. Upshur, of Richmond, then presented a
paper on
MALARIAL FEVER AS IT OCCURRED IN RICHMOND IN THE
SPRING AND SUMMER OF 1 884.
He called special attention to the fact that fever of
this type occurred generally in other parts of Virginia as
well as in Richmond. The type of fever presented some
peculiarities different from that ordinarily seen. No
doubt the cause of the fever was entirely atmospheric.
It will be remembered by the local profession that there
was a great deal of rain during the spring and early sum-
mer. The reader had noticed on several occasions at
nighty and it was remarked by others, that there was a
most peculiar odor in various parts of the city. It is
manifest that the water could have been no element in the
production of the fever, for the reason that if it had con-
tained the germs of infection, the disease would have
attacked all ages and all parts of the city alike, there be-
ing little difference in the constitution of the water whether
it comes from the canal, or the river, or from the old or
new reservoir. The subjects of the fever were mainly
young people. Another fact : the fever prevailed in other
parts of the State where the inhabitants, it may be in-
ferred, drank well-water, and not James River water.
The march of influenza and epizootic disease is an an-
alogous fact The disorder prevailed from the first of
May to the middle of June. The malarial influence
during the present summer has been apparent in all the
prevalent acute diseases. The doctor draws strong con-
clusions from the analysis of the drinking-water by Dr.
Wm. H. Taylor, State analyst, which has been recently
published in the Richmond newspapers. Finally, all of
the conditions of the weather were favorable to the pro-
duction of a malarial disease. An interesting feature of
the fever was the coolness of surface when the thermom-
eter indicated a high range of temperature. The doctor
reports several cases as illustrative of the features of the
fever, one of which is of special interest from the fact
that, neither the mouth nor bowel being available at the
period of greatest prostration, the patient was kept up
by systematic stimulation by means of the subcutaneous
injection of brandy. This patient recovered. Dr. Upshur
also called especisd attention to the presence of epigastric
pain as a symptom diagnostic of malaria in children.
Dr. William L. Robinson, of Danville, then read a
paper upon
TVPHO-MALARIAL FEVER
as it has occurred in his section of the State during the
past ten or twelve years. He presented the symptoms
of the fever, and showed that he was correct in describ-
ing it as peculiar. It seemed to differ from the same
328
THE MEDICAL RECORD.
[September 20, i884^
class of disorder occurring in other sections, and de-
manded a different form of therapeutic application from
that commonly employed. The writer thought that
quinine was given too often in large doses in this condi-
tion, and remarked that he had never had an abscess
from the use of this salt when employed hypodermically,
although he frequently gave it in this manner.
Dr. Thomas J. Moore, of Richmond, then delivered a
short and practical speech on the general points involved
in the causation, diagnosis, and treatment of
MALARIAL F]^VER.
He showed that no spot was safe from the attacks of this
disease, and that wherever heat, moisture, and decay-
ing vegetation existed it would almost invariably be
found. He spoke of the value of drainage, and that
malaria could be driven away mile by mile by a proper
system of the kind. He gave his personal experience
in cases of malarial haematuria which he had so frequently
met with in North Carolina. He rapidly went over the
different conditions under which this disease (malaria)
was usually found, showing the varying types. He rec-
ommended as treatment for malarial fever what had been
empirically found best adapted for this condition in each
certain section, except that, early and always, quinine
should, of course, be employed. He decidedly preferred
to administer the salt hypodermically, and thought that
abscesses would be less frequently met with if the needle
was boldly pushed into the cellular tissue, and the solu-
tion not thrown into the skin. He gave some excellent
advice about how to make up the solution, so that the
quinia should not only be perfectly dissolved, but that
the liquid should not have an acid reaction. He was also
impressed very favorably with the action of Warburg's
tincture. In connection with the hypodermic injection
of quinia, he had found that the addition of a small dose
of morphia to each injection was of great value in cer-
tain conditions of malaria.
The speaker spoke directly to the point and was listened
to with the closest attention.
The President, Dr. S. K. Jackson, made a few re-
marks upon some of the points raised, and especially
recommended the milk diet in typhoid fever. He was
absolutely opposed to all starchy foods. He had at
times, when using maltine, been able to allow the patient
to take a little of that class of food. He made great use
of strong beef- tea, and usually kept the patient on nothing
but the latter liquid and milk through the course of the
illness.
Drs. Stone, Moore, Upshur, and Rust discussed the
subject of malaria, but no novel views were presented.
A great difference of opinion was manifest regarding the
question as to whether typho-malarial fever was a distinct
disease.
A paper by Dr. E. E. Field, of Norfolk, entitled
yellow chills,
was read by title.
Dr. William Selden, of Norfolk, was elected an
Honorary Fellow of the Society, and a considerable
amount of routine business was transacted.
Dr. Joseph A. White, of Richmond, then presented
a paper entitled
SOME RSBIARKS ABOUT CATARACT, WITH A REPORT OF
FIFTY-TWO CASES.
After speaking of the mistakes often made in confound-
ing other eye troubles with cataract, by careless pracri-
tioners, some of which are ludicrous and some serious in
their tragical results, he gave a short history of the oper-
ation of " extraction " with the various modifications it
has undergone. He advocated strongly the performance
of iridectomy as increasing the chances of a successful
result, in opposition to the recent tendency of the French
school to return to Daniel's method, also showing its
advantages as a preliminary operation in certain cases,
as it divides and diminishes the traumatism. He gave
an account of Foster's operation of " trituration of the
lens" for ripening cataract, with a reference to some
cases of his own, but considered that it has, like all other
surgical operations, its attendant risks, and is as yet only
on probation. After some remarks on the opening of
the capsule, he passed to a consideration of the cases
operated on in Richmond during the past four and a half
years — fifty-two in number. There were no failures in
cases under seventy years of age, and only two over
seventy years, as a result of the traumatism. Another
patient lost his eye after recovery, from septic infection
of both eyes, by a sponge used by a hospital attendant,
setting up purulent ophthalmia. Anaesthesia was used in
eleven cases only, and the most serious accidents during
the operation, which occurred in nine cases, he attributed
to the vomiting induced by the anaesthetic He uses
anaesthesia only in very timid or cowardly patients, be-
cause there is very little pain from the operation if he can
trust to the statements of those operated upon. In regard
to antisepsis in cataract operations, he thinks that it is
quite suf^cient to see that the most scrupulous cleanli-
ness before and during the operation is observed, especi-
ally of all the instruments employed. He uses instruments
as little as possible, and after the iridectomy does away
with the blepharostat and uses the lids and his fingers to
remove the lens. In regard to the secondary operation of
cutting the capsule he considered it of great importance as
increasing the visual acuteness and lessening the chances
of subsequent reaction about the capsule and iris, and
instanced a case in point where, from neglect of this pre-
caution, a patient with good vision lost the eye eighteen
months after, the trouble starting in the capsule, which
had gradually thickened and wrinkled, ending in irido-
capsulitis and cyclitis. Dr. White concluded his paper
with a full report of a case of some physiological interest
as exemplifying the accepted theory of vision. A man
named Daniel F-
of Weldon, N. C, had become
blind with double cataract when seven years of age, was
educated in an asylum for the blind, and was operated
on in Richmond, Va., when thirty-two years old. The
result was perfect vision in both eyes. He could judge
nothing of the shape of an article until he touched it He
could not locate objects in space, and invariably miscal-
culated the distance when reaching for anything. He
was afraid to walk about because he could not judge of
the height or depth of anything in his way — such as gut-
ters or curbstones. In fact he was less independent
when he first recovered vision than before he was oper-
ated upon.
It was decided that the subject of ** Scarlet Fever *'
should be the one for general discussion at next year's
meeting, and Dr. Thomas J. Moore, of Richmond, was
appointed to read the first paper on the subject
The Society then adjourned sine die.
Altogether the session oi 1884 was the best one ever
held by the Society, the papers read were in the main
valuable and practical, the attendance the laigest in the
history of the Association, there being between 125 and
250 members registered as present, and over sixty new
members were elected.
The following are
THB OFFICERS ELECTED FOR 1884-85 :
/y^xiV/^/— Dr. Samuel K. Jackson, of Norfolk; First
Vice-President — Dr. Jesse Ewell, Sr., of Hickory Grove,
Prince William County ; Second Vice-President — Dr. Ben-
jamin Blackford, of Lynchburg ; Third Vice-President—
Dr. Robert I. Hicks, of Casanova, Fauquier County;
Recording Secretary — Dr. Landon B. Edwards, of Rich-
mond, Va,; Corresponding Secretary — Dr. Hugh Taylor,
of Richmond, Va. ; Trecuurer — Dr. Richard T. Styll, of
Richmond, Va, ; Executive Committee — Dr. W. W. Par-
ker, of Richmond (Chairman), Drs. Harvey Black, Fran-
cis D. Cunningham, John Herbert Claiborne, and L.
Ashton ; Committee on Publication — Drs. E. T. Robinson,
C. W. P. Brock, and George Ross.
September 20, 1884.]
THE MEDICAL RECORD.
329
EIGHTH SESSION.
Held at Copenhagen^ Denmark^ August 10-16, 1884.
REPORTS OF SECTIONS.
SECTION OF OBSTETRICS AND GYNECOLOGY.
Prof. KoEBERLfi, of Strasburg, read a paper on the
TREATMENT OF UTERINE MYOMATA BY LAPAROTOMY.
The indications for the operation were : the gravity of
the state of the patient in consequence of excessive or
prolonged catamenial hemorrhage, or from the rapid or
continued increase of the tumor, and from the age of the
patient, from the seat of the tumor, by the particular
circumstances, as when life became unsupportable from
the troubles caused by the tumor. Operation was contra-
indicated when there were extensive vascular adhesions
to the abdominal walls, or when the too extended tumor
had too extensive connections ; when it was enclosed in
the pelvis ; when there was ascitic effusions liable to in-
crease, and to reproduce them quickly ; or when there
was some concomitant incurable affection, or some
circumstances which might exercise an unfavorable
influence in recovery. The operative method varied
according to tlie seat and size of the tumor. Uterine
fibro-myomata should be operated on by the vaginal
method in cases where they formed a more or less pro-
nounced swelling in the uterine cavity and toward the
vagina, when the size of the canal thus allowed extrac-
tion in this way. Fibro-myoma, projecting into the ex-
treme cavity, and immovable by the genital canal, as
well as interstitial and sub-peritoneal tumors were cap-
able of removal by laparotomy. Professor Koeberl6
spoke on hysterotomy and hysterectomy, and gave the
general rules for their operation. He stated the result
was very favorable when the tumors were developed in
the body of the uterus. The operation was difficult and
grave when the tumors were developed in the broad
ligaments, and deeply imbedded in the pelvic cavity.
The reunion of the abdominal wound, dressing, and anti-
septic treatment were next passed in review. Dr.
Koeberl6 concluded his paper by affirming that the
treatment of uterine fibro-myomata by laparotomy con-
stituted a real progress in contemporary surgery, and
merited in every way serious considerations.
This communication was well received and discussed
by Sir Spencer Wells,, of London, Dr. Margary, of Turin,
and Dr. Apostoli, of Paris.
ELECTRIC TREATMENT OF UTERINE MYOMATA.
Dr. Apostoli, of Paris, proposed a new electrical thera-
peusis for uterine fibromata, distinguished by its point of
application, nature, intensity, and its manual mode of ap-
plication. To the old procedure 'of the application of
continuous currents to the cure of fibrous tumors — char-
acterized : (i) by very feeble electrical intensity ; (2) by
the vagina bemg oftenest the point of application of the
positive pole — he opposed a treatment always more
active, since it reached 100 millimetres of intensity, and
was always intrauterine, acting along the whole depth
and extent of the uterine mucous membrane. A clinical
experience, extending over two years, upon over one
hundred cases, had shown that the treatment constantly
reduced the size of the uterus, and completely restored
the patient.
DESTRUCTION OF UTERINE TUMORS BY ELECTROLYTIC
PUNCTURE.
Dr. P. Meniere, of Paris, advocated the destruction
of uterine tumors by electrolytic puncture. This, he
aid, constituted an operation which was effectual and of
little danger, provided that it were practised, not by the
vagina, but across the abdominal wall. It was indicated
— (i) when medical treatment had failed ; (2) where the
fibromas were very large, and also only slightly movable ;
(3) when they endangered the life of the patient by con-
tinuous metrorrhagias or grave general trouble ; (4) it
was a final resource in cases where total removal wa^
impossible. This operation had already been practised
by Cutler in 187 1, Broure in 1873, Kimbal in 1874, Cini-
salli in 1875, ^"^ Semeleder in 1876. But their opera-
tive procedures differed, were very vaguely described,
and little known in Europe. In face of the marvellous
results which he had got in six cases, the results of which
were indelibly fixed in his memory, it seemed to him to
be of interest and useful to call the attention of the Con-
gress to this point of gynecological therapeutics, and
particularly to the manual method of procedure, on
which he had, after numerous trials, finally settled. The
instruments employed were : (i) a battery of the contin-
uous current of Gaiffe, with twenty-four pairs of zinc
plates, and galvanometer divided in milliamperes ; (2
gold needles, ten centimetres long by a millimetre and a
half thick, flattened and pointed at their extremities ^o
lance-shape, with cutting edges) \ they were isolated for
a length of seven centimetres by means of resinous var-
nish, dried and calcined in the flame of a spirit-lamp
(3) a needle propeller, with a graduated stop-notch, so
as to insert the needles to a depth previously fixed upon ;
(4) light and flexible conducting wires, joined to the
needles by means of a serves fines. The operation was,
he said, repeated twice a week, or every ten days, in case
of inflammatory accidents; the sittings lasting twenty
minutes from the insertion of the positive and negative
electrodes the depth of eight centimetres ; a current of
from forty to fifty milliamperes ; and, after the extraction
of the needles, the closing of the cutaneous orifice with
collodion.
Dr. Margary, of Turin, advocated supravaginal am-
putation of the uterus from the vagina as a treatment for
fibromata in the posterior uterine wall.
oophorectomy as a remedy against uterine TUMORS.
Dr. Wiedow, of Freiburg, said that he had collected
the cases in which removal of the ovaries had been per-
formed for uterine tumors, partly from published records,
partly from private information. Through the friendly
co-operation of a large number of German, Austrian, and
Swiss practitioners, he was able to arrive at conclusions
as to the lasting influence of the operations, and the sub-
sequent condition of the patients on whom it was per-
formed. The principal point was to show the influence
of the operation on the cessadon of hemorrhage, and on
the diminution of the size of the tumors. He also en-
deavored to point out whether, and in what way, the re-
sult of the operation was modified by the situation and
size of the tumor.
Prof. Hegar, of Freiburg, and Sir Spencer Wells took
part in the discussion which followed.
THE CiESAREAN SECTION AND ITS MODIFICATIONS.
Prof. P. Muller, of Berne, read a paper on this sub-
ject. He said that the prognosis in Caesarean sections
had been hitherto very unfavorable, the death-rate ex-
ceeding eighty per cent 'The recent advances in
surgery, especially the improvements in laparotomy, had
had an influence on the operation, which was shown by
the endeavors to successfully combat the loss of blood
and sepsis. This object was sought to be attained by
two essentially different ways ; the modifications were
either radical or conservative. In the radical modifica-
tions the source of hemorrhage and of septic infection
was cut off by the uterus, in the conservative the uterus
was retained and an endeavor was made to ward off
these dangers by careful treatment of the uterine wound.
Both methods had doubtless certain advantages, but
theoretical considerations could not support the rsidical
modification. Yet, in tegard to this matter, the result
must turn the scale ; the operation which was attended
330
THE MEDICAL RECORD.
[September 20, 1884.
with the lowest mortality must be accepted as the best
The death-rate of the radical operation was about fifty
per cent. ; but trustworthy statistics were wanting with
regard to the conservative method, of which there had
been as yet less experience than of the former. It
therefore remained yet to be decided which operation
should be preferred. If the conservative method should
gain recognition, another condition would have to be ful-
filled, namely, to protect the woman against rupture of
the uterus in a subsequent pregnancy, and against the
danger of another Caesarean section ; and this would
have to be done in a much more satisfactory and safe
way than had hitherto been the case in the Csesarean
operation.
INTERMITTENT CONTRACTIONS OF THE UTERUS IN THE
DIAGNOSIS OF PREGNANCY AND ITS COMPLICATIONS.
Dr. Braxton Hicks, of London, presented a paper
on this subject, illustrated by three cases. He again
called attention to the value of this means of diagnosis,
and briefly referred to the discussion on his paper in the
last Congress, where it was stated that soft tumors of the
uterus also contracted at intervals. Presuming this was
ultimately found to be correct in general, the cases in
which this would interfere with the diagnosis were
pointed out, namely, those in which the foetus could not
be felt, and where hemorrhage was urgent, for instance,
where the uterus remained constantly firm, as in some
cases of blighted ovum, apoplectic ovum. In these
there was almost always a history of pregnancy, and of
recent hemorrhage ; while if there was amenorrhoea or
only normal menses, it would be exceedingly rare if it
were a soft tumor. He gave three cases, two of preg-
nancy complicated with uterine fibromata. In the third
one, of extreme obliquity of the uterus, it was difficult to
say how much was uterus. In all the cases, the exact
relation of the uterus was clearly and readily made out
by means of the alteration which occurred at short
intervals in the density of the uterus,
antiseptics in laparotomy.
Prof. Mikulicz, of Cracow, began by referring to
the necessity of antiseptics in laparotomy as well as in all
other operations attended with loss of blood. The prin-
ciples of the use of antiseptics in laparatomy were the
same as in other great operations ; but the details differed
essentially in some points. This depended on the pecu-
liarities of the peritoneum, which in some respects favored,
while in others they impeded the application of anti-
sepsis. The most important properties of the peritoneum
having an influence in antisepsis were, first, the great ex-
tent of surface, which was a source of danger of cooling
on exposure, of rapidly spreading inflammatory and sep-
tic processes, etc. ; seeing its great power of absorption
and excitation, the first leading, in septic peritonitis, to
general septic infection, while, in the healthy peritoneum,
it prevented the accumulation of large masses of secre-
tion ; thirdly, the liability to pour out plastic exudations,
and to rapidly form firm adhesions ; in this way, foci of
inflammation might be localized, and ligatures and sepa-
rated masses of tissue encapsuled. With regard to anti-
sepsis in laparotomy, attention was directed to the follow-
ing points : i. The peritoneum is more easily affected by
septic infective matters than any other tissue. Besides this,
it was not possible to use, as with wounds of other parts,
very active antiseptic measures, such as irrigation with
carbolic acid and other powerful means, as, on account
of the rapid absorption, the danger of poisoning by the
antiseptic was very great. Again, while drainage was of
great use in wounds of other parts, it was useless in the
peritoneal cavity, and could not obviate the results of in-
fection of any kind. For these reasons, the chief point
to be attended to in antisepsis during laparotomy was the
absolute withholding of septic ifaaterials from the peri-
toneum ; and herein lay the great difference between
antisepsis in laparotomy and other operations. In lapa*
rotomy, antisepsis was pre-eminently prophylactic. The
cleansing and disinfecting of everything which was to be
used in or had any relation to the operation must be car-
ried out much more thoroughly than in other operations.
The spray was superfluous in faultlessly clean rooms;
but in hospitals it should be used for half an hour to an
hour before the operation, for the mechanical purification
of the air. During the operation it was useless. In
operations on the stomach and intestines, the absolme
prevention of the escape of the gastric or intestinal con-
tents was one of the most important points in antisepsis.
Drainage of the peritoneum was nearly always quite
superfluous in operations performed aseptically; it might
even be dangerous to allow infection of the periosteum
to take place through the drainage openings. Complete
drainage of the peritoneum by the methods now in
use was, on mechanical grounds, altogether impossible.
Hence drainage was permissible in laparatomy only
in rare and exceptional cases. 2. Besides direct infec-
tion during the operation, spontaneous infection might
occur in the peritoneum in certain conditions. It oc-
curred when a large quantity of fresh, especially sero-
sanguineous fluid collected in the peritoneum and was
not rapidly absorbed. In this was developed bacteria,
which led to decomposition of the secretion, and infec-
tion of the peritoneum. Hence the second great prin-
ciple of antisepsis in laparotomy was to prevent the col-
lection of secretion in the peritoneal cavity. Any means
which limited the amount of secretion in the peritoneum
or favored its absorption was a part of antisepsis in lapa-
rotomy. An accurate *' toilet of peritoneum " was of the
first importance ; next came the prevention of secreting
wound-surfaces in the peritoneum by various means,
such as ligature en masse^ cauterization of the pedicle
and of adhesions, suture of the wounded surfaces, e,g,^
of the ligamenta lata or of the stump of the uterus (as
in Schroder's myomotomy), the shelling out of tumors
having a wide base or lying behind the periosteum, fol-
lowed by suture of the peritoneal covering to the abdom-
inal wound, so as to shut off the entire surface of die
wound from the peritoneum. Everything also most be
avoided which might too powerfully excite the perito-
neum to secretion ; e.g,^ irritation by strong antiseptics.
To favor absorption, a compressive bandage should be
applied over the whole abdomen ; it also fulfils the ne-
cessary object of keeping the abdomen at rest. With re-
gard to the material used for ligature, catgut and care-
fully disinfected silk were equally good from an antiseptic
point of view. The pedicle might be treated either ex-
traperitoneally or intraperitoneally, so long as the ab-
dominal cavity was perfectly closed. The manner in
which the sutures were applied to the abdomen has no
influence, provided that the surfaces of peritoneum were
properly united. Any special method of dressing the
wound was of very little importance, provided that no
drainage-tubes were introduced into the abdominal cav-
ity. A narrow strip of material, rendered antiseptic, was
quite suflSicient for the dressing of the wound ; and for
this purpose, solution of carbolic acid was the best and
safest means. Large quantities of iodoform were dan-
gerous, on account of the liability to poisoning ; but Dr.
Mikulicz had with advantage applied it in very small
quantities to the pedicle and to the sutured stump of the
uterus.
international nomenclature in obstetrics.
Prof. Simpson, of Edinburgh, submitted a report
on this subject, which he had brought before the Con-
gress in London in 188 1. At that Congress, a committee
had been appointed to consider the matter and report to
this Congress ; but, practically, nothmg had been done
by the committee. The section now reconsidered the
matter, reaflirmed its importance, and requested the
committee to go into it sifresh and report to the next
Congress.
September 20, 1884.]
THE MEDICAL RECORD.
33^^
THE SIGNIFICANCE OF ALBUMINURIA IN PREGNANT
WOMEN.
Prof. Halberstma, of Utrecht, in a paper on this
sobject, said, in the first place, that the facts observed
did not permit his recognizing, as the cause of albumi-
nuria in pregnant women, a reflex contraction of the
renal arteries; second, albuminuria in pregnant women
was specially observed when there was a want of propor-
tion between the size of the gravid utenis and the ab-
dominal cavity ; and, third, the cause of albuminuria in
pregnant women was, in the greater number of the cases,
the tension and compression of the uterus.
SOME DIAGNOSTIC DIFFICULTIES CAUSED BY HYPERTROPHY
OF THE CERVIX UTERI.
Prof. Howitz, of Copenhagen, pointed out that, in
cases of hypertrophy of the neck complicated by dila-
tation of the body and fundus of the uterus, special
symptoms arose in consequence of change of the anatom-
ical relations. In cases of pregnancy, especially in the
first months, this condition gave rise to diagnostic diffi-
culties. The elevated situation of the uterine enlarge-
ment, its strange mobility, its elastricity and situation, were
characteristic guides in such cases. The foetal l^ruif could
also be heard sooner than ordinary. A careful examination
by the vagina and rectum would give precise information
as to the exact condition of the uterus.
Dr. Priestley, of London, said he had seen cases
yery analogous to those described by Professor Howitz,
which produced, not difficulty in diagnosis, but difficulty
in accouchement. It was a question well deserving of
consideration, whether, in certain cases, some operative
measure might not be adopted.
THB OPERATIVE TREATMENT OF EXTRA-UTERINE PREG-
NANCY.
Prof. Werth, of Kiel, said that operation was in-
dicated in the early months of pregnancy when the
fcetns, being dead and lying in Douglas' pouch, produced
severe symptoms of incarceration. On the other hand,
laparotomy was without object when it was concluded
that rupture of the sac had taken place, and experience
up to the present time was in favor of expectant treat-
ment. When pregnancy was more advanced, and the
embryo was alive, operation gave little prospect of sav-
ing the child, and was of unfavorable prognosis for the
mother, except in cases where the anatomical conditions
favored the removal of the entire ovum with its mem-
branes. Hence it was a principle to avoid operation
while the child was alive, and to wait for its death. The
expulsive movements following the death of the embryo
could, as a rule, be held in check by appropriate means.
As the extra-uterine position of a foetus which had died
after having passed beyond the first stages of develop-
ment was a source of danger to the mother's life, re-
moval by operation of the dead foetus was necessary.
The prognosis was incomparably better than that of
operation during the life of the foetus, provided that a suit-
able time was chosen for the operation. This, whenever
possible, should not be performed before arrest of the
circulation in the maternal placenta might be supposed
to have taken place ; namely, from the tenth to the
twelfth week after the death of the foetus. Speaking of
the methods of operation, Dr. Werth said that, in the
rare cases of prolonged pregnancy in the outer part of
the Fallopian tube or in the ovary, with simultaneous
imfolding of the broad ligament, extirpation of the entire
sac was indicated ; the operation was like ovariotomy,
and the prognosis was similar. As a general rule, the
sac should be sutured to the abdominal wound. The
placenta and membranes of the ovum should be re-
iQoved, if there was no doubt as to the previous occlusion
of the placental sinuses by thrombosis. If strict anti-
septic precautions were followed during the operation,
and an occlusive dressing applied, then neither prevent-
ive drainage through the vagina nor permanent irriga-
tion of the sac was necessary, provided that decompo-
sition of the contents of the sac had not already set in.
Both these were to be avoided, as well as washing out
and plugging the sac when the operation was per-
formed during the life of the embryo or shortly after its
death, and when artificial or spontaneous detachment of
the placenta threatened fatal hemorrhage. On the other
hand, the author recommended in these circumstances
the partial filling of the fcetal sac with some substance
(tannin and salicylic acid in equal proportions, accord-
ing to Freund), which might enable the placenta to re-
main aseptic until it was thrown off at a later date. Ely-
trotomy was preferable to gastrostomy only in some rare
and peculiar cases. With regard to the proceeding rec-
ommended by Martin, of partial removal of the foetal
sac, suture of the remaining part, and drainage through
the vagina, further experience was required before a de-
cision could be arrived at as to its general applicability.
THE EARLY PERFORMANCE OF OVARIOTOMY.
Mr. Knowsley Thornton, of London, read a paper
on this subject. He first considered whether it was ever
right to interfere with an ovarian tumor by tapping or
by aspiration. Spencer Wells, Keith, and Thomas were
in favor of tapping ; and many other leading ovariotomists
encouraged it. He gave quotations from Gross, Em-
met, and Lawson Tait against the practice ; and referred
to the doubtful advantages claimed for this proceeding
compared with its dangers and its immediate and remote
mortality. He said that exploratory incision was far
safer and better in doubtful cases. Tapping should be
condemned, except in some very rare occasions. He
would always remove an ovarian tumor as soon as it was
large enough to be abdominal and slightly stretch the
parietes. There were objections to operating earlier, ex-
cept in special cases. The danger was in delay. Patho-
logical changes in the cysts might lead to the escape of
their contents, and to the formation of adhesions ; or the
pedicle might become twisted. He adduced illustrations
of the dangers of delay, drawn from over four hundred
ovariotomies he had performed, including forty cases in
which ovarian fluid was free in the peritoneum, and
thirty-four cases of twisted pedicle. He then summed
up by considering the following questions : i. Is tapping
ovarian or parovarian cysts, or cysts of the broad liga-
ment, ever justifiable ; and if so, what conditions justify
it ? 2. Can any fairly general and defined rule be laid
down as to the proper time at which to perform ovari-
otomy ; and if so, what conditions justify an earlier or
later operation ? He concluded by appealing to the
profession to still further improve the brilliant results of
ovariotomy by condemning tapping and supporting
early operation.
MANAGEMENT OF THE THIRD STAGE OF LABOR.
Prof. Stadfeldt, of Copenhagen, read a paper in
which he gave the result of the expectant method of
treatment. Credo's method, and the Dublin method. In
the expectant method, as practised in Copenhagen, the
placenta was allowed to become detached spontaneously,
and to escape into the vagina, unless severe hemorrhage
indicated earlier removal of the contents of the uterus.
As a rule, the detachment of the placenta took place
within about two hours. In Credo's method, circular
frictions of the fundus uteri were made immediately after
the birth of the child, and during a strong after- pain, gen-
erally the third, the placenta was press^ out by a com-
bined concentric and pushing down pressure on the fun«
dus and body of the uterus. The Dublin method was
described in somewhat different terms by different au-
thors. As a rule, the chief importance was attached to
pressure on the fundus uteri immediately after the birth
of the child. This, he thought, tended to increase ante-
flexion, and thereby to impede the escape of the placenta*
He had, therefore, applied friction to the fundus uteri, as
in the first stage of Credo's method, and when the placenta
332
THE MEDICAL RECORD.
[September 20, 1884.
had escaped into the vagina, it was easily removed
by the help of two fingers, with simultaneous gentle trac-
tion on the umbilical cord. In a few cases, where the
placenta was not expelled at the end of half an hour, he
made a depressing movement through the fundus. When
these methods failed, the placenta was removed by the
introduction of the hand into the uterus. Dr. Stadfeldt
liad treated a large number of cases by each of the three
methods above named, and gave results. From his sta-
tistics he excluded all cases of abortion and of placenta
praevia, cases in which the contents of the uterus were
putrid, and some cases of very difficult labor. From
April I, 1873, 10 March 31, 1877, he followed the expec-
tant method in 1,780 cases; from September i, 1877, to
February i, 1881, Cred6's method in 1,611 cases; from
May 12, 1882, to February 15, 1884, the Dublin method
in 971 cases ; and from February 16 to May 30, 188 1, the
expectant method in 198 cases. The results indicated
that, when compared with the expectant method, that of
Cred6 was preferable. Detachment and reunion of the
membranes, or of small portions of placenta, indeed, oc-
curred more frequently, but the preponderance was not
great (2,3 against 1.8 per cent), and any danger riiight
be obviated by the use of antiseptics. On the whole, it
seemed to him that the objectors to Credo's method were
wrong in attaching too much importance to its disadvan-
tages, and overlooking the fact that it removed the dangers
attendant on the expectant method during the time of wait-
ing, especially outside lying-in hospitals. It could not,
however, be denied that the proper and safe application
of Credo's method required so much intelligence and ac-
curacy that it might be attended with danger in the hands
of unskilful persons, and, therefore, it was not thought
right in Copenhagen to teach it to midwives. On the
other hand, the Dublin method was easily learnt, and
was free from the dangers of the expectant and Credo's
methods ; on the one hand, it diminished the danger of
flooding and of retention of the placenta ; and, on the
other, removed the danger of separation and retention of
the membranes. It had been said that Credo's Method,
by favoring retention of the membranes of the decidua,
was more liable than the expectant method to give rise
to puerperal disease and mortality. The contrary was
the result in Dr. Stadfeldt's experience ; the figures given
being, with the expectant method, for disease, 24 per
cent., and for mortality, 1.9 per cent. ; with Credo's
method, disease, 18.3 per cent., mortality, 0.6 per
cent. In both series antiseptics had been used with
equal energy. He believed that, in the present day, re-
tention of the membranes had little influence on puer-
peral disease and mortality, provided that strict antisep-
tic precautions were carried out during labor, and that
the accoucheur abstained from unnecessary meddling
during the lying-in period. Large portions of decidua
might even be left in the uterus without becoming septic,
and without giving rise to self-infection of the patient.
CONGENITAL LATEROPOSITIONS OF THE UTERUS, ETC.
Prof. Lazarewitsch, of Kharkoff, addressed the Sec-
tion on the congenital lateropositions of the uterus in
their relations to the mechanism of labor and to the
peri-uterine tumors. These congenital lateropositions
were, he said, frequent, especially those in which the
uterus was completely displaced to the left. Those which
depended on the development of pathological growths
must be chanced to other positions, and on that account
must be called accidental. But if they depended on a
defect in the development of the broad ligament, or of
the lateral wall of thejvagina, these positions were invari-
able, and did not alter during the growth of the tumors,
whatever these might be, which were formed round the
uterus, any more than during the period of pregnancy.
If the lateral position of the uterus was sufficiently marked,
the anterior position of the rectouterine pouch, being dis-
placed by the uterus, took an oblique shape ; and the
ovary, which corresponded to the large side of the peri-
uterine space, being pressed upon, often lay above the
peri-uterine pouch, and fell down more or less. The
ovary of the opposite side, not finding place near the
uterus, was ordinarily raised up and passed above the up-
per entrance to the cavity. According as the one or the
other ovary became cystic, the cyst either remained for a
longer or shorter lime in the deep cavity, and in its growth
displaced the uterus forward and upward, or, from the be-
ginning of the growth, was found above the deep pelvis
and the uterus, leaving it free. If the ovary corresponding
to the large side of the peri-uterine space became cystic,
the pedicle of the cyst was ordinarily long ; and on the
contrary, it was short if the cyst belonged to the ovary
on the smaller side of the peri-uterine space. Thus, so
fai' as the lateral position of the uterus was concerned,
one was not able to say to which of the ovaries the cyst
belonged ; but, if one knew to which ovary the cyst be-
longed, one could estimate the length of the pedicle. Be-
ing turned to one side, the uterus left free entrance to the
recto-uterine pouch ; and, for this reason, the blood of
the pouch could spread in all directions. If the uterus
was turned to one side, it was difficult to say that it was
completely inclined, or bent forward or backward ; it was
in this event that the cases of lateroversion and latero-
flexion were met with. In the case where the uterus was
turned to one side, pessaries could not maintain it, owing
to the difference in the length of the lateral walls, and
the different heights or ; lateral arches of the vagina.
One was often deceived as to the origin of the pain felt
sometimes on one side in the lower part of the abdomen,
particularly during menstruation, in attributing this to
the ovary. This pain most often proceeds from the lat-
erally displaced womb. The congenital lateropositions,
as well as the lateroversions of the womb, had an evident
influence on the mechanism of labor, but this influence
was not proportional. In the lateroversion the womb,
increasing during pregnancy, preserved its regular form,
changing only the direction of its axis ; whereas, when
displaced, in the lateroposition, it preserved the direction
of its axis but changed its shape, because, on the side on
which it approaches one of the lateral walls of the pelvis,
its lower segment did not expand, or expanded very little,
while the segment on the opposite side underwent the
sacciform expansion. During labor one could easily do
away with the lateroversion of the womb by making the
woman assume a suitable position, or by keeping up, by
means of the hands, the corresponding side of the womb.
But these measures' became useless if the womb was in
the state of lateroposition. In this case, it was enough
to introduce the finger into the neck of the uterus, and
to draw it toward the middle of the pelvis.
STATISTICS OF PUERPERAL FEVER IN DENMARK.
Dr. £. Ingerslev, of Copenhagen, read a paper in
which he gave a brief summary of a research into puer-
peral mortality in the towns of the Danish provinces and
in Copenhagen for the •last seventeen years. The prin-
cipal aim of the paper was to explain how the difference
between the mortality in the maternities and outside
of them, elsewhere brought into such strong relief, had
lost its raison (Pitrey since it was proved that the antisep-
tic measures to be taken in labor were still less per-
formed outside of maternities. He also stated his opinion
that matters were, up to this time, nearly as successfully
managed in the towns as in the country districts of Den-
mark. Dr. Ingerslev went on to show the ravages of
puerperal fever were most manifest when one looked at
the proportion between the puerperal mortality and the
total mortality in women from fifteen to forty-five years
of age, that was to say, of the age at which labor gener-
ally took place. In this regard, a great resemblance
was found between this and like researches made a short
time back in Prussia. The great difficulties in the way
of finding a fairly exact expression for the puerperal mor-
tality would be, perhaps, best overcome in a small
country, where one could most easily obtain a general
September 20, 1884.]
THE MEDICAL RECORD.
333
view of things, and make requisite corrections by address-
ing oneself to medical men for the necessary explana-
tions. He had made the attempt for a period of some
years, and in this way had made a calculation of the mor-
tality as near as possible, and showing, at the same time,
a minimum of errors. The calculation, so checked,
showed an evident decrease in the puerperal mortality,
which undoubtedly was due to a more strictly antiseptic
conduct of labors even outside the maternities.
THE UTERINE ADENOLVMPHANGITIS.
Dr. Martineau, of Paris, read a paper on the above
condition " as a cause of the so-called peri-uterine troubles
and its importance for the treatment of the inflammation
of the uterus/' He took the view that the uterine and
pcri-uterine adenolymphangilis was closely connected
with uterine inflammation. Acute or chronic metritis
could not exist without the uterine and peri-uterine lym-
phatic system sharing in the inflammation of the uterine
tissue. Peri-uterine adenolymphangitis was the origin
of the inflammatory accidents called peri-uterine, such
as phlegmon of the broad ligament, peri-uterine phleg-
mon, perimetritis, and pelvic peritonitis. The designa-
tion of these conditions by the names adenophlegmon of
ihe broad ligament, peri-uterine adenophlegmon, adeno-
pclvic peritonitis, was that which suited them, because it
recalled their origin and pathology. The peri- uterine
adenolymphangitis being equivalent to uterine inflamma-
tion, every cause which would have as a result the in-
creasing of this inflammation would at the same time
increase the peri-uterine adenolymphangitis, and bring
about the accidents of which itVas the origin. Adeno-
lymphangitis, when there was a question of instituting
local treatment, the treatment of the lesions of the me-
tritis, gave the indication and contra-indication for the
treatment, as pathogenic and nosological treatment could
produce an excitation of the uterine inflammation.
A NEW ELECTRIC TREATMENT OF PERIMETRITIS.
Dr. Apostoli proposed " a new electric treatment of
perimetritis by double faradization of the uterus." He
described, in the first place, the modification which he
had introduced in the manual application of uterine
&radization (A. Trifner's method) ; and he enumerated
its general advantages in the treatment of simple metritis.
He applied his method also advantageously in peri-
metritis, and described the manual method, the dose,
duration, and intensity of the application. Summing up,
he had always found the faradic currents, of high tension,
feeble dose, and long duration, relieve every perimetritis,
even acute, and' bring about its rapid resolution.
TREATMENT OF PUERPERAL FEVER BY COLD BATHS.
Prof. Vincent, of Lyons, said : i. That the ad-
ministration of cold baths was practicable with the re-
cently delivered attacked with puerperal fever. 2. That
cold baths were free from danger in the* puerperal state.
3. They had a certain and quick antifebrile effect in the
sequela of delivery. 4. Recovery from puerperal fever was
the rule with treatment by baths of proper temperature
and methodically administered. 5. Cold baths were in-
dicated in all high temperature forms of after-complica-
tions of childbirth, the very acute peritonitis excepted.
The indication for cold baths did not arise except where
the fever was kept up, without notable morning remission,
to about 40^ Cent, when the powerlessness of quinine
and diffusible stimulants in full doses had been shown,
and when, in flne, the lochias were fetid, and intra-
uterine injections had been carefully tried without bring-
ing a fall in the febrile condition. 6. Cold baths should
be administered at a temperature varying from 28° to 18°
Cent; according to the fall secured by the first bath,
given at 28° or 30°, the temperature of the subsequent
baths should be reduced (The rule was, to get with a
coW or tepid bath a fall of from one to two degrees of
the patient's temperature.) The method used in typhoid
fever, treated by cold baths after the system of Dr. Brand,
should be followed, with modifications. 7. The cold
baths were repeated every three hours until the tem-
perature had fallen to 38 , and stayed there, with only
ascending oscillations of some tenths in the evening.
8. When baths of 18° or 20° repeated every three hours,
night and day, did not bring about a notable reduction
of temperature, a large ice-bag should be placed in the
intervals of the baths, on the abdomen of the patient
9. Along with the cold baths and the ice-bags, spirits
and tonics should be freely administered ; the patients
should be fed with liquid or semi-liquid foods, having
much nutriment in a small bulk — soups, beef- tea, Ameri-
can broth, milk, etc.
Dr. Marcy, of Boston, advocated the restoration of
the perineum by a new method ; and Dr. Zambaco, of
Constantinople, submitted to the Section some " Physio-
logical and Pathological Remarks upon the Women of
the East "
(S^aw&span&enct.
OUR LONDON LEITER.
(From our Special Correspondent.)
ALCOHOL AND THE HEALTH EXHIBITION — DR. MOXON ON
LORD TENNYSON — ONSLAUGHTS ON DOCTORS — SMALL-
POX AND VACCINATION — DECREASE OF THE EPIDEMIC.
London, August 30, 1884.
The Health Exhibition continues to attract shoals of
visitors. I must confess that my own experience of it
has been very disappointing. A good many of the ex-
hibits are very interesting and some of them instructive,
but what possible relation many of them can be said to
bear to the subject of health I cannot say. Lace-making,
glove-making, candle-making, and so on, are all inter-
esting in a way, but what place have they in a health ex-
hibition ? The same remark applies to the Chinese and
Japanese Courts— entertaining as the latter are. The
number of alcoholic exhibits and the space occupied by
some of them would certainly lead a superficial observer
to imagine that, in England, alcohol is a sine qua non of
health. The " intelligent foreigner " who visits the Ex-
hibition, would perhaps be surprised to learn that there
are now nearly a million of total abstainers in Great
Britain, including some hundreds of medical men. Al-
though not an abstainer myself, I cannot but think that
the wholesale admission of alcoholic exhibits is calcu-
lated to do harm. Their presence in such an exhibi-
tion gives them a position, so to say, and people will be
tempted to imbibe alcoholic drinks more freely than
heretofore, because '* they have been shown at the
'Health.'" The gratuitous distribution of glasses of
wine and beer (as samples) by the exhibitors, does not
look at all well The Council have at last forbidden it
as regards the beer, but it still goes on as regards the
wine.
The poet-laureate has received the hardest blow I
should think he ever had administered to him. In the
current number of The Lancet^ in a most striking and
suggestive paper on the late Dr. Hilton Fagge, Dr.
Moxon takes Tennyson to task for his foul libel on the
medical profession in his volume of ballads published at
Christmas, 1880. I cannot resist quoting a piece :
**' Eagge's greatness as a physician appeared in his al-
ways kind and sympathetic and Christian treatment of
the sick poor. It is easy for poets to put their own de-
nials of Christ into other people's mouths, and then as
fashionable authors to spread them about on drawing-
room tables. It is convenient to be able to work off
your baser sentiments in a false character ; you yourself
then appear pure by contrast with your own creations.
But if one's solemn everyday duty is spent face to face and
eye to eye with the sorrowing and suffering poor, one won-
ders how even a poet-laureate could be capable of think-
334
THE MEDICAL RECORD.
[September 20, 1884
ing the matter of those loathsome lines of this new peer.
I wonder is he yet ashamed of them ? What footing has
this poet aristocrat on any grounds of charity that justi-
fies him in putting his blasphemous sentences into the
mouth of the child he supposes ? Let him go into a
children's hospital, and see how far the poor sick little
ones think as vilely as 'he of the kind-hearted doctor,
whose only sorrow is that his best help to his little pa-
tients too often proves ineffectual. Fagge was physician
Co the Evelina Hospital for Sick Children. His sympa-
thies were not with grandeur and the House of Lords."
This is harsh but not undeserved, as those who have
read through the poem referred to will admit. Many of
our prolession are doubtless reading Dr. Moxon's denun-
ciation of the laureate with keen appreciation. The
whole of the paper is well worth reading — a remark that
applies to all Dr. Moxon's writings.
The poet-laureate is not alone in attacking the pro-
fession. On taking up a religious newspaper yesterday,
I found a long letter inserted in which a furious on-
slaught was made on doctors generally, and their treat-
ment of hospital patients in particular. The same jour-
nal stated some time back, in an editorial on sanitation,
that the doctors were anxious to bring every one under
their ** tyranny." Such thanks do we get for trying to
check the spread of disease — a step which directly tends
to impoverish us.
I saw a little time since in a radical weekly journal, in
the course of a controversy then raging in its pages on
the subject of vaccination, a letter in which the writer
said that doctors supported vaccination because it was
profitable ! I was greatly tempted to write and give the
obvious answer, that we certainly did not advocate vac-
cination on that ground, as even if it did pay, it did not
pay a fractional part of what small-pox used to. Thirty
years ago it formed a very important part of a doctor's
practice. Now many never see a case. The recent
epidemic, which began to excite some alarm ^ has almost
subsided.
The anti-vaccinationists are very active. At Leicester
— one of their strongholds — twelve hundred persons are
shortly to be tried for non-compliance with the Vacci-
nation Acts.
OUR PARIS LETTER.
(From our Own Correspondent)
DR. BURQ AND METALLOTHERAPY — PROFESSOR BOUCHAR*
DAT DOES NOT BELIEVE UNHEALTHY LODGINGS SO
IMPORTANT A FACTOR IN THE PATHOGENY OF DIS-
EASE AS IS GENERALLY REPRESENTED — ^A BLOW TO
SANITARIANS — THRIVING IN SPITE OF DIRT AND BAD AIR
— HOW PROFESSOR BOUCHARDAT LIVES — PARIS DRINK-
ING-WATER UNJUSTLY ABUSED — THE CHOLERA IN
FRANCE.
Paris, August 99, 1884.
Dr. Burq, the founder of modern metallotherapy, which
is also called Burqism, as you are aware, died on the
1 7 th inst. at Bi^vres, where he had gone for a holiday.
He was sixty-two years of age. It is not necessary for
me to enter into the peculiar notions he held respecting
the action of metals in the economy, particularly those
connected with the efficacy of copper as a iireventive
and curative agent for cholera, as th-^y are well known.
The theories which Dr. Burq had promulgated, for the
first time as far back as 1853, were brought to the
notice of the Paris Academy of Medicine, and although
his communication was supported by Trousseau and
Bouchut, it was received with little or no favor. He
then retired almost into obscurity, and no more was
heard of him till 1877, when he published a series of
papers to the effect that the application of certain metals
on the skin determined, in anaesthetic patients, and some-
times in those organically affected, certain important
modifications, the principal being the return of general
and special sensibility. Moreover, he added, all patients
were not sensible to the same metal, and that gold, iron,
and copper produced positive or negative results accord-
ing to the subjects. The experiments of Dr. Burq were
verified by Professor Charcot, at the Salpetri^re Asylum,
where this system is frequently resorted to ; but I cannot
say that it has been generally adopted in France or else-
where. Like most inventors. Dr. Burq did not derive
much personal advantage from his discovery, and he
died almost penniless.
Professor Bouchardat does not consider unhealthy
lodgings so important a factor in the pathogeny of dis-
ease as is generally represented in the profession. He
believes that this idea has been greatly exaggerated, and
while admitting that, all things being equal, people badly
lodged contribute greatly to the general mortality, but
it is only when they are at the same time subjected to
the pangs of misery — which are much more terrible — in-
sufficient and irregular alimentation, excessive work, and
then alcoholic and other excesses. In a recent lecture
at the School of Medicine, Professor Bouchardat de-
veloped the subject in the following terms : " It is cer-
tain that, during the night, the respiratory organs, like
the other organs of the body, perform their functions less
actively, and that if, outside the hours of sleep, one
works moderately in the open air, the health will not
sensibly suffer from the insalubrity of lodgings. The
peasants are not better lodged than citizens, their food
is not so good, and yet their health is more robust.
Even among citizens, those who work hard, but in the
open air, are less susceptible to disease than the others."
M. Bouchardat cites the example of the chiflfonniers who
live crowded togetiier in huts, as less affected by disease
than the average of the working classes. The necessity
for pulling down unhealthy lodgings to replace them by
palaces is not so much felt as is represented, and even
when all the lodgings are improved, the public health
will not be much influenced by it, so long as the other
causes of disease are in existence. The learned pro-
fessor adds that it is imagined that the privies and night-
soil are powerful causes of the propagation of contagious
diseases in large cities, an assertion offered gratuitously
and without any scientific proof, and he brings forward
the sewer-men (dgou tiers), the night«nien, and others who
work in the general deposits of night-soil (d^potoirs), the
inhabitants of , Gennevilliers (just outside Paris), who
water their cultures with the waters from the drains of
this city, which are rich in night-soil, as not offering a
greater contingent of victims to contagious diseases than
those who live more comfortably. In fact, Professor
Bouchardat may present himself as an example of his
thesis in point, as he lives in one of the filthiest quarters
of Parish in a house he has occupied for nearly half a
century, and yet he has long passed his threescore and
ten without having a day's illness, and he does not recol-
lect that the inhabitants of the little street he is living in,
which is a d^k dirty lane in the old city, near the Ndtre
Dame Cathedral, have been more stricken with disease
than those of til)e modem palaces in the Boulevards.
With reference to the mortality of Paris being greater
than that ot the other cities of France, Professor Bou-
chardat attributes this to another cause : misery and the
conglomeration of unacdimatized individuals, who for
various reasons are attracted to this city, and who in the
case of an outbreak of any epidemic disease, are the first
to be affected. The hospitals become crowded with
them, and it is by them that the mortuary list is swelled.
It is thus he explains the great mortality fix>m typhoid
fever in Paris, yet it is not the less true that the causes
are local.
In the debate that is being drawn out at the Academy
of Medicine anent the cholera, M. Bouchardat observed
that the drinking-water in Paris has been greatly and un-
justly abused, particularly by foreigners. He declared
that the potable water distributed in Paris, even that fur-
nished firom the Seine and canals, is excellent, and may
be drunk with impunity, provided it is properly filtered.
September 20, 1884.]
THfe MEDICAL RECORD.
335
M. Bouchardat, who seems rather inclined to be persona),
again puts himself forward as an example of the innocu-
ous influence of the Paris water, which he has been drink-
ing for so many years, and he holds up also M. Chevreul
as another example, this eminent chemist being on the
eve of entering his ninety-ninth year.
The cholera is still lurking about the south of France,
but the epidemic is localized in the departments in the lit-
toral of the Mediterranean. There has been rather an
increase lately in the mortality at Toulon and Marseilles,
which has been attributed to the return of the fugitives
and to the continued insanitary condition of these places.
PERIOD OF GREATEST RISK FROM CON-
SUMPTION.
To THB Editor op Thb Medical Rxcord.
Sir: The communication of Dr. Marsh in your issue
of August 1 6th has come to my notice on return from
vacation.
The facts and figures were not supposed to be new,
nor the conclusion previously unknown, but they cer*
tainly have never been accepted as established.
Over and over again the subject has been . presented
in various journals, and your own issue of August 30,
1884, calls attention to tlie publication of an article by
Dr. Baker, of Michigan, issued in 1872.
The material in my possession on the subject renders
amusing the possibility of my ignorance of the views of
the authors to whom your correspondent alludes ; but
drawing from this material, and using only such as con-
siderable labor warranted me in believing reliable, I was
strack with the aggregate force of the information, and
sought to call this, and this only, to the attention of the
profession
The work alluded to by Dr. Marsh, and for which the
compiler is entitled to great credit, is not a private or
unknown document, but an open book, issued by the
Mutual Life Insurance Company for its own purposes,
and for several years well known to the public, as well as
to medical men, and I certainly have no desire to gain
credit for what is already public property.
The reliability of figures published by Life Insurance
Companies would seem to render superfluous the con-
siderable labor sarcastically alluded to by your corre-
spondent. Nevertheless, sdl the material drawn upon,
and much not used, was carefully gone over, as Car as the
original facts were attainable, and the experience of the
Mutual Benefit subjected to a like investigation ; but as
I did not suppose it necessalry to say that the experience
of the Mutual Life was compiled by other hands, so I
did not suppose I was claiming credit for any others
that I might choose to select as equally reliable.
Had your correspondent taken the very slight trouble
to notify me by letter, or otherwise, of failure to give
credit to himself or the company he represented, it
would have been promptly accorded.
Dr. Baker, with becoming modesty, claims even the
diagram, or a similar one, and to this originality he is
welcome, if only the views presented, old to a few^ new
(0 the many^ receive attention.
Edgar Holden, Ph.D.
NiwiUK, N. J.
HIPPOCAMPUS KS. HYPOCAMPA.
To TfUt Editor op Thb Mboical Rxcoro.
Su : Among the changes from the nomenclature now in
use, suggested by Wilder, is the adoption of '' hypocampa "
for " hippocampus." His chief reasons are the occurrence
of this term in Vicq d'Azyr's work, and a morphological
one to be refeired to. It is difficult to see what is to be
gauned by this adoption of what may be the product of a
typographical error in Vicq d'Azyr's work, who, quoting
Aiantius and Varolius as the discoverers of the hippo-
^^^pus, gives '' hippocampus '* as the name in his glos-
sary of anatomical terms, and hypocampe, with the Latin
forms hypocamfus and hypocampi in several figure refer-
ences. The transformation of a hastily written *' ip " to
a *'y " is a common one with printers, and may have
been indulged in by the old copyists. The use of the
term by the discoverer is, we think, the determining factor
here. Although Arantius is not accessible to us, yet
there is a very full citation of his description in that mag*
nificent work, Burdach's '* Vom Bau und Leben des Ge*
hirns." He cites Arantius (page 45, chapter iii., of the
latter's observations) as the discoverer of the hippocam-
pus^ and as he is exceedingly accurate in citation, his
work being the most complete and painstaking bibli-
ograpy of the subject of cerebral anatomy up to the year
18 19 extant, it is to be assumed that he saw the original
lines when he says "Arantius discovered it, and de-
scribed it as a white prominence resembling a hippocam"
pus or a vermis bombycinus^^ which having its head in the
third cavity, extends through the inferior cornu, circum-
scribes the crus, and ends anteriorly with a bent round
tail." That some obscure resemblance of the head to
the fish known as the sea-horse, or hippocampus, was be-
fore Arantius in penning this description, I think there
can be little doubt.
Wilder has possibly been misled by the accepted use
of the terms pes hippocampi major and pes hippocampi
minor, which are both manifestly improper. On this
head Burdach is again very explicit and satisfactory.
He says that of the term hippocamp, by a curious niis«
understanding, the authors — instancing Mayer — made
pes hippocampi. Inasmuch as the sea-horse has no foot,
either large or small, Mayer and Reil endeavored to
elude the quandary, by using the term pes hippopotami.
The question is disposed of by the adoption of *' calcar '*
for the eminence in the occipital horn, and '* digitati-
ones " for the series of eminences in the temporal horn
of the ventricles, so that hippocampus may be retained
for the gross prominence of the involuted cerebral wall,
as ''cornu ammonis" indicates its appearance in sec-
tion.
Burdach has a dozen references in his foot-notes to
Vicq d'Azyr's figures, which indicate a detailed and at-
tentive study both of these and of the text of that work.
His silence on the subject of hypocampe — since he was
at one and the same time an excellent classical scholar,
a painstaking reader, and acquainted, as is evident, with
the older literature beyond even Vicq d'Azyr — seems to
indicate that he regarded it as a printer's or clerical error,
and relied on the list of anatomical terms furnished by
Vicq d'Azyr as the proper interpretation of the latter's
nomenclatural views.
It is singular that Burdach, who in the two hundred
and seventieth annotation of his second volume cites the
entire literature regarding the hippocampus, and who was
so thoroughly acquainted with Vicq d'Azyr's work,
should fail to note Varolius as sharing in the discovery
of the hippocamp, which Vicq d*Azyr maintains. Aran-
tius and Varolius were contemporaries, both made thetr
discoveries at Bologna, and published their treatises at
nearly the same time. Of the two the great Vatx)liu8
was undoubtedly the one most deserving of the title
Genius, and as much in advance of his day as Willis was
of his, but it must not be forgotten that Arantitis was a
close observer, and devoted special attention to the tem-
poral comua, which he erroneously elevated to the posi-
tion of independent cavities, capable, as the primitive
anatomy of that time permitted him to say, of taking up
air 1 The omission of Burdach* s — if it be such — is the
more remarkable, as in his historical chapter, when he
arrives at what he calls the " sixth period " of cerebral
anatomy (15 73-1641), he designates it the period of Va-
rolius, and opens its consideration with these lines : '< With
deepest veneration I mention Varolius (1573) one of the
greatest names which the history of our science reveals."
The close of the paragraph seems to indicate that there
^Caterpillar of the silk-^
336
THE MEDICAL RECOTlD.
[September 20, 1884,
were at that time in Bologna, as to-day in New York,
men whose work was done on the same plan as that
shown in a recent much-criticized "Anatomy of the
Nervous System." But nowhere does Burdach, although
he gives a summary of Varolius' contributions, assign to
him any connection with the earlier descriptions of the
hippocamp. Aside from Arantius, he gives the names
of the following as having variously described and inter-
preted this body : Marchetti, Molinetti, Duvemoi, Mo-
rand, Aubert, Winslow, Bergen, Bonhomme, Wrede, Hal-
ler, Mayer, and Malacame. The connection of the
hippocamp and the fornix was known to Aran tins, who
undoubtedly had a clear idea of the gross relations of
these two bodies. As Burdach states, all knowledge of
the hippocamp was lost after the days of Arantius, Mar-
chetti, and Molinetti, neither Willis nor Vieussens ap-
pearing to have known of it or paid any attention to it.
The discovery of Arantius was not resuscitated till the
days of Morand, being buried in oblivion for ni^h a century.
Let the observer look at Plate XX. of Vicq d'Azyr,*
which represents the temporal cornua of the lateral ven-
tricles as opened from below, and he will appreciate how
the older anatomists interpreted the hippocampus. One
is almost inclined to suspect that the artist — the general
correctness of whose representations is remarkable — has
been biassed by the name, for the denticulations of the
fasciola (fascia) dentata and the sweep of the bodv of
the hippocamp are made to resemble the characteristic
position and the jointed scales of the sea-horse/ while
the digitations are represented as much as possible like
the head of a traditional dolphin, with a distinct eye and
snout, inverting Arantius' " tail."
Had it been Vicq d'Azyr's intention to introduce "hy-
pocampe " into nomenclature it would be certainly re-
markable that, having used it in the references to Plates
VII. and VIII. in a few places, he should resume hippo-
campe and hippocampus in the last or fourth part of the
volume. He also uses hypocampi as a genitive form.
This strikes me as signal evidence that the ''y"is a
printer's error, as the correct form (as Wilder has it)
would be hypocampae. Vicq d'Azyr's last reference to
these bodies reads '* hippocampe," and on one page, that
relating to Plate XX., this form occurs just ten times,
besides once on the following page, in the heading, as
well as in the full-page title. There seems to be — taking
the inconsistency of '' hypocampi " grammatically, the
numerical preponderance of hippocampe and hippocampus
over hypocampe^ and the way hippocampus is spelled in
the glossary — no doubt that Vicq d* Azyr recognized only
hippocampe as correct, and that the other form, as I
have stated, is a misprint.
Of course, the attributing to the hippocamp of a **foot "
was, as Burdach and Reil recognized, improper. The
''pes hippocampi," resembles nothing so much as the
foot of a cat with retracted claws, and I have a faint
recollection of reading the synonym pes leonis applied
to it, though I may be wrong. Seeing this resemblance,
and finding that the "pes " was a part of the hippocamp,
the ox and the ass were yoked together — not the first
time in the history of medical and zoological nomencla-
ture— ^and a fish became endowed with a cat's paw.
The discoverer of the hippocampus can have had only
an animal resemblance in mind, or he would not have
used as a second simile a caterpillar. The '' ribbing " of
the fasciola, suggested to his mind the jointed structure
of the fish known as the sea-horse as well as that of in-
sectean larva.
Wilder asks the question,' whether the denticulations
of the fasciola are found in other animals than man, and
whether they are recent appearances in all cases, and
^Tnit^ d'Anatomie et de Physiologic, tome premier, Paris, 1786. It may
mterest the student of history and particularly hun who delights in detecting the
sarcasm of events, to learn that this magnificent work is dedicated " to Louis XVI.,
to whom thirteen Sutes of the New World owe their liberty, the sea its indepen-
dence, Europe peace, France monuments of justice," ete., all of which culmi-
nated a little later on the guillotine.
' Hippocampus Hudsonius.
* In ha Cartwright Lectures.
have been accounted for. The finest denticulations I
have seen were in the hippopotamus and the common
horse ; they seem to be better marked in children than
in adults. Meynert offers a reason for their existence,
based on the alternate distribution of fibres. That they
are a very widely spread character of the fasciola is
shown by the following list of -animals in which their
presence has been distinctly noted by me : Man, orang-
outang, chimpanzee, semnopithecus^ cercopithecus^ maca^
cusy cynocephalus^ aUleSy hippopotamus, horse, goat, calf,
sheep, and in others of which the notes are difficult of
access at this moment.
Respectfully, E. C. Spitzka, M.D.
|i.mxs atxd g^ws g^cuxB.
Official List of Changes in the StaO&HS astd Duties of Qficm
tertdue in the MeaiceU Departnunt^ United Stata Army,
from September 7 to September 13, 1884*
Greenleaf, Charles R., Major and Surgeon. To
conduct a detachment of recruits to the Department of
the Columbia, and upon completion of this duty rejoin
his station, Columbus Barracks, Ohio. S. O. 210, A. CO.,
September 6, 1884.
GoKGAS, W. C, First Lieutenant and Assistant Sur-
geon. Assigned to duty at Fort Randall, D. T. S. 0.
98, Department of Dakota, September 5, 1884.
Egan, p. R., First Lieutenant and Assistant Surgeon.
When relieved by Assistant Surgeon Fisher, to report at
Fort Lowell, A. T., for duty as Post Surgeon. S. 0. 82,
Department of Arizona, September 2, 1884.
Macauley, C. N.' B., First Lieutenant and Assistant
Surgeon. Assigned to duty at Fort Sisseton, D. T. S. 0.
99, Department of Dakota, September 6, 1884.
Fisher, W. W. R., First Lieutenant and Assistant
Surgeon. Assigned to duty at Fort Apache, A. T., re-
lieving Assistant Surgeon Egan. S. O. 82, C. S., Depart-
ment of Arizona.
EwiNG, Charles B., First Lieutenant and Assistant
Surgeon. Assigned to duty as Post Surgeon at Fort
Stanton, N. M. S. O. 177, Department of the Missouri,
September 6, 1884.
McCaw, W. D., First Lieutenant and Assistant Sur-
geon (recently appointed). To report in person to the
Commanding General Department of the Missouri, for
assignment to duty. S. O. 209, A. G. O., September 5,
1884.
Official List of Changes in the Medical Corps of the U, 5.
Navy^ during the week ending September 13, 1884.
Hevl, T. C, Surgeon. From the Adams to the Re-
ceiving Ship Independence, Mare Island, CaL Septem-
ber 8, 1884.
pmcdical Stems.
CoMTACHOus Diseases — ^Weekly Statememt.— Re-
port of cases and deaths from contagioas diseases re-
ported to the Sanitary Bureaa» Health Department, for
the week ending September 13, 1884 :
WeekEndiBf
September 6, 1884
September 13, 1884
D^tUks,
September 6, 1884.
September 13, 1884
900
II 0 0
The Medical Re
A Weekly yournal of Medicine and Surgery
Vol. 26, No. 13
New York, September 27, 1884
Whole No. 72s
©rieitml %xXxtXz&.
A SUCCESSFUL CASE OF ARREST OF TUBAL
PREGNANCY BY GALVANISM.
By PAUL F. MUNDfi, M.D.,
mnr yosk.
Instances of extrauterine pregnancy observed at so early
a period as to admit not only of a certain diagnosis, but of
their successful treatment, are not so common, but that,
as yet, each additional case presents features of interest
sufficient to warrant placing it on record. Of late, two
cases have been reported by Veith, of Berlin, of success-
ful removal by laparotomy of the whole sac in tubal
pregnancy, in the first case the diagnosis being obscure,
in the second case clearly made before the operation
was decided upon. It is possible that at some future
time the details of laparotomy may be so simplified that
a fatal termination is a rare exception ; but at the present
day, in spite of Tail's wonderful results, the fact remains
andisputed that every patient whose abdominal cavity is
opened incurs the nsk of losing her life. So long as
that is the case, the majority of operators will hesitate
before performing a dangerous operation, when the same
result can be obtained, at least so far as a continuance
of the gestation is concerned, by an entirely harmless
and simple process. Whether now this process, the pas-
sage of an electric current through the gestation-sac, is
so entirely harmless, and whether it can be relied upon
always to arrest the growth of the ovum and its en-
velopes, and finally whether the ovum so arrested is a
safe thing to have in the abdominal cavity ad indejinitum^
these are points which only additional observations will
decide. As a contribution to the settlement of these
questions the following case is reported :
Mrs. P. A ^ thirty-eight years of age, mother of one
child eight years of age, one miscarriage six years pre-
viously, consulted me February 6, 1884, in order to
ascertain whether she was pregnant. She stated that
she had last menstruated during the last week of
November, 1883, that she had had connection imme-
diately after the cessation of the flow, December ist,
and not since, as she soon began to feel nauseated, and
being afraid of becoming pregnant had avoided inter-
course. Her next menstrual period, due about Christ-
mas, passed without a show, but early in January there
was some bloody discharge, although much less than
usual. She also began to feel colicky pains in the lower
part of the abdomen, which, together with the nausea,
persisted until I saw her, and were gradually growing
worse. She said that her appetite was good, but that she
invariably vomited soon after eating. Morning-sickness
was not specially marked. When she came to me she
had just had a second scanty show of blood. For several
days the abdominal pain had produced some faintness,
and her weakness had increased considerably. She was
a tall, graceful woman, rather thin and pale, and bore
traces of suffering in her face. A vaginal examination
showed the uterus pushed somewhat to the left side, but
slightly, if any, enlarged, and in the right half of the
pelvic cavity an oblong, irregular, deeply fluctuating
mass of the size of a goose's egg, which could be slightly
moved about, causing the uterus to move with it. Bi-
manual palpation of this mass caused intense pain, and
brought on faintness and the colicky, cramp-like pains
of which the patient had complained. Large vessels
could be felt pulsating through the right vaginal pouch.
Feeling confident that the uterus was empty, for it cer-
tainly was not enlarged to the size of a two months'
pregnancy, I introduced the sound, and it entered
toward the left to a depth of three inches. My already
formed diagnosis of tubal pregnancy was confirmed by
the appearance of the areolae, and the oozing of colos-
trum from the nipples on pressure, certainly unusual ex-
cept as a sign of pregnancy in a woman who had not
been pregnant for six years. The breasts were not en-
larged, however, although the lady said that they felt
rather fuller than usual.
I explained to the patient and her husband what I
thought to be the trouble, and the danger of allowing the
pregnancy to proceed, and the hope I had of checking
its growth by the electric current. But in order to share
the responsibility, and as a guarantee of the corrtctness
of the diagnosis, I proposed a consultation with Dr.
Thomas Addis Emmet, which was readily agreed to.
He saw the patient at his office the next day in my ])res-
ence, and without giving him my diagnosis, which I told
him I had formed the day before, he at once pronounced
it to be a pregnancy in the right tube, and advised the
galvanic current.
The patient had already felt considerably prostrated
before going to Dr. Emmet, where she was obliged to ride
in a carriage, although perfectly able to come to me the
day before in the horse-cars, and after his examination
she had so much pain that I prescribed a morphine sup-
pository, to be taken as soon as she reached home. Fear-
ing that delay might result in a rupture of the sac, I ar-
ranged to go to her residence that afternoon with my^
battery and pass a current through the mass. Accord-
ingly I went there at 4 p.m., and found the lady so much
prostrated, that her husband met me at the door with
the words, " I fear, doctor, you cannot do anything to-
day." But the danger of rupture was so vivid before my
mind, that I preferred to run the risk of producing that
rupture by the electricity, rather than what seemed to
me the greater risk of allowing the sac to grow even
twenty-four hours longer. Placing a leather-covered
button electrode in the rectum, and the other pole by a
flat sponge on the abdomen over the mass, I passed the
current of my newly filled galvanic battery through the
sac, gradually increasing its strength to twenty-four cells,
and rapidly breaking the current a dozen times or more.
The sitting lasted about ten minutes, and the shocks
were quite painful. I did. not think this current too
strong, for I remembered that in one of the successful cases
reported, McBurney's thirty-six cells had been used. I
left the patient fairly comfortable, no more prostrated
than before the application.
Early the next morning I was called, and when I ar-
rived I learned that the lady, whose nausea and retching
had continued all night, had sat up in bed toward morn-
ing to vomit, had been seized by a violent pain in the
abdomen, and had fallen back in a faint. I found her
perfectly conscious, but white as a sheet, with pinched,
clammy features, absolutely pulseless at either wrist, skin
cool, extremities cold. I naturally thought that the sac
had ruptured ; the history and present condition clearly
pointed to that conclusion. One thing only led me to
doubt a rupture, and that was the strength with which the
patient could turn about in bed and answer questions. It
was evidently a state of collapse, but it did not seem to
338
THE MEDICAL RECORD.
t
[September 27, 1884*
nie exactly like prostration from hemorrhage. I could
not but hope that it might be merely shock from the re-
peated examinations and the galvanic current through so
sensitive an organ as an overdistended tube. I made a
gentle va^nal examination and found the outline of the
mass as distinct as the day before. In any case, the only
^active measure, laparotomy, could not be carried out on
a. patient in so profound a state of collapse as to be
pulseless at the wrists ; she must simply have died on
the table. Hence, if there was a rupture, all I could do
was to stimulate her until she rallied sufficiently to justify
laparotomy; and if there was no rupture, then that
operation was not indicated. I therefore ordered hypo-
dermics of brandy, each containing five minims of arom.
spir. ammonia, one to be given every fifteen minutes in
diflferent parts of the body <the patient's stomach would
retain absolutely nothing), sent for a nurse, and went
home for my laparotomy instruments, in case at any mo-
ment they should be required. The physician who was
hurriedly called in, and whom I found at the bedside when
I arrived. Dr. Black, of the United States Army, on
leave of absence and temporarily residing in the neigh-
borhood, kindly stayed with the patient, and was relieved
later by my assistant. Dr. E. H. Grandin. On my re-
turn several hours later, I found the condition unchanged.
The hypodermics were continued during the day, some
fifty in all being given.
During the afternoon, while on my way to Mount
Sinai Hospital, where I was to operate, 1 met Dr.
Charles K. Briddon in the car, and remembering his
recently reported case of laparotomy after rupture of a
tubal gestation-sac, related my case to him, and the doubt
I was m as to whether rupture had occurred, and whether
I should operate or await developments. He strongly
advised me to operate at once in spite of the collapse,
saying that his patient also was pulseless, but that after
the operation her pulse rose. I decided to wait, however,
still feeling that, after all, it might be nothing but shock.
The next morning there was a faint trace of pulsation
at the wrist ; gradually it increased, and we began to
hope ; the retching diminished and the patient could re-
tain cracked ice. Her abdomen was very sore, and she
complained a great deal of colicky pains on the right side.
To make a long story short, she gradually rallied, began
to retain nourishment, and in a week was able to sit up
in bed, and in two weeks lie on a lounge. The sac had
become somewhat harder, fluctuation was less distinct,
pulsation had disappeared, but the mass was not per-
ceptibly smaller. The breasts had become flabby, but
they still secreted colostrum. Although there could not
be any reasonable doubt of the death of the foetus after
such a series of galvanic shocks, still, to make sure, 1
thought it best to pass the faradic current through the
sac a number of times, and beginning on the sixteenth
day after the galvanic sitting, I made six faradic applica-
tions to the sac, one pole in the vagina, the other over
the mass on the abdomen, using the full strength of a
Kidder tip-battery and frequently breaking the current.
One sitting per day was given, lasting about fifteen
minutes. This treatment caused no pain or shock what-
ever. From this time on the patient improved rapidly,
regained her flesh and color, and by the end of the fourth
week was able to go out. The colostrum gradually dis-
appeared from the breasts, but the sac diminished very
slowly, so that when I last saw her at my office on May
19th, three months and a half after the galvanic shock, it
was certainly still two-thirds as large as at first, although
perfectly solid. All pain in it had ceased before she was
allowed to go out. Menstruation reappeared on April
1 2 th, and again on May 7th, lasting seven days. The
uterus was measured and found to be two and three-
fourths inches deep. The lady left for Europe on May
2 1 St in perfect health, and without a complaint of any
kind, and is still abroad.
The special points of interest in this case are : first,
the occurrence and recognition of the nature of the col-
lapse after the galvanic sitting ; and second, the kind of
current which should be used, the galvanic or the faradic
I. As regards the collapse. I have no doubt that it
was due to the violent galvanic shocks passed through a
highly sensitive organ, at that time even more closely
connected than usual with the sympathetic system, and
that the previous examinations had sdready paved the way
for such an occurrence.
The recognition of the cause of the collapse was not
easy, and I confess that I expected all during that 7th
of February to be called upon at any moment to do
laparotomy as a last resort. But I wish again to call at-
tention to the one sjrraptom which led me to defer operat-
ing, and which, givmg it its correct interpretation, as 1
chanced to do, saved the patient's life, namely, her
singular physical strength, while pulseless at either wrist
and evidently collapsed in the highest degree. Had I
not considered this persistence of voluntary muscular
power incompatible with the loss of so great an amount
of blood (intra-abdominal, of course) as would produce
so severe a collapse, I should probably have done what
was the only other thing to do but wait, that is laparotomy,
which I do not think the patient would have survived.
2. My experience with the |;alvanic current in this case
leads me to prefer the faradic, which has been success-
fully used by Landis, Allen, Garrigues, and others, with-
out any of the shock or pain experienced in my case. 1
do not attribute the shock entirely to the character or
strength of the current, for there was undoubtedly some
present before it was used, and I am disposed to believe
that rupture was impending or had already begun ; but I
doubt 2r the shock would have become so severe if I had
used the faradic current. But the faradic will need to
be repeated frequently and at short intervals to insure
success.
Whether the encysted ovum ever gives rise to subse-
quent trouble by suppuration or septic infection I do not
know. As no such result has been mentioned in the re-
ported cases, I suppose it is fair to assume that its growth
once arrested it simply shrivels, mummifies, and is no
longer recognizable except as a small hard lump, causing
no inconvenience whatever.
Although I have heard incidentally of one or two other
unpublished cases of extra-uterine pregnancy checked by
electricity, I believe this is the twelfth case on record,
the eleven others having been reported by Garrigues in
vol. vii. of the American G3mecological Society's Trans-
actions.
ao WcsT FoBTY-nrra Stkbbt.
The newspapers state that two persons, one of whom
was a physician, have surrendered themselves to the au-
thorities of Norristown, Pa., and have admitted the steal-
ing of the body of John May, a murderer and suicide, from
the cemetery at that place. The purpose for which the
body was taken is not mentioned, but it was doubtless for
dissection. An act of this sort is certainly criminal, but
it is interesting to note the trouble the old law-writers
have had in detemiining exactly what kind of a crime it
was. They early came to the conclusion that it was not
theft, because a dead body could not be property, and no
one could be said to have ownership in a corpse. In
one case, however, it was held to be robbery, because
the grave clothes were taken as well as the corpse. In
more recent times, the act has been regarded as one
against the public instead of an individual, and heavy
penalties have been prescribed against those who wan-
tonly open a grave. At the same time most States and
communities have laws by which the bodies of unknown
and friendless persons are given to hospitals and medical
schools for dissecting purposes. Such laws will not, how-
ever, permit the removal of the unknown dead from ceme-
teries where they have been interred in the usual way.
Removal secretly of the bodies of such persons is as much
an offence as that of persons who are well known and
have died surrounded by their friends.
September 27, i884,]
THE MEDICAL RECORD.
339
TYPHUS FEVER, AS IT OCCURRED IN AN
EPIDEMIC AT THE PHILADELPHIA HOS-
PITAL, WITH A CONDENSED REPORT OF
NINETEEN CASES.
By LLOYD NORRIS HORWITZ, M.D.,
LATB BBSIDBMT PHYSICIAN TO THB PHILAIMILPHIA HOSPITAL,
PHUJLDBLPHIA, PA.
Although this report embraces but the record of nine-
teen cases, yet the writer's conclusions and remarks are
founded on the close observation and postmortem ex-
ainination of over forty cases which occurred in the wards
of his colleagues Drs. Elder and Gotwald.
This epidemic of typhus fever began about March i,
18S3, and lasted with more or less severity until June of
the same ^ear, and was then only checked by the strict
prophylaxis employed by the physicians at the hospital,
assisted by the hearty co-operation of the Board of Health,
as the contagious, infectious, and epidemic character of
the malady, in the writer's opinion, was clearly proven by
the cases which fell under his direct observation.
Case L — F. W , white, aged thirty-four, admitted
to the hospital March 2, 1883, was the second case of
typhus fever of the epidemic. Precisely like four-fifths
of all the cases admitted, he came from a locality in this
city noted for its filth, its unhealthy and unhygienic sur-
roundings, and for the squalor and poverty of its inhab-
itants, namely Alaska and St. Mary's Streets and the
numerous courts and alleys immediately adjacent
Although no satisfactory history of this case could be
obtained, owing to the patient's semi-delirious condition,
still, judging from his symptoms, he must have been
suffering between five and six days before he was brought
to the institution.
The patient was decidedly emaciated; his tongue was
of a brown dusky hue, but red at its tip ; the teeth were
covered with sordes, and the breath was peculiarly offen-
sive. The chest and lateral aspect of the body as well as
the lower portions of the thighs were quite thickly cov-
ered with the characteristic eruption of typhus. The
urine was scanty and high colored, and voided with much
difficulty; the bowels were loose, and of a fetid character,
a condition in the writer's experience almost as common
as that of constipation. The temperature, as in all cases
of this epidemic, was exceedingly high, it being at the
time of his admission 105^^. The delirium was of a low,
muttering type, and contmued so until the beginning of
the third week, and indeed it may here be remarked that
this is the characteristic delirium •f the disease, the busy,
violent delirium being rarely seen.
The writer has left to the last what, in his opinion, was
one of the most, if not the most valuable diagnostic
symptom of the disease, namely, muscular and osseous
hypersesthesia and tenderness on pressure; fer no matter
in what condition of comatose insensibility was the pa*
tient, cries of pain could readily be elicited by even slight
pressure over the tibia, ulna, humerus, or any of the sub-
cutaneous bones.
The peculiar typhus odor from the skin and breath,
referred to by some authors as so characteristic of the
disease, is, in the writer's opinion, of but little value, it
often being entirely absent, as was the case with this pa-
tient, and when present was in no way distinguishable
from the ordinary smell of the sick ward, and the writer
may also add in this connection that the characteristic
emption of the disease lends but little diagnostic aid to
the practitioner, both on account of its frequent absence,
and from the protracted delay in making its appearance,
and as proof of this would cite the nineteen cases of his
own, in which but ten showed any eruption whatever,
and in two of these the eruption did not make its appear-
ance until the eighth day of the disease. In the cases
treated by my colleagues, above referred to, the eruption
was as frequently absent or protracted in its appearance
as in those here recorded.
The patient remained in the condition described until
the fifteenth day of the disease, or nine days after his ad«
mission, when convalescence commenced, the fever and
delirium lessening, diarrhoea becoming checked, the tongue
cleaning up, and strength returning.
It may be here remarked that the overwheUnmg mus-
cular prostration attending the cases constitutes one of
the most important factors of the disease, and is even
greater than that which attends typhoid, although con-
valescence takes place with much greater rapidit}' in
typhus.
At the beginning of the fourth week the man was able
to move about the ward, still quite weak. A few days
later he was sent to the convalescent ward, cured.
Case IL — J. J , colored, aged sixty, admitted to
the hospital March 7, 1883. This case is of interest
principally on account of its rapidily fatal termination ;
the patient having died thirty-six hours after his admission.
The history of this case, like the former, was very un-
satisfactory; the ambulance doctor being unable to learn
anything from the sick man's drunken and bestial com-
panions. (It may be remarked, en passant^ that there
were no less than twenty-eight human beings living in a
three-story wooden boarding-house in Alaska Street, from
whence he was brought). However, in the opinion of Dr.
Bruen and the writer, it was one of those fulminating cases
of typhus fever, which afterward proved by no means of
rare occurrence during this epidemic.
The man was in a completely comatose condition, and
could only be aroused for a moment by pressure on the
extremities ; the tongue and teeth were in the usual con-
dition found in these cases; the pulse hard and very
rapid, showing 135 beats per minute ; the temperature
the highest of any case that came under my observation,
the thermometer io6f°; and finally, on examination of
the bladder, it was found to be greatly distended with
urine, which necessitated the use of the catheter; the
operation having to be repeated when necessary up to
the time of the patient's death. This retention of urine
was found to be generally diagnostic of a very severe
case, it having occurred in every fatal instance.
On post-mortem examination the viscera were found to
be congested, but otherwise in a normal condition ; this
condition was particularly noticeable with the kidneys.
The intestines were carefully examined, and no point of
ulceration could anywhere be detected, but the peculiar
and characteristic "shaven beard" appearance of the
mucous membrane was noticed in spots throughout the
whole length of the ilium. The precise nature and micro-
scopical anatomy of this morbid condition has not to my
knowledge been definitely described by pathologists, but
the practical fact remains that it was noticed in every
instance in which a post-mortem examination was held.
Case HI. — J. M , white, aged fifty-five, admitted
to the typhus ward March 24, 1883. This patient was
recently convalescent from a severe attack of facial ery-
sipelas in one of the wards of the hospital when stricken
with typhus fever.
His condition from the onset was grave, the fever be-
ing ushered in with a series of severe chills, and intense
nausea ; the latter symptom continuing for the first thirty-
six hours of the disease. All the symptoms of typhus
were well developed in this case ; the eruption appearing
quite copiously on the fifth day.
Nothing beyond the persistent nausea was noticed
which would invest this case with any particular interest.
Death ensued on the eighth day. The autopsy revealed
precisely the same pathological conditions as seen in
Case IL
Cases IV. and V.— John J , thirty-eight years of
age, and Wni. J , thirty years of age, both white.
They were admitted to the hospital on the same day, and
were brought from the same house on Alaska Street.
They both gave as a history of their cases a feeling of
great lassitude, weariness, and a condition of general
malaise for several days prior to the attack, and the man
J. J had a severe chill while being conveyed to the
340
THE MEDICAL RECORD.
[September 27, 1884.
hospital in the ambulance. The eruption did not appear
in the first case until the seventh day, and was then so
slight as to be recognized with much difficulty, while in
the second patient there was no perceptible eruption
whatever.
It is a curious fact, but one well borne out by the
writer*s experience in this epidemic, that in these cases
in which the eruption was slight or altogether absent the
temperature and all other symptoms were increased in
severity. This fact was well illustrated in these two cases,
in which all symptoms were of the gravest character. Con-
stipation was marked in the first case, but the bowels
were rather loose than otherwise in the second.
The second case died on the ninth day in a state of
complete coma; the first, however, recovered after a
protracted illness and a tedious and slow convalescence.
The autopsy held on the second case revealed pre-
cisely the same morbid conditions as in Cases II. and
III.
Case VI. — ^John L , sixty-five years of aj;e, white,
admitted to the hospital March 30, 1883, This patient
was also brought from the same infected locality as the
preceding ones. There was at the time of his admission
a slight typhus eruption scattered over the trunk, which
increased greatly in the next twenty fom: hours, and
turned to a dark black color a few hours before his death.
The thermometer showed a temperature of 104^°, the
significant brown tongue and an unusual degree of hyper-
aesthesia of the muscles and bones were present, with ex-
treme prostration and low delirium. He lingered in this
condition for two days, when he died.
On post-mortem examination the viscera were found
to be more than usually congested, especially the lungs.
The same pathological changes were found in the intes-
tines as in the preceding cases.
Case VII. — Thomas R , twenty-eight years of
age, white, admitted April 2d. The diagnosis of this
case was for a time involved in some doubt, as in its
early course it closely resembled typhoid fever, but the
appearance of the eruption on the fifth day, the peculiar
brown tongue before described, and the muscular hyper-
aesthesia, made the diagnosis at that time positive. The
attack was comparatively light, the temperature never
reaching over 102^°; the muscular hy perse sthesia being
not so well marked as in graver cases, and the patient
being able to be aroused from his stupor from time to
time.
Convalescence set in toward the end of the third
week, and complete recovery quickly ensued. The re-
turn to health and strength, as in most cases of this dis-
ease, was quite rapid.
Casks VIII. and IX. — Charles A , thirty-two years
of age, and Joseph P , thirty-six years of age, both
colored, the former admitted March 30th, the latter
March 31st. They were brought from the same shanty,
situated in a small alley running off Alaska Street, and
according to their own statements they were both taken
sick about the same time. The first case was of that
fulminating character described in a former patient, and
he died in a state of complete coma on the fifth day after
his admission. The retention of urine and his profound
comatose insensibility almost from the onset of the at-
tack formed the two most prominent symptoms of the
case ; constipation, muscular, and osseous hypersesthesia
were present in a marked degree. The autopsy revealed
the usual congestion of the viscera and the '* shaven-
beard" appearance of the raucous membrane of the
ilium. The brain was found in a normal condition, ex-
cept a slight increase in the '* puncta vasculosa."
The second case was of a light character, and was
analogous to Case VII. The individual was completely
convalescent by the fourth week, and his subsequent re-
covery was rapid.
Case X. — ^Joseph D , thirty-six years of age, white,
admitted April 2, 1883. The patient gave a history of
prostration and fever for three days prior to his entrance
into the hospital. When first seen no eruption could be
detected on any portion of the body, but on the fifth day
of the disease, or two days after his admission, a few
spots were noticed on the lower extremities; all the
other symptoms of typhus fever were wfell marked, except,
instead of constipation being present, the bowels were
loose, the patient having from three to four passages
daily, and the faeces being of a fetid character and of a
spinach-green color ; precisely similar in looks to that of
Case II. There was also present from the very onset of
the disease a peculiar symptom, and one not very fre-
quently seen, namely, intense nausea and vomiting, the
ejecta varying in color from a dirty brown to a pea-green.
This symptom lasted without any abatement up to the
time of the patient's death, which occurred forty-eight
hours after his admission. The temperature was very
high from the beginning, the maximum point reached by
the thermometer being io5f°; the muscular hyperaes-
thesia was well marked, but the delirium and coma were
not as great as we should have been led^ to expect from
the gravity of the other symptoms. Retention of urine
was also present.
On post-mortem the viscera were found to be all
deeply congested. The stomach showed decided evi-
dences of chronic gastritis, superinduced no doubt by
the patient's intemperate habits. The liver was in a far
advanced stage of '* interstitial hepatitis." The ileum
showed in many places the " shaven-beard " appearance
of the mucous membrane.
Case XI. — John W , twenty-six years of age, col-
ored ; admitted to the hospital April 7, 1883. The patient
was a pauper inmate of the institution when attacked by
the disease, and as an assistant attendant in the typhus
wards, was directly exposed to contagion. The writer
would here mention that this was by no means the only
case of typhus fever which arose from contact with the
sick, for the two men whose duty it was to carry the
patients from the ambulance to the wards, and the dead
to the dead-house, both contracted typhus fever, and one
died. This patient was first seized with a well-marked
chill, followed by some nausea, the temperature quickly
rose, until at the beginning of the third day it reached
103^*'. The delirium, which was at first but slight, increased
in severity up to the fifth day ; it was not of the usual
low character, but was of the active, busy type some-
times seen in typhoid fever. The bowels were exceed-
ingly constipated, and the urine scanty, and of a high
color, containing a small amount of albumen ; a condi-
tion of rare occurrence in this epidemic, not even a trace
having before been detected in the twenty-seven cases
whose urine the writer examined.
It is proper to state that this condition of slight albu-
minuria was not a constant feature even in this case ; it
disappeared on the eleventh day, and did not again re-
turn.
The hyperaesthesia was well marked and persistent,
the pulse hard and rapid, and the tongue cracked and
fissured in numerous places, of a dark brown hue with a
red and angry-looking tip.
These symptoms continued with more or less severity
until the thirteenth day, with exception of the tempera-
ture alone, which was reduced to ioi|° by the sixth day,
above which point it never again rose. Immediately a de-
cided amelioration in the symptoms occurred, and by the
end of the third week convalescence was fully established.
Some ten days later the patient was discharged cured.
Case XII. — George H , aged nineteen, white,
admitted April 15, 1883. This was the only patient of
the nineteen which fell to the writer's care (exclusive of
the two which originated in the institution) which did
not come from the infected locality of the city so often
referred to in the preceding pages.
The patient was of respectable parentage, and as far
as could be determined was under good sanitary and hy-
gienic surroundings prior to his attack. His illness dated
about four days prior to his admission to the hospital,
September 27, 1884.]
THE MEDICAL RECORD.
341
and was attended by a physician in the northern section
of the city, who recognized the nature of the case and
by whose advice he was sent to the hospital. When first
seen he was in a state of profound coma ; the eruption,
although not abundant, was still quite noticeable on the
abdomen and lower extremities; the hyperaeslhesia of
the muscles quite distinct ; the pulse rapid, but weak
and feeble, and the temperature registered io4f°. The
breath was very fetid, the teeth covered with sordes, the
tongue dry, cracked, and of the usual dark brown hue
almost to the tip. The bowels were costive, and the
urine had to be drawn oflf by the catheter.
The patient rapidly and progressively grew worse, the
coma deepened, the respiration became more and more
shallow, the heart's action more feeble, and death
finally occurred some thirty hours after his admission.
The autopsy revealed deep congestion of all the vis-
cera, particularly of the lungs and kidneys, and the char-
acteristic pathological appearances were noticed in the
ilium. The coqdition of the brain was normal, except a
slight increase of the " puncta vasculosa.'* The cerebro-
spinal fluid was about normal in quantity.
Case XIII. — George A , aged forty, white, ad-'
niitted April 26th. A pauper inmate of the out- wards of
the Almshouse, who, as far as could be learned, had not
been directly exposed to contagion. His case proved to
be of a lighter type than usually seen during this epi-
demic, and although all the symptoms of typhus fever
were present, still they were all of a mild degree. The
eruption occurred late, and was very light. He became
convalescent about the fourth week and soon after was
discharged cured.
Case XIV. — ^Thomas McG , aged fifty-one, white,
admitted May 3d. No history of this case could be ob-
tained from the patient, owing to his condition, but his
friends living in the locality from which he was brought
(Seventh and St. Mar/s Streets) told the ambulance
doctor that he had been in the condition in which he
then was nearly three days. This case differed in no
respect from other severe ones of the epidemic, except
that the fever was protracted to the end of the fourth
week, and convalescence was extremely slow, it being
nearly two months before he was able to walk even a
short distance unassisted. Diarrhoea was i)resent up to
the end of the third week.
Case XV.— Charles S , aged forty-three, white,
admitted May 21st. The disease as in many others cases
during this epidemic was ushered in with a severe chill.
The temperature arose on the third day to I03J^ and
remained at that point until the fifth day, when tor one
day it slightly declined. The pulse was hard and rapid,
registering with but little variation about 138 beats per
minute. The delirium was of a more violent type than
usual, and continued so up to the time of his death. The
urine was scanty and high colored, rich in urea and the
urates, a few tube casts being also noticed. The bowels
were rather loose, and the faeces of a dark green color
and very fetid. The eruption, which was quite copi-
ous, made its appearance on the fifth day. The exhaus-
tion and debility of the patient was very marked, and the
emaciation was undoubtedly greater than presented by
any other case of the epidemic ; this might be accounted
for by the exhausted constitution of the patient prior to
the inception of the disease.
After the fifth day the man began rapidly to grow
weaker and weaker, the stomach rejected both food and
medicine, except in the minutest quantities, and the
temperature, despite all remedies, remained at 105°. He
died on the ninth day in a state of complete coma.
On post-mortem examination the viscera, as in the
other cases, showed evidences of deep congestion ; the
intestines revealed the characteristic "shaved beard"
appearance of the mucous membrane ; the kidneys were
far advanced in parenchymatous nephritis, and the brain,
beyond a slight superficial congestion, showed no abnor-
mality.
Cases XVI. and XVII.— Patrick S and Michael
McG , aged respectively thirty-nine and twenty-
eight, white, both admitted May 26, 1883. ^^^ cases,
as far as could be ascertained, were taken ill about the
same day, and were 'brought from the vicinity of Sixth
and Lombard Streets. The eruption appeared in both
men on the seventh day, quite plent^ully in the first
patient, but rather scanty in the second ; the temperature
was never very high in either — the maximum being io2.f ^;
the delirium was not marked, and by the twelfth day
their intellects were perfectly clear. The bowels in each
were inclined to constipation. At the end of the fourth
week convalescence was fully established, and soon after
they were discharged cured.
Cases XVIII. and XIX. — Nothing of particular in-
terest was noticed in either case, all the symptoms being
well developed, but of a light type. Recovery occurred
in both cases toward the end of the fourth week.
The writer has postponed a recapitulation of the treat
ment of the cases presented in this epidemic until the
symptoms and pathological conditions of each could be
given in detail ; for the treatment pursued, with but few
exceptions to meet certain emergencies, being well-nigh
similar, it would be a work of supererogation to state it in
extenso in each case.
From the very commencement it was found necessary to
stimulate and support the patient, attention at the same
time being given to the secretions, and means taken to
arrest hyperpyrexia and hold in check excessive delirium.
Free stimulation with whiskey or brandy, preferably the
former was necessary from the onset, and the amount re-
quired was found to be about one ounce every three
hours for the first three days, and subsequently increased
by giving the same quantity every two hours, and as
convalescence became assured the interval was again
lengthened. There can be no doubt that our chief reme-
dial agent in this epidemic was alcohol,''and without its
use the mortality would have been greatly increased.
Much attention was paid to the administration of easily
digested and nourishing food. A strict adherence to a
liquid dietary is not necessaxy, indeed occasional indul-
gence in easily assimilated solid food is not only beneficial
but strongly indicated. Milk, eggs, strong animal broths,
arrowroot, rice, etc., were administered with regularity,
the patient taking nourishment in some form every two
hours by day, and three hours by night, even arousing
him from sleep for the purpose. Small amounts of solid
food, as finely chopped sweetbread, rare tender beef, or
chicken, were occasionally given, but care was exercised
that nourishment, whether liquid or solid, was taken only
in small quantities at one time.
Aconite and veratrum viride have been recommended
by some authorities as the most useful and potent reme-
dies we possess for the excessive hyperpyrexia, and
although the writer does not for a moment deny the
wonderful power of these two agents in controlling car-
diac action and reducing the temperature of the body,
nevertheless in his ^experience they have both proven
entirely too depressing in their action for a disease of
this character. The use of quinine in ten-grain doses
four times daily, along with the following prescription, is
attended with much more beneficial results :
$. Tincturse digitalis f 3 ij.
Spts. aether, nit f 3 jss.
Liq. potass, cit.,
Liq. ammon. acetat &a f | ji.
Aquae q. s. ad f|vj.
M. Fiat mistura. Sig. — Tablespoonful every three
hours.
These remedies along with frequent sponging with cool
water, a small amount of vinegar or bay rum being added,
seldom failed in the experience of the writer to reduce
the highest temperatures.
Some authors have recommended in cases of great and
persistent hyperpyrexia the immersion of the patient in a
342
THE MEDICAL RECORD.
[September 27, 1884,
cold bath ; but this is, to say the least, a practice attended
with the greatest danger, and should only be resorted to
in the most desperate cases, and then only when all
other means have been tried and failed. The writer cm-
ployed the cold bath treatment but -in one case, and then
only used it after having tried all other remedies without
avail. The beneficial effects of the bath were very tran-
sient ; a reduction of 2^° having occurred immediately
after the immersion, but scarcely had a half hour elapsed
before the thermometer registered \° higher than before
the bath. The operation was, however, repeated, but
with the same unsatisfactory results.
Chlorine water was extensively employed by Dr. Lud-
low in his cases, but with no very encouraging results,
although in a few instances it was claimed that consider-
able benefit was derived from its use. It is an old remedy
for the disease, and was originally brought forward on
account of its supposed specific effects ; but the history of
this epidemic, as well as those which have preceded it,
conclusively prove that there is no specific for typhus ;
or in other words, therapeutists have not yet discovered
any article that may be considered directly antagonistic
to the disease. The sulphites have also been employed
as supposed specifics, but with the same results. Chloral
and bromide of potassium, in a mixture containing ten
grains of the former to twenty grains of the latter, proved
very efficacious in abating the delirium when active and
exhaustive to the patient. The writer exclusively used
a combination of the oleoresin of lupulina, VI xv., and the
tincture of cannabis indica, VI xx. , for such cases, and can
testify to its great utility. Belladonna is also strongly
recommended by some authors, and is particularly ad-
vantageous in those cases characterized by low muttering
delirium. Opium should, as far as possible, be avoided
in all cases. If constipation is persistent, an occasional
laxative should be employed, and the writer knows of
none which so well answers the purpose as the ordinary
sulphate of magnesia, or Epsom salts. The use of the
mineral acids, especially nitro -muriatic, in ten-minim doses
is possibly of some utility, and may be combined with the
quinine treatment referred to above. If, as sometimes
occurs, the kidneys cease to excrete the proper amount of
urea, and as a consequence ursemic coma is threatened,
sinapisms over the renal region, and vesication of the
nucha are called for.
Bed-sores, which frequently occur during the course of
the disease, are beneficially treated at first by a lotion of
alcohol and alum, but when fully developed carbolized
oil is best used instead
In view of the contagious character of the disease,
typhus cases should not be treated in hospital wards with
other patients. If overcrowding; be prevented and free
ventilation secured, the fever miasm is not as easily gen-
erated, nor is the disease as likely to be communicated.
Extreme cleanliness, both of the patient and the wards,
along with the free use of disinfectants, such as carbolic
acid and chlorinated lime, are hygienic measures of great
importance.
Mortality, — Although the average mortality is gener-
ally placed at from eighteen per cent, to twenty-five per
cent, in this epidemic it reached at least thirty-three per
cent., but as age greatly modifies both the prognosis and
mortality (the disease not being a very fatal one before
the twentieth year), and as seventy-five per cent, of all
our cases were between thirty and thirty- five years old,
and many ranged between forty-five and fifty-five, a very
important factor in increasing the mortality of this epi-
demic was thus produced. It is also but just to say that
at least nine-tenths of all our patients were persons de-
bilitated and exhausted by every vice, and most of them
exposed from childhood to most unhygienic surroundings.
Chemical Euphemism. — Few people are aware, 01
seriously consider that when they take a cup of tea it
is essentially an aqueous solution of trimethybcanthine
(CgHj^N^OJ which they are drinking.
CEREBRAL LOCALIZATION— THE CENTRES
FOR VISION.
BV PHILIP ZENNER, A.M., M.D.,
cmaNNATi, o.
(Coadnued from p. 335.)
Pathological data.—Our investigations in this third line
of research will not lead us to as exact results as either
our anatomical or physiological studies. But they are,
nevertheless, the most valuable in promoting the main
object we have in view, cerebral localization in man, and
are quite sufficient to arrive at definite results.
Impainnent of vision may be caused by lesions of any
part of the intracranial visual apparatus, or by lesions of
indifferent portions of the brain, as optic neuritis so fre-
quently attends any coarse cerebral disease. But as we
are seeking for the centre of vision in the cerebral hemi-
spheres, visual disturbances will only interest us where
they appear to be directly produced by lesions of limited
portions of the hemispheres. To obtain such cases we
must be able to eliminate general causes, as, for instance,
optic neuritis, dependent upon increased intracranial
pressure, and the visual symptoms produced by involve-
ment of the more peripheral parts of the visual appara-
tus, the optic nerves, chiasma, and tracts, and the basal
ganglia, optic thalami, corpora quadrigemina, and genicu-
kte bodies.
A number of such cases have been reported. In all
of them there was disease of the occipital lobes, the part
which we have already been taught to consider the
chief, if not the only seat of the centre for vision.* In
all of these cases the same kind of disturbance of vision
was found, loss or impairment of vision on one side,
homonymous lateral hemianopia.*
As this symptom is so important for us in this connec-
tion, we will dwell briefly upon it. There is an obscura-
tion or entire defect of one-half, or approaching one-half,
of the field of vision, due to a loss of sensibility on the
corresponding sides of both retinae. Lesions of one
hemisphere cause loss of sensibility of the retinae on the
same side, and blindness in the field of vision of the op-
posite side. Thus a lesion in the left occipital lobe is
attended by paralysis of the left half of each retina, and
blindness of the right half of the field of vision, or right
hemianopia. It is to be remembered then, when we say
right or left hemianopia, we are describing the side on
which the patient does not see, and that it betokens dis-
ease of the opposite side of the brain.'
Of the cases of disease of a cerebral hemisphere with
accompanying hemianopia some cannot be utilized for
our present purposes for reasons already mentioned, be-
cause the disease is very extensive, and especially because
it involves the basal ganglia," or because there were at
the same time changes m the optic nerves ; * others,
because the lesion was of too recent date,' or because
the examination was not made with sufficient exactness,
or, at least, was not sufficiently detailed in the report*
We will proceed to the mention of the individual cases
which can be utilized in the present investigation. Each
one will be given as briefly as is consistent with our
present object.
In a case of Baumgartner ' a complete left hemianopia
appeared suddenly and remained until death. The post-
mortem examination revealed " an old apoplectic cyst,
> There is, to far at I know, but one apparent exception to this statement, a esse
of Hufenin (Ziemssen, xi., p. 816). where a lesion was found only in the animar
part of the (lanetal lobe. But as the disease extended into the subcortical medul-
larv matter it probabljr reached to the optic radiations.
* The terms hemiopi^ hemianopia, and hemianopsia are all used to express dw
same condition. The oldest one, nemiopia, is becoming less and less used. Tne
term hemianopia will be alone used in this paper.
» Cases of Pooley (Archives of Ophth.. v., o. 148) ; Vetter (DeuU Archiv. £ kL
Med., xxxii., p. 507) ; Hosch (Zehnder's Monatsblatt, 1878, p. 285) ; Wonida
(Gehim Krankheiten, iu, p. 70J ; Prevost, Fritach, Chaallou, and Chvosldc (ated
by Wilbrand. Ueber Hemianopsie).
* Cases of Jany (Archives of Ophth., xii., p. 9j») ; Haab(Zehndet's MooatsWatt,
1882, p. 141) : Gnesinger (>yilbrand, p. 154)*
• Case of Dmitrowsky (Wilbrand, p. 139).
• Cases of Lewick (American Journal of the Medical Sdenccs, 1866. p. 413K
Nothnagel (Topische Diagnosak, p. 4"); Frilsch, Traube,and Putschcr (wi-
brand).
' Centralblatt f. d. Med. Wissenschaften, 1878, p. 369.
September 27, 1884.]
THE MEDICAL RECORD.
343
the size of a walnut, in the right occipital lobe. Its inferior
wall was separated from the cavity of the right posterior
cornua by a layer of healthy tissue several millimetres in
thickness. The superior wall was formed by the three
occipital convolutions, which were altogether softened.
There was also a focus of softening, the size of a pea, in
the roof of the left anterior cornua, and an apoplectic cica-
trix, scarcely half the size of a lentil seed, in the centre
of the right thalamus. Optic nerves, tracts, and chiasraa,
and geniculate bodies and corpora quadrigemina were
normal" The lesions in the thalamus and anterior
cornua may be ignored, as we know they could not have
produced the symptoms. We need not, therefore, hesi-
tate to conclude that the hemianopia was here due to the
disease in the occipital lobe.
A case of Westphal ^ had occasional attacks of uni-
lateral convulsions for a number of years before death.
He had also a complete left hemianopia. The post-
mortem examination revealed a focus of softening in the
right occipital lobe, which extended into the parietal lobe
and the bordering temporal convolution. The softening
was in the medullary substance, the cortex being unaf-
fected. The motor regions of the hemispheres, the in-
ternal capsules, large ganglia, and optic tracts were nor-
mal
In a man of seventy- two, reported by Marchand,' with
complete left hemianopia and hemiplegia there were
found destructive changes in the occipital lobe, and also
a degree of softening of the cortex in parts between the
occipital lobe and the fissure of Rolando.
In Curschman's * case there was complete left hemia-
nopia without other cerebral symptoms. Post-mortem
examination revealed " a large focus of softening in the
right occipital lobe, which reached to the surface, chiefly
in the superior surface and apex of this lobe.'* Rest of
brain normal.
In a case of Haab * a woman of sixty-one, had com-
plete left hemianopia, with scarcely any other cerebral
symptom, for one year before her death. On post-mor-
tem examination there was found softening of the right
occipital lobe, especially its median surface. The cortex
was chiefly affected, but the softening extended deeply
into the medullary substance, though it did not reach as
far as the posterior cornua.
The foregoing cases prove that hemianopia may be
produced by disease of tiie hemispheres which does not
involve the primar}' visual centres (optic thalami, genicu-
late bodies, and corpora quadrigemina) or the more
peripheral visual apparatus. They prove also that this
symptom is caused by disease of the cerebral cortex. For,
though in all of these instances the subcortical medullary
substance was affected, we know that nerve-fibres are not
centres for functions, that they merely serve to convey im-
pressions and impulses ; and that, therefore, in the above
instances their involvement could only have produced
symptoms through cutting off the communication with the
cortex*
The cortex, then, is the centre for sight. But to what
part of the cortex this function belongs is not so defi-
nitely answered by these instances, for we cannot say
to just what extent the symptom was here due to destruc-
tion of the white subcortical substance, nor do we know
in exactly what area of the cortex the destroyed fibres
found their final distribution. But as in these instances
the disease was chiefly or entirely in the posterior parts
of the hemispheres, it is rendered probable from them that
the cortical visual centre is in the posterior part of the
brain. This conclusion is further corroborated by other
and more striking instances. But before considering the
latter we will briefly mention a few reported cases which,
though less convincing than those just given, still have
some weight in the above conclusion.
* Cbarit^ Annaleii, w. i cited by Wernicke* Gchirnkrankheiten, ii., p. 195.
* Axx:hiv. f. Ophthal., xxviii., a.
' Centnlbtati Auffenheilkunde. 1879, p. x8i. i
* Zchnder's Monatsblatt, 1882, p. 149.
In a case of Stenger,' with occasional left-sided convul-
sions, temporary left hemiplegia, and left hemianopia,
which remained permanently during the last six months
of life, there was found, in addition to an internal hydro-
cephalus and slight general charges in the brain, decided
lesions in the right occipital and parietal lobes.
In a second case of Stenger ' there were occasional
unilateral convulsions, right hemianopia, first observed
four months before death and remaining permanently,
and about one month before death also a left hemiano-
pia, so that the patient was now completely blind. The
post-mortem examination revealed slight general changes
both in the meninges and in the brain, and decided
atrophy of both occipital lobes, that in the left being
apparently of older date.
In both of these instances the general changes in the
brain, as well as the clinical histories, were like those of
general paralysis. But inasmuch as in general paraly-
sis the pathological changes are usually slight, and the
localizing symptoms slight and transitory, and in the
above instances the visual defect was both complete
and lasting, and the only decided lesions those in the
parts mentioned, it is highly probable that these lesions
and symptoms were in direct relation with each other.
In a case of Wernicke,* there was, in addition to cer-
tain disturbances of speech, a right hemianopia, which
existed for twenty months before death. There was
found extensive disease of the left hemisphere. The
rest of the brain appeared to be normal excepting that a
part of the left corpus striatum was softened, and the
optic thalamus seemed a little reduced in size.
The lesion in the corpus striatum could not have
produced hemianopia, and the changes in the thalamus
were apparently too trivial to account for the visual dis-
turbance.
In Nothnagel's * case .there was right hemianopia and
extensive destruction of the cortex of the left occipital
lobe. But there were also motor symptoms and lesions
in the anterior parts of the brain, so that the observation
has only a problematic value.
In a case of Jastrowitz,* with right hemianopia (fundi
oculi normal), a large part of the posterior part of the
left hemisphere was destroyed by a tumor, which reached
to the level of, but did not implicate, the optic thalamus.
The rest of the brain, ganglia at base, optic tracts, etc.,
was normal.
There might be some hesitancy in admitting this case
as evidence, because of a tumor which usually produces
general symptoms, symptoms due to increased intracra-
nial pressure. But hemianopia is a symptom of such
local significance, and there is nothing to explain it in
this case but the local lesion, so that this case has prob-
ably as much value as those just preceding it.
The five cases just given, notwithstanding the impos-
sibility of definite conclusions where each one is criti-
cally examined by itself, have still, when taken together,
a certain value in the solution of our problem.
Of far more value, perhaps the most valuable of those
yet recorded, is the case to be now mentioned, the
second one of Westphal, reported in the Chariti Annalen,
1882.* In this case there was, in addition to occasional
right unilateral convulsions and disturbances of speech,
an impairment of the muscular sense in the right arm and
hand, and a right hemianopia, which existed from the
time of the first observation, October, 1879, to the time
of death, December, 1881. There was found, post
mortem, disease of the cortex over the greater part of
the occipital lobe, the parietal lobe, including the pos-
terior central convolution, and a small part of the tem-
poral lobe. The disease did not extend into the sub-
cortical medullary substance.
> Achiv. f. Psychiatric, xiii., p. 046.
3 Ibid., p. a49*
* Gehirn Krankheitoi, iL, p. 190.
4 Topische Diagnostik, p. 389.
• Centralblatt Augenheilkunde, 1877, p. 254.
« Brain, 1889, p. 281.
344
THE MEDICAL RECORD.
[September 27, i884.
This case proves, what we had already concluded from
previous cases, that there is a visual centre in the cor-
tex. As regards its exact localization it does not lead us
beyond our former conclusions, that the visual centre is
in the posterior part of the hemispheres.
I will next mention two cases in which hemianopia
followed traumatic injury of the brain.
The first case was a man, aged twenty-three, wounded
at the battle of Antietam. According to the account of
Surgeon McCall,' the ball passed from about one inch
above the occipital protuberance into the cavity of the
cranium and emerged at a point to the left of the median
line about an inch and three-quarters from the point
of entry. There was temporary paralysis of right arm
and leg. Keen and Thompson' made a careful ex-
amination eight years after the injury. Fundi oculi were
normal. Central vision, and vision in left half of field
were normal, while in the right of the field of vision
there was complete blindness. The blind field reached
to a vertical line passing through the point of fixation.
Only at the latter point there appeared to be a very
slight bending of the line toward the affected side.
Nieden * reported the following interesting case, which,
at the time of his last report, in the latter part of 1883,
was still under observation. A young woman of twenty-
two sustained a severe injury in the occipital region from
a fall. Notwithstanding the continuance of headache
and slight paralytic symptoms, she attended to her ordi-
nary household duties until about seven months after
the injury, when, on account of the supervention of
serious symptoms, mental disturbance, convulsions, etc ,
operative interference was resorted to. There was at
this time slight paralysis of the right arm and leg, but
vision, which had been repeatedly and carefully ex-
amined, was altogether normal. TTie trephine was ap-
plied, and a button of bone removed, just to the left of
the sagittal suture, and one-half centimetre above the
external occipital protuberance.
This, according to the calculation of Nieden, was just
over the apex of the occipital lobe. During the operation
the dura mater was injured and subsequently brain-sub-
stance protruded through the opening in the bone.
The second day after the operation it was noted that
the paralysis and anaesthesia of the arm were diminished,
but that the patient spoke of a cloud before the eves, es-
pecially on the right side. Subsequently the patient en-
tirely recovered from the paralysis, headache, etc., but
the disturbance of vision remamed permanently. As
soon as a careful examination could be made it was noted
that in the right eye the whole of the temporal field of
vision and a part of the upper median field were missing,
and that central vision was impaired. In the left eye
central vision was perfect, but there was a slight con-
centric contraction of the field. A year subsequent to
the time of injury central vision in the left eye was still
perfect, but one-third of its median field was missing.
This was attributed to the cicatrization of the wound m
the occipital lobe causing further destructive changes in
a part of that lobe which had hitherto functioned for the
inner part of tlie left retina.
Though no post-mortem examination was made there
could scarcely be better evidence of cerebral localization
than this case. The impairment of vision wa« the im-
mediate result of an injury of the surface of the brain, in
just that locality where such a result might be expected,
but, besides that, the visual disturbance followed the in-
jury inunediately, no other cerebral symptoms appeared,
in fact, those previously existing began immediately to
<iisappear, so that the visual symptoms cannot be at-
tributed to any general injury or involvement of distant
l>arts, but is a direct expression of local changes.
The last three cases are almost positive proof of the
general conclusion above drawn, that there is a cortical
> Medical and Surgical History of the War, Part I., vol. ii., p. ao6.
* Trans, of the Am. Ophth. Soc., X871, p. xa2.
Z* Archiv. C Ophthal., judx., 3.
centre for vision which is situated in the post part of the
hemispheres. When these observations in man are com-
pared with experimental results in animals, we may state
that the visual centre is mainly in the occipital lobes.
I shall add but one case to the foregoing, which, on ac-
count of the theoretical and practical value, will be given
somewhat in detail.* A man of forty-five suffered in
March, 1881, with severe headache in the left occipital re*
gion, and observed also that he did not see objects on the
right of the field of vision. A careful examination, in July^
revealed a right hemianopia nearly to the median line,
and normal fundi oculL At this time there was no other
cerebral symptom of local significance, but shortly after-
ward an awkwardness in the use of the right extremities
was observed. There was also observed impairment of
the cutaneous sensibility, muscular sense and muscular
power of the right extremities. At first these were more
marked in the leg, but they gradually increased in both
arm and leg, until these functions became entirely
abolished. August ist, slight paralysis of the muscles
supplied by the lower branch of the right seventh nerve
was observed.
From the above symptoms and the presence of fever,
emaciation, etc., a brain abscess was diagnosed, and,
August 3d, the abscess was opened. The trephine was
applied at a locality supposed to correspond to the
posterior superior angle of the left parietal bone. About
an ounce and a half of pus escaped after an incision into
the brain. For some days there was improvement, dim-
inution of paralysis, etc., but patient died August 16th.
Post-mortem examination revealed what Wernicke de-
scribed as a tubercular abscess of the brain. The abscess
was of the size of a large hen's egg, and occupied the
left occipital and parietal lobes, occupying rather the
median than external portion of the parietal lobe.
The lesion here found in itself might be of no more |
localizing value for the symptom hemianopia than sev-
eral of those already mentioned, merely indicating that
hemianopia was dependent upon disease of a hemisphere.
But taken in consideration with the development of the
symptoms and other facts in cerebral localization the
case is more significant. There was a gradual develop-
ment of the symptoms, first hemianopia and then gradual
involvement of the leg, arm, and face. Now the centres
for the nmscles of the leg, arm, and face lie respectively
more and more distant from what we have taken to be
the centre for vision. So the development of the symp-
toms seem to demand the following explanation : the
abscess began in the occipital lobe, causing only disturb-
ance of vision, and as it extended forward it gradually 1
involved the centres for the leg, arm, and face.
It may be permitted to add a word of admiration for
the boldness of applying to practice the principles gained
from scientific study. Although operative interference
was without avail in this case, it may, nevertheless lead
to its more successful issue in the future.
This closes the pathological material at our command
for the establishment of a cerebral centre of vision in
man. The cases are few in number, partly because those
instances are rare where such circumscribed lesions oc-
cur, partly because careful examinations during life are
usually not made, have scarcely been made at all until
recent years. More than one-half of the above cases
were reported within the last three years.
A proper examination for the symptoms is more im-
portant than is usually believed. Patients 'very fre-
quently do not observe visual disturbances when they
are only partial, or they falsely interpret them, for in-
stance, say that they do not see with the left eye, when
there is left hemianopia. Physicians also frequently over-
look these symptoms, and blunders have been made by
skilled specialists which were only rectified by careful peri-
scopic examinations.
We have now done with the evidence, gained from the
> Wernicke aod Hahn (Virchow*s Archiv., i88a, xxxvii., a).
September 27, 1884.]
THE MEDICAL RECORD.
345
study of anatomical, physiological, and pathological data,
trhich bears on the question of the cerebral centres of
vision. We have seen that all points alike to the pres-
ence of such a centre in the cortex of the posterior por-
tion of the hemispheres. It may be that other parts of
the brain are in some manner connected with the sense
of vision, for the subject is not entirely cleared up. But
it mast be accepted as an acquired fact in anthropological
science that the sense of vision is intimately connected
with a limited portion of the cerebral cortex.
A CASEJOF POISONING BY PODOPHYLLUM
PELTATUM.
By WALTER B. REYNOLDS, M.D.,
WASHINGTON, D. C, *
The following case is presented to the profession with
the belief that it is of sufficiently rare occurrence to
make it of some interest to them, as, well as being worthy
of record.
About I P.M., on the 9th of June last, I was summoned
to come at once to see Mrs. C , who was said to
have been taken suddenly and critically ill. On reach-
ing the patient I found her with the following symptoms,
to wit : incessant retching ; scant, but very frequent
bloody stools ; violent colic and tenesmus ; eyes sensi-
tive to light, and pupils slightly contracted ; skin and
extremities cold ; slight indications of respiratory paral-
ysis ; pulse rapid and weak, and other usual symptoms of
collapse. She was considerably excited, but perfectly con-
scious, and stated that she had been feeling badly for
several weeks on account of chilly sensations and the
irregularity of her bowels. To remedy these troubles
she had taken, the evening before, three of Dr. Jayne's
liver pills, to which she attributed her illness. She de-
nied having taken anything else, but mentioned, in reply
to a question, that she had not had her sickness for six
weeks. Nor had she suffered from any of the early
symptoms of gestation. Brandy and fomentations were
the domestic remedies that had been used.
I had her head lowered, applied external warmth, with
a large sinapism over her abdomen, and gave a hot
brandy punch (which was repeated every half hour) just
as soon as she ceased retching, which had returned
shortly after my arrival. The matter vomited consisted
of bile and glairy mucus, each in a small quantity. The
punch was retained, and together with the external
warmth caused, in a short time, her skin to become
somewhat warmer, and she expressed herself as feeling
more comfortable ; but she still had frequent paroxysms
of great pain. To relieve this I endeavored to adminis-
ter a hypodermic injection of sulphate of morphia, and
also brandy, but my syringe could not be made to work.
As the patient had been almost constantly vomiting and
purging since 2 a.m., neither an emetic nor cathartic
were considered necessary. A messenger having re-
turned from the drug store, I placed on her tongue one
powder of the following formula :
5. Bismuth, subnit 6.00 grm.
Pulv. ipecac, comp 2.00 grm.
M, Ft. chts. no. vj.
Sig. — One every half hour until two have been taken,
and then repeat hourly.
I A warm starch enema was also given, and repeated
I after an interval of two hours. The patient was to use
I a bed-pan, and to be kept as quiet as possible. After
remaining awhile I left, giving instructions that I should
be sent for in case any change occurred, and that I would
return later.
At 6 P.M. Mrs, C was somewhat easier. Her
bowels continued to move frequently, and were still mel-
aenatic in character, but did not occasion as much pain.
Her pulse was 90, a little stronger, but irregular. Retch-
ing had ceased. She considered herself stronger, but
complained of difficulty in breathing, and had suppression
of urine. The punch was made stronger (32 grm. instead
of 16 grm. of brandy to a tumbler of milk), and ordered
to be given, in the form of milk punch, a tablespoonful
every fifteen or twenty minutes until the distress in
breathing had improved, as I noticed it was not so great
for awhile after tlie stimulant had been taken. The
powders were continued every two hours. Warm cloths
were applied over the hypogastric region, and renewed
every two hours, with a wineglassful of flax-seed tea
every three or four hours. Her diet to consist of milk,
weak tea, and two soft boiled eggs in case she desired
anything to eat.
Her husband was present at this visit, and I elicited
the following facts, which confirmed my suspicion that
his wife had taken an excessive dose of one of the drastic
cathartics. At the suggestion of a lady neighbor she
purchased the previous day two May-apples (weighing
16 grm.), one of which she steeped for an hour in half a
pint of boiling water ; all of which she drank warm, after
straining it, on retiring at 10 p.m., the 8th. Mrs. C
is a healthy, tall, well-developed German woman, about
twenty-five years of age, and the mother of three living
children.
On the morning of the loth she was very much im-
proved. However, she slept very little during the night,
owing to continued hypercatharsis, which had occurred
about every three hours since my last visit. Her pulse
was 85, and stronger, but still irreisrular. She suffered
with comparatively little pain, and while it continued to
return periodically, yet the intervals were gradually being
lengthened. Complained of general weakness and sore-
ness, with a feeling throughout the digestive tract as if
she " had swallowed boiling water." She had to discon-
tinue the milk punch, as it produced retching, but took
instead brandy and water at the hours ordered. The
powders were continued every three hours; also flax-
seed tea every two hours. Warm applications were con-
stantly kept over the abdomen, for their soothing effect,
her urine being passed in the normal quantity. The other
treatment was coi3 tinned, with the exception of the
brandy, which was allowed only three times daily, as no
difficulty of breathing was experienced.
The following morning I found that the patient had
had a good night's rest, and no movement of the bowels
nor pain since 5 p.m., the previous day. Said she rel-
ished her breakfast, and felt well enough to be up if she
were not so sore and weak. There was no symptom of
salivation at any stage of her case, as has generally oc-
curred in experiments with this medicine, especially on
the lower animals. I gave directions for her to remain
quietly in bed for a few days ; to take beef-tea in addi-
tion to her other diet, with one powder twice, and brandy
(16 grm.) three times daily. Flax-seed tea every three
or four hours.
Three days later I called, and found Mrs. C at-
tending to her household duties. She had steadily im-
proved, and I did not detect any irregularity in her pulse,
though it was still weaker and faster than normal. She
looked pale, and said she felt weak, but in all other
respects thought herself better than she was before tak-
mg the May-apple. I cautioned her in regard to diet ;
stopped the powders, but continued the brandy twice
daily. I ordered the following :
3. Tinct. ferri chlor 24.00 c.c.
Quiniae sulph 4.00 grm.
Strichniae sulph 0.03 grm.
Syr. aurantii flor 48.00 c.c.
Aquae q. s. ad. 128.00 c.c.
M. Ft. sol. Sig. — A teaspoonful in a tablespoonful
of water morning and night, through a quill. ^
No. 152a Connecticut Avenub.'
346
THE MEDICAL RECORD.
[September 27, 1884.
HYSTERIA IN THE MALE.
By spencer M. FREE, A.M., M.D.,
iPmrStCtAN TO NOBTHWBSTKRN MINING AND BXCHANGB COMPANY.
Having read in several recent journals reports of hysteria
in the male subject, I present my experience, hoping it
may be of value in helping others to avoid the errors
which I made.
My practice is in a mining town of about three thou-
sand inhabitants (including children), and nearly all of
them are under my care as the company's physician. I
have hence seen many ca^es of this disease, but only four
in the male in my own practice, and one in consultation.
This makes my proportion of cases one male to about
fifty female, instead of one to twenty as recorded by
Briquet.
I shall relate one case in /«//, as it illustrates clearly
the disease as well as the mistakes of diagnosis.
Case I. — June 20, 1882, I was called to see L.
T , adult, single, laborer, generally in the woods or
on the farm ; weight, one hundred and sixty-five pounds.
He had always been well. Had been suddenly attacked
with diarrhoea and slight vomiting. Diagnosed, "summer
diarrhoea.'* Treatment caused improvement for a few
days, when a second attack occurred. He again improved
until June 29th, when he was ** taken with " headache.
The pain gradually extended downward along the spine,
until at the end of five days the whole vertebral column
was involved. Pains were paroxysmal, and at times so
severe as to be alarmmg. There was much tenderness
on pressure. The system in general showed symptoms
of disease, except the temperature, which remained below
99.2**. Treatment availed very little. Occasionally he
improved for a few hours. Diagnosis now made of spinal
irritation or meningitis. This state of things continued
until July 6th, when he was attacked with pains in the
abdomen, resembling colic. He and the family said he
had high fever each afternoon, and that at these times the
pains were much worse. I took occasion to see him at
such times^ but the thermometer showed only slight in-
crease of temperature. When the abdominal pains de-
veloped those along the spine subsided to a great extent,
though they did not disappear. I became worried. I
had twice made a wrong diagnosis. While thinking over
the case it flashed into my mind, "Could it be hysteria ? "
I traced the family history for two generations, but noth-
ing of value was found, except that some of his mother's
family were "nervous" (^to use her words). On the night
of July 8th I was called m haste, as he was ** dying." I
found him apparently with severe colic. I applied hot
fomentations, gave hypodermic injections of morphia,
and carefully watched for hysteric symptoms. I gave
him two and one-third grains of morphia in this way and
a small amount of chloroform by inhalation ere he slept.
(I have noted several times the large amount of morphia
that hysterical patients will tolerate without producing
sleep.) I noticed that he inquired for a young lady of
the house, and was restless when she was out of the
room ; that he would not allow me to leave the bedside ;
and that he manifested a few other symptoms of an
hysterical nature. I learned that he had proposed mar-
riage to this young lady and had been refused. I de-
termined, in view of all this, to treat for hysteria, and the
next morning I gave him a remedy which is a favorite
with me in this feigning (sham) variety, namely, a " blow-
ing up." I began severely by telling him that nothing
was the matter, that he should be ashamed of himself,
that he should get up and go to work and relieve the
family of this annoyance and expense, etc.
Of course he pleaded and tried to arouse my sympathy.
I gaare none ; he then tried abusing me and berating my
knowledge, I did not become angry, but continued my
severity. Finally he began to swear, he sprang up in
bed, clenched his fists, and prepared to " lick " me and
put me out of the house. I did not flinch but looked
him steadily and firmly in the eye. Suddenly he dropped
" in a heap " upon the bed, was powerless, and cried
and sobbed. I had conquered. After giving a few in-
structions as to his management I left
He got out of his bed in a few hours (a thing which
he had not done before for nearly three weeks). In two
days he went to work, and has lost no time on account of
sickness up to this date. I consider this a pure, un-
adulterated case of hysteria, and the only discoverable
cause disappointment in love.
The plan of treatment here used would not be ap-
propriate were the physician dependent upon patronage
for his practice and living, as he would not be called
upon again by the patient, and possibly not by the fam-
ily. The ant et potass, tartrate would probably be as
effective, and not productive of harm to the one pre-
scribing it.
Case II. — E. L , adult, laborer. While intox-
icated he fell into a chaldron of boiling oil. After ano-
dynes had been dispensed with he became wakeful, and
soporifics had little effect. I noticed that he fancied the
thermometer, and following the suggestion I impressed
him with its wonderful power. He said he could feel its
influence through the entire body. In from two to three
minutes after placing it in the mouth, he would be asleep
and remain so for several hours. I used it in this way
twice a day until his death, twelve days after the acci-
dent, from perforation of the duodenum.
Case III. — Consultation. Adult, woodsman. He had
bronchitis, but was nearlv well, when he suddenly " lost
his voice." This condition had lasted five days when I
saw him. I told him the doctor would get him an in«
strument, explained its effect, etc. He returned at the
appointed time still speechless. The doctor placed the
thermometer under his tongue, and had the pleasure of
seeing him perfectly cured by one application. The dis-
ease had not returned when I heard from him more than
two years afterward.
Cases IV. and V. are miners, adults, unmarried.
In Case IV. the hysteria took the form of " irritable blad-
der." Case V. "felt funny all over," nor could we evei
obtain a better description of his ailments. Both were
cured (not perfectly, but satisfactorily) with placebo
treathient. These cases are interesting, chiefly as illus-
trating the cause. The patients both masturbated to a
small extent, and will probably be permanently cured by
marriage.
After carefully studying the cause in all my cases,
male and female, I find that in the great majority of
them it is some disturbance of the sexual system or or-
gans. This is nearly always true in the feigned variety
of cases.
Dagus Minbi, Elk County, Pa. ;
Rectal Etherization. — Dr. W. H. Taylor, of New
Bedford, Mass., sends us the following : " Apropos of rectal
etherization, I beg leave to submit the following case :
On July 30, 1884, at 10 A.M., I made an attempt to close
a wound of the larynx which had been produced with
suicidal intent on May 15, 1884. Anaesthesia was at
first induced by ether applied on a sponge over the
wound. When full insensibility occurred, ether vapor
was conducted into the previously washed rectum from a
bottle in a water-bath at 140** F., supplied with a rubber
tube eight feet in length. About four ounces pf Squibb's
stronger ether were given by rectum, and all entered ex-
cept a few drops which had condensed in the rubber tube'
The apparatus was in charge of my friend; G. De N.
Hough, M.D., one of the internes of Bellevue Hospital
Notwithstanding the free entrance of the vapor, the pa-
tient manifested evidences of pain during the operation,
and stated subsequently that he was conscious during a
large part of the time. He sat up on the afternoon of
the same day, and partook of the evening meal as usual.
No trouble was experienced at any time from the ether,
except the failure to induce anaesthesia, "j
September 27, i884,]
THE MEDICAL RECORD.
347
Cardiopathy of the Menopause. — Under this title
Dr. £. Client writes, in the Zyon Midical of August
3 and 10, 1884, concerning a peculiar functional dis-
order of which he has had occasion to observe several
examples. The patients presented all the symptoms of a
profound disturbance of the cardiac functions without
any physicial signs of valvular lesion. The age at which
the first symptoms appeared was from forty-six to fifty
years. The patients presented nothing striking in their
personal or hereditary history. They were all well built,
healthy women, accustomed to manual or household
labor, but never exposed to excessive fatigue such as
might occasion cardiac hypertrophy. Some had borne
children, others had never been pregnant. There was
no hysterical element in the cases, nor had any of them
suffered from rheumatism. The first symptoms appeared
before the menses had ceased entirely, but when they
bad become irregular either in their time of recurrence
or in the amount of the flow. The onset was gradual.
During an indeterminate period, for perhaps two or three
months, the women suffered from an indefinite feeling of
malaise, their strength diminished and they were less
able to resist fatigue, and finally they began to suffer
from palpitation. The evolution of the £sease, while
progressive, is yet interrupted by intervals, more or less
extended, of apparent health, but each recurring attack
is more severe than the preceding one. The palpitations
are soon followed by dyspnoea on exertion, although
there is not the slightest difficulty of breathing when at
rest Sleep, however, is often broken by distress in the
region of the heart. After a time all these symptoms
become very niarked upon the slightest movement, and
are only alleviated somewhat when the patient sits per-
fectly still in the chair. Another phenomenon is a feel-
ing of faintness, which goes on sometimes to actual
syncope. The examination of the heart gives a negative
result. The cardiac impulse is a little exaggerated, the
rhythm may be irregular, but the valvular sounds are
distinct and without the faintest murmur, the first sound
being somewhat the weaker. There is, however, an ex-
treme rapidity of the heart's action, the pulse-rate being
often 150 to 160 to the minute. At first there is no
cedema, but after three or four attacks there may be a
slight swelling about the malleoli or in the integument
over the hypogastric region. Whatever may be the in-
tensity of the cardiac symptoms, there are no bronchial
nor pulmonary disturbances. The dyspnoea is entirely
of cardiac origin. There is never any venous stasis, but
there is an evident spasm of the arterioles. There is a
remarkable pallor of the face, which is due, the author
believes, to this vascular spasm rather than to anaemia.
The urine is in general abundant enough, except at the
height of an attack, when its excretion may be nearly
suppressed ; it never contains any albumen. The course
of the affection is peculiar, occurring as it does in par-
oxysms separated by intervals of varying duration. As
the disease advances the intervals of remission grow
shorter. The attacks last usually about a week, but
might be of longer duration were * it not for medical in-
tervention. The affection continues for an indefinite
period, but the prognosis is favorable despite the ap-
parently grave symptoms of dyspnoea, oedema, weak-
ness, etc. The -disease subsides as it began, the inter-
vals of health growing longer and the paroxysms shorter
and of less intensity. The cause, the author thinks, is to
be found in a modification of innervation by the great
sympathetic, and especially in excitation of the cardiac
nerves. The treatment is by means of large doses of
infiision of digitalis, beginning with an infusion of eight
gndns of the powdered leaves, and reducing gradually to
five grains. Sometimes the patients acquire a disgust
for this drug, and then Dr. Clement substitutes the alco-
holic extract of convallaria maialis in the dose of fifteen
to twenty grains. But the results are much less satis-
factory than when digitalis is employed. The paroxysms
of dyspnoea are best relieved by the preparations of opium,
more especially morphine. At the same time, of course,
the patients should remain as quiet as possible and avoid
anything that may cause mental or physical disturbance.
Malarial Orchitis. — Dr. Angelo Zacco relates in
the Gazetta degli Ospiiali, Nos. 16 and 18, 1884, the
case of a man who applied for relief on account of or-
chitis. The right testicle was swollen to three times its
normal size and was painful to the touch. There was
also a slight amount of epididymitis. The patient had
received no injury and had never had syphilis, gonor-
rhoea, nor mumps. All the ordinary remedies were tried
without effect, and as the patient was suffering from a
mild form of intermittent fever he was given quinine.
Under this treatment the swelling of the testicle rapidly
subsided. The author believed that the orchitis was
caused by direct action of the njalarial microbe carried
to the testicle in the blood stream.
Treatment of Sciatica by Congelation. — Actirg
upon the theory that blisters and other revulsive meas-
ures exert their therapeutic effects in sciatica through
the nerve terminations, M. Debore thought to act upon
a greater extent of surface and obtain a correspondingly
greater benefit by congealing the integument. This he
did in a number of cases by a spray of chloride of methyl,
and says that the effect was marvellous. The relief to
the pain was instantaneous, though there were some-
times slight relapses, which yielded at once, however, to
a repetition of the congelation. The spray was directed
wherever the patient experienced any pain, sometimes
over quite an extensive surface. The skin was blanched
temporarily and occasionally vesication was produced,
but ho other accidents occurred. The patients were all
men and free from any suspicion of hysteria. — Revue
MidicaUy August 16, 1884.
Myasis. — Under this title Dr. Posada-Arango de-
scribes, in the Journal de Medecine de Paris of Augjust
16, 1884, an affection caused by the deposition of fiies'
eggs in the nasal fossae. He relates a case occurring in
a farmer*s boy fifteen years of age. The patient was an-
noyed one morning by a fiy getting into his nostril, but
it soon emerged and no more was thought of it. Forty-
eight hours later he began to have pain in the nose, ac-
companied by a slight bloody discharge, and soon he
noticed a worm coming from the nostril. He com-
plained of severe headache and a noise within the head
like the rumbling of carts over a stony road. Dr. Aran-
go removed as many of the worms as he could by
means of a curette, and then injected a decoction of an
aromatic plant called cordoncillo (a sort of pepper plant),
and blew tobacco fumes into the nostril. By means of
these applications, frequently repeated, the nostrils were
finally cleared of about one hundred and twenty worms.
Of the fourteen cases of this affection hitherto reported,
nine ended fatally. The fly which deposits the eggs is
a little larger than the ordinary house-fly, and is of a
general bluish color, though presenting a green or violet
metallic hue when seen in certain lights. The worms
are white, pointed at the buccal and truncated at the
caudal extremity.
Acute Mania at the Menstrual Period. — Dr.
Cabad6 relates the case of a woman who, while menstru-
ating, lost her husband under very terrifying circum-
stances. Menstruation ceased at once and did not return
for eight months, during which time the patient was ex-
ceedingly nervous and suffered from slight convulsive
attacks. Later she had acute maniacal attacks at each
menstrual period, being perfectly sane in the intervals.
The mania recurred at each monthly period, and was
only controlled by large continued doses of bromide of
potassium. — Wiener Medizinische Wochenschrift, No-
vember 29, 1884.
348
THEu<MEDICAL RECORD.
[September 27, 1881
The Medical Record
A Weekly yournal of Medicine and Surgery,
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD & Co., Nos. 56 and 58 Ufayette Place.
New York, September 27, 1884.
MEDICAL MANNERS— ANCIENT AND MOD-
ERN.
A WRITER in an English exchange laments the decadence
of polite learning and punctilious manners among the
medical men of to-day. Once they were y^xy proficient
classical scholars. Now, alas, a little dog Latin, quantum
sufficit for prescription writing, is all that most of our
modern luminaries possess. ♦* Then," he continues, ** if
you meet some of our very old practitioners and contrast
their manners with the shining lights of to day the differ-
ence will be perceived. The gracious demeanor, the
courtly address, the punctilious observance of courtesy,
the accuracy of phraseology, the general tone expressed
in the word gentleman, are remarkable for their absence
in the leading medical men of to-day. Brusqueness,
dogmatism, self-sufficiency, brevity have taken their
place. Science is accountable for this. Only half edu-
cation could produce such men. Science contracts —
limits the range of reading. It confines the imagination
by which the soul grows. The old classical education
enlarged the bounds of reading and of interest. In the
old classical writers we find the almost perfection of
language, and I might even say of morality."
It may be admitted that there is some truth in the
criticism thus quoted. Nevertheless we are quite sure
that so far as the "minor morals and manners " are con-
cerned, a comparison of those of to-day with those of the
last century will show a vast advantage to the former.
In all ages there have been charges that virtue was de-
clining. Said some one to Dr. Akenside : ** Doctor, after
all you have said, my opinion of the profession is this : The
ancients endeavored to make it a science, and failed ; the
moderns, to make it a trade, and succeeded." This was
in 1759, and at the present day we hear the same melan-
choly accusation.
It may be admitted that a hundred years ago there
was more ceremonious politeness and a greater stress
laid upon conventional forms in social and professional
intercourse. But he who reads the history of those days
will be convinced that beneath the polished exterior there
was far more dislike, envy, and bad feeling than exist
to-day.
John Hunter died from a quarrel with his hospital col-
leagues. In the eighteenth century all medical Europe
rang with the quarrels between CuUen and Brown and
their respective adherents. In the time of Garth a furi-
ous war raged between the supporters and opposers of
the dispensary system. That was the age of scribblers,
and prominent physicians were constantly being lam.
pooned by their less known enemies.
Says Dr. Wynter to Dr. Cheyne :
" Eat grass, reduce thyself and die,
Thy patients then may live."
And some punctilious friend wrote of Sir Richard
Blackmore, schoolmaster and physician :
" In vain his drugs, as well as birch he tried,
His boys grew blockheads, and his patients died."
Dr. Armstrong, author of the " Art of Health," con-
fessed that he never attained a large practice because
** I could not tell a heap of lies in my own praise, nor
intrigue with nurses, nor associate, much less assimilate,
with the various kinds of pert, insipid, lively, stupid,
well-bred, impertinent, good-humored, malicious, oblig-
ing, deceitful, drivelling gossips ; nor enter into juntot
with people I did not like."
A great part of the courtly, not to say obsequions,
manners of the last-century physician was assumed as a
feature in his business.
"If you would be esteemed very wise, sober, and
grave," writes Mead to a young physician, " you should
then learn most obsequiously to fawn and soothe man,
woman, and child, since few else will thrive well."
It would be quite easy to cite many more illustrations
in evidence that there is now more mutual good feeling
and kindness, and less coarseness and vulgarity among
physicians than there ever has been. The tendency to
excessive specialism, at the expense of general knowl-
edge and culture, must be admitted, and scientific study
does not tend emollire mores.
It would be an interesting task to trace this gradual
decline of learning, in its broadest sense, among eminent
physicians of the past. Of the Elizabethan physicians
Lord Bacon says : " For you shall have of them anti-
quaries, poets, statesmen, humorists, merchants, divines '^
— everything in fact except skilful practitioners.
Later Sir William Temple paid a similar tribute to the
Faculty, which Dr. Johnson still later accepts with some
hesitation, ** Whether what Temple says be true, that
physicians have had more learning than the other facul-
ties I will not stay to inquire ; but I believe every man
has found in physicians great liberality and dignity of
sentiment, very prompt eflfusion of benevolence, and
willingness to exert a lucrative art where there is no
hope of lucre."
Of the modern physician it cannot be said that he is
a man of wide learning. He seeks rather to accumulate
scientific knowledge and technical skill. Whether a re-
action toward a more general culture, at least as a basis
for his education, might not be a greater help in the
practice of his art, is a burning question just now.
THE IMPORTANCE OF HOLIDAY SEASONS FOR PHY-
SICIANS.
When Addison tells us in the " Spectator " that " the pre-
servation of life should be only a secondary concern, and
the direction of it the principal," * he says what is very
true, for a well-directed life insures a healthful life. While,
therefore, the higher aim is to be approved, and undue
1 Spectator^ No. 35.
September 27, 1884.]
THE MEDICAL RECORD.
349
solidtude about the health should be condemned, it is
onderstood that when to every man in the performance
of his daily duties work becomes irksome and painful,
respite is imperatively demanded, he cannot longer per-
sist in his tasks without physical detriment
It cannot be too much kept in mind that labor is
physiological only when it is agreeable, and that every
hour spent in goading a tired organism to toil, may
have a pathological outcome. When study is attended
with that sense of bien itrt which indicates that the brain
is abreast of its tasks, then and only then is it profitable ;
all experience will attest this. When the physician can
go through his regular routine of daily calls with interest,
even with zest, and a flow of spirits, he is working to ad-
vantage ; when interest flags and the spirits droop, and
there is organic discomfort, it is time for him to have a sea-
son of rest ; all this is so plain as to need only to be stated.
Now that the holiday season is well-nigh over, and
business men are returning to their offices and clergymen
to their pulpits, it is well that that model of perseverance
and devotion to a good calling, the city physician, who
has been sweltering at home during the hot season, should
ask himself whether he can afford not to take suitable
holiday enjoyments ?
The question hardly deserves discussion, for every
medical man will be ready to give the proper answer in
its application to everybody but himself. He knows
that it is a law of nature that physicians, as well as other
men, should have periodical seasons of rest, relaxation,
and recreation. He is ready to urge upon his patients
the importance of their availing themselves of the hy-
gienic benefits of frequent change of scene. He tells the
active man of business, the public officer, the banker, the
merchant whose liver and whose kidneys are becoming
sluggish, whose brain will not work well, to get out of
the old ruts, and he orders the dyspeptic clergyman from
his pulpit to the prairies, the forest, or ocean. As for
himself, however, while others go to the seaside he stays at
home ; the peculiar nature of his profession forbids that
he should absent himself from his office longer than a day
or two. The clergyman's salary goes on as usual while
he is away, and the manufacturer may direct his business
by telegraph or by letter, but the physician sees the per-
spective of his vacation pleasures marred by a dark back-
ground of lost fees and estranged patrons; in short,
pecuniarily he cannot afford the recreation he needs.
We are speaking, of course, of the great body of strug-
gling practitioners, who have every interest in keeping
what practice they have and in adding thereto— not of
those fortunate ones who were born with silver spoons in
their mouths. There is, moreover, an important distinc-
tion to be made in this respect between city and country
practitioners. The city physician is subjected to causes
of ill-health from which his country confrere is compara-
tively exempt. The latter habitually breathes purer air ;
has invigorating rides over hill and plain where nature in
her grandeur and loveliness breaks in on the monotony
of his toil ; if he has but a few patients, these scattered
over a wide area occupy the larger part of his time, giv-
ing him his fees and mileage ; he has some gardening,
and perhaps some farming, which distract his mind from
the cares of his profession, if they do not add much to
his income ; his taxes are less than those of his city
brother, and it costs him in every way less to live. He
has fewer eager competitors, and has far less reason for
harassing anxiety than his metropolitan friend. If the
latter has social and aesthetic and professional advan-
tages of a higher order, and more leisure for study and
research, his manner of life is more sedentary and conse-
quently less invigorating, and he labors under the disad-
vantage of not being able to live easily on a thousand a
year ; he has a multiplicity of cares and wants that are pe-
culiar to his condition ; he feels constantly the pressure of
fierce competition, and unless possessed of rare equipoise
of temper and a philosophic mind he will be given to
worry, and this, whether his practice be considerable, or
whether it be little. Statistics have shown that out of
equal numbers of city and country practitioners the bal-
ance of longevity is in favor of the latter, who seem, as
we have indicated, to be especially favored in the benev-
olent economy of nature. It is apparent then, that reg-
ular holiday seasons must be of great hygenic benefit to
every hard-worked medical man, and especially to the
harassed practitioner of the town, to whom it is, indeed,
a physiological necessity.
Some time since we had a brief conversation with a
medical gentleman of repute in a neighboring city, who
acknowledged that he had not for ten years had a vaca-
tion of even one week ! The experiment, he affirmed,
would have been too perilous ! He felt that he must be
at his post day and night. He had a large family to
support, and he had no practice to lose. He never
needed money more, and cessation from work would be
ruin I On questioning this individual we ascertained
that life was to him a constant worry, and work was
pain. Appetite and digestion were failing, and he no
longer slept well He had become *' disgusted with his
practice and with his patients,'' and it was with difficulty
" that he could treat them with any sympathy and pa-
tience.*' '* I hate those old cases, and those old faces/'
he said, "collecting has become irksome, and the sight
of an unpaid bill makes me desperate." Some vehement
expostulation on our part, and urging of our friend to
break away from his work at whatever risk and cost finan-
cially, was certainly of no avail ; and we have within a
few days seen in a local paper the notice of his death,
"from mental alienation and softening of the brain."
We do not doubt that there are many in the profession
to-day who are the subjects of experiences similar to
those above depicted, and who have the same appeals
from the depths of the unconscious life; appeals and
warnings which cannot safely be disregarded. It will
not do to trifle with these imperious feelings of the or-
ganic nature, indicative of discomfort, maladjustment,
and uncompensated waste in the highest centres of in-
nervation. The part of true economy, as well as the
part of duty, is always to seek suitable relaxation and rest.
THE PROGRESS OF THE COLLECTIVE INVESTIGATION
MOVEMENT.
As the result of considerable previous work on the part of
GuU, Paget, Clark, Lister, and other English physicians,
an International Committee on Collective Investigation
was organized at the meeting of the Medical Congress
in Copenhagen. This Committee, after two meetings,
arranged for the nomination of the following Working
350
THE MEDICAL RECORD.
[September 27, 1884.
Committee at the close of Sir William GulVs address :
For England, Gull, Humphry, and Mahomed; for India,
Fayrer ; for Denmark, Trier and Lange ; for Scandinavia,
Bull ; for Russia, Rauchfuss ; for Switzerland, Despine ;
for Germany, Ewald and Bernhardt ; for Austria, Schnitz-
ler and Pribram ; for France, Bouchard and Lupine ; for
the United States of America, Jacobi and Davies ; for
South America, Gutierrez Ponce. Professor Koranyi
was subsequently added as representative of the kingdom
of Hungary.
The above Committee immediately met and organized.
Its first work was to appoint an Executive or Sub-Com-
mittee, which was done in the following resolutions :
1. That the Secretary be instructed to prepare a state-
ment as to the objects of the Committee, for translation
and publication in the journals of the various countries
represented.
2. That a Sub-Committee be appointed.
3. That for the present it consist of not more than
three members.
4. That the three members be Professor Humphry,
Dr. Mahomed, and Dr. Isambard Owen.
5. That the Sub-Committee be directed in the first
instance to prepare a list of subjects suitable for investi-
gation by the Committee, and to submit the list to the
members of the Committee for choice ; further, upon such
choice being made, to prepare memoranda and questions
upon the subjects chosen, and submit them to the mem-
bers of the Committee in like manner ; and that, upon
the acceptance of the memoranda and questions by the
members of the Committee, the representatives of each
nation be left to obtain the information required, inde-
pendently, in such manner as they may prefer.
6. That each member of the Committee be requested?
on returning home, to write his views on the subject of
the proposed investigation to the Sub-Committee, who
will communicate again with the members.
Thus the work stands for the present.
It is getting to be more and more felt by the medical
world that collective investigation is to be a power-
ful agent in medical progress. But it is still more surely
seen that it is an agent which has to be managed very
carefully. There are only certain lines of medical inquiry
along which it will as yet serve any good purpose. And
eventually it will be found that to get trustworthy results
collective investigation must be confined to professional
men of known character and capacity, in other words,
collective investigation must be limited to experts.
FURTHER CONTRIBUTIONS TO THE CHOLERA GERM
QUESTION.
Dr. H. Van Dyke Carter, of Bombay, in The Lancet iox
-September 6th, describes the results of his investigations
of cholera stools. He has discovered an organism which
he figures, and which certainly resembles very much the
comma-bacillus of Koch. As Dr. Carter represents it,
however, it is longer and has more of the spiral curves,
being unmistakably, if the drawings are correct, a spiril-
lum. This organism was not found in every case of
cholera examined, while it was found, though rarely, in
the stools in dysenteric and diarrhoeal cases. Its real
character was not tested by cultivation, however, so that
Dr. Carter's observations have in themselves but little
value.
From Marseilles come reports of a different nature
regarding the cholera organism. Drs. S. Maurin and
Lange, who have been working in that city since the
departure of Koch, announce that they have found a
mucor which they believe to be the actual agent in the
propagation of cholera. This mucor is really only the
mature form of the comma-bacillus, out of which it de-
velops.
It appears, according to an account given in the Brit"
ish Medical Journal^ on the fourth or fifth day, on the
putrefying stools of cholera, and on these only. It has
the form of a mycelium, the tapering ends of which are
surmounted by cup-shaped sporangia, which burst on the
slightest agitation, discharging vast numbers of spores.
These spores require, for their germination, to be de-
posited on, or to come into contact with, some putrid
organic matter, when they develop into a mucor of
another form, an anaSrobium, which they believe to be
the immediate cause of the phenomena of the disease,
and which again, in its turn sporifying, gives birth to the
bacilli of Koch.
The bacilli in themselves are innocuous, but, deposited
on a putrid medium, and in contact with the air, they
develop the first-mentioned mucor, and the cycle is re-
newed.
The first mucor, unlike the bacillus, possesses in a
high degree the power of resisting the action of so-called
disinfectants ; it is not killed by ten-per-cent. solutions ,
of nitric or of hydrochloric acid ; it vegetates freely in a ]
solution of carbolic acid in like proportions, and can sus- j
tain any temperature up to 150° Cent (302® Fahr.), but
above this it breaks up, as it does also in a ten-per-cent
solution of tincture of iodine ; and a specimen mounted
in oil of turpentine went through its whole development
up to the discharge of its spores.
The British Medical Journal is inclined to give some
credence to the above-described account. It appears to
us, however, to be beyond the bounds of probability that
the cholera bacillus should have any such life-history
as the Marseilles investigators assert. Dr. Koch culti-
vated it in gelatine, in broths, and on potato, yet never
found any such mucor as MM. Maurin and Lange de-
scribe.
EXAMINATION FOR ALBUMINOSE OR PEPTONE IN ^
THE URINE.
In 1872 Tanret proposed, as a reagent for the quan-
titative determination of the albumen, the acetic solu-
tion of the iodide of mercury and potash, of which the
formula is iodide of potassium, 3.32 grms. ; bichloride of
mercury, 1.35 grm. ; acetic acid, 20 c.c. ; and distilled
water, 64 cc. As an agent for the precipitation of al-
bumen, says Mehn, this reagent is valuable ; it does not
precipitate urea or mineral salts ; it is very sensitive and
much superior to nitric acid, needs no heat and keeps
well.
Three years ago Mehn discovered that this solution
precipitates the proteid material known as albuminose
or peptone. In examining a very limpid acid urine,
shaken until quite frothy, he has found that afler separ-
ating the albumen coagulable by heat, a certain degree
September 27, 1884.]
THE MEDICAL RECORD.
351
of agitation still caused considerable frothiness. The
urine contained neither pus, sugar, nor blood, yet the
solution caused, in this urine deprived of albumen, an
abundant precipitate, which water acidulated with acetic
acid and alcohol did not dissolve. Furthermore, he has
several times examined urines which contained no albu-
men, but only albuminose or peptone coagulable by this
reagent, and also a mixture of coagulable and non-co-
agulable albumen. In some specimens of urine he has
found coagulable albumen ; this being removed the urine
was still feebly clouded by nitric acid. This second
cloud being removed, he obtained an abundant precipi-
tate, due to peptone, by the acetic solution of the iodide
of mercury and potassium.
Various attempts have been made to extract the
whole of the coagulable or non-coagulable albuminous
material with five volumes of alcohol, after acidulating
with acetic acid, and also to obtain the albuminose of a
liquid deprived by heat and filtration of coagulable albu-
men. It has been found that the results are of no value,
since the peptone is not altogether insoluble in the alco-
hol The addition of ether to the filtrate still gives an
albuminous precipitate. Nor have any very satisfactory
results been obtained by emplo3ring neutral solvents,
such as absolute alcohol and sulphide of carbon. The
solution under consideration seems to give the best re-
sults. Specimens of urine containing peptone seem to
be rare, although some observers seem to think that the
cloudiness caused by the mercury reagent in boiled urine
is entirely due to that body.
At present we do not possess any means of isolating
albuminose or peptone, other than those which com-
bine with the materials from which it seems impossible to
separate it without altering it ; and the rules which ap-
ply to ordinary or artificial peptones do not apply to
urine peptones, and cannot until the identity of the two
has been demonstrated, which has not as yet been done.
While it is theoretically admitted that all albuminous
materials subjected to the action of pepsin, at a suffi-
ciently elevated temperature, finally gave a peptone
whose centesimal composition is constant, it is not the
less true that under the name peptones are embraced
products distinguished by their different reactions with
the same reagents. Peptones obtained by the action of
pepsin are precipitated by the iodide of mercury and
potassium solution, whilst those obtained by the action
of pancreatine are not.
This solution is also quite sensitive to the presence of
semen in urine, giving a precipitate which is more or
less abundant. While, therefore, a valuable reagent for
the detection of peptone, it should be used with great
care, as errors may result fi-om the formation of other
precipitates.
PUERPERAL EPILEPSY.
Thb older writers, says M. Ch. F6r6, believed eclampsia,
whether infantile or puerperal, to be a neurosis analo-
gous to epilepsy or hysteria. But since it has been dis-
covered that in scarlatina and pregnancy there is often
albuminuria, it has been the custom to explain all cases
of eclampsia in these conditions by the action of the
poisoned blood upon the nerve-centres. M. F6r6 has
brought forward in the Archives de Neurologie of July,
1884, some observations and reasons in support of the
view that puerperal eclampsia, for example, is the expres-
sion of a neuropathic state in which the conditions in
pregnancy are only the exciting cause. Puerperal
eclampsia, he thinks, may be regarded as an acute epi-
lepsy or an *' eclamptic epilepsy."
If the antecedents be carefiilly inquired into, in cases
of puerperal eclampsia, there will generally be found,
says F^r6, a hereditary or acquired neuropathic history.
A number of cases are cited also in which the puerperal
eclampsia, so-called, was only the beginning of a chronic
idiopathic epilepsy.
The influence of pregnancy upon the course of epilepsy
has been investigated by several observers with some-
what contradictory results. On the whole, however, it
appears that during pregnancy the number of epileptic
attacks is diminished. It is also well known that epilep-
tics, and " neuropathies " generally, often pass through
pregnancy and even scarlatina without any convulsion.
In explanation of these facts, however, Ykxk puts for-
ward the view that in those disposed to epileptic attacks
there exist various epileptogenic zones, €,g,^ gastric,
uterine, peripheral, etc In some cases the irritation
must be gastric or peripheric, in other cases uterine, in
order to excite the paroxysm and call forth the disease.
It is known that in puerperal eclampsia, albuminuria
does not always exist Thus Charpentier alone dtes one
hundred and forty-one cases of this kind (*' Traits pra-
tique des accouchements," 1883). And Nothnagel admits
that puerperal eclampsia b sometimes the result of an
irritation of the uterine or sacral nerves acting upon an
unstable nervous system.
Finally, many persons suffer from albuminuria and
some degree of uraemia without having convulsions.
M. F6r6 has made out a case, therefore, which deserves
some attention. Physicians should not be too ready to
ascribe puerperal eclampsia entirely to blood-poisoning.
They ought to be especially watchful when patients who
are pregnant have a well-marked neuropathic history.
At the same time, practical experience shows that the
large majority of nervous and hysterical women go
through pregnancy safely, showing that the pregnant
uterus does not often become an epileptogenic zone.
INFANT FEEDING.
Upon nothing does there seem just now to be more
disagreement than the subject of infant diet The
points in dispute are : the mode of diluting cows' milk
and the best diluent ; the use of mixed milk or of the
milk from a single cow ; the value of condensed milk ;
the value of infant foods ; the question of a wet-nurse
or artificial feeding. These points are by no means sat-
isfieictorily settled. One evidence of this is seen in the
letters which appear in the present issue of The Record.
We observe, also, in a current issue of The Lancet and
Clinic^ a carefully written article by Dr. C. W. Earle, in
which he says, among other things, that <' condensed
milk seems to agree with a considerable number of chil-
dren, but in many cases a sufficient quantity is not given
to nourish a child. Used in sufficient quantities, and
diluted with rice- or barley-water, it is without doubt one
of the best of artificial foods." On the other hand, the
352
THE MEDICAL RECORD.
[September 27, 1884.
editor of The Kansas City Medical Record, in an exceU
lent article upon the subject of infant diet, states that
condensed milk has always proved hurtful in his hands.
Some contributions from our readers to this subject of
infant feeding would be timely. Writers should, how-
ever, be careful not to go over old ground more than
possible.
PATIENTS FROM THE COUNTRY OBTAINING ADVICE
FREE IN THE CITY.
The thricetold tale, yet always of painful interest to
the stmggling rural practitioner, concerning the abuse of
medical charity, comes to us from Connecticut in a
communication from Dr. Donaldson to the Medical So-
ciety of the County of New York. We are glad to refer
to the practice, that we may condemn it.
It appears useless to say that rich patients from the
country have no right to gratuitous services. They come,
nevertheless, and the college clinics and hospital wards
welcome them with an eager cordiality not to be mis-
taken. It is safe to say that it is impossible to find out
the pecuniary liability of every stranger, but, with a little
care on the part of clinical lecturers and hospital men,
the evil can be very much lessened. It is perfectly com-
petent for such gentlemen to refuse to prescribe for
Any but the really needy; but, we regret to say, the
thirst for clinical material overcomes many other con-
siderations, and we oftentimes find ourselves preaching
in vain, and are as far from a remedy as ever.
i:ewB tit Wit ^aetjeeii.
The Management of the New York Polyclinic,
have during the past summer made some improvements
which have added greatly to the capacity of the school
and the comfort of the physicians who study there. The
library, waiting- and reading- rooms have been enlarged
and newly and neatly furnished. The clinic-room for
diseases of the throat, nose, eye, and ear has been made
iwice the former size, and has now thirty-one stalls and
Mackenzie condensers, which as many students can em-
ploy at once. On the second floor are three large, iwell-
lighted and ventilated lecture- and clinicrooms, capable
■of seating in all three hundred persons, a laboratory
with twenty stands, two waiting-rooms for patients, and a
private examining-room. The school has been furnished
with stationary and portable batteries, electric bells and
-clocks, which are sounded at the hours. In one amphi-
theatre the clinics in gynecology, surgery, and skin
<iiseases are held. The second lecture-room is devoted
to clinics in diseases of children, diseases of the mind
And nervous system, and orthopedic surgery. A third
room is used for diseases of the chest, physical diagnosis,
general medicine, and practice in surgical dressings,
bandaging, etc. During last session, as shown by the
catalogue, one hundred and eighty-two practitioners
studied at the Polyclinic. The purchase of the large
property heretofore in part occupied by the Polyclinic,
means that the management believe in the future of this
institution. During the coming year the following
clinics will be given weekly : gynecology, surgery, dis-
eases of children, diseases of the skin, diseases of the
mind and nervous S3r8tem, eye, throat, nose, and ear,
clinical chemistry, obstetrics, chest, diagnosis, and medi-
cine.
Mr. Lawson Tait, who has been on a brief visit to
this country, sailed for his home on Saturday last. On. the
Friday evening preceding he and Mrs. Tait were enter,
tained at a dinner given in their honor by Dr. and Mrs,
Fordyce Barker. Among the other guests present were
Dr. and Mrs. T. A. Emmet, Drs. T. G. Thomas, Isaac
E. Taylor, W. T. Lusk, W. M. Polk, A. A. Smith, and
George F. Shrady. It is needless to say that the occasion
was an enjoyable one to all concerned.
Ramsey County Medical Society and the Death
OF Dr. Stewart. — At a special meeting of the Ramsey
County (Minnesota) Medical Society, held at Dr. Stone's
office, the following resolutions were unanimously adopted :
WHiereas^ In the sad and sudden death of Dr. J. H.
Stewart this Society recognizes its loss of an esteemed
and respected member ;
Resolved^ That we, his former associates, desire to re-
cord our sorrow and testify our warm appreciation of his
professional and manly qualities. He was learned and
more than ordinarily skilful in the practice of his profes-
sion, endearing his patients to himself by a most happy
faculty. By his death we have lost a professional as-
sociate, conscientious and considerate, whose wise and
superior counsel we shall deeply miss.
Resolved, That we deplore the loss to the community
of which he was so eminent and respected a member,
and whose trusts so frequently confided to him were so
conscientiously and honorably guarded.
Resolved^ That we tender to his greatly bereaved
family our deepest sympathy.
Resolved, That a copy of these resolutions be forwarded
to the family, and that they be printed in the daily papers,
the Northwestern Lancet, and the New York Medical
Record.
An Office Fraud and Confidence Man Abroad.
— A young, short, thick-set mulatto (a graduate of the
College of Physicians and Surgeons, New York) is going
about town obtaining money from physicians and others
on one of many pretexts which appeal to one's sympathy.
Numbers have been victimized by the scamp. We learn
that the fellow has been carrying on this peculiar business
for some years, and that he has served a term in Sing
Sing Prison for forging the name of the Rev. Dr. Deems,
of this city, on a check.
A Complimentary Dinner was tendered to Dr. J. V.
Shoemaker, of Philadelphia, by his friends, on his return
from Europe, at the St. George Hotel, on Saturday even-
ing, September 20, 1884.
American Gynecological Society. — The Ninth An-
nual Meeting of this Society will be held at the Palmer
House, Chicago, Tuesday, Wednesday, and Thursday,
September 30 and October i and 2, 1884.
Assistant Physicians Wanted in the Hudson
RrvER State Hospftau — ^To fill a vacancy in the office
of First Assistant Physician at the Hudson River State
Hospital, and for the appointment of a Third Assistant
Physician and Sanitarian at the said hospital, open
competitive examinations of applicants for the ap>
September 27, 1884.]
THE MEDICAL RECORD.
353
pointments will be held under the rules of the New York
Civil Service Commission, Candidates for the positions
will be examined in general medicine and surgery ; in
psychiatric medicine ; in the anatomy, physiology, and
pathology of the brain and nervous system ; in the use
of the microscope and instruments of precision ; in sani-
tary science and hygiene; in foreign languages; and
also in regard to special qualifications for the respective
appointments.
It is required that candidates be graduates of a repu-
table medical college, and have completed the term of
service required by a regular appointment in the resident
medical stafif of a general hospital, and that they be
familiar with the practice of home and foreign institutions
for the insane.
There are no restrictions imposed as to the residence
or citizenship of candidates.
The examinations will be held at such times and places
as the Civil Service Commission may designate. Ten
days' notice of each^examination will be mailed to all
eligible applicants of record, and will be published in the
State paper, and in one other journal published in Albany.
Applicants will be admitted to examination upon the
production of the official notification to appear for that
purpose.
The First Assistant Physician will receive $3,000
salary per annum and bis board ; the Third Assistant
Physician will receive $1,000 salary per annum and his
board
Printed application papers for admission to the com-
petitive examinations will be mailed to candidates on
application to Dr. Joseph M. Cleaveland, Superintendent
Hudson River State Hospital, Poughkeepsie, Dutchess
County, N. Y. Applications must be forwarded on or
before October i, 1884.
Mississippi Medical Society. — The Tenth Annual
Meeting of the Mississippi Valley Medical Society (**^The
Tri-State Medical Society ") will be held at Springfield,
III, September 23-26, 1884.
American Public Health Association. — ^The open-
ing session of the Twelfth Annual Meeting of the
American Public Health Association will be held on
Tuesday, October 14th, in the main hall of the Lieder-
kranz Building, St. Louis.
The National Conference of the State Boards of
Health, postponed from August 7th, at Washington, will
also be held here during the same week.
Open to Universal Competition. — The Cartwright
prize of the Alumni Association of the College of Phy-
sicians and Surgeons of New York is open to the com-
petition of the alumni of any medical college.
It consists of a prize of $500, to be awarded to
the best medical essay submitted upon any subject the
writer may select. The award will be paid as soon as
the successful article shall have appeared in print.
If no one of the competing essays be deemed suffi-
ciently meritorious the prize will not be awarded. An
essay in order to be held worthy of the prize must con-
tain results of original investigation made by the writer.
An award of this prize will be made at the commencement
of 1885. Essays must be sent to a member of the Prize
Committee before April i, 1885. Competing essays
must each be marked with a device or motto and ac-
companied by a sealed envelope similarly marked con«
taining the name and address of the author.
IL W. Amidon, M.D., 18 W. Twenty-first Street,
Chairman; Robert Abbe, M.D., 32 E. Twenty-fifth
Street; Waiter Mendelson, M.D., 209 W. Forty-sixth
Street, Committee on Prize Essay.
Victor Hugo and the Ambulance Service. — ^The
establishment of an ambulance service like that in New
York is very nearly an accomplished fact irf Paris. Dr.
Henri Nachtel has published a pamphlet upon the sub-
ject. It is prefaced by the following characteristic let-
ter from Victor Hugo :
31 JuiUet, Z884.
New York has begun, Paris will continue. That
which you advise. Monsieur, is sustained by reason and by
evidence. Success will confirm your confidence. The
plan is clear, it is appropriate, it is humane. I com-
mend you and I congratulate you. Victor Hugo.
The Singular Persistence with which the Midland
Medical Miscellany continues to appropriate editorials
and other matter from The Medical Record without
acknowledgment interests us very much. It is fur-
nishing us an exciting psycho-journalistic study. It is,
we think, an exquisite case of moral SchwcUhezusiand^ or
perhaps of imperative conceptions (combined with pre-
hensions), there being in its midland mind no solution in
the general continuity of the tneum and iuum.
An Anthropological Congress was held recently in
Breslau. Among the interesting contributions made at
that time was one by Professor Schaffhausen, of Bonn, who
has found, as the result of a series of cranial measurements,
that the antero-posterior or longitudinal growth of the
skull ceases before the lateral growth, and that the lon-
gitudinal growth bears a distinct relation to that of the
body, while the lateral growth stands in relation to the in-
telligence. Here is then a physical basis for the school-
master to work upon in assigning his tasks and making
his prophecies.
Prizes for Essays on the Prevention of Blind-
ness.— At the Hygienic Congress held at the Hague,
August 27th, a prize of 2,000 francs was awarded to Dr.
Fuchs, of LUttich, for an essay on the ** Causes and Pre-
vention of Blindness." The prize of 1,000 francs offered
for an essay on a similar subject was awarded to a Ger-
man author, whose name, strange to say, could not be
discovered.
Works of the Late Dr. Farr. — A movement is on
foot to collect and publish the statistical papers of the
late Dr. Farr. The editor will be Mr. Noel Humphreys.
The Hygienic Congress at the Hague has unan-
imously adopted the propositions of Professor Proust
expressing the desirability of the meeting of a new Inter-
national Sanitary Conference and the creation of a per-
manent international scientific committee to act against
epidemics. It has also passed a resolution in favor of
an international sanitary code. Holland will be asked
to be the interpreter of the views of the Congress to the
other Governments. In the Second Section, on the 27th
ult., a long debate took place upon cremation. In the
general meeting of the Congress, Mr. Corfield, of Lon-
don, defended the axiom that science is the enemy of
354
THE MEDICAL RECORD.
[September 27, 1884.
disease. M. Trelat, of Paris, spoke upon the tempera-
ture which should be maintained in dwelling-houses.
Mrs. Bovell-Sturge, of London, condemned the system
by which at present the State provides for the education
of children who have been abandoned by their parents,
and advocated their being educated in private houses.
A New Hospital at Romb. — ^The Pope has given
$200,000 for the erection of a new hospital at Rome
near the Vatican.
•
More Yellow -Fever Cases in New York and
Brooklyn. — Two sailors died of yellow fever at the
Long Island College Hospital last week. They came
from the West Indies on the British steamer African,
and landed at Perth Amboy, N. J.
A steerage passenger on the Newport, from Havana,
which arrived at this port recently, was found at a hotel
on West Fourteenth Street apparently suffering from
yellow fever. He was at once put in quarantine.
At this time of year there is no possible danger of
yellow fever extending through the city.
The Sanitary Council of Maryland held a suc-
cessful meeting at the Blue Mountain House, September
1 7th, 1 8th, and 1 9th. Among the subjects discussed were :
"The Adulterations of Food and Medicines;" "The
Pollution of the Water-courses in Maryland;" "The
Relation of the Diseases of Animals to the Human Race ;"
" The Sanitary Problems of the Cities and Towns of
Maryland ;"" The Relation of the Press to Sanitary
Work ;*' " The Relation of Teachers to Sanitary Work ;"
"The Physical Dangers of Alcoholic Beverages;" "The
Relation of the Clergy to Sanitary Work ;" " The Duty
of State and Municipal Governments in Connection with
the Public Health ;" <* The Disposal of the Dead."
A Reception to Dr. Playfair, of Lopdon, was
tendered by Dr.. T. Addis Emmet at his residence in this
city, on September 26th.
Medicine at Winnipeg, Manitoba. — A correspondent
of the Canadian Practitioner writes : " Manitoba has
been making the same rapid strides in medical matters
as in all other departments. With the rapid influx of
people came an equally rapid increase of doctors, until
we can boast of the largest proportion of medical men to
the total population of any province in the Dominion.
Indeed, at present, the field is too well occupied, espe-
cially in our cities and towns. Without doubt, however,
there are many points in rural districts where a doctor's
presence would be hailed with pleasure, and where he
could make a present living and be reasonably sure of a
future reward commensurate with the arduous nature of
his early work." Winnipeg having got a medical school
started, is soon to have a hospital.
Doctors in Canada and the United States. —
There are, says Dr. Sullivah, three thousand five hundred
and seven physicians in Canada, or one to about fifteen
hundred inhabitants. Indiana with about the same popu-
lation as Ontario, has three thousand two hundred and
seventy-five more doctors. Canada has about nine hun-
dred medical students distributed among eight medical
schools.
The Philadelphia Maternity Hospital.— The ob-
stetrical staff of this hospital has filed a petition with the
managers asking for the appointment of a female resident
physician.
The MosQurro as a Yellow Fever Vaccinator.—
The editor of the St, Louis Courier of Medicine gives an
account of the studies of Dr. Carlos Finlay {Cronica
Medico quirurgica de la Habana\ with reference to mos-
quitoes and yellow fever. Dr. Finlay believes that he
has demonstrated that yellow fever is inoculable by the
sting of the Cuban day-mosquito during the third, fourth,
fifth and sixth days of its evolution, but not during the
first two days nor after the sixth, no matter what be the
severity of the symptoms at those periods. The dura-
tion of incubation ofifers the same variations in the inocu-
lated as in the natural disease, in either case varying
from five to twenty-four days. The duration and inten-
sity of the fever produced by inoculation by the mosquito
appears to be in proportion to the number of punctures
and the quantity of inoculable matter retained by the in-
sect's sting. The inoculation by one or two punctures
in no case produced any other morbid phenomena than
those of benign natural yellow fever. Dr. Finlay thinks
that the results already obtained warrant the assertion
that the inoculation of yellow fever by one or two mos-
quito bites is a plausible means of imparting, without
peril, immunity against the severe forms of the disease to
which those are exposed who dwell in an infected dis-
trict.
Through Quarantine. — Our India medical exchanges
smell so strongly of smoke and carbolic acid as to give a
realistic sensation of the existence of an epidemic.
A School of Dentistry is to be opened at the be-
ginning of the winter term at the University of Leipzig,
under the direction of Professor Dr. Fr. Hesse.
The Medical Department of the Prussian War
Ministry, assisted by the Medical Department of the
Bavarian and Wurtemberg War Ministries, and the Saxon
Sanitary Board, are now bringing out a sanitary report of
the German armies in the Franco-German war of 1870-
71. The first and fourth volumes have just appeared, r
Mr. Tait's Tribute to the Medical Colleges.—
Mr. Lawson Tait has heralded his entrance to this coun-
try by some very flattering remarks. He wishes now
that he had come to America instead of Germany to
finish his medical education; and he prophesies that
" ere long it will be to the medical schools of America
rather than of Europe that English students will travel, "*
before settling in practice. This is very'complimentary,
and it has already been appropriated by some of our
contemporaries as a truthful tribute to the medical col-
leges of the United States, although Mr. Tait had not
left the Dominion when he made the remark. Let us
not be too easily caught by a somewhat overloaded com-
pliment.
Dermatology in Paris and Vienna. — For a long
time it has been noticeable that whoever writes letters
from medical Vienna is sure to say a great deal about the
dermatological teaching. Vienna has certainly won pre-
eminence through the*world in this department of raedi-
September 27, 1884.]
THE MEDICAL RECORD.
355
cine. In a recent issue of Le Progrls Medical thejjd-
itor devotes a long article to the subject of the decadence
of dennatology in Paris, and its flourishing condition in
^enna. In Paris dennatology is at a low ebb because
the clinics are not well organized and the material at dis-
posal not utilized. There seems to be a good deal of
official dulness and obstruction at the bottom of it all.
In Vienna the clinics are well organized, the material is
centralized, and all can be made use of. Perhaps the
large excess of ignorance, filth, and syphilis has some-
thing to do with tbe brilliancy of the skin clinics. Vienna,
though a great medical centre, has one of the highest
mortality rates in Europe. Le JProgrh Medical advises
the reorganization of the H6pital St. Louis, which con-
tains a wealth of dermatological material.
Instruction in the Methods of Examining Micro-
organisms.— It is well known that the ordinary examina-
tion of fluids and tissues for micro-organisms does not
involve, generally, any very delicate, or complex pro-
cedures. No doubt in time a practical acquaintance
with these details will be thought as necessary to the
student as dissection. Educational institutions already
3ee the need of teaching '* bacteriology.'' Recently the
Berlin Government has taken a new step. Herr von
Gossler, Minister of Public Worship, Education, and
Medical Affairs, has ordered that a certain number of
medical men are to be summoned to Berlin every year,
to go through a course of study, lasting from a fortnight
to three weeks, in order to learn the new methods of in-
vestigation connected with bacteria and micro-organisms,
but chiefly to become acquainted with everything con-
nected with the comma-bacillus and the methods of
cultivating it according to Koch's method. The several
Federal Governments have been already requested to
select a number of medical men for this course, and to
inform them to hold themselves in readiness to come to
Berlin. The day for the commencement of the first
course, says the British Medical Journal^ has not yet
been fixed, but will be very shortly.
The CHOLERA.-^The epidemic continues to decline.
The number of cases reported in Italy, September 17th,
was 581 ; a week later the number was 435. During
the same time the daily number of new cases in Naples
has fallen from 463 to 251. The total number of deaths
from cholera in Italy up to September 24th was 7,212.
This represents fully twice that number of cases. The
mortality in the past weeks, if correctly given, has aver-
aged over fifty per cent., showing that the disease is very
malignant or treatment is very ineflectual. It is prob-
able, however, that the number of cases reported is much
below the truth.
In the south of France the cholera continues to at-
tack small towns, but with no great severity. There have
as yet been only about 300 cases in Spain, and these
chiefly in the Eastern Pyrenees.
CuiciDE OF A Medical Student. — Mr. John F. Keat-
ing, a medical student in the Medical Department of New
York University, committed suicide last week by shoot-
ing himself with a pistol. The cause given by him was
the sickness and approaching death of his mother. It
seems probable that he was not sane at the time.
THE SIMS MEMORIAL FUND.
To the Medical Profession and Others throughout tht
World:
The great achievements of Dr. J. Marion Sims call
for some more lasting testimonial than obituaries and
eulogies. To him medical science is indebted for much
brilliant and original work, especially in gynecological
surgery. Those who have been benefited by his teach-
ings and new operations, and such as have had the direct
advantage of his personal skill are among the first to
recognize and acknowledge this debt
To him is due the honor of giving the first strong im-
pulse to the study of gynecological surgery in America.
It is believed that the medical profession everywhere,
the vast number of women who owe their relief firom
suffering directly to him, and those who realize the
benefits he first made possible, will gladly unite thus to
honor the man through whose originsd and inventive ge-
nius such blessings have been conferred upon humanity.
At the suggestion of many fiiends, therefore, the sub-
joined committee has been organized, and it is proposed
that a suitable monument be erected to his memory in
the city of New York.
To this end the active co-operation of the medical
profession and the many other friends of Dr. Sims
throughout the world is respectfiiUy solicited. Contribu-
tions of one dollar and upward may be forwarded to the
journal which has been constituted the treasury of this
fund — ^The Medical Record, New York.
FORDYCE BARKER, M.D., Chairman.
GEORGE F. SHRADY, M.D., Secretary.
Thomas Addis Emmet, M.D., New York.
T. Gaillard Thomas, M.D., "
William T. Lusk, M.D., "
William M. Polk, M.D., "
Paul F. MundA, M.D., "
S. O. Vander Poel, M.D., "
Frank P. Foster, M.D., «
E. S. Gaillard, M.D., "
Alex. J. C. Skene, M.D., Brooklyn, N. Y,
Samuel D. Gross, M.D., Philadelphia, Pa.
William Goodell, M.D., "
James R. Chadwick, M.D., Boston, Mass.
William H. Byford, M.D., Chicago^ III
A. Reeves Jackson, M. D., "
Thad. a. Reamy, M.D., Cincinnati, O.
C. D. Palmer, M.D., "
George J. Engelmann, M.D., St. Louis, Mo.
R. Beverley Cole, M.D., San Francisco, Cal.
H. F. Campbell, M.D., Augusta, Ga.
R. B. Maury, M.D., Memphis, Tenn.
E. S. Lewis, M.D., New Orleans, La.
J. T. Searcy, M.D., Tuskaloosa, Ala.
R. A. Kinloch, M.D., Charleston, S. C.
Hunter Maguire, M.D., Richmond, Va«
S. C. Busey, M.D., Washington, D. C.
Harvey L. Byrd, M.D., Baltimore, Md.
W. T. Howard, M.D., "
D. ^W. Yandell, M.D,, Louisville, Ky.
Seth C. Gordon, M.D., Portland, Me.
Frank E. Beckwith, M.D., New Haven, Conn,
A. W. Knox, M.D., Raleigh, N.C.
L. W. Oakley, M.D., Elizabeth, N. J.
A. T. Woodward,* M.D., Brandon, Vt.
Albert H. Crosby, M.D., Concord, N. H.
E. S. DuNSTER, M.D., Ann Arbor, Mich.
Alex. J. Stone, St. Paul, Minn.
Additional List of Subscribers.
A. R. Carman, M.D., New York $5 00
A. R. Mott, Sr., M.D., Leesburg, Va 1 00
Nelson G. West, M.D., " i 00
Hubert Haywood, M.D., Raleigh, N. C 5 00
Henry Griswold, M.D., New York 25 00
R. C. McCorkhiil, M.D., West Famham, Canada. 1 50
356
THE MEDICAL RECORD.
[September 27, 1884.
^exriewrs and g^otices*
Osteotomy and Osteoclasis for Deformities of the
Lower Extremities. By Charles T. Poore, Sur-
geon to St. Mary's Free Hospital for Children, New
York. 8vo, pp. 187. New York : D. Appleton & Co.
1884.
Dr. Poore, who has already become so well known by
journal articles on bone surgery, has condensed his ex-
perience in the work before us. He has succeeded in
doing this in a very satisfactory way. He has gone over
the subject in a very thorough manner, thus giving a
concise treatise on osteotomy. This has been very much
needed, considering the rapid progress which has been
made in this department of surgery within the last few
years, and the number of articles of rare value which
have been scattered through the journals. Dr. Poore
has not only described in a very intelligent and concise
manner all the different methods of osteotomy advocated
by the leading surgeons abroad, but has studied the same
from the light of a personal experience which has been
sufficiently large for purposes of deduction and analysis.
He is not backward in stating his preferences regarding
procedures, but he does so with becoming respect for the
opinions of others, and with a modest candor which is
quite convincing. There is manifested throughout a dis-
position to give the facts to the reader with such conclu-
sions as can be legitimately drawn from them.
Dr. Poore speaks strongly in favor of the chisel as
against the saw, for the performance of osteotomy. The
obvious reason for this is that he has never used any
variety of saw, and is particularly skilful with a chisel of
his own device, which, by the way, is a perfect instru-
ment of its kind. It is a matter of personal preference
for the chisel, which he has, under the circumstances, a
perfect right to maintain. It is needless to follow the
author through the various stages of his work ; suffice it
to say, however, that he puts his points fairly, and draws
his conclusions logically as to methods of treatment re-
commended. His advocacy of MacEwen's supra-con-
dyloid operation is what might be expected, and is in
full accord with the verdict of the surgical section of the
late meeting of the International Medical Congress. We
cannot too strongly commend the clear and succinct
manner in which the author weighs the indications for
treatment in particular cases. In so doing he shows a
knowledge of his subject which is as extensive as it is
profound, and no one at all interested in orthopedy can
read his conclusions without profit. His own cases, which
are carefully reported, are valuable additions to the liter-
ature of the subject. These, together with others, which
are only summarized, contain so much practical informa-
tion and sound surgery that they give a special value to
the work, altogether independent of its other excellences.
It is a good book in every way, and we congratulate the
author accordingly.
Atlas of Female Pelvic Anatomy. By D. Berry
Hart, M. D., Lecturer on Midwifery and Diseases of
Women, School of Medicine, Edinburgh, etc. With
Preface by Alexander J. C. Skene, M.D., Professor
Medical and Surgical Diseases of Women, Long Island
College Hospital, Brooklyn, N. Y. 4to, pp. 89. New
York : D. Appleton & Co. 1BS4.
^* In this Atlas," says the author in his preface, " I have
tried to give a faithful account of the anatomy of the
female pelvic organs." How he has succeeded can only
be appreciated by a careful study of the numerous mag-
nificently executed and accurately delineated plates to
be found in this superbly printed volume. It is hardly
possible to give any idea of their excellence by any de-
scription. They are simply magnificent, and so completely
meet every desideratum of the anatomist and practical
surgeon that nothing is left to be desired. Very many
of the drawings are original in design and novel in exe-
cution, illustrating in outline and detail many points in
relative anatomy not generally referred to by leading
authorities, and in every particular, so far as we know to
the contrary, bringing our knowledge up to the level of
the latest investigations of the anatomy of the parts, de-
scriptive and topographical. Take, for instance, the study
of the female perineum, the reflections of the pelvic
fascia and natural relations of the healthy uterus. Many
of the plates are beautifully colored, with the principd
organs indicated by abbreviated names upon them, after
the manner of Gray. This lettering does not in any way
interfere with the strikingly artistic efifect of the plates as
a whole, while they greatly aid, as will be obvious to
every student, the proper study of relations of diflferenl
parts to each other without constant reference to the
text. The outline drawings are also models of their
kind and do not aim at giving too much in one figure.
One point is illustrated al a time, and the collection
makes a consistent whole with the more elaborately and
accurately detailed chromo-lithographic illustrations. The
micro-photographic representations of tissue formation
are well executed, but are rather disappointing in their
small number, and in some instances sharpness of detail.
This is, however, only speaking comparatively in regard
to the other plates throu|;hout the work.
The descriptive text is not voluminous. This would
hardly be considered necessary in a work of this kind,
the main objects of which are to teach by the pencil
rather than by the pen. In the higher walks of anatomy,
where this remarkable atlas finds a leading place, there
is no need for much detail description. The student is
expected to have mastered the elements and to have
gone on. Hence, evidently following out this idea, the
author contents himself mostly with straightforward de-
monstrations, giving only such word descriptions as shall
enable him to make his subject sufficiently understood
in consistent outline.
•As a new work by a well-known author there is a
natural prejudice in its favor, but this becomes the more
deeply rooted as we constantly get new views of old fields,
new landmarks for better outlooks, new light upon here-
tofore obscure points. To particularize would be to re-
view all the recent advances made by leading anatomists
in the study of female pelvic anatomy — a detail which
would be for the purpose of this notice plainly unneces-
sary. In a word, we can, after the most critical study of
its contents, say with the distinguished editor, Professor
Skene, that 'Mt is far in advance of any work of its kind
yet produced." As such it becomes a necessity for the
progressive gynecologist, for the operating surgeon, and
for the leading general practitioner. We congratulate the
publishers on the reproduction of this grand work and
bespeak for it a becoming appreciation by the profession
of this country.
Lessons in Longevity : Paragraphs on Home Hygiene
and the Art of Prolonging Life. By John B. Hamil-
ton, M.D. Washington: William H. Morrison. 1884.
This modest little pamphlet contains much sound sense
as well as sanitary wisdom. The author possesses a
graceful style and knows how to adorn his texts, mingling
du/ce et utile.
Origin of Eating Goose on Michaelmas Day.—
Queen Elizabeth on her way to Tilbury Fort on Septem-
ber 29, 1589, dined on roast goose and Burgundy wine.
She fed so heartily that she required an extra half pint
of Burgundy, with which she drank " Destruction to the
Spanish Armada." She had scarcely set her glass down
when news came of the destruction of the Spanish fleet
by a storm. She immediately took another bumper to
digest the good news as well as the goose, and ordered
that roast goose should be served up to her every year
on that day. The court followed the custom, and the
people generally soon adopted it. Burgundy wine could
be taken at all times.
September 27, 1884. J
THE MEDICAL RECORD.
357
%ntevrmtiotml ptjejflijcal d^ongxtsB.
EIGHTH SESSION.
Ife/dat Copenhagen^ Denmark^ August 10-16, 1884.
REPORTS OF SECTIONS.
SECTION ON DISEASES OF CHILDREN.
Monday, August iith — First Day.
The Section was called to order by the President, Pro-
fessor Hirschsprung, of Copenhagen, who welcomed
the members, outlined briefly the work that was to be
done, and expressed the hope that the science of pediat-
rics would receive a new impetus from the labors of the
eminent men who had given their adherence to this im-
portant section.
He then announced the election of the following of-
ficers:
PRESIDENTS.
Professors A. Jacobi, of New York, and Rauchfiiss, of
St Petersburg.
SECRETARIES.
Drs. Israel and Wichmann, both of Copenhagen.
The Chair was then taken by Dr. Jacobi.
Dr. Rauchfuss read a paper on
THE EDUCATIONAL VALUE OF POLICLINICS
for the treatment of dieases of children. He main-
tained that not the least of the benefits that resulted from
policlinics was the diffusion throughout the community,
and especially among the poor and the ignorant, of a
knowledge of hygiene. If ignorant motliers could only
be impressed with the importance of observing at least
the elementary rules of hygiene, a vast amount of good
would be accomplished. Prevention was better than
cure.
Dr. a. Baginsky, of Berlin, then read a communica-
tion entitled
THE PATHOLOGY AND TREATMENT OF CHOLERA INFANTUM.
This disease, the author said, is to be reckoned, in Ber-
lin at least, as the chief cause of death in infants. ITie
number of cases of the disease in any given summer is in
direct proportion to the height of the temperature of
the air, but seems to be only indirectly dependent upon
the height of the temperature of the ground, the lower-
ing of the level of the ground water, or the degree of
moisture of the atmosphere. The quality of the nour-
ishment and the de^ee of care which the child receives,
as well as the situation of the dwelling, are very impor-
tant factors in the etiology. Teething has no direct in-
fluence on the disease.
As regards pathology, the different forms of summer
diarrhoea of infants may be divided into : 1, primary
d3rspeptic catarrh ; 2, genuine cholera infantum (chol-
era nostras) ; 2, follicular disease of the intestinal tract ;
4, secondary dyspeptic catarrh ; and 5, intestinal atro-
phy. All these processes are as links in a chain, and
inay pass one into the other. Post-mortem examina-
tions prove the correctness of this statement. Micro-
organisms are found in the walls of the intestines, and
are perhaps not unconcerned in the causation of the dis-
ease. The therapeutic management varies according to
the fomi of the disease with which we have to deal.
Professor Hirschsprung, of Copenhagen, then read
a paper summing up the results of
OBSERVATIONS ON HiGMOGLOBINURIA
during the first year of life, and gave a demonstration of
this condition.
Dr. H. Rehn, of Frankfort-on-rhe-Main, followed with
a paper on
SO-CALLED ACUTE RICKETS,
in which he attempted to answer the question whether
the ext>eriences of later years have enabled us to deter
mine the position of the affection known as acute
rachitis.
Most of the papers elicited more or less discussion
from those present.
No session was held on Tuesday, August 12th, but
the members of the Section, together with those of the
Section on Hygiene and State Medicine, made an ex-
cursion to the
ASYLUM FOR YOUNG GIRLS
at the Chateau Jaegerspris near Copenhagen.
On Wednesday, August 13th, no meetings of Sections
were held, as all the members of the Congress joined in
the excursions to Elsinore and other places.
Thursday, August 14TH — Fourth Day.
In the morning the Section held a joint meeting with
that on Hygiene and State Medicine.
Dr. Schkpelern, of Refsnaes, read a paper on
the treatment of CHRONIC DISEASES OF CHILDREN AT
SEA-COAST HOSPITALS.
The speaker advanced the proposition that sea- side
sanitaria ought to be kept open the entire year, winter
as well as summer. He then spoke of the good results
following a winter course of treatment, dwelling more
especially upon the value of hydrotherapy in this con-
nection. Among the diseases of childhood in which
great benefit may be derived by a course of treatment at
sea-side sanitaria, the author spoke more particularly of
the scrofulous affections. One point upon which he
dwelt at some length was the value of an increase in
weight as evidence of the favorable progress toward re-
covery in scrofula.
Dr. Engelsted, of Copenhagen, read a second paper
on the same subject. His views did not differ substan-
tially from those of the preceding speaker.
At the afternoon session Dr. Rauchfuss, of St. Peters-
burg, read a paper on
CROUP,
in which he argued the question as to how far this condi-
tion can be considered, from a clinical point of view, as
a well-defined morbid entity.
A discussion followed, which was participated in by
Professor Virchow, of Berlin, and others.
Friday, August 15TH — ^Fifth Day.
Professor Rauchfuss, of St. Petersburg, occupied
the chair.
Dr. Rupprecht, of Dresden, read a paper on the
antiseptic treatment of wounds in childhood.
The author thought the best disinfectant was a one-third
per cent, solution of salicylic acid, or for very septic
wounds, a four to eight per cent, solution of chloride of
zinc. One of the poorest materials for use in operations
on children was carbolic acid. The general admissibility
of corrosive sublimate solution (i to 1,000) in childhood
was, he thought, questionable. For certain wounds
iodoform in small quantities is indispensable.
The best material for dressings was gauze impregnated
with salicylic acid (five to ten per cent.) or corrosive
sublimate (i part per 1,000), while carbolized gauze was
objectionable. Wood-wool cushions are of advantage
for certain wounds. Dry dressings are best for fresh, as
well as for large suppurating wounds, but for small sup-
purating wounds moist dressings are more suitable. In
these, however, neither carbolic acid nor corrosive subli-
mate should ever be used.
In order to prevent soiling of the dressings with urine
he favored covering them with a waterproof cloth, the
358
THE MEDICAL RECORD.
[September 27, 1884.
edges of the dressings bein^ smeared with grease. Other
methods of avoiding irritation from the urine were verti-
cal suspension of the child, frequent changing of the
dressings^ or the permanent bath.
In concluding, the author pointed out the special indi-
cations for the employment of one or the other mode of
treatment of wounds occurring in children.
Professor Jacobi, of New York, then presented a
communication on
PRIMARY SARCOMA OF THE KIDNEY
in the new-bom and in the young.
This was followed by a paper of Dr. Sophus Meyer,
of Copenhagen, upon the
PROPHYLACTIC TREATMENT OF OPHTHALMO-BLENNOR-
RHCEA NEONATORUM.
Ophthalmia neonatorum is an essentially dangerous
affection, and measures of prophylaxis are therefore of
especial importance. We do not yet know with cer-
tainty the cause of the disease, and we ought to encour-
age all investigations tending to elucidate this matter.
Among the measures employed of late years, that of
Cred6 may be considered the best. It is certainly a very
satisfactory one, as, since its introduction into lying-in
institutions the malady has almost disappeared. Credo's
method is not dangerous, and can be employed by mid-
wives just as well as by physicians. The speaker con-
cluded by urj'jng upon his hearers the necessity of in-
ducing midwives generally to make a constant use of the
method in every case.
A paper was then read by Professors Hirsch-
sprung, of Copenhagen, and Ribbing, of Lund, on
INTESTINAL INVAGINATION.
This condition was treated of as it occurs in children,
and some remarks were made upon its comparative fre-
quence in different countries. The authors endeavored
to show that the great difference in this respect, as shown
by the statistics of the several countries mentioned, was
rather apparent than real.
Professor Faye, of Stockholm, followed with some
remarks on
THE TREATMENT OF SCOLIOSIS.
At the conclusion of this paper the session adjourned.
Saturday, August i6th — Sixth Day.
In the morning a joint session of the Sections on
Pediatrics and on Hygiene and State Medicine was
held.
Two highly interesting papers were read by Mr. Mal-
ling-Hansen, of Copenhagen, and Dr. Vahl, of Jaegers-
pris, on the
normal increase of WEIGHT IN ADVANCED CHILDHOOD.
The observations were made upon girls, from four to
fifteen years of age, inmates of the Jaegerspris Asylum.'
The children were weighed in April and October of each
year, from 1874 to 1883. It was found that the normal
weight of girls at this age increases in regular progres-
sion from thirty-two and a half to ninety-eight and a
half pounds ^16.25 to 49.25 kilos). Up to the end of
the fourteenth year the annual increment is eleven per
cent, of the weight of the previous year, but after this
time the rate of increase falls off somewhat. The in-
crease during the six warmer months is greater than in
the six colder months, in the proportion of four to three.
At the afternoon session Professor Medin, of Stock*
holm, read a paper on the
TUBERCULAR MENINGITIS OF EARLY INFANCY.
Tuberculosis, the speaker maintained, is frequent in the
new-born, occurring sometimes in very severe epidemics,
but tubercular meningitis is rare. Even epidemic cerebro-
spinal meningitis is of more common occurrence in young
infants. The author then spoke of the influence of age
and sex and of the seasons, and pointed out the differ-
ences in the symptoms and course of the disease as it
occurs in young infants and in children of a more ad-
vanced age. Tuberculosis of the meninges may occur,
he said, without producing meningitis, and in such cases
there are no symptoms by which the condition can be
recognized. The paper was illustrated with a number
of charts.
Professor Pr&vost then read a communication from
Professor d'Espinb, of Geneva, who was absent, on
A RAPIDLY CURABLE FORM OF INFANTILE SPINAL PA-
RALYSIS.
At the conclusion of this paper
ADDRESSES
were made to the Section by the presidents, Professor
Rauchfuss, of St. Petersburg, in French ; Professor Ja-
cobi, of New York, in Enj;lish ; and Professor Hirsch-
sprung, of Copenhngen, m German.
According to the announcement of the last-named
speaker, the labors of the Section were now concluded.
COMBINED SECTIONS OF ANATOMY AND PHYSI-
OLOGY.
Tuesday, August i2TH — Second Day.
Professor v. Ebner presented a communication on
behalf of Professor Rollet, on the
HISTOLOGY OF STRIATED MUSCLE.
The author of the paper believed that the primary cle-
ment in the muscular fibre is the fibrilla, the Cohnheini
fields being a section of a number of these fibrilla with an
intermediate substance. This intermediate substance not
only surrounds the fibrilla, but in some species there is a
layer of it between the sarcolemma and the fibrillar
There is a network of minute fibres which embraces the
elements of which Cohnheim's fields are a section. The
transverse disks are produced by this transverse network
under the influence of the various reagents. The varied
appearances observed in a muscular fibre are caused by
the varying relations of the unformed substance, the
fibrilla and this network.
In the discussion which followed the reading of this
paper Professors Engelmann and Retzeus stated that
they agreed with the author on the main points in the
paper.
Dr. Thin remarked that in all essential points the
structure of striped muscular fibre, as described by the
author of the paper, was that first expounded by himself
in 1874, in two papers published respectively in the
" Proceedings of the Royal Society " and the Edinburgh
Medical Journal. The network described by Rollet in
the paper just read, and also by Retzius in his mono-
graph published last year, is the same as that described
and figured by himself in the Edinburgh Medical Journal,
Professor Kronecker, of Berlin, then read a paper on
THE CENTRE OF COORDINATION FOR THE MOVEMENTS OF
THE VENTRICLES OF THE HEART.
The approximate position of this centre in the dog was,
the speaker said, about one centimetre behind the de-
scending branch of the left coronary artery. Injury to
this centre stopped pulsation at once, irregular vibrations
and twitchings silone remaining. By a series of experi-
ments. Professor Kronecker has ascertained that this
centre is neither inhibitory nor motor, but distinctly co-
ordinating.
Dr. Gaskell, of Cambridge, read a paper on
INHIBITORY ACTIONS AND THE INHIBITORY NERVES IK
GENERAL.
After referring in detail to the present views on inhib-
itory and excitor impulses in single nerve-trunks, and to
Foster's experiments on direct inhibition of the cardiac
September 27, 1884.]
THE MEDICAL RECORD,
359
muscle of the snail, Dr. Gaskell described experiments on
portions of the cardiac muscle of the tortoise, upon croc-
odiles in which the vagi had been mutilated, so as to in-
sure complete degeneration of their cardiac periphery,
and upon the cardiac nerves of frogs in which the vagus
and sympathetic rami were completely isolated. Some
recent experiments in the Cambridge laboratory were
also quoted as entirely disposing of Foster's experiment
upon the snail's heart. Dr. Gaskell's experiments, the
record of which in the shape of most complete polygraphic
I tracings was shown, led him conclusively to state that
muscle functions are not inhibited except through nerve
stimuli. As to the condition of inhibited tissues or or-
gans, whether the state is one of death or of increased
potential energy, he emphatically expressed his opinion
that the latter was the actual condition. He showed
tracings of the cardiac contractions during stimulation of
the sympathetic, after or during stimulation of the vagus,
which supported him in this view.
SECTION ON DERMATOLOGY AND SYPHILIS.
THE ETIOLOGY OF LUPUS.
Professor Doutrelkpont, of Bonn, opened the discus-
sion by reading a paper in which he stated his belief that
lupus is really a tuberculosis of the skin. Not only are
the histological characters of the lupus nodules and the
miliary tubercle very similar, but the specific bacillus of
tuberculosis is found in both. The clinical course of the
t^o diseases also presents, as he thought, some very
marked points of resemblance — the slow course, for ex-
ample, of some cases of phthisis, accompanied with many
relapses. But the most important and most direct proof
has been found in the inoculation of small pieces of lupus
tissue into the cornea of rabbits, and the growth of dis-
tinct tubercle at the point of inoculation.
Dr. Lbloir, of Paris, also read a paper dealing with
the same points, and quoted a case of undoubted lupus
of the bones, in which the disease resembled tuberculosis.
He, too, had inoculated animals with lupus, and thereby
produced tuberculosis.
Professor Kaposi, of Vienna, said that before the
bacteria time it used to be remarked how unusually free
from tuberculosis lupus patients were. He had seen
1,200 cases of lupus in twenty years, and had never seen
any connection between the two diseases, although some
patients had been covered with the lupus for many years.
Real tuberculosis of the skin, of which he had seen fifteen
cases, was a rare and entirely different disease, in which
the actual miliary tubercles were seen plainly on the most
superficial layers of the skin, and it was always rapidly
&taL Now, however, lupus, which is a perfectly clear
and distinct clinical entity, has been confused with tuber-
culosis.
Professor Pick, of Prague, had long been led to sus-
pect a close relationship between lupus and tuberculosis,
but could not establish a satisfactory clinical identity.
The discovery of giant cells at first promised to establish
tiis connection, but the theory of their specificity was
afterward disproved. The discovery of the bacillus tuber-
culosis had had a more satisfactory result. It had been
jound that the bacillus was always present in abundance
in certain stages of the disease, and that this was the
case even where no tubercular condition of other organs
was present. Observers are, however, divided as to
▼hether the bacillus is causal. Professor Pick considers
that it is, and thinks that tuberculosis of the skin may
exist as lupus vulgaris, as tuberculosis cutis of Kaposi, or
in many other possibly not yet discovered forms, which
may differ exceedingly, just as syphilides and gummata
differ exceedingly, and which it may take a long time to
distinguish and classify, as was the case with lupus and
the serpiginous eruptions of syphilis. Although tuber-
culosis cutis is not lupus, lupus might still be, and proba
bly is, a tuberculosis.
Professor Neisser, of Breslau, vigorously opposed
Kaposi, the value of whose statistics he disputed, since
the case had not been examined with a view to settling
this question. There was a slow and a galloping syphilis,
and there might be similar conditions in tuberculosis of
the skin. He considered that the slow course and fre-
quent recurrences in lupus were very like the course and
relapses of tuberculosis, and this latter, too, like lupus^
might last for years. Kaposi seemed to simply disbelieve
in the bacillus tuberculosis, but with the present weight
of scientific evidence on its side, Kaposi certainly would
have to undertake the proof that lupus was not a tuber-
culosis in order to support his position.
Dr. Unna, of Hamburg, agreed with Doutrelepont
and thinks with Pick that there are a series of bacilloses
of the skin, all containing the bacillus tuberculosis. He
knows of four such affections at the present time, viz.,
lupus vulgaris, tuberculosis cutis Kaposi, lupus papillaris
Aubert, and scrofulous eczema, followed by caseous
glands. He finds the bacilli are obtainable in quantity
by partially digesting hardened specimens and examining
the precipitate of what Has fallen.
Professor Edward Lange, of Innsbruck, said that the
murderous disease described by Kaposi did not corre-
spond to ordinary mild, often curable, cases of tuber-
culosis. There was probably some form of skin tuber-
culosis which did so correspond, just as there were cases
of carcinoma which were rapidly fatal, and cases which
dragged on for decades.
Dr. Goldscheidbn gave an interesting address on the
specific sensibility of the skin.
He strongly supported Helmholtz's theory that every
nerve, however excited, gave rise to only one specific
perception in the cerebral ganglion cell with which it was
connected. His investigations had shown him' that there
were only certain points which were capable of feeling
heat, while a completely different and complementary ^set
perceived only cold. It was immaterial how these points
were excited, whether mechanically or by temperature
change or electrically, the effect was the same ; this fact,
of course, refuted the old theory* of perception of heat
and cold by simple increase or decrease of the amount
of heat in the nerve. These temperature nerves when
excited give rise to no pain, nor do they possess any
sensibility. Only certain "pressure points" possess
acute specific sensibility, and outside these there exists
only a diffuse indefinite perception. The points at which
pain is appreciated are sdso quite distinct and very sen-
sitive to various irritations. These pressure and pain
points are always complementary to the points at which
heat and cold are perceived* The touch nerves, like
them, are always arranged in areolae, and hence the ne-
cessity of passing the finger over any body which we are
feeling, until an areola is met with capable of appreciat-
ing the shape and surface of the particular body. All
these functions improve notably with education, as seen
especially in the case of blind people. But there are
many areas normally destitute of all appreciation of one
or more of these different modes of sensibility.
Dr. Armauer Hansen, of Bergen, spoke at length on
the etiology and pathology of lepra. He exhibited pa-
tients to show the difference between the tubercular
form and the macular. The former was almost always
fatal in nine or ten years, and the latter was often cured.
The anaesthesia and atrophy which follow are effects of
the healing process, not of the leprosy, and necrosis of
the affected parts is always secondary to injury. The
paralyses, too, are local ; there are never any traces of
spinal lesions to be found clinically or microscopically.
He insisted that lepra was not an hereditary, but a
specific contagious disease ; the recurring crops of nod-
ules showed its anti-inoculability, and since the growths
tend to heal, it must be specific. There is, moreover,
no anatomical correlation between the parts affected as
in the metastasis of neoplasms. The cause of the dis-
ease had long been obscure. Years ago he had noticed
36o
THE MEDICAL RECORD.
[September 27, 1884.
peculiar brown cells, which were always present in mi-
croscopic sections of lepra. In 1871 he described mi-
nute moving rods in the contents of a breaking down
tubercle, and immediately after Koch's discovery he
found the bacillus leprae by applying the same methods.
He had never found them in anaesthetic patches, but
Ahning has found them in anaesthetic nerves. The
speaker and Professor Neisser have both cultivated them.
Inoculation on rabbits and cats (Hansen), and on fish
(Kobner and Hansen) had been unsuccessful, but Neis-
ser had produced a new growth by inoculating a dog.
No animal has, however, been lepraized as yet. He
does not believe in the heredity of a contagious disease ;
a disease may be congenital without being hereditary,
for example, small-pox. Heredity and the transmission
of such a disease as syphilis are entii^ly different mat-
ters ; the latter may develop late, and is incapable of
atavism, etc. Relationship, even, with leprous people,
is by no means always present. The inhabitants of a
valley become in time all more or less related, and the
members of one family naturalfy come into closer con-
tact with each other than with outsiders, hence the
apparent frequency of the spread among relations. Isola-
tion is necessary, for although the disease is spontane-
ously curable, we cannot cure it ; but the effect of isola-
ting the cases in Norway has been effective in reducing
the number of lepers by nearly one-half in twenty
years.
Professor Neisser agreed in Hansen's views as to
contagiousness and heredity in lepra. The spores which
Dr. Hansen had spoken of were probably vacuoles.
Professor Pick read a paper on
EXCISION OF THE INITIAL SCLEROSIS IN SYPHILIS.
He confined his remarks to hard chancres, and dis-
tinguished carefully between those cases in which the
glands were indurated and those in which they were not.
Where the glands are affected they must also be excised,
but in such cases, almost without exception, whether ex-
cision is practised or not, general symptoms make their
appearance. The conditions under which the operation
may be performed are only partially known. Simple
excision of the sclerosis where the glands are affected
will never give success, and no excision avails when
the deep glands are swollen. Pick considers the ef-
fect on the therapeutics is but slight, mostly only a
delay in the appearance of the general symptoms.
The operation has, however, served to show that the
indurated sclerosis is not the expression of general
syphilis. The lymphatics have recently been found to
be much enlarged in these cases, and Pick believes
that the syphilitic poison passes into the organism
through these, and not as Auspitz believes, entirely
through the blood.
Dr. Unna, of Hamburg, believes that syphilis spreads
not by any one path, but by botn the blood-vessels,
lymph-vessels, and by simple contiguity of tissue.
Professor Neisser, of Breslau, observed that al-
though it was not yet certain by what path the syphilitic
virus entered the system, still since it was a bacterial
virus, there was no theoretical reason why it should not
be prevented from entering by timely destruction of the
bacteria.
Professor Bergh, of Copenhagen, gave accurate
statistics extending over some years, and showing the
comparative worthlessness of the operation as a protec-
tive measure.
Drs. Leloir and Barthelemy, of Paris, quoted most
favorable cases in which excision, a few hours after the
first appearance of the chancre, failed to prevent infec-
tion, and the latter stated that French opinion was now
decidedly opposed to the procedure.
Dr. Martineau, of Paris, in opposition to the Ger-
man speakers, regarded the chancre as a manifestation
of general infection, and considered it, therefore, to be
manifestly u.»eless to excise it.
Professor Liebrsich, of Berlin, in a paper on
THE TREATMENT OF SYPHILIS BY MERCURIAL INJECTIONS,
said he found that certain conditions were requisite in
any mercurial compound which was to be subcutaneously
injected, viz., it must not precipitate albumen, must be
indifferent to the connective tissue of the skin, must not
be decomposed by an alkaline solution, must be easily
broken up, so that with sulphur sulphide of mercury is
precipitated. Corrosive sublimate forms insoluble com-
pounds with albumen, and wnich is only absorbed when
these are broken up ; it, moreover, breaks all the other
conditions except the last. Tannates and citrates of
mercury also unite with albumen and reach the blood in
complicated combinations. A body which fulfils all these
conditions is found in the formamide of mercury, which
is easily prepared by precipitating the oxide by carbon-
afe of ammonia and dissolving it in formamide. Amides
of a number of other fatty acids also work well. If in-
jected in quantity they form sloughs in the bowels during
elimination (as does the sublimate) showing that they
can work efficiently, the mercury in the compound being
simply masked by the amide. They cause neither pain
nor irritation of the tissues, and the dose is somewhat
less than that of sublimate. It is, above all, ini|>ortant
that the course of injections nmst be several times re-
peated ; it is impossible to be sure of curing by one
course alone. In the midst of the injections the
case sometimes ceases to improve ; the original vigor,
however, can be rapidly restored by giving a good
diet, with plenty of chloride of sodium, this salt and
chloride of ammonium both assisting powerfully as
"help cures."
Dr. Martineau said he had used injections exclu-
sively in the treatment of syphilis for the last few years,
and believed that it was the only reliable method, assur-
ing a cure and causing no stomatitis or other alimentary
troubles. In no case was the disease itself cured, but
merely the manifestations, and in doing this, mercury in-
jected subcutaneously occupied less than half the time
required by the other methods.
There was a general consensus of opinion among the
after speakers that the injection of mercurials was a valu-
able method of treating syphilis, but by no means the
only one. No one method suited all cases. Mcisser
thought that the injections should be smaller and more
frequent, and considered that the formamides eliminated
too quickly.
Professor Doutrelepont said he does not believe
formamide to be absolutely the best form for injection.
All salts when injected in a sufficient therapeutic dose,
may cause stomatitis.
Dr. Shoemaker, of Philadelphia, after prolonged ex-
periments on the various methods of injecting mercury,
had come back to the simple solution of sublimate in
water, as the most effectual and least irritating.
Dr. Wulff, of Strasburg, had made and injected the
formamides five years ago. He always used them per-
fectly freshly made from triturated solutions ; they then
work quickly and well.
Dr. Unna advocated the use of keratinized mercurial
pills, which dissolve in the alkaline juices of the small
intestine, leaving the stomach untouched ; in this way
the irritation caused by injection may be avoided.
Dr. Barthelemy always used the peptones for injec-
tion and found that they acted quickly, but believed that
pills were by far the best and simplest method for con-
tinued treatment.
Professor Kaposi found injections useful, but con-
sidered that inunction was by far the quickest and most
vigorous method of cure.
Most of the speakers considered that although statis-
tics were a valuable help in deciding the relative merits
of the different methods of cure, especially the statistics
of venereal hospitals for prostitutes, yet the judgment of
the relative merits of different methods depended mostly
September 27, 1884.]
THE MEDICAL RECORD,
361
on the good clinical observation of the individual experi-
menter.
INOCULATION OF SYPHILIS IN ANIMALS.
Dr. Martineau had successfully inoculated a monkey
with syphilis and produced a distinct chanae, erosive and
ulcerative syphilides of the skin and pharynx, and hyper-
trophic papular syphilides of the scrotum and thigh.
Professor Pick had seen the monkey which Klebs
claimed to have syphilized. He was only acquainted
wiJh syphilis in the human subject, but the eruption
which broke out in the monkey looked to him more like
a varicella accidentally inoculated, than like any syphi-
litic eruption m man.
PRACriTlONERS' SOCIETY OF NEW YORK.
Stated Meetings June 6, 1884.
Samlel Sexton, M.D., President, /r^ tern.
Dr. VVm. T. Lusk read the paper of the evening, en-
titled:
sudden death in childbirth.
The case illustrating such had the following history:
The patient was a pritnipara, healthy, and twenty-three
years of age. I first saw her January ist of present year
at 7 A.M. Patient said pains had begun on previous af-
ternoon, and she had paced the floor all night She said
that when in mo lion she found it easier to bear her pains.
Examination : Extreme tenderness of vagina and cervix ;
cervical canal dilated by head, os extended, size of half
dollar \ head covered tightly by membranes, no pouch«
At II o'clock little progress. Gave chloroform and
pushed up head so as to allow bag of waters to form.
This manoeuvre was followed by rapid dilatation. Head
in twenty minutes on perineal floor. 1 then urged
forceps. Patient wished •* glory of having her baby her-
self." Waited at her instance until between i and 2
0 clock. Patient suddenly lost color and seemed dazed
when spoken to. Applied forceps to head at vulva.
Easy extraction followed by some hemorrhage, but the
latter was quickly controlled. Patient's face showed
signs of complete collapse. Stimulants, warm hypoder-
mics of brandy, and hot tea were given at short intervals.
Apparent rally. At 7 p.m. went to dinner, thinking
period of safety reached. Patient suddenly turned in
bed, and pulse became very feeble. There was a slight
rally, and then came death. Absence of respiratory
troubles excluded pulmonary embolism either from ve-
nous thrombi or from air. The associated symptoms were
those of surgical shock, to which the patient was prob-
ably predisposed by the ante-partum exhaustion. The
writer argued against the rejection of surgical shock
among the causes of sudden death in childbed, holding
that the entry of air into veins, embolism, and pulmonary
thrombosis are insufficient to account for all cases.
Dr. G. F. Shrady mentioned two cases which had
just been published in The Medical Record, and in
which death, as he thought Dr. Lusk would agree, was
due probably to shock. He had seen in journals the
reports of two other cases within the last six months.
Dr. Lusic remarked that text-books on obstetrics as-
sumed that it was not possible for a woman to die of
shock in parturition, but from what he had observed, he
was inclined to believe that death in lying-in women was
not infre(^uently produced by that cause.
Dr. Shrady thought that death in Dr. Lusk's case
was best explained on the supposition that it was pro-
duced by shock ; for the phenomena were exactly what
occurred in surgical practice from sudden loss of blood
in a nervous patient.
Dr. Dana asked if the patient's heart was examined.
Dr. Lusk said he examined the heart and did not find
any sounds to indicate the presence of cardiac disease,
and the patient was so young and had enjoyed such
perfect health that he thought any change afifecting the
muscular structure of the heart could be reasonably ex-
cluded.
Dr. Dana asked if any pathological evidence had
been obtained to sustain the view that shock was due to
paralysis of the splanchnic nerves.
Dr. Lusk replied that the view was the result of ex-
periments on animals.
Dr. Dana thought that experiments on animals proved
just the opposite, because when these nerves were com-
pletely divided, causing paralysis of the blood-vessels
supplying these viscera, the animals do not die.
Dr. Lusk said the experiments were performed by
striking upon the abdominal walls, producing paralysis of
the blood-vessels and withdrawal of blood from the heart.
Dr. Dana remarked that striking the abdomen, espe-
cially when the peritoneum was inflamed, might stop the
heart, but it did so by affecting certain sensory nerves.
Dr. Ball asked if the eflect was not too sudden to
account for it upon the supposition of withdrawal of
blood from the heart.
Dr. Lusk remarked that he did not feel called upon to
defend the theory of the production of shock, but in the
most recent articles on shock the theory of Fisher was
that which had been adopted, and to him shock as a
cause of death in the cases under consideration seemed
to be the most reasonable explanation which had been
offered.
Dr. Dana asked further if it was not a clinical fact
that death had occurred with chloroform some time after
the anaesthetic had been removed.
Dr Lusk said that such cases had been reported, but
he was not aware that any had been reported in which
death occurred after the patient had regained com-
plete consciousness, and during the administration
showed no undue sensitiveness to*tlthe anaesthetic. It
had been suggested by Dr. Delafleld that this was the
explanation of sudden death in these cases, but on look-
ing over the literature of the subject. Dr. Lusk had found
that the cases occurred so much more frequently before
chloroform was introduced into obstetric practice than
they had since that the fact seemed to disprove the sup-
position that death was due to chloroform.
In Dr. Lusk*s case there was an interval of two hours
between the first and second administration, and during
this interval the woman was perfectly conscious and gave
no evidence that she had been unduly afifected by the
chloroform ; at tlie first it was administered in moderate
quantities for half an hour, and at the second adminis-
tration it was given for fifteen minutes.
Dr. E. L. Partridge alluded to two cases of sudden
death following labor. One was a case in which the
woman died suddenly on the twelfth day after confine-
ment without any unfavorable symptoms during the pu-
erperal period, except a moderate cellulitis, from which
she recovered promptly, all the symptoms disappearing,
and the pulse and temperature becoming normal. One
morning, while the nurse and physician were standing
at the bedside, just after the pulse had been noted at 88
and the temperature 99^ F., the patient asked for a
drink of water in the usual way, and within ten minutes
was dead, without a symptom or movement. The pulse
continued to beat two or three moments after respiration
ceased.
The autopsy revealed an abscess of the cerebellum.
The patient had had ear trouble, without discharge or
anything to direct attention to it during her stay in the
hospital (Nursery and Child's). It was not supposed that
parturition had anything to do with the abscess m the
cerebellum. But the case was interesting as an illus-
tration of the fact that parturient women can die from
causes other than those connected with the process of
labor.
In the other case, the woman died of shock and ner-
vous prostration following tedious labor. The forceps
were applied early ; there was no hemorrhage, but the
362
THE MEDICAL RECORD.
[September 27, 1884.
woman died within twenty-four hours. At the autopsy
nothing was found to explain the sudden death.
In absence of post-mortem examination he would
not be willing to say that death in Dr. Lusk's case was
due to shock ; and at the same time he did not feel will-
ing to say that she did not die of shock.
Dr. Lusk said he assumed that a woman who took no
rest for the length of time his patient abstained from it
must necessarily place herself in an unfavorable condi-
tion, and he had believed that such symptoms were due
to exhaustion.
Dr. a. a. Smith narrated a case as follows : In the
year 1873 he was asked to attend a young woman in
confinement. He promised to visit her on a Tuesday.
The mother sent for him on Monday afternoon, and
when he arrived he heard the following history : On
Saturday afternoon the patient reached up to pull the
window down, and, 'as she did so, she felt something
give way, and was seized at once with sharp pain in the
lower part of the abdomen. She sat down in a chair for
a short time, but, not feeling very well, went to bed. On
the following day she felt tolerably well, but on Monday
Dr. Smith was sent for on account of sharp pain and
quite free hemorrhage. Vaginal examination revealed
the fact that labor had begun, and the case progressed
very well up to three hours afterward, when the woman
be^an to complain of feeling weak, and, although the
child's head was quite well down in the pelvis, there
seemed to be a tumor of considerable size above. He
was unable to obtain sufficient evidence to make it cer-
tain that there was internal hemorrhage, but delivered
the woman at once of a child weighing six and a-half
pounds, and with the delivery there was rise of pulse
and evidence of hemorrhage, as shown by one great
gush of blood with the delivery of the child. No further
hemorrhage occurred, but the woman died within an
hour after the birth of the child, as the result of ex-
haustion and shock caused by antepartum loss of blood.
Dr. Smith believed that if he could have diagnosticated
ante-partum hemorrhage he could have saved the pa-
tient's life by the h)(podermic injections of ergot and
atropia, etc.
SUCCESSFUL OPERATION FOR EXSTROVERSIGN OF THE
BLADDER.
Dr. George F. Shrady presented a cMagram which
illustrated the successive steps in an operation he had
performed at the Presbyterian Hospital, in a case of ex-
stroversion of the bladder.
The patient was a male, five months old. A triangu-
lar skin-flap with its apex just below the umbilicus was
dissected downward to the upper surface of the exposed
posterior wall of the bladder and turned downward like
the leaf of a book, the base of the flap being left attached.
By this means the exstroversion was completely covered,
leaving two raw triangular surfaces exposed with a com-
mon base. One of these surfaces was the bed of the flap,
and the other the posterior surface of reversed flap it-
self. To cover the raw ^surface of the reversed flap a
quadrilateral flap, looking downward and inward, includ-
ing skin from the lower portion of abdomen, groin, and
sides of the scrotum, was made on either side and turned
inward so that the lower and free extremities of each
could be joined in the median line. The triangular raw
surface of the bed of the reversed flap above was con-
verted into an inverted T-shaped wound by loosening
the basal angles of the raw surface and joining them in
the median line. The beds of the quadrilateral flaps
in the groin, which were triangular in shape, were also
converted into T-shaped wounds by carefully sliding the
opposing edges toward each other.
The reversed flap was first sewed in position, com-
pletely covering in the bladder, one thread of each suture
being left long so as to be brought out externally from
between the edges of the superimposed flaps. The
quadrilateral flaps were then sewed in place, and then
the upper raw surfaces and the beds of the quadrilateral
flaps were closed as indicated.
The wounds healed by first intention, except at one
unimportant point, which subsequently closed by granu-
lation, and the child made a perfect recovery, tiiie urine
escaping only by a small opening over the pubes.
A condition of epispadias existed, which Dr. Shrady
intended to remedy by subsequent operations when the
child was old enough to warrant them.'
EXTRA-UTERINE PREGNANCY.
Dr. Charles S. Ward presented the child and pla-
centa removed by operation in a case of extra-uterine
pregnancy, with the following history. Mrs. B -,
twenty-three years of age, the mother of one child, and
no miscarriages. Her child was bom four years ago,
and the labor was normal. Her menstrual history was
normal until last July, when a slight show became con-
stant until lately. She first noticed enlargement of her
abdomen in August last. The abdomen gradually in-
creased in size, and movements were tfirst noticed in
September, and ceased in March last. The woman
thought she was at full term in March. During the last
three months she had had aching in the pelvis. The
mammary signs were normal until last March. During
the last three weeks she has lost flesh. Dr. Thomas
diagnosticated abdominal pregnancy when he saw the
woman in March. He performed laparotomy June 5th,
and removed the foetus with a part of the placenta.
The abdomen presented the appearance of that of a
woman in the seventh month of pregnancy. On palpa-
tion, an elastic tumor could be felt, and per vaginam the
uterus could be recognized as anteverted, somewhat
enlarged, with a cervix normal to the touch, and ballotte-
ment was absent. Neither was there any body to be
detected, except by the fact that something filled the
superior strait of the pelvis. Up to three months ago
the woman believed that she was pregnant. Except for
the extreme degree of pigmentation of the abdommal
walls, Dr. Ward would have felt sure that extra-uterine
pregnancy did not exist.
On making an incision through the abdominal walls in
the median hne, he reached' first a brownish-black look-
ing body, which presented very much the appearance of
the liver. After opening the membrane about a quart of
fluid, resembling molasses and water poured out, and in
passing his hand in Dr. Thomas was able to seize a leg
and delivered a child weighing nine pounds. It was the
sixth case which Dr. Ward had seen operated on, and
the next step of special interest pertained to the manage-
ment of the placenta, which presented the appearance of
a cup covering the entire anterior surface of the growth,
and looking very much like the liver, both in color and
contour, and giving very much the feel of the liver. It
was attached to the ileo-pectineal line on the right side,
extended upward under the diaphragm, und dipped down
into the pelvis on the left side. The placenta was par-
tially removed by tying it off in sections from its attach-
ment to the pelvic rim, omentum, and intestines, and
this was accomplished with comparatively a small amount
of hemorrhage.
The question concerning the advisability of leaving the
after-birth was raised. In some of the cases it had been
allowed to remain and to discharge from the opening in
the abdominal wall ; but it was probable that such a mass,
weighing several pounds, could not be discharge^, and it
was determined to remove a portion of it at least, if it
could be detached from the intestines and omentum so
as.to avoid hemorrhage, as the |^art attached to the pelvic
brim could be secured so as to avoid special danger
from that source. The remaining portion of the pla-
centa was sewed to the abdominal wound, and an open-
> The child continued to do well for two months after the operation, and was
altogether in a very satisfactorjr condition, when during the heated term of die
present summer it was seized with cholera infantum, dying of the disease to one
week. No.auiopsy was obtainable.
September 27, 1884.]
XHE MEDICAL RECORD.
363
ing left for drainage. Thus far the patient was doing
well. . . ,.
Dr. Lusk had a case, a short tune ago, m which
diagnosis was very puzzling. The patient came to him
with a note from her physician, who said that she was
uDinistakably pregnant, but that all the symptoms had
disappeared. Dr. Lusk found that there were no special
symptoms of pregnancy, and the patient soon afterward
left the hospital. She returned two months ago, when it
was found that the tumor had increased in size. Dr.
Lusk then introduced a needle and withdrew considera-
ble pus. He then regarded the case as one of pyo-
salpinx, and proceeded to operate. After exposing the
mass and tying ofif the omentum, he endeavored to de-
tach the tumor, which was embedded in the pelvis and
extended between the bladder and the rectum, and on
lifting it up and working his fingers down by its side they
passed directly into the rectum. He soon found that it
would be impossible to enucleate the mass, and there-
fore cut into it, when he found a very marked thicken-
ing of the decidua, and inferred that it was a case of
tubo-ovarian pregnancy, although he was unable to find
any trace of the embryo. He then emptied the sac,
stitched its walls and the peritoneal growth to the edges
of the abdominal wound, and the patient did very well.
The sac gradually closed, the wound had been reduced
to small size, and the patient was sitting up in the ward.
The Society then adjourned.
MEDICAL SOCIETY OF THE COUNTY OF
iNEW YORK. .
^Stated Meetings September 22, 1884.
David Webster, M.D., President pro tern,
CANDIDATES FOR MEMBERSHIP.
The Comitia Minora recommended for membership
Dis. A. K. Hills and A. T. Hills, graduates of Homoeo-
pathic Medical Colleges. On motion the recommenda-
tion was referred back to the Comitia for further investi-
gation.
NOMINATION OF OFFICERS.
The following nominations were made for officers for
the ensuing year :
For President — Drs. Daniel Lewis, Henry B. Sands,
D. B. St. John Roosa, and Andrew H. Smith.
For Vice-President — Drs. Frank P. Foster and Lau-
rence Johnson.
For Secretary — Dr. Wesley M. Carpenter;
For Assistant Secretary — Dr. Charles H. Avery.
For Treasurer — Dr. Orlando B. Douglas.
For Censors— Drs. J. W. Howe, F. R. S. Drake, W.
0. Moore, ¥. M. Weld, A. S. Hunter, H. E. Crampton,
a T. Peirce, J. H. Ripley, and W. R. Gillette.
Dr. a. Jacobi then read a paper on
LXFECnOUS DISEASES IN THE CHILDREN'S SERVICE OF
BELLEVUE HOSPITAL,
and directed special attention to typhoid fever and diph-
theria. It will appear in a subsequent number of The
Record.
The paper was discussed by Drs. G. B. Fowler, C. H.
Knight, M. B. Feeney, E. H. M. Sell, A. Seibert , and
the discussion was closed by Dr. Jacobi.
Dr. R. Van Santvoord, Secretary, read a report
from the Committee on Hygiene on
THE free baths OF THE CITY OF NEW YORK,
in which attention was directed to their usefulness and
the urgent necessity for a greater number was pointed
oat
The report was accepted and its recommendations
adopted.
PROPOSED AMENDMENTS TO THE BY-LAWS.
Any member neglecting to pay dues and assessments
for two years, shall forfeit his or her membership, pro-
vided he or she shall have received from the Treasurer
one month's notice of his or her delinquency. Such
member may be reinstated upon the recommendation of
the Comitia Minora after the payment of his or her
arrears.
Stated meetings shall be held on the fourth Monday of
every month, except in the months of June, July, Au-
gust, and October (annual meeting).
Dr. John L. Vandevoort was nominated for honor-
ary membership.
abuse OF medical charity.
The Secretary read a communication received from
Dr. W. H. Donaldson, Secretary of the Bridgeport
Medical Society and of the Fairfield County Medical
Society, Connecticut, directing attention to the fact that
many persons who were abundantly able to pay phy-
sicians' fees came from that locality to New York and
obtained gratuitous medical advice at hospitals and dis-
pensaries in the city of New York.
The communication was received and referred to a
committe of three, Dr. A. Jacobi, Chairman, to be re-
ported on at some future meeting.
The Society then adjourned.
©orrjeBpottdjenjce.
SOME OBJECTIONS TO THE USE OF PEPTON-
IZED MILK IN THE FEEDING OF INFANTS.
To THs Editob op Thb Mjuxoo. Rbookd.
Sir : The importance of the subject of the artificial feed-
ing of infants, and the difficulty of finding an efficient
substitute for mother's milk may, I trust, prove sufficient
excuse for mjr transgression on your valuable space.
Since the pubhcation of your editorial and the communi-
cation of Professor J. Lewis Smith in regard to the above
subject, I have adopted the plan therein recommended
for peptonizing milk, and I would ask correction on the
following points : Casein, being an albuminoid, is largely
acted upon in the stomach and absorbed directly from
that viscus, and only those portions which may escape
into the intestine are acted upon by the pancreatic secre-
tion. It seems rational that the immediate coagulation
of the casein in the stomach is to prevent its passage
through the pylorus until acted upon by the pepsin of the
gastric secretions in presence of an acid. By introduc-
ing an excess of ajkali with the milk the gastric secretion
is rendered in6rt (for the time being) and the milk does
not coagulate, but passes on into contact with the secre-
tions of the pancreas, small intestine, etc., where it is only
farticUly^ converted into albuminose. Stomach digestion
IS, by this plan of management, practically " eliminated."
The milk, instead of being retained for several hours, as it
is in the stomach (normally), in direct contact with the
gastric ferment, passes ftoo rapidly ?) on through the in-
testine. In patients with "intestinal catarrh," fed on
peptonized milk, some of the dejections consisted of two
nearly distinct portions : a greater or less amount of mu-
cus and a perfectly homogeneous mass of putty-like, par-
tially digested casein. The quantity of food allowed was
one fluid ounce every four hours ; Fairchild's pancreatin
was used, with Squibb' s sodium bicarbonate, five grains
of the former to fiifteen grains of the latter, the details of
the process as published having been carefully carried
out. In cases in which vomiting is not troublesome,
would it not be rational to confine digestion to the stom-
ach, as far as possible, with the object of relieving the
inflamed intestine ? I am induced to make these crude
suggestions in the hope that a ** weighty word " may be
elicited in reply. Very respectfully,
N. E. Oliver, M.D.
364
THE MEDICAL RECORD.
[September 27, 1884.
THE USE OF PEPTONIZED MILK FOR
INFANTS.
To THB Editor or Thb Mbdical Rbcdsd.
Sir : There is a practical objection to the use of pepton-
ized milk for infants in the' manner that has been sug-
gested by Dr. Smith and others. It consists in the fact
that young infants have to be fed in the middle of the
night. Now a sleepy mother, however affectionate, will
not be disposed to get up at 2 a.m., prepareithe milk,
warm the water, and wait twenty minutes for the mixture
to digest, while the infant ad interim howls, wakes up
the male parent, and disturbs the household generally.
I would inquire whether a little pepsin containing the
curdling ferment or a little gelatine will not do just as
well. Also, whether the casein m condensed milk does not
coagulate in fine flakes. Certainly I have found con-
densed milk to nourish children admirably, despite its
sweetness. Yours, vcr}' truly, M. S.
Philadblphia, Sq[>tember 3, 1884.
THE J^ORTH CAROLINA CLIMATE FOR CON-
SUMPTIVES.
To THB Editor op Thb Mbdical Rbcord.
Sir : Physicians are sending consumptives from the
Northern and New England States to California, Colo-
rado, Texas, and Florida, when there is a more accessible
and equally eiiicacious region much nearer. I refer to
Western North Carolina, of which region Asheville, Bun-
combe County, is the metropolis, railroad centre, and
great health resort for winter and summer. Fifteen years
ago my father, Dr. H. P. GatchelJ, Sr., wrote a pam-
phlet on this region, from which I get my facts regarding
the climate. Asheville is 2,250 feet above tide-water;
it is a place of five or six thousand inhabitants. It has
six hotels and boarding-houses, capable of caring for
twenty-five hundred guests. There is a club-house, a
public library with free reading-room, and there are the
usual churches and schools found in a place of this size.
The climate of Asheville compares favorably with that
of Geneva in Switzerland, Turin and Milan in Italy, and
Vienne in the valley of the Rhone, East France.
spring. Summer. Autumn. Winter. Year.
Temp. deg. Temp. deg. Temp. deg. Temp. deg. Temp. deg.
Geneva. . 52.2 70.3 54.2 34.0 52.7
Turin.... 53.7 71.5 53.8 33.5 53.1
Asheville. 54.3 71.3 55.3 37.8 55.3
Vienne.. 56.2 71.8 54.6 38.7 55-3
Milan . . . 54.9 72.8 55.9 36.1 54.9
From the above table it may be seen that the winter
climate of Asheville is milder than any of the places
with which it is compared except Vienne. This place is
enjoying a wide reputation as a resort for the cure of in-
cipient phthisis. The writer has known of not a few
complete recoveries, and many desperate cases which
greatly improved. To show the immunity of this region
from pulmonary disease, I append the following table.
Out of every 1,000 deaths .there are from consumption
In Northern New England (nearly) 250
In Minnesota and California 150
In Kentucky and Tennessee (nearly). ,. 100
In Louisiana and Florida 50
In Western North Carolina 30
Dr. Cain, formerly of Charleston, S. C, says that not
one of the many consumptives, in different stages of the
disease, that he has sent to Asheville, has failed to im-
prove ; and he regards it as the most healthful country
in the world.
The distinguished Professor Dickson, of Jeflferson
Medical College, stated that he and his family nowhere
improved so much as in Asheville. He is " not aware
of any spot, in Europe or America, so full of all that is
desirable."
Dr. S. E. Chaill6, of New Orleans, who spent from
three to five months in this region annually for four
years, wrote that he had seen but one case of consump-
tion, a mulattress, and not a native of this section The
above is taken from an article by Dr. Chaill^ which
may be found in the Medical and Surgical Reporter for
April, 1878, p. 269; and in which he gives the results
obtained at this place by Dr. W. Gleitzman in his Sanu
tarium ; he stated that every incipient case of consump.
tion was cured, or the disease arrested and the patient
so much improved that it was safe to say that the im-
provement would go on to complete cure under the
same conditions.
The scenery is grand and picturesque. On the West-
em North Carolina Railroad there are feats of engineer-
ing, and bits of scenery surpassing anything in the
mountains of Pennsylvania, and equalled, perhaps, no-
where in the country.
The people are kind and hospitable, and life and prop.
erty are as safe as in any section of the United States.
Edwin A. Gatchell, M.D.
Asheville, N. C.
Official List ^ Changes in the Stations and Dutus ef Oj/Uefs
serving in the Afeaical DefiartwutU^ United Statu Army^
from September 14 to September 20, 1884*
Caldwell, D. G., Major and Surgeon. Granted leave
of absence for one month and twenty days, to commence
about October 15, 1884. S. O. 95, Headquarters, Di-
vision of the Missouri, August 16, 1884.
Cronkhite, Henry M., Captain and Assistant Sur-
geon. From Department of the Platte to Department
of the Missouri. S. O. 215, par. i, A. G. O., September
13, 1884.
Taylor, Arthur W., First Lieutenant and Assistant
Surgeon. From Department of the Missouri to Depart-
ment of the Platte. S. O. 215, par. i, A. G. O., Septem-
ber 13, 1884.
Wilson, William J., Captain and Assistant Surgeon.
From Department of Dakota to Department of the East.
S. O. 220, par. I, A. G. O., September 19, 1884.
Gardiner, J. ds B. W., Captain and Assistant Sur-
geon. From Department of Arizona to Department of
the East. S. O. 220, par. i, A. G. O., September 19,
1884.
CoRBUSiER, William H., Captain and Assistant Sur-
geon. From Department of the East to Department of
Arizona. S. 0. 220, par. i, A. G. O., September 19, 1884.
La Garde, L. A., Captain and Assistant Surgeon.
From Department of Missouri to Department of Dakota.
S. O. 220, par. 1, A. G. O., September 19, 1884.
Barrows, C. C., First Lieutenant and Assistant Sur-
geon. Granted one month's leave of absence, with per-
mission to apply to the proper authority for an extension
of one month. S. O. 86, par. 4, Headquarters Depart-
ment of Arizona, September 13, 1884.
lltXcdical Items.
Contagious Diseases — Weekly Statement.— Re-
port of cases and deaths from contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the week ending September. 20, 1884 :
Week Ending
Casts.
September 13, 1884
September 20, 1884
Dtaiks,
September 13, 1884
September 20, 1884
6
4
II o
19 o
The Medical Record
A Weekly yournal of Medicine and Surgery
Vol. a6, No. 14
New York, October 4, 1884
Whole No« 736
®ri0itml %x\Xt\t^.
THE THREE TONSILS — SOME PRACTICAL
SUGGESTIONS IN REGARD TO THEIR
STRUCTURE, FUNCTION, AND DISEASES/
By F. H. BOSWORTH, M.D.,
raonssoK of disbasbs op thb throat in bbllbvub hospital mxdical col-
LKGB. NEW YORK.
I INVITE your attention this evening to a consideration
of the three tonsils, in order that I may bring forward
certain views in regard to them which I have for some
time entertained, and which, while contrary, I think, to
the generally accepted opinion, will, if true, serve to clear
up much that is vague in the prevailing views as to the
functions of these glands, and also to give a more prac-
tical direction to our therapeutical measures in the man-
agement of many of the commoner forms of disease in
the fauces.
By the three tonsils it is to be understood that I refer
to the two glandular masses found between the pillars of
the fauces, and to which the name tonsil is usually ap-
plied, and to that mass of glands which is found in the
vault of the phaiynx, and which was first recognized and
described by William Hunter," and subsequently, and to a
fuller extent, by Luschka,' and to which the name of
Luschka's tonsil has been given, and also that of the
pharyngeal tonsil. These three masses being so nearly
identical in their structure, function, and diseases, I think
that they may be properly designated as the three tonsils.
The masses between the pillars of the fauces will be
spoken of as the faucial tonsils, while that structure at
the vault of the pharynx will be designated as the pharyn-
geal tonsil.
It has been the custom to describe the faucial tonsils
as ** two almond-shaped organs lying between the pillars
of the fauces, and covered by a fibrous investing mem-
brane or sheath, in which are from seven to twelve open-
ings, which mark the orifices of a number of mucous
glands, of which the organs are composed." There are,
I think, several sources of error in this description. The
fatida] tonsil is not covered by a fibrous sheath. Under-
lying it there is a more or less dense connective-tissue
layer, which is continuous with the submucous layer which
underlies all mucous membranes. Beneath the mass
this is thickened by the same morbid process which has
developed the tonsil. Further than this there is no sheath
to the gland. It is not an almond-shaped organ as a
rule, but is of whatever shape the morbid process which
has caused its growth may give it. The number of
openings on its surface is entirely dependent upon the
number of the glands which are involved in the hyper-
trophic processes which have produced it. It is not an
organ of the body in the sense that the liver and spleen
are organs, and which I think is a commonly accepted
view, and therefore, in this sense, has no especial func-
tion to jperform in the economy. In my work on " Dis-
eases of the Throat," published three years ago, I sub-
jected myself to criticism by the assertion that in the
healthy throat there are virtually no tonsils. This opin-
ion I still entertain. The " almond-shaped organ," etc,
described by anatomists does not exist in a healthy throat,
* Read before the New York Academy of Medidue, October a, 1884.
* Cohen : Diseases of the Throat, second editioo, p. 253.
* Der Schlundkopf der Menschen.
but is the result of a morbid process. This morbid pro-
cess may have been of such limited extent as to have de-
veloped but a small tonsil, and one not sufficient to give rise
to any other than trivial symptoms ; or it may have goti^e
CO the extent of developing a mass of svillicient extent to
cause serious disturbances. All mucous membranes are
richly endowed with glands, in order thut they may be
kept in that soft and pliable condition which the proper
performance of their functions demands. Perhaps no
portion of the mucous tract demands a greater supply of
mucus in the performance of its functions than the up-
per air-tract. In this region, therefore^ we find these
muciparous glands not only richly distributed throughout
the membrane, but also aggregated in masses. This ten-
dency to aggregation is especially noticeable in the pharyn-
geal vault, and between the pillars of the faucei^. In a
condition of health these aggregations of glands do not
project prominently from the membrane, and hence, in a
perfectly healthy state, their existence is not easily demon-
strated by gross inspection.
The mucous membrane of the upper air passages,
however, perhaps more than any other portion of the '
body, is liable to be the seat of morbid action. It is a
very noticeable clinical fact, also, that while in adults it is
the mucous membrane proper which is most liable to be
the seat of disease, in children it is the glandular structures
which are especially susceptible ; hence we - find that
morbid conditions of these glands, both in the fauces
and in the pharyngeal vault, are of exceedingly frequent
occurrence, especially in children.
The tendency of chronic inflammatory processes is to
develop in hypertrophy. Hence wc find a moderate
hypertrophy of these glandular masses of exceedingly
frequent occurrence in young people, constituting in thft
one case so-called enlarged faucial tonsils, and in the
other an enlarged pharyngeal tonsil.
In order to. msike clearer my meaning* I will very
briefly allude to the anatomy and functions of the upper
air-tra^t. The nasal cavity proper extends from the
nostrils in front to the posterior nares behind. They are
lined by mucous membrane covered with columnai- cili-
ated epithelia, whose ciliae move in a direction from be-
hind forward. These cavities fulfil a double function \
they contain the distribution of the olfactory nerve and
preside over the function of olfaction. With this wc
have nothing to do in the present consideration. The
other function consists in guarding the entrance to the
lungs, warming, moistening, and cleansing the inspired air*
For the latter purpose the nasal mucoijs membrane is
very richly supplied with glands which pour out an abun-
dant sero-mucus, by which the inspired air becomes
charged with moisture. The nasal cavities, then, belong
purely to the air-tract. Behind the nasal chamber lies
the pharynx. This is usually described as one cavity,
extending from the basilar process of the occipital bone
to the oesophagus. There is, I think, a source of error in
this. That portion of the pharynx which lit^s above the
border of the soft palate is lined with a mucous mem-
brane covered with columnar ciliated epitlielia, and very
richly endowed with muciparous glands, ' those in the
vault constituting the pharyngeal tonsiL Below the border
of the soft palate the pharynx is lined with a mucous
membrane, which is covered with pavement epilhelia and
very scantily supplied with glands. The characteristic
anatomical feature of the air-passages is that they are
lined with a mucous membrane covered by columnar
I
366
THE MEDICAL RECORD.
[October 4, 1884.
ciliated epithelia, and richly endowed with mucous
glands ; a form of mucous membrane which, while ex-
ceedingly delicate and sensitive, is eminently adapted to
its function. It tolerates the passage of air, corrects its
temperature, regulates its humidity, and prepares it for
the lungs. At the same time it resents the impact of
any foreign body, harsh substance, or the^entrance of any
irritating gas or vapor. It is also endowed with glands
which secrete a more fluid mucus, more of the character
of a sero-mucus.
On the other hand, the food-passage is lined with a
inucdus membrane which is covered with squamous epi-
thelia. Its function is to allow the passage of masses of
food of oftentimes firm consistence, but whose impact
upon the membrane of the air-passage would not be toler-
aited. For this purpose the niembrane is so constructed
that it is hard, dense, and resisting, and not especially
sensitive. It is richly endowed with glands which pour
out a viscid mucus, whose function is as a lubricant
mainly.
The pharynx, then, as it is usually described by
anatomists, is really composed of two cavities differing
materially in structure and function. The upper pharynx
belongs to the air-tract, while the I6wer pharynx belongs
to the food-tract. This view is still further sustained by
the fact that an inflammatory process in the one region
does not involve the other as a rule. A pharyngitis in-
volving the lower pharynx is, I thiqk, a very rare disease,
and when met with, is not connected with any morbid
condition of the upper pharynx, but rather with some dis-
turbance of the food-tract, such as a gastritis, etc.
The lower pharynx, as before remarked, is very scantily
supplied with glands, and yet in the peiformance of its
functions it demands an abundant supply of mucus, in
order that it may be kept sufficiently lubricated to allow
of the easy passage of food in deglutition. Gland struc-
tures are exceedmgly delicate, and liable to injury on
exposure. The lower pharynx is perhaps the most ex-
posed region of the mucus tract ; it is tfierefore a hard,
dense membrane with but few glands. In order to com-
pensate for this deficiency it is surrounded on three
sides with large aggregations of glands, one on either
side between the pillars of the fauces, another inime-
diately above in the vault of the pharynx, constituting
in the one case the faucial tonsils, in the other the
pharyngeal tonsil The sole and only function of these
masses of glands which constitute the three tonsils is, I
believe, to supply mucus to moisten and lubricate the
lower pharynx, and the design of Nature in so locating
them has been most wise, for had the lower phar3nix been
endowed with glands sufficient for its demands, disease
occurring in them would be attended with far graver con-
sequences than attend morbid conditions of the gland
arranged as we find them.
The minute anatomical structure of the faucial and
pharyngeal tonsils have been so often described that
further allusion to them need not be made. Their resem-
blance is so clear that the only difference in structure is
easily accounted for by the fact that the pharyngeal tonsil
is protected from any impact of foreign substances, and
i^ therefore of a soft and spongy consistence, and con-
tains connective tissue, less in amount and less firmly
organized than the faucial tonsils, which are subjected to
much harsher usage in the act of deglutition.
From a patholpgical point of view we find stijl further
grounds for grouping the three tonsils together, for the
same morbid processes which occur in the faucial tonsils
are met with in the pharyngeal tonsil. These are: acute
inflammation ; chronic inflammation, resulting in hyper-
trophy ; acute follicular inflammation ; croupous inflam-
mation, and diphtheritic inflammation.
Acute tonsillitis is a name generally given to quinsy.
I shall endeavor to show later that quinsy is not a dis-
ease of the tonsil, but is an inflammation of the cellular
tissue of the soft palate or neighboring parts, and that
phlegmonous inflammation does not occur in the tonsil.
As a matter of fact, therefore, the only form of acute in-
flammation met with in the tonsil is a catanhal inflam-
mation, viz., one attended with hyperaemia, swelling, and
hypersecretion. This is usually described under the
term subacute inflammation. In deference to common
usage, therefore, I use the usual nomenclature.
Subacute tonsillitis, — This in the faucial tonsil consists
of a mild form of inflammatory action characterized by
swelling and hyperaemia of the glands, and is the result,
generally, of exposure to cold. The constitutional dis-
turbance is not great, there being, as a rule, a mere feel*
ing of general malaise with chilly sensations. The ton-
sils are swollen to twice or three times their size in the
quiescent state, and project into and encroach upon the
isthmus of the fauces, two red, angry^looking masses.
The palate may be involved in the hyperaemia, but
there is no notable swelling beyond the tonsil proper.
The attack is not of any serious import, and runs its
course in from four to seven days. The predisposmg
cause is enlarged tonsils, and it occurs in children more
frequently than in adults, simply for the reason that in
children enlarged tonsils are most frequently met with.
Subacute tonsillitis occurs in the pharyngeal tonsil with
the same frequency as in the fauci^ tonsil ; it is attended
by the same constitutional symptoms, a mild febrile dis-
turbance, and no more ; and it is caused, as a rule, by ex-
posure to cold. The main predisposing cause is an en-
larged pharyngeal tonsil. It occurs most frequently in
children, runs its course and subsides in the same way as
the faucial disease. The only difference in the two affec-
tions is in the symptoms, which differ merely from the
location of the morbid process. As far as I know, the
afifection has never been described under the above
heading, although Me^er, in his original article on
"Adenoid Vegetation m the Naso-pharyngeal Cavity,"*
described their tendency to sudden attacks of turgescence,
by which their size varied greatly at different examina-
tions.
Lowenberg " and other writers allude also to the same
symptom. It will be easily understood how, in tlie case
of a mild inflammatory process occurring in the pharyn-
geal tonsil, the symptoms will be mainly nasal. There is
apparently a cold in the head. The nasal passages are
obstructed, the voice becomes affected, changing to
what Meyer calls the dead voice, its nasal resonance is
destroyed, and there is more or less discharge of mucus
or muco-pus into the fauces. The attack is what is
usually regarded as a cold in the head, and is often called
an acute coryza. This, I think, is a frequent error. An
acute inflammation of the nasal mucous membrane in
children is very rare. As before remarked, the glandu-
lar structures are the parts generally attacked in children
and not the mucous membrane proper, and their colds,
if in the throat, are in the faucial tonsils, and if in the
nasal passages, are in the pharyngeal tonsil rather than
in the nasal membrane. The attack subsides in a few
days, as in the faucial disorder, its frequent recurrence,
however, should call attention to the probable existence
of the chronic disorder which is in most cases the predis-
posing cause of the attack.
Acute follicular tonsillitis. — The epidemic of this
disease, which prevailed to such a great extent last
spring, and indeed which has prevailed so extensively
in the past three or four years, has served to bring it
prominently to the attention of all of us. It consists of
an inflammatory process, involving one or both tonsils,
which is characterized by the exudation into the crypts
of the glands of a fibrinous material which fills and dis-
tends their cavities. The onset of the attack is marked
by a chill, .followed by general febrile disturbance of a
marked character. The skin becomes hot and flushed,
there are headache, pains in the bones, loss of appetite,
and all the evidences of a febrile movement far greater
' Medioo-Chinu:pcaI Transactions, vol. lifi. London, 187a
f^' Les Tumeurs Ad^noldes du phaiynx xaaaX.
October 4. 1884.]
THE MEDICAL RECORD.
367
than can be accounted for by the amount of local inflam-
matory action. !. , ■ .
In a paper, read at the meetmg of the Arnencan
I^aryngological Association in May last, on " The Clinical
Stfoificance of Fibrinous Exudations,** * I took the
groond that this disease is an essential fever with a local
manifestation in the throat, something in the nature of
one of the exanthemata, I think there is much ground
for regarding this as the correct view. In the same paper
I called attention to the fact that the same disease oc-
curred frequently in the pharyngeal tonsil. In each case
the onset and progress of the disease is characterized by
the same symptoms, the only difference being in the
locality of the eruption, and in the subjective symptoms
with reference to pain in deglutition, etc.
Croupous tonsillitis. — During the prevalence of follic-
ular tonsillitis we meet frequently with cases in which
the attack is marked by the same group of local and
constitutional s)anptoms, with the exception that an in-
spection of the fauces reveals, in place of the small
pearly white spots on the tonsil, a broad membrane
covering more or less the whole face of the gland.
This I regard as the same disease as the former, with an
eruption which is more marked or efflorescent. The
exudation which in the former case confines itself to the
crypts of the glands, in the latter fills and overflows them,
forming a continuous membrane. If this be detached
from the surface, there will be found beneath it the
appearances of the follicular disease.
The same membrane I have frequently observed on
the pharyngeal tonsil, and its appearance is attended
with the same general symptoms as in the faucial disease.
Diphtheritic totisillitis, — A diphtheritic membrane on
the faucial or phar3mgeal tonsil occurs in connection
with the blood-poison of diphtheria. Wherever it may
be developed, its clinical significance is the same.
Hypertrophied tonsils. — Hypertrophy of the faucial
tonsUs gives rise to a train of symptoms which are mainly
due to the mechanical presence of these glandular
masses in the fauces. They occur mostly in young
people. Their development is attended by the occur-
lence of repeated attacks of subacute inflammation or
ordinaiy catarrhal sore throat, and they show a tendency
to subside at puberty. Their development also is the
f^t of a purely local morbid process, and is not, as a
rale, the outcropping of any of the constitutional dys-
mast. If there is any impairment of health, it is to be
accounted for by the mechanical action of the growths,
ID obstructing respiration, disturbing sleep, or otherwise
interfering with the natural functions.
Hypertrophy of the pharyngeal tonsil has been de-
scribed by many writers under the heading usually of
adenoid tumors, or vegetations at the vault of the
pharynx. It seems to me that a clearer coniprehen-
Ron of this affection would be reached by showing its re-
lation with enlarged faucial tonsils. This form of hyper-
trophy, like that in the faucial tonsil, occurs mostly in
young people ; it gives rise to a train of symptoms which
»e largely mechanical ; its deV^elopment is attended by
lepeated attacks of subacute inflammation ; it is a purely
kcal trouble ; it shows a tendency to subside with the
Attainment of puberty, and in fact in all its aspects is
identical with the faucial disorder, except in its location.
In this view, then, enlarged tonsils in either region are
simply masses of diseased glands, whose function has in
Ibe main been abolished or perverted by the morbid pro-
cess which has fixed itself upon them. If the hypertro-
Pjiic process is limited and the tonsils are of small size,
giring rise to no untoward symptoms, either by their
mechanical interference with function, or by exciting an
formal discharge from the parts, they require no treat-
laent. I^ on the other hand, the hypertrophy has gone
{0 the extent of developing a glandular mass, which by
tts presence interferes with the function of the parts, 'or
1 :New Yerk Medical Jouraal, May 12, 1884.
which in any way gives rise to serious symptoms, it seems
to me that there should be no question as to the proper
remedy. They are diseased structures and should be ex-
tirpated. This rule, I think, should apply whether we
have to deal with an exceptionally large mass, or with a
single follicle not larger than a split pea. As regards
any local medication I believe it to be absolutely inert
in redticing genuinely hypertrophied glands. It is some-
times said that Nature placed these tonsils in the throat,
and that they should not be removed. Nature certaiiily
never put them there.
Perhaps one of the most remarkable suggestions ever
made in regard to the tonsils was that of Penrose, that
their removal might result in a loss of virile power. This
strange suggestion has been so completely answered by
Daly,* that I only allude to it as a curiosity. It is some-
times suggested that a portion of the tonsil might be re-
moved, but not all. I see no more reason for this than
for the removal of only a portion of any other morbid
growth, a fibroid for instance. The danger of hemor-
rhage after tonsillotomy has often been urged as an ob-
jection to the procedure. This danger is, I believe,
overestimated. Literature records no fatal case, as far
as I know, with the exception of those cases in which the
carotid artery was cut. I cannot conceive of an intelli-
gent operator making this blunder. Furthermore, it
should be stated, hemorrhage never occurs in the opera-
tion upon children. The nutrient artery of the tonsil in
young people is small and its walls collapse easily. In
adults, on the other hand, hemorrhage afler tonsillotomy
is almost the rule. This is often exceedingly trouble-
some. I have never seen a case, however, in which the
bleeding was not promptly arrested by the application of
a wire heated to a dull, red heat This is a simple pro-
cedure and should be resorted to always in preference to
the ordinary styptics, which are useless in controlling arte-
rial hemorrhage, and the only troublesome bleeding
which occm's in these cases is from the nutrient artery.
As regards the removal of the pharyngeal tonsil I have
nothing to say in addition to what I have already given
before the Academy * two years ago. .
Quinsy. — I have already alluded to €[uinsy as a disease
of the cellular tissue of the fauces rather than of the ton-
sil. Phlegmonous or suppurative disease does not occur
in glandular structures, but belongs rather to areolar ris-
sue. It is true that we occasionally meet with small ab-
scesses in the glands of the tonsils or in other portions
of the mucous membranes of the air-passages, but they
are small abscesses, as a rule, which result from the oc-
clusion of a gland, and are not phlegmonous in character.
For three years I have entertained the view that quinsy
was not a disease of the tonsil, and in that time have
carefully watched and examined the cases which have,
come under my observation, and I do not recall a single
instance in which I have not been able to demonstrate
conclusively to my students, or others who have been
present at my clinic, that the tonsil was not involved di-
rectly in the inflammatory process. The tonsil oftentimes
presents a red and angry appearance, but this is always
secondary, and due to the fact of its nearness to the
phlegmon. Again, the tonsil is occasionally very promi-
nent, being lifted from its bed, and at times projecting
far toward the opposite side of the fauces. This is due
to the phlegmon occurring behind it. The disease I be-
lieve to be an acute cellulitis of the areolar tissue of the
fauces. In the very large majority of cases it occurs in
the soft palate ; in others it occurs in one or the other
of the pillars of the fauces ; and in still rarer instances,
in the pharyngeal wall. Furthermore, the cause of quinsy
I believe to be in very many cases the rheumatic habit.
This view is an old one, and has been maintained by
many writers on the subject. I had not paid any close
attention to this view until Dr. Fowler ' called renewed
> Medical and Sureical Reporter, December 15, 1883.
' Growths in the Nasal Passages, Medical Record, January 13, 1883.
' London Lancet, December xi, z88o.
368
THE MEDICAL RECORD.
[October 4, 1884,
attention to the connection between rheumatism and
quinsy^ and reported a number of cases which supported
the view. Dr. Fowler also suggested the value of the
salicylates in the treatment of the disease.
For three years I have treated all my cases of quinsy
as cases of phlegmonous inflammation of the submucous
cellular tissues, and as probably due to the rheumatic
habit. The following summary is offered as affording
some points of interest : The whole number of cases seen
has been 133. Males, 88 ; females, 45. Under ten years,
3 ; ten to twenty years, 30 ; twenty to thirty years, 61 ;
thirty to forty years, 11 ; over forty years, 12. The old-
est case was sixty-nine years, the youngest nine months.
This latter case was a female diild which I saw the
fourth day of the attack. The case had gone to suppura^
tion and I opened the abscess in the soft palate.
In the 133 cases the phlegmon was in the soft palate
in 115 cases; in one or the other of the posterior
pillars of the fauces in 1 1 cases ; beneath the tonsil in 2
cases, and in the wall of the pharynx in 2 cases. These
latter two cases would have been called perhaps retro-
pharyngeal abscesses. They were unquestionably quinsy.
In many cases there was the clinical history of attacks of
rheumatism, either arthritic or muscular. Unfortunately
my notes give no accurate information as to the propor-
tion of these cases, but I think it was fully sixty per cent
If the effect of remedies is to be regarded as any evi-
dence, the connection between the two diseases is still
further evidenced by the fact that so large a number of
cases of quinsy were aborted by the early administration of
the salicylates. These cases were mostly seen at my
clinic at the out-door department of Bellevue Hospital
Many of them came several days after the onset of the
attack. Of those whom I saw within the first thirty-six
hours, the attack was aborted by the administration of the
salicylates in a majority of cases. In those cases in
which the attack was not aborted, suppuration seemed
to be very much hastened. The form in which the
remedy was administered was as follows :
5. Sodae salicylatis 3 iij.
Aquse 5 vj.
M. Sig. — One tablespoonful every two hours.
Last spring Dr. Barker suggested to me the value of
bicarbonate of soda locally applied. The soda is to be
taken up on the moistened finger and plastered over the
inflamed surface every ten or fifteen minutes. I have
since then made use of this remedy in connection with
the salicylates, and in one or two cases its action has
been most gratifying. I am not prepared, however, to
abandon the use of salicylates in favor of the soda. In
several cases also in which the quinsy habit has existed
I have given the above prescription, with directions to
commence its use immediately upon experiencing any
symptoms of these attacks. These were cases in private
practice. In no one of these cases has there been an
attack of the disease. If the attack is not aborted by
medication, it seems to me that it is of importance to us
to recognize and treat the disease, as far as the local pro-
cess is concerned, as an abscess in any other portion of
the body. In other words, to treat it on general surgi-
cal principles. I think that the importance of introduc-
ing the finger into the fauces is not sufficiently recog-
nized. No case — no case of quinsy, certainly — should
ever be treated without it. By introducing the finger into
the fauces, the condition and location of the phlegnion
can be determined, and the occurrence of suppuration
and the proper point at which to introduce a bistoury
recognized. In this manner the treatment of a quinsy
becomes a very simple matter, and does away with the
use of gargles, inhalations, sprays, fomentations, etc.,
which oftentimes add to the discomfort of the patient
rather than to his relief.
In conclusion, I have only to say that if I have
brought forward any suggestions whidi are at variance
with old established teaching, they are offered very
modestly, but still as convictions which have been the
result of a somewhat large experience. In acting upon
them I am confident that I have obtained better results
in the treatment of throat diseases than in following the
older doctors.
TWO CASES OF NEURECTOMY FOR THE RE.
LIEF OF FACIAL NEURALGIA.
By GEORGE R. FOWLER, M.D.,
8UKGBON TO ST. UAXY's CBNKSAL HOSPITAL, BSOOKLYM, K. Y.
The two following cases arc deemed by me of sufficient
importance to warrant their publication, inasmuch as
they illustrate the two most common forms of nenralgia
of the face and the complete relief afforded, in otherwise
most intractable cases, by the resources of operative sur-
gical art.
Case I. — Mrs. M. L applied to me in Januaiy,
1883, for the relief of a most violent and prolonged neu-
ralgia, referred to the area of distribution of the frontal
division of the ophthalmic or first portion of the fifth
ner\'e. She had suflfered more or less for several yean
with milder attacks in the same region, but the present
attack had proven so severe and persistent, despite
every therapeutical measure, that in sheer desperation
she consented to submit to any plan of treatment which
held out the slightest hope of relief. When she came
under my care she had not had the slightest remissbn
of the pain for full three weeks. Even opiates, unless
pushed to the point of dangerous narcosis, failed to
mitigate the pain. The conjunctiva upon the affected
side was injected, ptosis was marked, and the lachrymal
secretion flowed copiously upon attempts being made to
raise the eyelid. There was intense tenderness over the
point of emergence of the supra-orbital nerve from the
foramen.
On February 4, 1884, 1 operated by Lienhart's method
as follows : An incision was made along the upper mar-
gin of the left orbit, and in a direction parallel to the
same directly down to the bone. The tarsal cartilage
was separated upon a director. The supra-orbital nerve
now came into sight, and by keeping the levator pal-
pebrar, as well as the other contents of the orbit waft,
depressed by a spatula, was traced back to the point
where both it and the supra-trochlear branch are given
oflf from the frontal nerve ; beyond which point, after
separating the trunk from its accompanying artery, it
was severed By means of a pair of stout scissors the
fibrous bridge which binds down the nerve as it ap-
proaches the foramen was broken down, the nerve drawn
out, and by retracting the upper lip of the horizontal
incision, branches of the nerve distributed to the fore-
head were traced and dissected out. The supra-trochlear
branch was divided at the point where it comes upward
toward the pulley of the superior oblique muscle. The
wound was irrigated with Koch's solution (mercuric bi-
chloride, I to 1,000), its edges approximated by horse-hair
sutures, and a naphthalinated cotton dressing applied.
The after-history of this case is entirely uneventfiiL
The wound pursued an aseptic course, occupying lesS:
than a week in healing, and the neuralgia disappeared at
once. Up to the present time, six months after the
operation, there has been no return of the trouble, and a
cure may confidently be asserted as having been accom-
plished.
Case IL— A. V , aged fifty-three, German. This
patient applied to me in March, 1884, for relief His
neuralgia was of the variety known as tic douloureux, and
was of three months' standing; for the last six weeks of
this time he had been deprived almost entirely of sleeps
suffering all the while the most intense and agonizing
torture. He had been treated by a number of physiciaiis,
and all the usual remedies had been prescribed for him,*
without, however, affording him any relief. The pain
extended through the branches of the second division of
the fifth nerve, upon the left side ; hyperaesthesia of the
October 4, 1834.}
THE MEDICAL RECORD.
369
whole surface of afifected aresl existed, as well as a most
exquisite sensitiveness of the gum and teeth of the upper
jaw of that side. The slightest touch of the integument
or an attempt at taking food brought on a paroxysm of
JDcreased pain, with twitching of die left facial muscles.
The pain was more or less constant during the intervals
of freedom from twitching, but when the pain and " tic "
were conjoined the agony was painful to witness.
On March 20, 1884, I performed the following modifi-
cation of the operation first devised and practised by
Camochan, of New York : Ether having been administered,
a curvilinear incision was made parallel to and slightly
below the inferior orbital margin, from the inner to the
outer angle of the eye. This was^ carried directly down
to the bone and the flap dissected upward until the edge of
the infra-orbital ridge was reached. The leash of nerves
constituting the branches of the infra-orbital after it
leaves the foramen was now dissected from the under
surface of this flap. The tissues covering the anterior sur-
face of the superior maxillary bone were next detached
and drawn downward by a retractor and there held by an
assistant. A trephine flve-eighths of an inch in diameter
was now applied in such a way that its point punctured
the antrum of Highmore upon a vertical line running
directly downward from the infra-orbital foramen, while
its rim or cutting edge -slightly overlapped the foramen
itself. By following this rule in the application of the
trephine, it was found that all of the available space
possible was gained for operating. The removal of a
button of bone from the anterior wall of the antrum hav-
ing been accomplished, the patient was lifted from the
operating table to a chair and placed in a sitting position
with his back to a window ; a reflecting mirror upon my
forehead furnished the necessary light for the performance
of the rest of the operation. The posterior wall of the
antrum was now perforated by a trephine half an inch
in diameter. In using this latter the centre- pin was with-
drawn prior to its application, the converging surfaces of
the cavity being found sufficient to support the instru-
ment, and the danger of unwittingly thnisting the pin
into the spheno-manllary fossa avoided.
Upon perforating the postenor wall of the antrum, the
spheno-maxillary fossa, together with its contents, was
brought into view. With a small chisel the infra-orbital
canal was opened and broken down so as to release the
netye and its accompan)dng arter>', and tracing the nerve
rapidly back to the point where it enters the orbit, with
a pair of small double-curved scissors section of the
trunk of the superior maxillary nerve was made beyond
the point where it joins the ganglion of Meckel. The or-
bital, spheno-palatine, and inferior dental branches being
divided, the ganglion and nerve-tnink were together
drawn out. A smart hemorrhage from that portion of
the internal maxillary artery contained in the spheno-max-
illary fossa now occurred, but it was readily controlled
by a small piece of compressed sponge attached to a
stout thread and crowded into the fossa. This latter was
left in position in order to guard against the bleeding.
The parts were irrigated with Koch's solution, the exter-
nal wound drawn together by a few horse-hair sutures,
an opening being led at the most dependent angle for
drainage, as well as to facilitate the withdrawal of the
compressed sponge, and a dressing of naphthalinated
cotton applied.
The next day the sponge was removed. Daily irriga-
tions with Koch's solution and dressing with naphthalin-
ated cotton were practised. The wound healed slowly,
owing to the impracticability of keeping it in an aseptic con-
dition, and a month elapsed before it had entirely closed.
For the first few hours after the operation the patient
complained of wandering pains over the whole left side
of the face, but the " tic " had disappeared entirely, and
m twenty-four hours he expressed himself as being per-
fectly free from pain ; this improvement continued, and
no recurrence of the pain took place. A slight depres-
sion exists at the site of removal of the button of bone.
Remarks, — Fortunately, as a matter of clinical expe-
rience, intractable and persistent facial neuralgia requir-
ing operative measures for its relief is comparatively
rare. It is a matter of congratulation, likevnise, that it
occurs, in the vast majority of cases, in nerves purely
sensory, admitting of neurotomy or neurectomy with-
out destruction of important functions. There can be no
question as to the propriety of operating in these desper-
ate cases, for a sufficiently large number are on record
in which relief has been afforded to attest the value of
the proceeding. In the choice of operation preference
should always be given to neurectomy rather than to
neurotomy, for the reason that ex]>erience proves that
almost invariably the pain returns after the latter pro-
cedure, and even in some instances has been at^gravated
after a lapse of time, owing probably to the nerve be-
coming involved in the cicatrix at the site of operation.
On the other hand, neurectomy gives a relief more or
less decided and lasting.
As to the origin of these severe fomis of neiualgia of
the facial nerves, I can offer but little \ nor can it be
said that a positive opinion can be advanced in a given
case as to whether the neuralgia is of central or per-
ipheral origin. Fortunately, however, either variety is
benefited, though not equally so, by neurectomy* In
the central variety, there can be no doubt that the
paroxysms of severe pain are induced by the application
of stimuli to the periphery, and that a removal of the
nerve- trunk and its branches as far as practicable de-
stroys the medium by means of which these stimuli are
conducted centripetally. The suspension of the excit-
ability of the nerve-centre, even though temporarily, is
of benefit by fulfilling the first indication in the treatment,
namely, rest and freedom from irritation. Further, the
reflected or irradiated pains, of themselves sources of
much siiflfering, are relieved by quieting the central ex-
citability.
Where the neuralgia is indubitably of peripheral origin,
as for instance in those cases where a portion of a nerve-
trunk or its branches are involved in a cicatrix, or a
neuroma has developed upon the same, a cure may be
confidently promised if neurectomy be resorted to. Here
removal of the nerve-trunk as far away from the original
point of irritation as is practicable is advised. Every
effort should be made to promote rapid healing after
operation, for the reason that the greater the amount of
connective-tissue proliferation and formation of cicatri-
cial tissue about the nerve-stump, the greater the chance
of the developing therein of nerve-fibres, these communis
eating with or springing from the nerve-stump, and sub-
sequently dragging upon the latter and becoming a re-
newed source of irritation. The antiseptic method of
operating is, therefore, to be commended as being most
likely to accomplish the best possible results.
Physio-Medicalism. — ^A correspondent asks for infor-
mation regarding "physio-medical" colleges and practi-
tioners. So far as we can learn, physio- medicalism is an
" ism " which flourishes only in Ohio and Indiana, There
have been in Cincinnati a Physio-Medical College and a
Physio-Eclectic Medical College, both of which institu-
tions, like the good, died youn^. There is now in Cin-
cinnati The Physio-Medical Institute^ which has been in
existence since 1877, and which graduates a dozen stu-
dents every year. Its catalogue requirements are as high
as those of most regular colleges, but it graduates a higher
per cent, of students upon matriculants than the average.
There is also a Physio-Medical College in Indianapolis,
Ind., which was also founded in 1877, and which also grad-
uates a very high per cent, of students. What the peculiar
tenets of physio-medicalism are we do not know. There
cannot be many over a hundred legitimate graduates in
this specialty, and its existence is of small importance.
The extinct institutions were probably merely advertising
dodges for a few quacks»
37^
THE MEDICAL RECORD.
H^
[October 4, 1884,
LAPAROMYOMOTOMY.
Rei»ort of Two Cases Successfully Treated in a
General Hospital.
By lewis ^. STIMSON, M.D.,
PROFBS8OR OP CLINICAL SUXGEKY IN THK MEDICAL DBPARTMKNT OP TUB UNI-
VBKSITY OP TBB QTY OP NBW YOKK.
I OFFER the following brief history of two cases of suc-
cessful removal of the uterus and ovaries by abdominal
section as a contribution to a subject which is now re-
ceiving much attention. A point of special interest is
the fact that both were treated in the common ward of a
general hospital. Each was a case of multiple fibromata
of the uterus.
The antiseptic precautions consisted in thorough disin-
fection by the bichloride of mercury of the hands of the
surgeons, of all sponges and cloths, and of the wound oi
the abdominal parieties by irrigation. The instruments
were kept in a strong solution of carbolic acid, and
the sponges that were introduced into the abdominal
cavity were first purified by immersion in the [bichloride
solution and kept during the operation in a hot solu-
tion of carbolic acid. The pedicle was secured by trans-
fixion and ligation with india-rubber coed, and treated
by the extra-peritoneal method. The ligatures came
away on the tenth and seventeenth days respectively.
The external wound was kept covered with iodoform and
dressings of borated cotton and iodoform or carbolized
gauze. In each case the final cicatrization of the wound
was slow.
In the first case, the stump of the uterus promptly
sank back to its original position ; in the second, it re-
mained for. several weeks drawn high up and firmly ad-
herent to the anterior abdominal wall. At no time did
the symptoms in either case cause more anxiety than that
which would be naturally associated with the operation.
In both cases I was greatly aided by the advice and as-
sistance of my friend and colleague Professor Wm. M,
Polk.
Case I. — Effie V , colored, about thirty years of
age, was sent to me for treatment from Bedminster, N.
J. I admitted her to the Presbyterian Hospital early in
May, 1884.
She bore a child ten years ago. For the eighteen
months preceding her admission to the hospital she had
been troubled by an abdominal tumor, which caused much
pain, entirely prevented her from working, and was ac-
companied by profuse menorrhagia. Her courses were
very profuse.
There was a hard, irregular tumor within the abdominal
cavity, extending from a little to the right of the median
line in the hypogastrium upward and to the left to a
point above the level of the umbilicus, and protruding
into the vagina so as to force the uterus upward and
backward almost beyond the reach of the finger. The
tumor Was slightly movable at first, and changed its po-
sition downward and to the right and became more
movable while the patient was under observation. The
cavity of the uterus was four and one-half inches long.
The diagnosis was " pedunculated fibroid of the anterior
wall of the uterus, with enlargement of the uterus by
intra-mural fibroids."
May 24th. — Operation. The surface of the abdomen
was washed with soap and water and then with the bi-
chloride solution, the limbs and upper portion of the
trunk wrapped in blankets, and the lower portion of the
trunk wrapped in a rubber sheet in which an oval hole
had been cut at the part corresponding to the field of
operation. Over this sheet were placed cloths wet with
the bichloride solution. An incision was made in the
median line from a point a little below the umbilicus to
the pubes, and all bleeding arrested before the peritoneum
was divided. After division of the peritoneum the hand
was introduced into the cavity, and with some difficulty
the pedunculated tumor, which had a long pedicle, was
turned out. The left ovary was found to lie at some dis-
tance from the uterus, and a double silk ligature was
passed through the broad ligament below the pampim.
form plexus by means of an ivory pin, and tied on each side
of the ovary; the latter was then cut ofL The right
ovary lay close against the uterus, and as it was thoi^ght
it could not be separately removed without risk of
hemorrhage, and as the uterus was found to be studded
with tumors, the latter was drawn forcibly upward, and
its neck, which was long and free, was transfixed from
before backward with the ivory pin, and a double india-
rubber cord four millimetres in diameter drawn through
and tied around each half. On the left side the rubber
ligature passed just below the ligature that had been
placed under the ovary ; on the right side it passed out-
side the ovary and embraced the entire thickness of the
broad ligament. Each ligature was drawn very tight and
secured by tying it in a single knot and fastening the ends
together close to the knot by a loop of silk. The uterus
was then cut off and the stump brought to the lower angle
of the abdominal wound and transfixed with two long pins
close to the ligatures in the distal side. Very liitie bleed-
ing took place from the punctures made in transfixion,
and a sponge passed into Douglas' cul-de-sac brou^t
out only a small clot of blood.
The peritoneum, the aponeurotic-muscular layer, and
the skin were each united with a continuous catgut suture,
and three silver wire and button sutures, not including the
entire thickness of the wall, applied to bear the strain. A
decalcified bone drain was placed in the parietal wound
between the skin and peritoneum, extending from the
upper angle of the wound to the stump. Iodoform,
gauze, body-bandage.
The pedunculated tumor was flattened, and its pedicle
ran from the centre of the flattened surface ; it measured
four by six inches across the top, and three inches from
the pedicle to the upper surface ; the pedicle was two
inches long, one and a half inch wide, and one-fourth
inch thick when compressed between the fingers. The
uterus was irregular in form, with one small (one inch)
pedunculated fibroid and many intra-mural ones; it
measured four inches across the fundus, and the length
of the portion removed was the same.
May 25th. — Temperature, loo^^ Slight abdominal
pain. Ordered morphine, and an ice-water coil on each
side of the abdomen. The wound had oozed freely, but
was then dry. In order to make the application of the
ice-water coil more efficient, the gauze dressings were
removed, and a compress kept wet with the bichloride
solurion substituted.
May 26th. — Temperature, looj^.
May 27th. — Removed drainage-tube and button su-
tures.
May 29th. — Temperature, 984^°. Discontinued coD.
June 2d. — Removed the rubber ligatures, which were
lying loose, and the slough of the stump. This left a
good-sized suppurating cavity, at the bottom of which
was an opening into which a probe passed easily to the
depth of two iriches below the surface of the skin. It
was apparently formed by the sinking of the stump after
it had become adherent to the peritoneum lining of the
anterior abdominal wall. Dressed the wound with iodo-
form and dry absorbent cotton, the latter to be fre-
quently changed.
June 9th. — ^The cavity is slowly filling, but the pouch
at the bottom remains unchanged, except that its orifice
is smaller ; it is about one inch deep and one-third inch
in diameter.
June 1 6th, — ^Wound is slowly contracting; pouch still
one inch deep.
June 23d. — Pouch no longer recognizable; wound
nearly flat.
July ist. — Patient sits up ; the neck of the uterus can
be readily felt high in the vagina.
July 1 2th. — Wound entirely healed. Discharged.
Case II. — Mrs. F , forty years of age, entered the
Presbyterian Hospital June 17, 1884. She had been
suffering for eight and a half months with a tumor in the
w
October 4, 1884.]
THE MEDICAL RECORD.
37^
lower part of the abdomen, profuse menorrhagia, and
pain. For four months of this time she had continuous
pain and fever, and she still sufifers so much that, al-
though fully aware of the risks of an operation, she de-
sires to undergo it in the hope of relief. The tumor
occupies the lower portion of the abdominal cavity, ex-
tending up to the umbilicus, is hard, irregular, and mov-
able, and projects into the vagina, crowding the uterus
so far back and upward that the os can barely be reached
with the finger.
Diagnosis. — Intra-mural fibroids, probably with exten-
sive adhesions.
July 8th. — Operation. This was conducted as in the
preceding case. The uterus was found studded with in-
tra-mural and sub-peritoneal fibroids, and the peritoneum
covering it doubled by a soft, very vascular layer adher-
ent to the rectum in bands. The right ovary was free
and quite distant from the uterus ; the left ovary was quite
closely attached to the sigmoid flexure, and its tube was
adherent to the rectum and sacral wall and dilated to
one inch in diameter. The adhesions to the rectum
were divided between double catgut ligatures, and the
ovaries freed by transfixing and cutting between double
silk ligatures. In the anterior wall of the uterus, low
down, was a large globular fibroid, over the lower por-
tion of which the bladder was broadly spread out. I
made a transverse cut through the peritoneum above the
reflection of the bladder, stripped the latter away firom
the uterus with the finger, passed a double rubber cord
through the cervix and included fibroid tissue, and tied it.
As it seemed inadequate properly to constrict the tissues
embraced in its loop, I passed a second larger cord
through the same puncture and tied with both, then cut
away the bulk of the mass and enucleated from the
stomp the remaining fibroids and portions of fibroids.
The parietal ligature beyond the left ovary meanwhile
had dipped and some bleeding followed, which was ar-
rested by passing an armed needle through the mass of
divided vessels close to the sigmoid flexure and tying on
both sidqs. The oozing in the pouch made by stripping
up the bladder was quite free, and was finally arrested
by the actual cautery ; this pouch was drained by a rub-
ber tube, its surface dusted with iodoform, and its mouth
closed in great part by stitching the peritoneum to-
gether. The stump was brought to the lower porrion of
the wound and transfixed with four long pins. The peri-
toneal portion of the abdominal wound was closed by a
continuous catgut suture, the musculo-aponeurotic layer
hy interrupted catgut sutures, and the skin by interrupted
cat^t and two silver sutures. A long decalcified bone
drainage-tube was passed into Douglas' cul-de-sac, and
the incision and stump dusted with iodoform and dressed
with iodoform gauze, borated cotton, and a body-band-
age. Morphine ordered.
July 9th. — ^Temperature rose gradually to 102° in
the morning, and sank to ioof° in the afternoon.
Changed dressing and removed the bone drainage-tube.
The deeper layers of the dressing were saturated with a
dark, thin discharge. Irrigation coil applied on each side.
July loth. — ^Temperature, .loof**. Occasional pain,
otherwise comfortable.
July nth. — Much nausea; removed one inch of the
nibber drainage-tube ; dressing dry except for a small
stain over the tube ; temperature, 99° to 101° ; morphine
discontinued.
July 1 2th. — ^Temperature has remained below 100**;
the only complaint is of the nausea and of pain caused
by vomiting.
July 15th. — Changed dressing and removed the tube ;
temperature still below 100® ; some little nausea.
July 1 6th. — Pressure caused about two ounces of pus
to flow out beside the stump and from the upper angle
of the wound.
July 24th. — Stump came away this morning ; the liga-
Ctirss had not cut through, but remained fast on the
porion that sloughed off, the slough extending about a
quarter of an inch beyond them. The cavity is an inch
deep and its bottom flat and solid ; the adjoining skin
has turned inward, especially on the left side, and united
with the surface of the wound,
July ^6th. — After a severe fit of vomiting this morning
free bleeding took place from the deeper part of the
wound ; it was arrested by lightly touching the bleeding
point with the cautery,
August 14th. — ^The patient has been doing Ytry w^Il,
except for occasional nausea* The wound is deeply
retracted; the skin on the left side extends to the bottom;
on the other side is a flat granulating surface about one
and a half inch long and a quarter of an inch wide.
I failed to touch the cervix in vaginal examination*
The abdominal wall at the wound is not movable upon
the underlying parts ; some tenderness on pressure on
each side above the wound ; told to sit up.
August 29th. — ^The wound has become level with the
surface of the abdomen by the rising of the retracted
skin, and is cicatrized at its centre. The cervix is lower
and can now be readily felt in the vagina.
At intervals of about a week the patient has had
attacks of nausea and pain in the lower |?art of the
abdomen, which have always ceased after a free evacua-
tion of the bowels has been obtained by enema.
September nth. — Patient left hospital well and ** feel-
ing better than in years," There has been no recurrence
of the nausea and pain in the abdomen since the latter
part of August.
I chose the extra-peritoneal method of treating the
pedicle because I deemed the consequent delay In the
final healing of the external wound of no importance
when compared with the security which the method
gives against complications arising from retention of
pus or decomposition of the portion of the pedicle em-
braced in the ligature. It may be that the first of these
two cases would have done as well if the pedicle had
been allowed to drop back into the abdominal cavity,
but it could hardly have done any better. By the ninth
day the ligatures had fallen, the abdominal cavity was
closed, and there remained only the granulating wound
of the anterior abdominal wall, and this soon cicatrized.
With intra-peritoneal treatment of the pedicle the healing
of the external wound may be equally delayed, and even
when this healing takes place most promptly the patient
gains but little in time or in security, for the risks or
discomforts arising from the small unhealed surface are
trifling, and a due regard for the safety of the internal
cicatrices would compel an equally prolonged confine-
ment to the bed even if the external wound were healed.
In the second case I am convinced that the intra
peritoneal method would have placed the patient's life in
extreme peril. The cervix was itself occupied by tumors,
and through two of these the ligature had to be passed.
Separation took place, not in the plane constricted by
the ligature, but at a little distance on its proximal side,
apparently at the limit of the transfixed tumors, and
when the ligatures came away (on the seventeenth day)
they still firmly held the slough. It is extremely Im-
probable that such an occurrence could have taken place
within the abdominal cavity without provoking suppura-
tion, and for the pus so formed there would have been
no outlet except such as might have spontaneously
formed. The formation and retention of that pus and
the possible decomposition of the slough would have
been most dangerous complications.
The only serious objection to the extra-peritoneal
method which I foresaw was the possible interference of
the pedicle with the subsequent distention of the bladder.
I expected that the cervix would remain attached to the
anterior abdominal wall closely enough to compress the
bladder against the pubes and allow of its dilatation
only on each side. This anticipation was not realized.
In neither case did the patient find it difficult to retain
her urine for the usual length of time, and in each the
372
THE MEDICAL RECORD.
[October 4, 1884^
cervix sank back (promptly in the first case, much later
in the second) to' its former place in the pelvis. Ap-
parently this was accomplished by the stretching or slid-
ing of the peritoneum after adhesion had taken place
between its confronted surfaces ; and in the first case, in
.which it was found to have occurred when the ligatures
fell, a deep pouch like a glove-finger was formed and
easily demonstrated at the bottom of the wound. The
^effect of this occurrence is to place the parts in what is
practically the same condition as that in which they are
left by the intra-peritoneal method of treating the stump,
and thus to restrict the differences between- the two
methods to those existing during the process of repair of
the wound. Those differences appear to make the extra-
peritoneal method much the saier, for in it there is no
possibility of the inclusion of a decomposing slough or of
the retention of pus that has formed about the ligature,
and if hemorrhage occurs through the slipping of the liga-
ture, as has occasionally happened and with fatal results,
it is at once detected and is accessible to treatment.
ANTISEPTIC MIDWIFERY.
By a. C. page, M.D.,
TSUKO, N. S.
Mr. President : The object of this writing is to intro-
duce the question of ** Antiseptic Midwifery," hoping in
this way to obtain the experiences of wiser and abler men,
so that while I am being taught, our younger brethren
may catch some useful hints to help them over hard
places. At the February meeting of the Colchester
County Medical Association, Dr. I. W. McDonald, of
Londonderry Iron Mines, was kind enough to give an ob-
ject-lesson; illustrating the materials used and the manner
of, applying antiseptic dressings in surgery.
In the discussion that followed. Dr. Neil Sutherland, of
Spring Hill Mines, called attention to the importance of
antiseptics in midwifery practice, and Dr. McLeod, of
Economy, related a case where, for want of such atten-
tion, he was caused great inconvenience and anxiety,
he having, as he supposed, carried septic germs to his
patient from a suppurating wound he had just previously
been dressing, with nearly fatal consequences. I have
been in the habit, from the beginning of my practice,
twenty-eight years ago, of washing out the vagina with
Labarraque*s solution in all cases where the discharges
after confinement were offensive, and my attention was
called to it ; but in many of my cases I never saw my pa-
tient more than once after delivery, and many not even
once. Of late, however, the journals are teeming with
articles on this subject, and the indolent or ignorant are
being faithfully warned of the dangers by which our pa-
tients are surrounded constantly, and in a feeble way
means are pointed out having for their end the avoid-
ance of those dangers. Antiseptic midwifery, as well as
surgery, is based upon the theory that the air we breathe,
by which we are constantly encompassed, and which we
cannot very well get away from, as well as the water we
drink — that is, the few of us who drink water — in fact,
our whole environment, is loaded with disease -germs,
ready at all times — but sometimes with more malignancy
than others — to pounce upon the unwary or unsulphur-
ized, and enter by any or all avenues, particularly by raw
or abraded surfaces, into the blood, and poison that pre-
cious fluid to destruction and death. The puerperal
woman seems to have a peculiar attraction for these
germs, and if one of them comes at all within her reach,
it fastens itself with a death-grip upon the spot most fav-
orable to the development of its destructive power, not
only destroying her life, but multiplying itself till all per-
sons and all things that have been near her are filled
with the same deadly influence, which they may and do
distribute, right and left, killing as they go. This is truly
a fearful fact to contemplate, in the face of the other fact,
that the only way known for obeying the scripture in-
1 Read before the Nova Scotia Medical Society.
junction, " Multiply and replenish the earth,** is by woman
assuming the risk of mateniity.
One of the most talented and successful practitioners
and teachers of female diseases, whose reputation is
world-wide, and whom all who know honor and respect,
recently published in one of the journals some " prophy-
lactic measures which should be adopted in all midwifery
cases, whether they occur in hospital or in private prac-
tice." Listen to them :
" I. The room in which the confinement is to take
place should have the floor, walls, and furniture thor-
oughly washed with a ten-per-cent. solution of carbolic
acid or mercuric bichloride, i to 1,000, and the bedstead
and mattresses should be sponged with the same solu-
tion ; carpets, curtains, and upholstered furniture should
be dispensed with as far as possible.
** 2. The nurse and physician should take care that all
their clothing, both upper and under, be clean and free
from exposure to the effluvia of any septic aflection.
Should either of them have been exposed within a fort-
night to the effluvia of such affections as scarlet fever,
typhus, er}'sipelas, septicaemia, or the like, they should
change every article of clothing, and bathe the entire
body, especially the hair and beard, with a reliable anti-
septic solution ; that which I prefer for this purpose is a
saturated solution of boracic acid.
''3. As labor sets in, the nurse, having thoroughly
washed her hands, cleaned her nails with a stifi* nail-
brush, and soaked them in antiseptic fluid, should admin-
ister to the patient a warm vaginsil injection of antiseptic
character ; bathe the vulva and surrounding parts freely
with the sartie ; repeat this every four hours during labor,
and keep a napkin wrung out of the warm antiseptic
fluid over the genital organs until the birth of the child.
"4. Before the moment of labor both doctor and
nurse should wash the hands thoroughly with soap and
water, scrub the nails with a stiff" nail-brush, and soak the
hands for several minutes in a bichloride solution, i to
1,000.
" 5. The third stage should be efficiently produced ;
all portions of placenta and membranes removed, and
ergot administered in moderate doses three times a day,
and kept up for at least a week, for a complete closure of
the uterine cavity, expulsion of clots, and occlusion of
the utero-placental vessels.
"6. The doctor, taking nothing for granted, should, at
the conclusion of the labor, carefully examine the vulva
of the patient. If the perineum be lacerated, it should
be closed at once by suture, and should slight solutions
of continuity be found in the labia or the vulvar extrem-
ity of the vagina, these should be dried by pressure of a
linen cloth touched with equal parts of sol. fern per-
sulph. and carbolic acid, again dried thoroughly by
pressure with the cloth, and then painted over with gutta-
percha collodion. If this be thoroughly done absorption
will be prevented at these points for at least three or
four days, when the application may be repeated.
" 7. After the labor, when the patient has rested, the
vagina should be syringed out with an antiseptic solu-
tion, and a suppository of, cocoa butter, containing from
three to five grains of iodoform, should be placed within
it under the os uteri. A syringe with intermittent jets
should be used, which will wash away with gentle force
all blood-clots.
" 8. These vaginal injections and suppositories should,
in cases of normal labor, be repeated every eight hours ;
in cases of difficult or instrumental labor twice as often,
and these should be kept up for at least ten days, the
nurse observing to the last the precaution already men-
tioned of washing her hands before every approach to
the genital tract of the patient.
"9. When catheterization becomes necessary, it is
safest to employ a new gum-elastic catheter, which be-
fore use should be thoroughly immersed in antiseptic
fluid, and which should be destroyed at the conclusion of
the case.
October 4, 1884.]
THE MEDICAL RECORD.
373
•'•' 10. Last, Dut by no means least, let the physician in-
form himself b> personal observation as to the competency
of the nurse to syringe out the vagina, thoroughly to place
the antiseptic suppositories just where they should be,
and to use the catheter without injury to the patient."
These instructions were no doubt dictated by a kind
heart, and are very well as far as they go ; but it seems
to nie that in view of the prevalence of the cause of sep-
ticaemia, and the great necessity of protecting the lives
of women, if it is only for the purpose of child-bearing,
they fall far short of perfect protection. Perfect protec-
tion is, humanly speaking, impossible, I presiune. No
matter how clean the doctor and nurse may be when
they start for their case, who knows what they may en-
counter and imbibe on the way ? Sponging a bedstead
and mattress is scarcely a practical suggestion for private
practice, especially in the country. It appears plain
enough that in this country especially, where there is
such a feverish thirst for rapid increase of population,
and in fact a political necessity for it, that the Govern-
ment roust take this matter in hand. The country should
be divided into districts, and in each district should be
built a large l3ring-in hospital, in a location approved^ by
the Government sanitary engineer or commission. The
buildings should be of iron and glass, with glass floors ;
the bedsteads of iron, japanned ; the beds of rubber and
air; carpets, curtains, and upholstered furniture should
have no abiding-place in the buildings. The furniture
of the lying-in room should consist of a bed and one or
two white glazed earthenware basins only. All the rooms,
when not in use, should be kept filled with the vapor of
burning sulphur. There should be a sufficient number
of suites of rooms, numbering from i to i6 in each suite,
so that the patient could be promoted from No. i, where
she was delivered, to No. i6, advancing a room daily,
by which time she might, under ordinary circumstances,
be considered out of danger of septicaemia, and occupy
the nursery parlors until she was fit to be returned to
her feraily and friends.
Such a staff of doctors and nurses should be kept
constantly ready that there would be no need of rushing
from one case to another without sufficient time for anti-
septic ablutions and thorough cleansing and rest. Every
pregnant woman in the district should be compelled by
law to report herself at the hospital at least two weeks
before her expected confinement, for admission. She
should be immediately scrubbed with some antiseptic
fluid, and thoroughly new, clean, pure clothing provided
for her. When her hour came she should be again
thoroughly disinftcted and conducted to the lying-in
room No. i, under spray. The doctor and nurse ap-
pointed to attend her should be thoroughly washed —
not necessarily together — disinfected, and having been
clothed in antiseptic gauze — not too thin — placed in a
disinfected glass case and rolled into the room No. i,
with the patient, under spray, there to remain till the
patient is delivered, washed, placed in a glass trough
filled with warm disinfecting fluid, and passed under spray
into No. 2, where another nurse takes charge of her and
places her comfortably in bed. The doctor and nurse
now retire from No. i as they entered, under spray, to
their respecrive bath-rooms, and after being thoroughly
scrubbed and clothed anew, they can await their next
patient. In the meantime everything movable is taken
out of No. I, and the room thoroughly disinfected with
burning sulphur, and made ready for patient No. 2. On
the following morning patient No. i, now in room No. 2,
is gently and kindly washed, placed without clothing in
the trough with antiseptic fluid, and rolled under spray
into room No. 3, and put into a warm, clean bed. Room
No, 2 is now cleaned, disinfected, and made ready for
patient No. 2. The only persons having access to these
rooms ordinarily are the doctors and nurses, and they
invariably enter and retire under spray, as does any ad-
ditional help required in cases of emergency.
All the details of nursing, feeding, and medical attend- \
ance are to be carried out with this single end in view,
of avoiding the possibility of septic-poisoning, and under
the strictest scrutiny of the Government sanitary engineer.
These details would be quite incomplete without tak-
ing proper precautions against the possibility, of the
mother being poisoned through fissures in her nipples
from the infants mouth. Millions of women probably
die from poison absorbed in that way. Keep the child's
mouth faithfully disinfected ; but if a solution of bichlo-
ride of mercury is used for that purpose, it will be prudent
not to make it too strong, for a strong solution of cor-
rosive sublimate might prove prejudicial to the health of
any but the very strongest of infants.
The deaths from puerperal fever amount to about one
or two in a hundred in hospitals. The greatest mortality
is in hospitals. In private practice, especially country
practice, the mortality is less. In my own practice of
twenty-eight years, and an experience of about a thou-
sand cases, the mortality from septicaemia or puerperal
fever has not been greater than one or two in a thousand,
and it is a question whether, with such a record without
any antiseptic precautions, it will be worth while to build
such hospitals as I propose right away, or, furthermore,
whether it would be prudent to surround the parturient
woman with such meddlesome, wearisome watchfulness as
will keep her constantly on the ragged edge of despair,
and most certainly produce the very conditions we are
most anxious to avoid. Death from puerperal fever is
no worse, and scarcely more certain, than death from
fear.
Don't allow anything I have written to lead you to
suppose that I have anything but the most profound
respect for science ; but while I adore the teachings of
science, I object to exciting unnecessary fears among a
class of patients who at all times and under the most
favorable circumstances have their nervous system
severely taxed. More than half the lying-in women in
Colchester County are attended by mid wives, and among
them puerperal fever is more rare than triplets. Take
courage, therefore, my brothers, especially my younger
brothers, and fearlessly, faithfully, and prayerfully if you
like, do your duty to your puerperal patients, and I
doubt not that He who hears the cry of the young ravens
and tempers the winds to the shorn lamb will throw His
strong arm and His disinfecting breath about the mothers
of the future, as He so mercifully and consistently has in
the past.
The Right of Parents to Refuse Surgical Aid
FOR THEIR Children. — In a communication addressed
to the RaccoglUore Medico Dr. Turazza, of Venice, raises
the question as to how far parents should be allowed to
interfere with the medical authorities in the treatment of
their children. He cites some instances occurring in his
hospital practice in which the lives of children were
sacrificed because the parents would not consent to cer-
tain necessary surgical operations. And he asks whether,
in the case of a sick or wounded child whose only hope
of recovery rests upon the performance of some surgical
measure, the parents should not be held guilty of homi-
cide when they obstinately refuse to permit of the opera^
tion. And he also asks whether the surgeon, in such a
case ought not, in hospital practice, at least where such
a thing is possible, to undertake the necessary operation
even in opposition to the will of the parents. These are
certainly important questions, but at the same time ques-
tions upon which there is room for wide differences of
opinion. Cases of this sort are not rare in which a life
is seemingly sacrificed to the ignorant prejudices ot
parents, who cannot perhaps be blamed for refusing so
sad an alternative. And yet the question of personal
liberty is also involved, and it must be considered how
far the State shall be allowed to encroach upon the
family. Dr. Tarazzo did not himself attempt to answer
the points raised but hoped to elicit a discussion and*
thereby to obtain the opinions of others.
374
THE MEDICAL RECORD.
[October 4, 1884,
^epavta at ^oapitala.
NEW YORK EYE AND EAR INFIRMARY.
Aural Service of SAMUEL SEXTON, M.D.
(Reported by Wiluam A. Bartlbtt, M.D., Assiitant Surgeon* )1
PAIN IN THE EARS DUE TO IRRITATION IN THE JAWS.
Some of the following cases of otalgia and inflammation
of the ear were presented by Dr. Sexton to the physicians
attending the aural clinical instruction given by the
School of Ophthalmology, Otology, and Laryngology of the
New York Eye and Ear Infirmary ; others were taken from
the clinical records. The experience of the clinic shows
that among the poor earache is, in many instances, due
to simple otalgia arising from dental caries. Sometimes
it is found that even when otalgia is very severe indeed,
no signs of hyperasmia or of inflammation are to be
found in any part of the ear. Again> in certain chronic
or acute inflammatory processes present in the ear, very
great exasperation of the case is manifestly produced by
the reflex agencies already alluded to.
These cases, divested of other details than those more
particularly relating to the subject, are taken from the
record-book in the order in which they presented them-
selves, and may be said to be fairly illustrative of the
troubles under consideration. They do not, however,
represent the entire number of cases of this kind seen
during the period of time embraced between the first and
last cases noted. Very often, it may be premised, a
cure is effected in these cases by the extraction of dis-
eased teeth.
Case 1. — Bertha S— , aged six (vol. vii., p, 2).
Otalgia, — Came to the Infirmary June 15, 1883. For the
past year has at times had pains in ears, and two years ago
one of them discharged. Several days ago pain began
again in both ears, and she cannot sleep at night Ex-
aminaiian showed the left canal to contain a mass of
cerumen; the right membrana tympani lustreless and
hyperemic. Tel^: Lower first and second molars on
both sides mere shells. Treatment: She was recom-
mended to have the shells extracted from the jaws, and
was given small doses of the tincture of aconite root for
the pains. Remarks : In this case the irritation from the
carious teeth had doubtlessly been the cause of the col-
lection of wax ,in the left canal and the otalgia in the
right ear.
Case II. — Mary B , aged twenty-one (vol. vii., p.
12). Otalgia ; Cerumen. — Came to the Infirmary June
22, 1883. Complains of severe pains felt in left ear
for two weeks, which seem to constantly get worse.
Worse in open air, and at night so intense as to keep her
awake. No tinnitus or discharge. Examination : Both
canals filled with cerumen. Teeth : Both upper wisdom-
teeth in a carious state. Both lower wisdom-teeth just
cut. Owing to loss of some of the upper teeth, a vulcan-
ite plate has been worn for four years past. Remarks :
The irritation caused by dental caries and the cutting of
the lower wisdom-teeth in the above case was increased,
no doubt, by the vulcanite plate worn.
Cask III. — Nora H , aged forty (vol. vii., p.
44). Otitis med.dif. Externa ; Otalgia.^-^-Q.dxat to the
Infirmary August 7, 1883. Has had headache for one
year and a half, but never had aural trouble before.
Has^had pains in the right ear for the past two days with-
out discharge. Examination : The teeth are exceedingly
bad, and the right external auditory canal is the seat of
diffuse inflammation. Treatment : Calc. sulphide in one-
half-grain doses every three or four hours; tincture of
aconite root in small doses.
August loth. — Swelling less ; feels a little better. The
patient probably became more free of pain, for she did
uot return.
Case IV. — Henrietta G , aged seven (voL vii^
p. 54). Otalgia; Odontalgia. — Came to the Infirmary
August 14, 1883, with her own diagnosis — that her ear-
ache was due to toothache. Examination : The right
membrana tympani is hyperaemic. Teeth : Both of the
lower six-year molars are carious.
Case V. — N. M , aged ten (vol. vii, p. 71).
Otalgia. — Has had more or less deafness for five or six
years past and teachers have occasionally discovered the
defect in hearing. Was obliged to leave school on ac-
count of otalgia. Examination : The right membrana
tympani lustreless, with prominent folds due to defective
development. The left canal contains considerable soft
wax, obscuring view of membcana tympani. Teeth: All
of the six-year molars are carious as well as many of the
other teeth. Hears a loud voice only in both ears. Treat-
ment: Small doses of aconite were ordered and the
teeth were to be attended to.
Case VI. — ^Amelia P , aged twenty-two (vol. vii., p.
84). Otalgia, — Came to the Infirmary on September 18,
1883. Heretofore has never had any ear trouble, but for
past two weeks has had a pain in left ear, intermittent in
character, and worse at night when Ipng down. Had
both upper canine teeth extracted and the upper right
second molar, but this had no perceptible influence on flie
otalgia. The ear pain shoots over the brow and down the
lower jaw. Has some laryngeal discomfort on account of
pharyngitis with tendency to ozena. Menstruation if
nornaal. Examination : Right canal ' small and mem-
brana tympani hyperasmic. Canal contains small quantity
of cerumen. The left ear in same condition as the right
Teeth: Had both upper second bicuspids removed pre-
vious to coming. In the lower jaw there remain in a
carious state the two right inferior bicuspids and the first
left bicuspid. Removal of the dead teeth recommended
Case VII. — Lizzie C , aged twenty, Irish, seam-
stress. Otalgia. — Came to the clinic October 1, 1883,
giving the following history : No specific, malarial, or
rheumatic taint. Has slight pharyngitis and has never
suffered from dentalgia to any great extent. During the
past four years has had repeated attacks of e»rache on left
side lasting for a day or a day and a half, unaccompanied
by tinnitus or deafness. The present attack, for which
she came for relief, began four weeks ago and has con-
tinued constantly and quite severe to date. Examination :
Teeth covered with tartar, several being carious in both
the upper and the lower jaw. The auditory canals and
tympanic membranes normal in appearance. Treat-
ment: To have the dead teeth extracted and tartar re-
moved. October 4th, removal was followed by almost
complete relief. October 7th, has been entirely free
from pains since last note was made.
Case VIII. — Mary L , aged twenty-four (vol riL,
p. 119). Otalgia; Otitis externa circ. Acuta; Disease tf
Teeth.^CsLme to the Infirmary October 30, 1883. Takes
cold easily. For a week so much pain in right ear that
rest has been difficult, and in consequence she is very
nervous. The right ear discharges a little ; tinnitus is
not complained of, and hearing is unaffected. Two years
ago the ear pained without discharging. The teeth have
ached a good deal. Examination of right ear showed
that the meatus was closed by swollen tissues; hears
a low voice in both ears. Teeth : Upper right first and
second molars absent. Lower first right molar carious,
and the third molar just cut. Treatment: Calc suL,
grs. -^ every two hours ; hot poultices.
November 3d. — No redness; pains ceased on ni^ht
of the I St inst., when a discharge began ; canal contains
some pus. Treatment continued. Advised to have dead
teeth removed and fillings put into such as had suffi-
ciently healthy pulps.
It is noteworthy in the above case, that besides dental
caries there was the additional irritation caused by the
rather late, and probably somewhat difficult, eruption of
a wisdom-tooth on the same side with the affected ear,
and it is not improbable that the previous otalgia experi-
October 4, 1884.]
THE MEDICAL RECORD.
375
enced was dae to this cause. That the furuncle was
due to the irritation in the nerves of the inferior maxil-
lary branch seems most probable.
In commenting on this subject, Dr. Sexton drew atten-
tion to the frequent attendance of females suffering from
aural trouble through sympathy of the nerves, and the
comparative infrequency of the complaint among men ;
even in children, he thought the greater number of otal-
gias occurred among females. In reference to the treat-
ment of these cases, it was believed that since dentistry
had become such a popular business, and dead and dis-
eased teeth had been so carefully retained in the jaws
through their influence, especially among the better-to-
do, nervous diseases about the head were becoming
alarmingly common.' The very general custom of wear-
ing false teeth in the mouth attached to vulcanite rubber,
celluloid, and other plates was also an evil of vast pro-
portions. Indeed, he sometimes thought that the evil
done through ill-advised dentistry was greater than the
possible good arising from the work of the more capable
dentists.
gt:00KjeBa of pCjedijcal ^tietucje*
The Dangers of Removal of the Thyroid Gland.
— Dr. G. Zesas comes to the conclusion, based upon the
results of a number of experiments on animals, that the
thyroid gland is a supplementary organ to the spleen,
and that its extirpation is followed by an increase in the
number of the white blood-corpuscles. Death invariably
ensued upon the removal of both organs. There is an-
other much more important function of the thyroid gland,
however, and this is its office of regulating the circula-
tion within the cranium. As shown by Schiflf, the removal
of this gland is followed by nervous disturbances, such as
stupor, sluggish movements without actual paralysis,
fibrillary muscular contractions, and tremor, and even in
some cases well-marked tetanus. Zesas concludes on
this account that removal of the thyroid gland is a physio-
logically unjustifiable operation. — Wiener Medizinische
Wochenschrift, August 16, 1884.
Masiced SEPTiCiBMiA. — Dr. E. Moritz relates three
cases of septicaemia in which the symptoms were of an
unusual character, leading at first to the diagnosis of some
other condition. In the first case the patient complained
chiefly of headache and pains in the limbs. The body
was covered with numerous petechial spots. It was
supposed at first, owing to the peculiar temperature
curve, that the case was one of relapsing fever, but a
daily examination of the blood failed to show the pres-
ence of spirilli. The diagnosis of septicaemia was then
made and this was confirmed by the autopsy. The sec-
ond case was supposed to be one of diphtheria, though
the probability of septicaemia was recognized before
death. In the third case the symptoms seemed to point
to a commencing small-pox. In all these instances the
autopsy f revealed small sub-pleural ecchymoses, septic
endocarditis, a large softened spleen, and parenchymatous
degeneration of various organs. The points of infection
seemed to have been : in the first case a large clavus on
the sole of the foot ; in the second a diphtheritic inflam-
mation of the pharynx ; and in the third case exten-
sive submucous extravasations in the small intestine.—
Schmidfs Jahrbucher^ July 23, 1884.
Treatment of Strumous Adenitis by Nitrate of
Silver. — Professor Ferraris recommends daily inunctions
of strumous glands with an ointment containing one
drachm of nitrate of silver to ten drachms of vaseline.
Four applications usually suffice to obtain diminution of
pain, or even complete resolution of the enlarged glands.
It is claimed that by this means the inflammation is lim-
ited to the gland tissue, and the formation of fistulae with
subsequent cicatrices is averted.^— ybi/rwa/ de Midecine
de Paris J August 16, 1884.
Hydatid Cyst of the Liver — Spontaneous Cure.
— Dr. Conti relates the case of a man, sixty years of age,
of a robust physique, who had always enjoyed excellent
health up to the time of his present trouble. He began
to suffer from gastritis with violent pains over the hepat-
ic region, like those caused by the passage of a biliary
calculus. In a short time symptoms of hepatitis ap-
peared, fever, jaundice, and enlargement of the liver
without any signs of a distinct tumor. Finally the pa-
tient fell into a state of collapse, with constant vomiting
and obstinate constipation. Some days later he had a
number of diarrhcetic stools mixed with pus. On exam-
ination of the discharges an echinococcus cyst the size
of an orange was discovered. The vomiting ceased,
though the fever and diarrhoea persisted for some time,
with symptoms of pyaemic infection. Dr. Conti believes
the cyst was situated on the under surface of the liver
and was discharged by ulceration through the wall of
the coXon,— Journal de Midecine de Paris y August 16,
1884.
ExsEci'iON OF the Fascia in Dupuytren^s Contrac-
tion.— In an article in the Wiener Medizinische Wochen-
schrift of August 9, 1884, Dr. R. Gersuny describes a
new operative measure used by him in the treatment of
contraction of the palmar fascia. He makes a longi-
tudinal incision of the integument over the prominent
aponeurotic bands, and then, through the opening caused
by the retraction of the skin, excises this part of the
palmar fascia. The wound is then easily closed by a few
sutures and dressed antiseptically. The advantages of
this method, he claims, are that there are no thickened
and knotty cords left in the aponeurosis, and further, that
owing to the direction of the line of incision in the skin
there is but little retraction of the tissues and the wound
heals readily.
Urinary Disturbances in Diseases of the Nervous
System. — ^The urinary organs are often the seat of vari-
ous troubles during the course of nervous diseases. In
an article on this subject {Revue Mddicale^ August 23,
1884) Dr. Charles F6r6 groups these phenomena under
disturbances of secretion, excretion, and sensibility. A
diminution in the quantity of urine, he says, is observed,
especially in severe forms of hysteria, when the ischuria
may persist for several days. In such cases the vomited
matters contain urea, a point of some value in the de-
tection of malingerers. Under the influence of strong
emotions there may be a decrease in the amount of urine
passed, as well as a relatively smaller proportion of urea
and chlorides. Polyuria may be caused by undue sexual
excitement, severe neural^a, and especially the milder
forms of hysteria. Polyuna may also follow the renal or
vesical crises of locomotor ataxia, and may exist as a
permanent condition in aflections of the mesocephalon.
Albuminuria and glycosuria may accompany this con-
dition, not only following lesions in the floor of tlie
fourth ventricle but also occurring in diseases of the
mesocephalon. A slight degree of albuminuria is met
with also in several convulsive neuroses, and more par-
ticularly in epilepsy. The author explains this occurrence
by supposing submucous extravasations into the walls of
the bladder, similar to the facial ecchymoses sometimes
occasioned by an epileptic attack. If the urine contains
a large quantity of albumen, it is merely coincidental and
due to some other pathological condition. A transitory
neuropathic glycosuria may follow physical or mental
fatigue, sexual excesses, or depressing emotions. The
increase of urea and the urates may be encountered in
any of the aflections with clonic or tonic convulsions.
Retention may be due to spasm of the sphincter or pa-
ralyses of the walls of the bladder. Paralytic retention
is common in apoplectic coma, traumatic aflections of
the cord. Pott's disease, acute or subacute myelitis. In
certain cases of this kind the urine becomes rapidly alka-
line, a fact explainable only on the theory of some
' trophic trouble. _^ True incontinence occurs only in
376
THE MEDICAL RECORD.
[October 4, 1884,
acute myelitis or in traumatic aflfections of the cord.
Unconscious micturition is common in tabes dorsalis,
general paralysis of the insane, and cerebral tumors lo-
cated in the mesocephalon. The neurotic incontinence
of childhood is often, the author asserts, a forerunner of
epilepsy or ataxia. The various forms of irritable blad-
der may be met with in acute or chronic nervous con-
ditions, in neurasthenia, spinal meningitis, or locomotor
ataxia. The author does not agreie with M. Geffier, who
asserts that ataxia may be recognized by its urinary
symptoms apart from any pthers, but he thinks that these
troubles may often be of purely nervous origin, and are
most probably of this nature in the absence of any well-
defined lesions of the urinary tract.
Scrofula and Tuberculosis. — The history of the
teachings upon tuberculosis and scrofula is a somewhat
curious one. In the sixteenth century scrofula was the
only condition recognized, but little by little tuberculosis
began to assume an independent position in the minds
of pathologists, and up to within a comparatively recent
time they were supposed to be two separate and distinct
diatheses or morbid conditions. But now tuberculosis
began to get the upper hand, and one after another of
the so-called scrofulous affections were recognized to be
tubercular in character. Koch's discovery of the tubercle
bacillus has lent additional weight to these views, and at
the present day there are very few writers who would
deny the tubercular nature of fungus arthritis, lupus,
caseous cervical adenitis, and cold abscess. While some
deny the very existence of scrofula as opposed to tuber-
culosis, others retain the name, using it merely to desig-
nate a diathesis or morbid predisposition. The exterior
manifestations of this condition have been reduced to
certain forms of eczema, impetigo, sluggish inflamma-
tion of the mucous membranes, and possbily superficial
adenitis. But it is not certain that even these local
manifestations of the scrofulous diathesis may not event-
ually be found to be caused by a mild form of tuber-
culosis. Dr. J. Grancher has recently inoculated guinea-
pigs with pus and crusts of impetigo, and publishes the
results obtained by him in L Union Medicate of August
21, 1884. The experiments were all conducted with
great care, every precaution being taken to protect the
animals from contagion from without. Several inocula-
tions were first made with pus taken from suppurating
glands of the neck and from spina ventosa of the thumb,
and in every instance the animals acquired tuberculosis.
In the second series the pus was taJcen from impetigo
crusts, strumous conjunctivitis, etc. The results were
negative in all but two out of twenty three cases. In
the two successful inoculations ^the pus was not taken
from the impetigo crusts, but in one case from a neigh-
boring papule, and in the other from a small abscess of
the skin. Dr. Grancher concludes that his experiments,
as far as they go, would seem to show that the superficial
scrofulous inflammations are not in themselves tuber-
culous, but that they may be the door through which
the specinc microbe gains admittance into the human
organism.
Treatment of Suppurating Buboes. — This affection
may be cured, according to Delahousse, in from six to
twelvedaysbyadopting the following procedure i^V Union
MedicaUy August 5, 1884): The skin is washed with soap
and warm water, shaved, and then washed again with a
one per cent, solution of carbolic acid. These precautions
having been taken, the abscess is punctured and a solu-
tion of chloride of zinc (one part to six of distilled water)
is injected into the cavity. After being retained for a
short time in contact with the walls of the abscess, it is
let out and replaced by a full injection of carbolized
water. The wound is then covered with eight or ten
folds of gauze saturated with carbolized water and gly-
cerine (four per cent.). The dressing is retained for
forty-eight hours, when the former procedure is repeated,
the same precautions being observed.
Treatment of Dandruff. — M. Vidal uses the fol-
lowing pomade in the treatment of dry seborrhcea of
the scalp {Revue Midicale^ August 23, 1884) ' Pre-
cipitated sulphur, one-half ounce ; balsam of Peru, one-
half drachm; cocoa butter, three drachms; castor-oil,
one and one-half ounce. The proportions of the cocoa
butter and castor-oil should be varied according to the
season to obtain a pomade of the desired consistency.
Acute Nicotinism. — In experiments upon dogs and
rabbits Dr.Tomassio found that a subcutaneous injection
of pure nicotine caused a reduction of temperature of
from 1.5° to 2°. Immediately following the injection
there was a slight muscular trembling, and a diminution
in the number and force of the pulsations and respiratory
movements. Collapse followed in from forty to fifty
minutes. At the autopsy the author found congestion
and hemorrhage into the lungs, the brain, and the ab-
dominal organs. There was an intense odor of tobacco
in all the tissues. — Lyon Medical^ August 24, 1884.
Traumatism and Tuberculosis. — At a recent meet-
ing of the Surgical Society of Paris (Z* Union Medicale^
August 5, 1884), M. Kirmisson related the case of a child,
five and one-half years old, suffering from hemiplegia with
contractures, coming on a week after a fall on the head.
The appearance of the cerebral symptoms, severe pain
in the temple on the side of the injury, the plaintive cries,
vomiting, etc., led to the supposition of a purulent collect
tion following probably a fracture of the cranium. Yet the
slow progress of the symptoms, following at some interval
the traumatism, caused M. Kirmisson to think that there
might be a mere coincidence between the injury and the
appearance of a tuberculous or cancerous neoplasm. The
skull was nevertheless trephined, but with negative re-
sults, and the child died within twenty-four hours. At
the autopsy the bones, membranes, and surface of the
brain were found to be healthy. But in the centre of the
right hemisphere there was a tuberculous mass which had
destroyed the optic thalamus and corpus striatum. Histo-
logical examination established the tuberculous nature
of the tumor. The speaker related several other cases,
collected from the literature, showing a simple coincidence
between traumatism and the development of tuberculosis.
Gastric Secretion in the Fcetus. — When iodide of
potassium is given to pregnant rabbits it quickly appears
in the amniotic fluid. It is often found also in the
stomach of the fcetus, but this was supposed to be due to
swallowing of the fluid, and, indeed, the fact was cited
by Zuntz as a proof that the foetus possessed the power
of deglutition. Krukenberg, however, has found this
substance in the stomach of the fcetus of the guinearpig,
after its subcutaneous injection into the mother, before
it was present in the amniotic fluid. This would show
that the iodide of potassium passed through the placenta
into the foetal circulation and was thence excreted (?) into
the stomach. — Wiener Medizinische Wochenschrtft^ Au-
gust 23, 1884.
Iodoform in the Treatment of Gonorrhceal Oph-
thalmia.— Dr. L. Guaita has treated successfully a se-
vere case of blennorrhagic conjunctivitis on the follow-
ing plan : Every morning, after having thoroughly bathed
the eye with a solution of boracic acid, he filled the con-
junctival cul-de-sacs with a quantity of finely pulverized
iodoform. In addition, the eye was covered with iodo-
form gauze and a layer of gutta-percha cloth. This
operation causes only a slight smarting, which disappears
in a few minutes. If the iodoform gives rise to any severe
pain it is because it is not finely enough pulverized.—
Journal de Medecine de Paris^ August 23, 1884.
Pelvic HiEMATOCELE. — In a thesis on this subject Dr.
Jousset has collected the statistics of upward of thirty
cases of pelvic haematocele, more than twenty of which
ended fatally and were examined post-mortem. As a
result of his studies Hi arrived at the following con-
elusions : i. This affection is not a disease sui generis^
October 4, 1884.]
THE MEDICAL RECORD.
377
but is a symptom of several very different conditions. 2.
The tumor itself is so characteristic that the diagnosis
may be made without an exploratory puncture, provided
only that the patient be seen early. 3. The symptoms
of haematocele are for the most part those of the disease
which has occasioned the extravasation. 4. One variety
of haematocele arises in consequence of extra-uterine
pregnancy or from rupture of the non-gravid condition.
In this case the affection occurs suddenly with signs of
internal hemorrhage, either after some vague symptoms
of pregnancy or in the midst of perfect health. This
manner of onset is rare and is of ominous significance. 5.
Another form of haematocele, also rare and of evil prog-
nosis, occurs in connection with uterine hemorrhage. It
comes on rapidly after metrorrhagia, or more slowly after
dysmenorrhoea. 6. The most common variety is that
which arises in the course of pelvic peritonitis from rup-
ture of the vessels in the pseudo-membrane. The prog-
nosis in this form is of less gravity. 7. Surgical measures
arc only permissible when rupture into the abdominal
cavity is threatened. — Centralblatt fUr Gyndkologie, Au-
gust 23, 1884.
Hygiene of the Mouth in the Nbw-Born. — In an
article on the diseases of the mouth in infants (erythema,
Bednar's aphthse, stomatitis catarrhalis, thrush, etc.). Dr.
Epstein states it as his belief that the most frequent cause
of these affections is to be found in the manner of wash-
ing the mouth of the new-bom child. The cleansing of
the mouth, as usually performed by nurses and midwives,
is done roughly and unskilfully, and not only causes in-
jury to the mucous membrane, but is also frequently the
means of introducing infection from without. He advises
that the buccal cavity be washed only once a day after
the morning bath, and protests especially against cleans-
ing the mouth immediately after birth without previous
disinfection of the nurse's hands. In the treatment of
aphthae no attempt should be made to remove any patches
except those that lie within sight and easy reach, and
any undue force should be most carefully avoided. —
CeniralbkUt fur GyndkologUj August 23, 1884.
Symmetrical Brachydactylus. — Dr. K. L&bker re-
lates the case of an otherwise normally developed wo-
man who had a congenital shortening of four fingers
due to absence of the middle phalanx. The thumb was,
however, normal. The author argues that, in this case
of symmetrical absence of the middle phalanx of all four
fingers, if the first phalanx of the thumb were really the
middle phalanx, it would also have been wanting. Hence
the metacarpus poUicis cannot be regarded as a phalanx.
—Centralblatt fur Chirurgie^ August 23, 1884.
The Weight of Drops. — M. Bo^mond has ascertained
by a number of trials that the weight of a drop depends
upon the external diameter of the tube, and not, as is
usually supposed, upon its internal diameter. The size
of the latter affects only the rapidity of the flow. The
nature of the liquid (water, alcohol, ether, etc.) also de-
termines the weight of the drop independently of any
substances which it may hold in solution. In order to
obtain drops of distilled water (of a temperature of
58.5® F.) weighing five centigrammes — or 80 drops to a
drachm — the external diameter of the tube should be
exactly -A- inch. The author gives a table showing the
comparative weights of drops of different medicinal prep-
arations falling from a tube of the given size. One
gramme (15 minims) of distilled water is equivalent to 20
^ops ; of alcohol at 90**, 61 drops ; at 60®, 52 drops ; of
an essential oil, 48 drops ; of a volatile oil, 50 drops ; of
laudanum, from 33 to 35 drops, varying according to its
strength. The tinctures give a varying number of drops
according to the proportion of alcohol. An aqueous
solution, no matter what its strength, gives the same
number of drops as distilled water. Thus two solutions
of muriate of morphia of ^ and -^^ respectively give
each 20 drops to the gramme. — Journal di MMfcine de
Paris, August 23, 1884,
Periproctitis Simulating Typhoid Fever. — Profes-
sor Llicke relates the case of a strong and healthy man who
was struck on the abdomen with a pole, but without receiv-
ing any apparent injury. Two weeks later he was seized
with typhoid symptoms, high fever, and diarrhoea. These
were followed by tenesmus, bloody, and then purulent
discharges, a gangrenous piece of the rectum was passed,
and soon the man died. At the autopsy there was found
a perforation in the posterior wall of the rectum and a
large fecal abscess extending to the sacrum. There
were no typhoid lesions in the intestinal canal, no caries
of the sacrum or coccyx, and no actinomycosis. The
author believed that the affection was caused by a lodg-
ment of the actinomycosis fungus in the folds of the
rectum, giving rise to ulceration and abscess. The original
fungus of actinomycosis can often not be found in abscesses
of which it is the cause. — Deutsche Medicinal-Zeitung,
August 21, 1884.
An Instrument for Pencilling Children's
Throats. — Dr. H. Guttmann has devised an instrument
to facilitate the making of local applications to the
throat in dealing with refractory children. It consists
simply of a wedge of hard rubber, with rounded edges,
to the broad end of which is attached a handle. The
wedge is perforated to permit the passage of the brush. By
the use of this instrument it is claimed that the possibility
of injury to the soft parts is done away with, the diph-
theritic throat may be pencilled with great ease, and lastly
the danger of infection from coughed-up matters is
avoided. — Deutsche Medicinal-Zeitungy August 18, 1884
Acute Painful Paraplegia. — Dr. Dumolard de-
scribes under this name a special form of paraplegia, not
mentioned in the books, of which he has had occasion
recently to observe several instances. The affection
commences with lumbar pain and a sensation of uneasi-
ness and stiffness in the back. This pain, variable in its
intensity and duration, begins in the lumbar region and
extends up the back, passing sometimes into the neck.
There may also be pains in the thighs and legs, not fol-
lowing, however, the course of the sciatic nerve nor local-
ized in the joints, but extending over the entire surface
of the limbs. When the patient attempts to walk, his
gait is like that of a person suffering from rheumatism.
In severe cases the pains begin with great intensity and
are accompanied with a slight febrile movement. After
some days of suffering the patient finds himself paralyzed
in his lower limbs and is uuable to rise from the bed.
The reflexes are so exaggerated that the least touch on
the feet excites tetanic contractions. The general con-
dition of the patient is never serious, the pulse does not
exceed 80, and the skin is moist. The bladder is usually
somewhat weakened, but neither the paralysis of the
bladder nor of the limbs is ever total The pains are
usually confined to the region of the kidneys and to
the lower limbs during the whole course of the affection,
but sometimes they leave these parts suddenly and attack
the arms, which then also become paretic. The acute
stage of the disease usually lasts from ten to fifteen days,
the pain then rapidly subsides, and the paresis of the
bladder and extremities begins to disappear. In all the
cases observed by Dr. Dumolard complete recovery took
place after from thirty to forty days. The cause of this
affection is not determined, though cold and damp seem
to have some share in its production. The persons at-
tacked had arrived at the middle age. Counter-irritation
along the vertebral column, purgatives, bromide of po-
tassium, chloral, and morphine are the measures which
seemed to do the most good in Dr. Dumolard' s hands.
The author does not regard the disease as belonging to
any form of meningitis, but thinks it may be identical
with an epidemic affection recently observed in Spain.
This was characterized by pain and weakness in the lower
extremities, and having once appeared in the village of
Azannon recurred nearly every year under an epidemic
form. — LAheille M^dicale^ August 25, t884.
378
THE MEDICAL RECORD.r.
[October 4, 1884.
The Medical Record:
A Weekly yournal of Medicine and Surgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD &. Co., Nos. 56 and 58 Ufayette Place.
New Yorky October 4, 1884.
THE ALCOHOL QUESTION.
When that goody young man Telemachus and his
celestial guide Mentor, both models of excellent pro-
priety for the times in which they lived, were on their
memorable travels, they became acquainted with a race
of people who probably had been educated from science
text-books similar to those which are largely in use at
the present day. " Do they drink wine ?" Telemachus
asks of Adoam. " Oh, no ! '' replies Adoam ; " they would
never <io that ! It is not because they want grapes — no
country grows such delicious ones ; but they content
themselves with eating them before they are spoiled by
fermentation, and they fear wine as the comiptor of man.
It is a species of poison, they say, which maddens peo-
ple ; it does not kill a man outright, but it renders him a
brute. Men can preserve their health and strength with-
out wine ; with wine they run the risk of ruining their
health and losing their good manners." '
In discussing the alcohol question from a medical
standpoint we have no occasion for den3nng that the
ideal society which Fdn^lon describes was right in its
judgment and in its practice, and that the Utopia of our
civilization will be distinguished by temperance and
sobriety. It is, however, notoriously a fact that society
is not now, and will not for many years to come be, in
that ideal condition; that debilitating diseases abound
from whose results the remedial use of alcohol often
offers the best means of defence ; that multitudes of per-
sons have weakly neurasthenic constitutions which seem
to be benefited by the vinous stimulus indulged in
moderation ; that, in fact, alcoholic medication con-
stitutes an important part of the physician's armamen-
tarium : all this must be conceded, besides the uses of
alcohol in the arts.
The two aspects of the subject must be kept in mind
in any attempt to treat it fairly ; the dark side with its
horrors, which are undisputed (representing the abuses) \
the counterpart, or the strictly medical side, with which
chiefly physicians are concerned and which has to do
with the benefits obtainable from a physiological and
therapeutical use of alcohol, which is properly a medica-
ment, and as such of so great value that Raymond Lully
styles it "the supreme cordial of the human body."'
The discussion of the question is further complicated
> F6i61on*i T^l^maque, Lhr. viii.
> StiU^ : Therapeutics and Materia Medica ; artide. Alcohol.
by the fact that the effects of alcoholic stimulants vary
according to the quality of the spirit used and the quantity
taken, and according as the individual is sick or well.
1. With regard to quality, this would have to be con-
sidered under several heads, such as the kind of alcoholic
liquor used, whether fermented or distilled, and from what
source, and whether modified by age and by the natural
or artificial mixture of other substances, such, especially,
as the higher atomic (amyl, butyl, propyl) alcohols. It
is known that age has an improving effect on both fer-
mented and distilled liquors, by some process as yet un-
known. Eliminating such noxious impurities as fusel
oil and aldehyde, in any case, whether used as a bever-
age or as medicine, the action of the intoxicant would be
different on the economy according as the product in-
gested were fresh from the fermenting vat or still, or had
become mellow from age.
That the natural or artificial contaminations of spiritu-
ous liquors, of which the most common and the most
baneful is undoubtedly amyl alcohol, or fusel oil, mate*
rially modify the stimulant or narcotic effect of the
alcoholic preparation is well known to physiologists at
the present day. Of this we have lately had a decisive
demonstration in the instructive experiments performed
on animals (dogs and swine) by Drs. Dujardin-Beau-
metz and Audig^, of Paris.* These experiments proved
the exceeding noxiousness of all the higher atomic
alcohols as compared with ethyl alcohol, as also the
powerfully toxic nature of the alcoholic derivatives, acetic
aldehyde, acetic ether, and acetone. This was shown
by the results of acute poisoning with all these substances
in the state of purity, and the state of dilution, and by
the results of chronic poisoning which demonstrate the
relative innocuousness of rectified wine, grain, beet, or
potato spirits as contrasted with crude spirits that have
not undergone rectification. A wide experience, more-
over, has proved that the least noxious of the intoxicating
beverages are those which approach the nearest to the
ntatured products of vinous fermentation.
Organic chemistry has taught us that the alcohol which
distinguishes vinous fermentation and vinous distillation
is the ethylic — C,H,0. It has been again and again
made clear that while a certain moderate quantity of
diluted ethyl spirits may be borne by the human organ-
ism not only with impunity, but often with the happiest
physiological results, the ingestion of even inconsiderable
quantities of the other alcohols — unfortunately too gen-
erally components in notable proportion of the crude
liquors of commerce — is attended with results which are
always pathological and which are often most deplorable.
2. Under the head quantity we should have to consider
acute and chronic poisoning by, and the stimulant and
narcotic action of the alcohols. Here there is no dearth
of facts from which to form judgments, and we now knovr
the fixed toxic dose for every member of the alcohol
series. It has been, for instance, shown that the medium
quantity of ethyl alcohol sure to cause death within
twenty-four hours is eight grammes per kilogramme of
weight of the person or animal ingesting the spirit, and that
the quantity of the other alcohols is much less ; it has
also been shown that when the daily dose of pure ethyl
1 See iheie experiments detailed at length in the Therapeutic Gaiette for July
and August, 1884, with comments by Dr. Hurd, of Newburyport, Mas«.
October 4, 1884.]
THE MEDICAL RECORD.
379
spirits does not exceed one gramme for each kilogramme
of weight, it may be borne without inconvenience for a
rery long time, no perceptible lesions on the part of the
digestive, hepatic, or nervous systems being produced.'
3. With regard to the action of alcohol on the human
system, every physician is well aware of the difference of
effect, whether the individual be in robust health or
whether he be suffering from the debility of disease, quan-
tities being toxic in the one case which are therapeutical
and restorative in the other. There is no doubt that in
sickness we often obtain a healthful stimulant action from
doses which to a well man would be narcotic and detri-
mental ; nor should there be any confusion between these
terms stimulant and narcotic. The author of the best work
in the English^ if not in any language on stimulants and
narcotics (Anstie), defines a stimulant as " any substance
which, brought to bear in proper quantities upon the
nervous system, facilitates nutrition." At the head of
all stimulants he would place oxygen. Anstie's investi-
gations show that alcohol is a food, medicine, or poison,
according to the circumstances under which it is taken
and according to the quantity taken. The effect of a small
quantity he calls true stimulation, and urges that this is
often beneficial, and comparable to the effect of food ; a
large dose produces narcotism, and is always injurious.
A small stimulant dose is physiological, a large narcotic
dose is pathological, and between the two there is a
definite poison line, varying with each individual case.
He denies that true stimulation is ever followed by re-
active depression. True stimulation, whether produced
by the oxygen we breathe or by the wine we drink, facili-
tates nutrition and hence supports life. Such, in brief, is
j Anstie's doctrine.
A careful consideration of the alcohol question firom
' this standpoint and in the manner we have above indi-
cated (which is the only fair way) shows how difficult
and how complex is the problem with which legislators,
I sociologists^ and educators are dealing ; moreover, it will
be seen how great are the difficulties in the way of a proper
and comprehensive presentation of the subject in text-
books on physiology designed to instruct youthful minds
in the truths concerning the actions of alcohol on the
' human system. Better that the children attending our
public schools should grow up without this technical
knowledge, but with the examples duly impressed
, upon them of the evils of intemperance on individuals,
their families, 'and on society, all of which come under
their daily observation and may be made by parent or
teacher the theme of many an effective moral lesson,
than that such loose'and superficial teachings and half-
tmths as characterize the treatment of the subject by
some of our physiological books should be instilled into
their minds, much of it to be unlearned in after years.
DEAD TEETH IN THE JAWS.
The columns of The Record some months since con-
tained several interesting communications to the effect
that the retention of these defective members was not
always unattended with danger to the patient. The
'* clinical notes on aural disease " in another part of The
RicoRD furnish additional evidence of the perils of tooth-
^ See die Recherdies sur la pultaaiice toxiques des Alcools, by Dujardin-
saving. It is stated by the careful observer that not only
a large number of aural diseases, including otalgia pure
and simple, may arise from the irritation of diseased
teeth, but that doubtlessly a great deal of the nervous-
ness with which some people are affected at the present
day is attributable to the ill-advised retention of dead
teeth and the unskilfol stopping of teeth where the pulp
is sensitive, though not as yet irreparably impaired by
caries. It would seem, from the accumulated evidence
on this point, that perhaps the time is nigh at hand
when medical men should be themselves better informed
concerning diseases of the jaws and mouth, rather than
refer the ailments of this region to individuals whose
limited knowledge of medicine does not prevent them
from " treating " dead teeth long after their presence in
the jaws has given rise to alveolar abscesses and neuralgias
more or less painful.
One recalls in this connection the rather amusing emular
tion shown by the numerous correspondents of a London
medical journal some years ago concerning the possibility
of replacing teeth that had recently been lost, as though
such a proceeding were one to be commended. It
would not be strange if, in the course of events, the
day would soon come when just the contrary practice
would prevail — when all teeth without pulps, and hence
in process of more or less rapid decay, as well as those
which the deposit of tartar, or other cause, had entirely
divested of periosteal nourishment, would be promptly
condemned as unfit to remain in the jaws — ^regarded, in
fact, as foreign bodies liable to give rise not only to cere-
bral irritation and disease in the organs of special sense,
through the propagation of local disturbances in the
mouth to the regions mentioned, but to endanger like-
wise the general health through purulent matter discharged
into the mouth from alveolar abscesses, to be continuously
swallowed for a long time, or, indeed, in some instances,
to be absorbed and thus produce septicaemic poisoning.
It is certainly gratifying to note the establishment of
instruction in oral surgery in some of the medical schools,
and it is to be hoped that this subject will receive the at-
tention its importance demands. It must not be sup-
posed, however, that '' dentistry " should be taught, for
surely this in its broadest sense by no means constitutes
oral surgery ; nor does the latter embrace the former.
The stopping of teeth and the fitting of plates m the
mouth, requiring skill and experience for their successful
performance, need no more be taught the medical student
than the manufacture of surgical instruments and ap-
pliances. On the other hand, there has always been a
desire to combine the medical art with the mechanics of
dentistry, but the medical training usually given the
dental apprentice is entirely too superficial to qualify
him to treat disease, -whether arising from the state of the
teeth or not ; in point of fact, his training does not al-
ways prevent harm being done to persons who are will-
ing to have placed in the mouth some one or more of the
numerous harmful dental appliances of the present day.
SOME THERAPEUTICAL DELUSIONS.
We have received from an esteemed correspondent an
extremely pungent criticism of the therapeutical fashions
of the day. The writer eamesdy urges the necessity of
a more critical and careful analysis of therapeutical ex-
38o
THE MEDICAL RECORD.
[October 4, 1884.
perience, and prays for a cyclone to strike some three-
fourths of the therapeutical recommendations now in
vogue. He concludes by enumerating a series of thera-
peutical delusions which he finds to be more or less cuirent.
While we greatly deprecate nihilism in therapeutics, be-
lieving that that phase of medical feeling has had its day,
we earnestly desire to encourage a more critical study of
the action of remedies and of alleged therapeutic results.
We have carefully examined the ** delusions " set forth
by our correspondent, and find that in the main they
agree with results of the more conservative clinicians and
of pharmacological experiment.
They are as follows :
" It is a delusion that veratrum viride or aconite will
abort croupous pneumonia or essentially modify its course ;
that potas. chlorate is of any use in catarrhal angina ;
that potassium nitrate is an antipyretic, anti-rheumatic,
or (to any appreciable extent) diuretic ; that lime-water
will, in practice, dissolve a diphtheritic or croupous mem-
brane ; that nitrate of silver is of any value in epilepsy ;
that the excessive and continued use of iron induces
plethora with dizziness, flushings, and palpitations ; that
iron should be given in phthisis ; that mercury is anti-
plastic and antiphlogistic ; that arsenic has any value in
diabetes mellitus ; that potassium iodide promotes ab-
sorption of serous exudations and non-specific connec-
tive tissue in hyperplasias ; that sulphur and sulphur in
baths is of any value in rheumatism ; that charcoal, when
moist in the stomach and intestines, has any absorptive
power, or is of any use in flatulence by virtue of that
power; that dilute acids are < cooling,' 1.^., lower tem-
perature and lessen heart- action in the non-febrile ; that
colchicum is of benefit in rheumatism ; that drinking
sulphuric acid prevents chronic lead-poisoning; that
iodoform given internally is anything but a poor substi-
tute for potassium iodide ; that croton-chloral has a
specific efiect on the fifth cranial nerve ; that tannic
acid (or the plants containing it) is of any value given
internally for hemorrhages, except perhaps those of the
stomach and bowels, or that it is of any value as a
gargle in chronic pharyngitis, or that it is an astringent
to mucous surfaces and blood-vessels ; that turpentine is
a stimulant to the heart and nervous system ; that musk
is a nerve or heart stimulant (it belongs, with turpen-
tine, to nerve depressants) ; that ox-gall is of the slightest
therapeutical utility at either end of the digestive tract ;
that hydrocyanic acid in ordinary medicinal doses is
either a local or general sedative (it is rather an irri-
tant) ; that quinine in either small or large doses is a
stomachic tonic, except in convalescence from malarial
attacks ; that hydriodic acid has any specific effects other
than those possessed by the iodides."
PALATO-GRAPHY.
Dr. Harrison Allen, of Philadelphia, has described *
a method of recording the movements of the soft palate,
which is likely to prove of much scientific and perhaps
practical importance. He says :
" When a straight rod is passed through the nose from
before backward in the living subject, as far as is possi-
ble, it will be found to impinge against the roof of the
naso-pharynx. In this position the rod is not influenced
by any motions of the soft palate ; but if the end of the
rod which remains without the nostril be raised so that
the rod be brought in contact with the anterior border of
the nostril, the pharyngeal end of the rod will lie in a
position which will cause a decided motion to be trans-
mitted to it when the soft palate is raised"
By the use of a flexible copper wire attached to the
rod, and then to a head-band, the rod is kept in place on
the palate, and the free end is allowed to rest upon a re-
volving drum or kymographion, where it registers its
movements. It is then found that the rod produces dif-
ferent curves with every motion of the palate in speak-
ing, coughing, hawking, breathing, etc.
Dr. Allen has studied these curves and found them to
vary for each of the dififerent vowels and consonants, as
well as for different words.
The tracings obtained are tolerably alike for the same
words, although dififerent individuals sometimes produce
different tracings.
Dr. Allen gives illustrations of the tracings obtained
with vowels, consonants, syllables, words, phrases, etc.
He believes that palato-graphy may be of use in study-
ing the mechanism of the soft palate in disease, as well
as in health. It may probably prove of use in studying
stammering, and in determining the degree of degenera-
tion of the levator-palati muscles in progressive dry
aural catarrh.
It may also be employed in studying phonetics, and
the suggestion is made that the instrument may be avail-
able for the comparative study of language, for the in-
struction of the deaf, and for the formation of a new
system of short-hand writing.
While one can see many practical objections to such
a rose-colored view of the future of the palate-myograph,
it is evident that Dr. Allen has made an addition to our
instruments of precision which will be of considerable
value.
Icvaa of tlije WHtiik.
r. 1 A New Method of Recording'^the (Motions of the SoftJPalatcT By^Harriion
Allen, M.D. ^PhiUddphia :iP.tBlakistonJ&»Son.Mx884. j
The Dosage of Phosphorus. — Dr. Rutgers, of Rot-
terdam, directs attention to a typographical error occnr-
ring in The Record of April 5, 1884, p. 376. It is there
stated that Dr. Kassowitz recommends teaspoonful doses
of a solution of phosphorus in cod-liver oil, x part to
1,000, in the treatment of rickets. The proportion should
have been given as i to 10,000, the former dose being
that suitable for an adult, and of course much too large for
a young child. We always endeavor to be scrupulously
exact in transcribing directions for the treatment of dis-
ease, especially when the question of the dosage of power-
ful drugs is involved, but errors will occasionally creep
in, despite the greatest vigilance. It is always a good
plan before accepting any formula, no matter by whom
recommended nor where found, to make a simple calcu-
lation in order to determine the exact amount of the
active ingredient contained in the prescribed dose. If
this be done in every instance, errors of transcription or
of printing can readily be detected, and the possibly un-
oward consequences averted.
October 4. 1884.]
THE MEDICAL RECORD.
381
HOMffiOPATHY AND THE GaRFIELD MEMORIAL HOSPI-
^^_In order to satisfy the demands of certain homoeo-
paths at Washington, the Trustees of the Garfield Me-
morial Hospital have adopted the following by-law :
"The executive committee shall provide that homoeo-
pathic treatment shall be furnished to those patients who
desire iU provided the physician selected for such purpose
shall render his services upon the same terms as the
medical staff of the hospital."
Death of a Noted Epidemiologist. — The death is
announced of Mr. John N. Radcliflfe, M.R.C.S., one of
the best of modem epidemiologists. He was the author
of a number of painstaking reports upon epidemics,
being especially skilful as a historian in that line. He
vas for some years one of the two public health inspec-
tors of London.
The Cholera. — Up to September 30th, the total num-
ber of deaths from cholera in Europe was not far from
15,000. Of these Italy has over 8,000 ; France, about
6^000 ; Spain, 400.
In France there are now 23 Departments where cases
have been reported, and 19 that have had deaths. The
stricken communities number 237. Marseilles has had
1,733 deaths ; Toulon, 982 ; Aries, 383 ; Perpignan,
186 ; Aix, 162 ; and Carcassonne, 106. The disease
has nearly disappeared from France and Spain, and it
continues to abate in Italy.
The total number of fresh cases in Italy, September
29tb, was 355, with 212 deaths. This includes 171
cases and 100 deaths at Naples.
A cablegram from Paris, September 30th, states :
"The cholera commission appointed to investigate the
epidemic here have submitted their report. They state
that they followed the progress of the disease by hourly
examining the blood of persons stricken with it. They
found that in each case at first a few of the globules pre-
sented an unhealthy appearance, then one-third were
affected, then one-half, then two-thirds, and finally death
resulted. The important fact was developed that all the
globules were not simultaneously affected."
The American Academy of Medicine. — The Ninth
Annual Meeting of the Academy will be held at the Johns
Hopkins University, Baltimore, Md., on Tuesday and
Wednesday, October 28th and 29th, beginning on Tues-
day, at three o'clock p.m. The address of the President,
Dr. Benjamin Lee, of Philadelphia, will be delivered at
eight o'clock p.m. Papers will be read by Dr. N. Allen,
of Lowell, Mass., on "Physiology in its more Public
Relations (public health, physical culture, family institu-
tions, true civilization)"; Dr. H. O. Marcy, of Boston,
Mass., on **The R61e of Bacteria in Infectious Diseases";
Dr. R. Stansbury Sutton, of Pittsburg, on "The Teach-
ings Derived from Observations in One Hundred and
Thirty-seven Abdominal Sections"; Dr. H. Knapp, of
New York, on "Statistics of Glaucoma''; Dr. A. L.
Gihon, U. S. Navy, on "The Trade Aspect of Medicine";
Dr. E. Jackson, of Philadelphia, on "The Examination
of Applicants for Licence to Practice, a Means of Rais-
ing the Standard of Medical Education"; Dr. A. C.
Kemper, of Cincinnati, O., on "Medical Fees"; Dr.
V. P. Gibney, of New York, on "Some Comparative
Results of Treatment of Chronic Articular Osteitis of
the Hip"; Dr. C. C. Bombaugh, of Baltimore, Md., on
" The Place of the Physician in Literature "; Dr. Peter
D. Keyser, of Philadelphia, on "The Relation of the
Medical Colleges to Preliminary Education"; Dr. A. D.
Rockwell, of New York, on "The Induction Coil, its
Varieties and the Diflferential Indications for their Use";
Drs. Dunglison and Marcy, '* Report on Laws Regulating
the Practice of Medicine in the United States and Canada."
The Comma-Bacillus found in the Mouth and
Fauces of Healthy Persons. — Dr. T. R. Lewis, of
the British Army, has been studying the microscopical
appearances in cholera at Marseilles. He states that he
finds the comma^bacillus in all cases, but that he has
also found this bacillus in the mouth and fauces of
healthy individuals. Although Dr. Lewis regards this
fact as one of great significance, it cannot be so re-
garded as yet, since he did not test the oral micro-
organisms by cultivation.
Collective Investigation in Connecticut. — We
have received a circular from the " Committee on Matters
of Professional Interest in the State," in which is pre-
sented a plan for collective investigation among the mem-
bers of the State Society. The subjects chosen for in-
vestigation are : convallaria maialis, piscidia erythrina,
cascara sagrada, and the oleates. A list of questions
under each head is furnished, and the members are each
urged to do whatever is possible to promote the success
of the investigation.
Dr. Alexander H. Stephens and Sir James Paget.
— In an address delivered before the New York State
Medical Society at Albany, in 1850, we believe, Dr. Al-
exander H. Stephens, President, gave a very similar series
of facts and line of reasoning regarding the cost of sick-
ness and disease that Sir James Paget did in his much-
quoted address at the Healtheries. Dr. Stephens' ad-
dress was not " much-quoted " however. Times were
not then ripe.
The New York Post-Graduate Medical School
AND Hospital opened its Session of 1884-85 on Octo-
ber I St, in its new and spacious building, where, during
the summer, many changes have been made to add to
the comfort of the physicians who attend the clinics. The
building is four stories high, has a frontage of ninety '
feet, and has a large yard, in which is the well-ventilated
building for the teaching of operative surgery, regional
anatomy, and the like. In the basement is found the
pharmacy and patients' waiting-room ; on the first floor
the amphitheatre, comfortable and light, for surgical, gy-
necological, ophthahnic, and other operations, and for
the various clinics ; also a second lecture-room for ortho-
pedic surgery, and instruction in naval, military, and
State hygiene ; together with eight other rooms for the
treatment of patients, and the reading-room, well sup-
plied with medical journals. On the second floor is the
large room for laryngoscopy, ophthalmoscopy, and oto-
scopy, with facilities for teaching thirty at once, if neces-
sary. The new histological and pathological laboratory
is also most thoroughly equipped, and contains one of
the largest collections of specimens in this country. A
photographic gallery for taking pictures of important
cases is a new feature. The two upper floors are devoted
to hospital purposes, where private patientsjjare treated.
382
THE MEDICAL RECORD.
[October 4, 1884.
either in separate rooms or in a general ward, recently
opened. Some of the private rooms are marvels of
beauty. During the last session one hundred and eigh-
teen physicians studied at the School, and the present
demand for post-graduate instruction is on the increase.
During the winter clinics will be given on the following
topics : Surgery, Clinical and Operative ; Gynecology ;
Venereal Diseases ; Diseases of the Eye and Ear ; Phy-
sical Diagnosis ; General Medicine ; Diseases of Chil-
dren ; Urinary Analysis ; Surgical Dressings ; Obstet-
rics ; Applied Anatomy ; Diseases of the Nervous Sys-
tem ; Orthopedic Surgery ; Diseases of the Nose and
Throat ; Skin Diseases ; Pathology and Histology ;
Hygiene ; Pharmacy ; Anatomy and Physiology of the
Nervous System ; and Genito-urinary Diseases.
^vmvi and Hatr^ ^exus.
Official List cf Changes in the Staiums and Duties of Officers
serving in the Medical Department, United States Army,
from September 21 to September 27, 1884.
MiDDLETON, Passmore, Major and Surgeon. Having
reported from sick leave of absence, assigned to duty at
Fort Leavenworth, Kan. S. O. 188, par. 2, Headquar-
ters Department of Missouri, September 19, 1884.
White, R. H., Captain and Assistant Surgeon. As-
signed to duty as Post Surgeon at Fort Winfield Scott,
Cal., relieving Assistant Surgeon A. S. Polhemus, who,
upon being relieved will report to commanding officer
Alcatraz Island, Cal., for duty. S. O. 113, par. i.
Headquarters Department of California, September 19,
1884.
Hall, John D., Captain and Assistant Surgeon. As-
signed to duty at Fort Townsend, Wash. Ten, to relieve
Surgeon R. S. Vickery. Surgeon Vickery on being re-
lieved directed to report to commanding officer Van-
couver Barracks, Wash. Ten, for duty. S. O. 140, par.
3, Headquarters Department of Colorado, September 15,
1884.
Tesson, L. S., Captain and Assistant Surgeon. Di-
rected to report to commanding officer Fort Stockton,
Texas, for temporary duty. S. O. 127, par. 3, Head-
quarters Department of Texas, September 22, 1884.
Birmingham, H. P., First Lieutenant and Assistant
Surgeon. Leave of absence extended twenty days. S.
O. 116, par. 2, Headquarters Division of the Missouri,
September 22, 1884.
Maddox, T. J. C, First Lieutenant and Assistant
Surgeon. Directed to report to commanding officer post
of San Antonio, Texas, for duty. S. O. 127, par. 5,
Headquarters Department of Texas, September 22, 1884.
Barrows, C. C, First Lieutenant and Assistant Sur-
geon. Leave of absence extended one month. S. O.
97, par. 6, Headquarters Division of the Pacific, Septem-
ber 19, 1884.
DiETZ, W. D. , First I^ieutenant and Assistant Surgeon.
Assigned to duty at Fort Selden, N. M. (Post Surgeon),
S. O. 187, par. 4, Headquarters Department of Missouri,
September 18, 1884.
McCaw, W. D., First Lieutenant and Assistant Sur-
geon. Assigned to duty as Post Surgeon, Fort Craig,
N. M. S. O. 187, par. 5, Headquarters Department of
Missouri, September 18, 1884.
Official List of Changes in the Medical Corps of the U, 5.
Navy, during the week ending September 27, 1884.
Bloodgood, D., Medical Inspector. To Washington
for examination preliminary to promotion, and as to
qualifications for sea duty, October i, 1884.
HoRD, W. T., Medical Director. As member of Naval
Examining Board, October i, 1884.
Turner, T. J., Medical Director. As member of
Naval Examining Board, October i, 1884.
Boyd, J. C, Passed Assistant Surgeon. Placed on
waiting orders, September 25, 1884.
Oberly, a. S., Surgeon. To Washington for exam-
ination preliminary to promotion, and as to qualifications
for sea duty, October i, 1884.
§ljepr0rtB at ^atxzlizs.
AMERICAN GYNECOLOGICAL SOCIETY.
Ninth Annual Meeting, held in Chicago, September 30,
October i and 2, 1884.
(By Telegnph to Thb Mbdicax. Rbcokd.)
Tuesday, September 30TH — First Day — Morning
Session.
The Society was called to order by the President, Dr.
Albert H. Smith, of Philadelphia.
Dr. W. H. Byford, of Chicago, gave the address of wel-
come.
Dr. John C. Reeve, of Dayton, O., read a paper on
INVERSION OF THE UTERUS.
The following points were among those upon which
opinions were divided :
First. — Could inversion of the uterus occur entirely
independent of pregnancy or polypus, or even in a nul-
liparous organ ? There was a fair argument in favor of
the proposition that it might so occur, and some cases
seemed to prove it.
Second. — Did inversion of the uterus always begin at
the fundus uteri ? There seemed sufficient data to es-
tablish the proposition that inversion could begin at the
cervix.
Third. — Did puerperal inversion of the uterus ever
occur except at or immediately after delivery ? Testi-
mony rendered argument in its support unnecessary ;
several cases were mentioned which sustained the propo-
sition.
Fourth. — Might inversions of the uterus take place
• without sufficient symptoms to attract attention or to in-
dicate that anything had gone wrong ? Cases were cited
which sustained the affirmative of the proposition.
The paper was discussed by Drs, John Scott, of San
Francisco ; W. H. Byford, of Chicago ; B. B. Browne, of
Baltimore ; A. Dunlap, of Sprinfigeld, O. ; E. W. Sawyer,
of Chicago ; and W. T. Howard, of Baltimore.
Dr. H. p. C. Wilson, of Baltimore, read a paper on
FOREIGN BODIES IN THE ABDOMEN AFTER LAPAROTOMY.
He had been unsuccessful in gathering statistics but had
succeeded in collecting twenty-one cases. Of these only
five had been published. Six occurred in this country,
fifteen in Europe. In six American cases sponges were
left in five, and forceps in the remaining one. Dr. Wil-
son gave a history of his case, that of a woman five
months in pregnancy, upon whom he performed ovari-
otomy. Abortion occurred eighteen days after the opera-
tion. A sponge remained in the abdominal cavity five
months ; it was then discharged piecemeal through the
abdominal walls, and the patient recovered completely.
The paper was discussed by Dr. Thoacas, of New
York. He said he was in the habit of attaching long
pieces of tape to each sponge to prevent its loss in the
abdomen. He had never had an accident occur to him-
self except once in four or five hundred laparotomies,
and then a piece of sponge was found post-mortem, only
a few hours after operation.
Dr. a. Reeves Jackson, of Chicago, knew of three
unpublished cases, two in which sponge, and one in
which forceps had been left in the abdomen. To pre-
October 4, 1884.]
THE MEDICAL RECORD.
383
vent accident he used a list of instruments and sponges,
and compared the count after operations.
Dr. John C. Reevk, of Dayton, O., mentioned that
Wilson used antiseptic sponges.
Dr. Dunlap, of Springfield, O., used few instruments
and sponges, and allowed no one to put the hand in the
abdomen except himself. He made the incision large
so as to allow inspection, and used large sponges.
The discussion was continued by Drs. Howard, of
Baltimore ; Engelmann, of St. Louis ; Mund6, of New
York; Baker, of Boston ; and was closed by Dr. Wilson,
who stated that, from discussion and from one case learned
otherwise, he could add seven to those reported in his
paper ; making a total of twenty-eight.
Tuesday, September 2oth — First Day — ^Afternoon
Session.
The Society was called to order at three o'clock by
the President.^
Dr. C. D. Palmer, of Cincinnati, O., read a paper on
ABDOMINAL SECTION — ITS VALUE AND RANGE OF APPLI-
CATION AS A MEANS OF DIAGNOSIS AND TREATMENT.
In no class of diseases were there greater difficulties
in diagnosis to be encountered than in certain pelvic and
abdominal affections of women. Great stress had been
laid upon the value of tapping as a diagnostic means.
Probably the middle ground of favor occupied by most
gynecologists was the correct one. But had not the im-
portance of tapping as a means of diagnosis been exag-
gerated? The advantages offered by the plan were men-
tioned, and then reference was made to the immense
damage that indiscriminate tapping had done. Tapping
should be omitted if a diagnosis could be established
without it, or some other equally risky procedure. The
author of the paper would not assume the extreme posi-
tion against i^ but from experience we were justified in
contending that tapping, in a large proportion of cases,
in which it had usually been practised, was unnecessary
and superfluous ; for diagnosis, exploratory section was
the only means in our possession to accurately determine
certain diseases and conditions of the pelvis and abdo-
men. After referring to the views of Tait, Bird, Atlee,
Kceberle, Spencer Wells, C. C. Lee, and his own expe-
rience. Dr. Palmer gave the general proposition that ab-
dominal section was not dangerous in most cases, in
which it appears justifiable. That
THE RISK OF PURE ABDOMINAL SECTION FOR DIAGNOSIS,
EXCEPT IN MALIGNANT DISEASES, IS LESS THAN MIGHT
BE EXPECTED.
In a group of cases the mortality would be heavier
than in completed operations. Tait well remarked that
the surgeon should most carefully consider what he was
about to do before he turned an exploratory incision into
an incomplete operation. Generally speaking, in all
seriously doubtful and obscure cases of abdominal and
pelvic disease, after other methods of exploration had
failed, and when there were severe and threatening
symptoms with urgent indications for relief, the abdomen
might, or should be, opened. The diseases in which it
might be resorted to were : First, ovarian tumors ; sec-
ond, certain interstitial and extrauterine fibroids ; third,
certain cases of acute and chronic peritonitis ; fourth, in-
testinal obstruction ; fifth, chronic pelvic abscess ; sixth,
extra-uterine pregnancy. These explorative incisions
should be performed antiseptically.
Dr. Engelmann, of St. Louis, thought that explora-
tory section had been practised too little in this country
as a means of diagnosis. He regarded it as far more safe,
and certainly more satisfactory, than tapping.
Dr. MuNDi, of New York, regarded exploratory in-
cision, in the majority of cases, as rather a safe procedure.
In pelvic abscess he would first aspirate, and, finding pus,
make a fi-ee incision.
Dr. Wilson, of Baltimore, regarded every ovariotomy
as an exploratory incision, because it was very rare that
the operator knew when he cut into the abdomen exactly
what he would find.
The discussion was continued by Drs. Maury, of Mem-
phis ; Jackson, of Chicago ; Scott, of San Francisco ; and
closed by Dr. Palmer.
Dr. p. F. MuNDi, of New York, read a paper entitled
CERVICAL FIBROIDS AS A CAUSE OF DYSTOCIA, AND THEIR
REMOVAL BY VAGINAL ENUCLEATION.
The paper was accompanied by specimens. It con-
tained comments concerning the frequency of the occur-
rence of cervical fibroids, being much less frequent than
tumors situated in the body of the uterus. A rSsum^ of
the literature of the subject, and a history of the case under
his own care was related, in which a tumor weighing three
pounds was removed by enucleation from the anterior lip
and a portion of the body of the uterus of a woman thirty-
eight years old, the mother of seven children. The patient
recovered, and when discharged from the hospital nothing
but thickening of the anterior lip of the cervix remained.
The meeting then adjourned to Wednesday morning.
The following were the members present : Drs. Baker,
of Boston \ Browne, of Baltimore ; Byford, of Chicago ;
Dunlap, of Springfield, O. ; Engelmann, of St. Louis ;
Foster, of New York ; Howard, of Baltimore ; Jackson,
of Chicago; Jenks, of Detroit; Maury, of Memphis;
Reeves, of Dayton, O. ; Sawyer, of Chicago ; Scott, of
San Francisco ; Smith, of Philadelphia ; Vandewarker, of
Syracuse ; Wilson, of Baltimore ; Johnson, of Washing-
ton; Mund6, of New York; Richardson, of Boston;
Thomas, of New York.
Invited guests : Drs. E. C. Dudley, W. E. Clark, F.
P. Seeley, N. S. Davis, of Chicago ; P. McClure, of Du-
buque ; H. G. Dearborn, of Nashua, N. H. ; J. H. Cars-
tens, of Detroit ; T. B. Harvey, of Indianapolis ; Fritz
Netzler, of Stockholm ; F. Woodbury, of Philadelphia ;
and Wesley M. Carpenter, of New York.
A banquet was given by the Chicago Gynecological
Societ}* on Tuesday evening at the Palmer House.
Wednesday, October ist — Second Day — Morning
Session.
The Society was called to order by Dr. W. H. Byford,
of Chicago.
The following gentlemen were made members by in-
vitation : Drs. W. H. Meyers, Fort Wa3me ; J. H. Ranch,
Springfield, O.; J. K. Bartlett, Milwaukee; Liston H.
Montgomery, Chicago ; T. A. Roger, Montreal ; William
Fox, Milwaukee.
discussion on dr. mund^'s paper.
Dr. Jenks, of Detroit, reported a case in which a
small cervical fibroid was present at labor, and which he
enucleated without difficulty, and labor proceeded with-
out interruption. He favored enucleation, although he
was a believer in Csesarean section if performed before
the woman becomes exhausted.
Dr. Byford, of Chicago, said his practice had been,
whatever was the size of the tumor, whether sessile or
pedunculated, to wait until labor began, believing that
these tumors can be removed as easily at that time as at
any other. Thus the danger of producing miscarriage,
and consequently sacrificing the child, was avoided ; be-
sides, in many of these cases the tumor was pushed before
the head and delivery completed without injury to the
child.
The discussion was continued by Drs. Wilson, of
Baltimore ; Dunlap, of Springfield, O. ; Van De Warker,
of Syracuse ; Reamy, of Cincinnati ; and closed by Dr.
Mund^.
Dr. T. Gaillard Thomas, of New York, read a paper
on
EXTRA-tJTERINE PREGNANCY, WITH REPORT OF SIX CASES.
It was sup))lementary to a report made two years ago.
Notwithstanding the great advance made concerning
384
THE MEDICAL RECORD.
[October 4, igg^.
early and certain diagnosis, it was far from easy. The
dictum of Depaul, however, that diagnosis at third or
fourth month was impossible, must be disregarded. Refer-
ence was made to experiments performed on rabbits by
Leopold, who introduced foetal rabbits after performing
laparotomy and studied the changes which followed.
They had a direct and favorable bearing on destruction
of the foetus by means of the galvanic current Leopold
also believed that recovery of patients after rupture of
the Fallopian tube was much more common than gener-
ally supposed, a position which Dr. Thomas fully en-
dorsed. Dr. Stephen Rogers, of New York, twenty
years ago advocated laparotomy and application of liga-
tures for control of hemorrhage from rupture of blood-
vessels with extra-uterine pregnancy, but had no experi-
ence in the plan of treatment. Lawson Tait, in January,
1883, operated under these circumstances, and in 1884
in four additional cases, with four recoveries in all. Dr.
Charles K. Briddon, of New York, followed Tait, in
October, 1883, and the history of the case was incorpo-
rated in his paper. Dr. Thomas' conclusion upon this
point was that neglect to perform laparotomy under such
circumstances would be criminal. The author of the
paper then gave detailed histories of six additional cases
of extra-uterine pregnancy treated with the galvanic cur-
rent.
The paper was discussed by Drs. Mund6, of New York ;
Harvey, of Indianapolis ; Palmer, of Cincinnati ; Wilson,
of Baltimore ; Howard, of Baltimore ; Baker, of Boston ;
and Reamy, of Cincinnati
Dr. R. B. Maury, of Memphis, read a paper entitled
CASE OF TUBAL PREGNANCY WITH RUPTURE OF THE SAC
AND REMARKS CONCERNING THE PROPRIETY OF LAPA-
ROTOMY.
The case was one of ruptured perineum with rectocele
cured by the usual operations, and followed by pregnancy
in which there developed suddenly evidence of rupture
of the sac of extrauterine pregnancy, diagnosticated to
be of the tubal variety. The patient recovered.. After
referring to the views of Tait, Thomas, and others, Dr.
Maury submitted that even under perfect surgical
methods, we may never hope, as a rule, to obtain satis-
factory results from immediate laparotomy, and at this
time it would seem to be more in accordance with sound
surgical principles to postpone all consideration of lapa^
rotomy until the period of shock had passed away.
Wednesday, October ist — Second Day — Afternoon
Session.
The Society was called to order by Dr. Jackson, of
Chicago.
Dr. Christian Fenger, of Chicago, was made a mem-
ber by invitation.
Dr. p. F. MuNDi read a paper entitled
LIMITS OF vaginal HYSTERECTOMY FOR CANCER.
It was essentially a rejoinder to a paper by Dr. Jackson,
of Chicago, read at the meeting last year, in which the
conclusions were reached, first^ that a diagnosis of uterine
cancer could not be made sufficiently early to insure its
complete removal by extirpation of the uterus ; second
that when a diagnosis could be made there was no rea-
sonable hope for a radical cure, and other methods of
treatment for ameliorating sufifering or retarding the prog-
ress of the disease, and prolonging life, were equally
eflfectual ; thirds that extirpation of a cancerous uterus
was a dangerous operation. The author reported two
cases and exhibited specimens. He then discussed the
propositions made by Jackson from a clinical and statis-
tical point of view, and reached substantially the following
conclusions concerning the precise conditions in which
alone operation seems justifiable : firsts absolute limita-
tion of the cancerous disease to the uterus ; second^ the
probability of a complete removal of the disease by high
supravaginal amputation and cautery, questionable*
third, cancer or sarcoma of the body of the utenis-
fourth^ perfect freedom of motion of the uterus ; fifth
capacious vagina; sixths sufficiently vigorous condition
of the general system. What he wished to accomplish by
the paper was to protest against wholesale condemnation
of a perfectly radical surgical measure on the more or
less theoretical ground that it is too dangerous and not
sufficiently beneficial, when facts, as shown by statistics,
prove to the contrary, and to claim for the operation cer-
tain justification.
Dr. Jackson, of Chicago, maintained that surgical
procedure, to be justifiable, should alleviate sufifering and
prolong life. The operation under consideration did
neither of these, and therefore was unjustifiable without
regard to special cases.
Dr. Van De Warker, of Syracuse, said the question
was not how many died and how many recovered after
operation, but was there any better way to reach the
same result? He believed there were other methods
which were safer and equally as competent as the use of
the knife.
Dr. Engelmann, of St. Louis, argued in favor of
operation, and claimed that the success already obtained
warranted its continuation until more fully tested.
Dr. Palmer, of Cincinnati, thought that vagnial
hysterectomy was not applicable in cases in which cancer
had its starting-point in the cervix.
Dr. Baker, of Boston, sustained the operation as
justifiable.
Dr. Scott, of San Francisco, thought young fellows
were arranged upon one side and old fellows upon the
other.
Dr. Reamy, of Cincinnati, thought statistics did not
prove, nor did the paper prove, that operation prolonged
life or cured the disease, or from a clinical standard that
it was justifiable.
The discussion was continued by Dr. Ferger, of Chi-
cago, and closed by Dr. Mund6.
The Society then adjourned to Thursday morning.
Thursday, October 2D — Third Day — Morning
Session.
The delivery of the President's address on the present
aspect of the puerperal diseases was postponed on ac*
count of the sickness of the President.
Dr. Edward Sawyer, of Chicago, read a paper on
" Occipito-posterior Position in Vertex Labors." A
paper was also read on *' Rare and Fatal Form of Sepsis
without Symptoms," by Dr. G. J. Engelmann, of St
Louis.
PAPERS READ BY TITLE :
"Hygiene of Pregnancy,'* by Dr. S. C. Busey, of
Washington ; " Rapid Dilation of Cervical Canal," by
Dr. William Goodell, of Philadelphia ; ** Physiognomy
of Vulva a Sequence of Anal Disease," by Dr. Isaac E.
Taylor, of New York ; " Early History of the Treatment
of Vesico-Vaginal Fistula in the United States," by Dr.
Nathan Bozeman, of New York ; ** Periodical S)rmptoms
in Uterine Disease," by Dr. G. J. Engelmann, of St,
Louis ; " Topography and Sectional Anatomy of the Fe-
male Pelvis," by D. B. Hart, of Edinburgh; " Fibro-
Myomata of the Uterus," by Dr. R. S. Sutton, of Pitts-
burg.
The following officers were elected : President — Will-
iam T. Howard, Baltimore, Md. ; Vice-Presidents — W.
L. Richardson, Boston, Mass., and Paul F. Mund6, New
York ; Secretary — Frank P. Foster, New York ; Treas-
urer— Matthew D. Mann, Buffalo, N. Y. ; Members of
Council — A. Reeves Jackson, Chicago, 111. ; H. P.
C. Wilson, Baltimore, Md.; Joseph Tabor Johnson,
Washington, D. C; Ely Van De Warker, Syracuse, N. Y.
The next meeting will take place at Washington,] D.
C, on the third Tuesday in September, 1885.
October 4i 1884.]
THE MEDICAL RECORD.
385
THE HOSPITALS MEDICAL SOCIETY OF
PARIS.
Stated Meeting, July 25, 1884.
M. BucQUOY, President, in the Chair.
(Special Report for Thb Mbxmcal Rbcokd.)
The Society having been called to order by the Presi-
dent, M. Martineau rose to state his views upon the
relations of
syphilis and Choi^era,
and the influence exerted upon the latter by the former
affection. It had been asserted that the mercury given
in the treatment of syphilis, especially the biniodide of
mercury, acted also as one of the best prophylactics
against cholera. The speaker opposed this view, and
stated that of nine fatal cases of cholera occurring during
the epidemic of 1849 ^^ ^^ H6pital de Lourcine, eight
o{ the patients were under treatment for syphilis. A
similar experience obtained in 1866. At that time two
wards were devoted to the reception of cholera patients,
but the disease spread throughout the hospital and at-
tacked by preference the syphilitics.
M. Dujardin-Beaumetz had observed the same un-
toward results in the case of
syphilis and typhoid fever.
It had become a common saying in the H6pital Co-
chin that a patient in the early stage of syphilis, if
attacked by typhoid, fever, was a doomed man. Thus
the mercury was seen to fail likewise in this disease. It
was true, as stated by Miquel, that the biniodide of mer-
cury was a most powerful disinfectant. But it was very
unsafe to reason that, because a certain dnig acted as a
microbicide in the test-tube, it would act similarly in the
human organism.
M. BucQUOY agreed with the last speaker as to the
gravity of typhoid fever when it attacked a patient al-
ready suffering from syphilis.
M. Damaschino recalled several fatal cases of cholera
occurring in syphilitic patients during the epidemic of
1866.
M. F£r£ol regarded syphilis and cholera as a com-
bmation of great gravity, but could not entirely agree
r with the last speakers as regards the evil influence of
syphilis upon the course of typhoid fever. He had seen
a number of cases of this kind in which recovery took
place.
M. Vallin exhibited a
^ chamberland's water filter
made after the model of that used by Pasteur in his la-
boratory. Two cylinders are placed one within the other,
the inner one being made of porcelain and being the
filter proper. A pressure of one atmosphere and a half
was necessary to force the water through the sides of the
cylinder. The water was cleared absolutely of all sus-
pended matters. The filter could be readily taken apart
and purified by passing the inner cylinder through a
flame.
M. GiRiN-RozE thought the objection to such a filter
was that it removed the suspended particles, but not the
matters held in solution. He preferred a charcoal filter,
even though it might be a little more complicated and
difficult to cleanse.
M. Dujardin-Beaumetz presented a young man in
whom there was a
transposition of the viscera.
The patient had had a pleurisy with efliision, and the
heart-sounds were heard on the right side. But after
the pleurisy was cured the heart still remained on this
side, and it was then that the fact of the transposition of
the viscera was noted.
M. BuCQUOY had observed a similar state of affairs in
a woman. In this case the patient herself called atten-
tion to the fact that her liver was on the left side.
M. Damaschino presented a co mm imi cation on the
distoma h^matobium
offered by a physician of Alexandria. The microscopical
preparations which accompanied the paper were from
cases of distoma of the liver and of the kidneys.
M. Dujardin-Beaumetz then read a paper on the
diagnosis of cancer of the stomach.
His object was to call attention especially to the diffi*
culties of a correct diagnosis. There was indeed no cer-
tain pathognomonic symptom of carcinoma of the stomach.
In the first place, we are usually unable to determine the
exact nature of any internal tumor. Histology has given
us a very complete list of the various forms of cancer,
but clinically we can make no such fine distinctions.
It has been asserted that the duration of carcinoma is
shorter than is that of other chronic affections of the
stomach, three years being given as the maximum. But
while this might be true of some varieties of cancer, it
was not so of all. The author recalled one case of un-
doubted carcinoma, as proved by autopsyj in which the
earliest symptoms preceded death by twelve years. It
might be objected that the case was one of cancer fol-
lowing ulcer of the stomachy and that the earlier synip-
toms were those of the latter affection. Such an assump-
tion was, however, gratuitous, and, besides, the author
had seen other cases in which the duration, though
shorter than in the instance just cited, yet exceeded
greatly that usually set down for carcinoma.
The diagnosis between cancer and dilatation of the
stomach was a matter of considerable difficulty. As re-
gards sex, men are more subject to cancer, and so they
are to dilatation. Both affections are met with usually at
about the age of forty years. Qiiesnel's assertion, that
every cachectic person suffering froju a chronic affection
of the stomach has carcinoma, cannot be maintained.
And even painful oedema of the legs, regarded by Trous-
seau as characteristic of cancer, may occur with simple
dilatation. Pain is not a symptom of any great value,
for although it usually exists it may also be absent. The
vomiting of coffee-ground matters, formerly regarded as
pathognomonic of cancer, may occur in dilatation, and is
therefore a sign of no exceeding value. Even the exist-
ence of a tumor may be misleading, for a thickening of
the stomach walls may occur in dilatation and may be
mistaken for cancer. If, however, the tumor be well
defined stnd lobulated, the diagnosis of cancer is rendered
fairly certain. The German method of setting free a
large quantity of gas in the stomach, the author con-
sidered to be practically of no value in diagnosis. It
has been asserted that in the case of cancer the hydro-
chloric acid is wanting in the gastric juice, but this is
equally inapplicable and valueless in practice.
M. Romelare, of Brussels, had noted a fact which M,
Dujardin-Beaumetz thought might prove useful in this
connection. He had found that in cancerous affections
of the stomach and liver the amount of urea excreted
was reduced to an average of 1 30 grains, and never ex-
ceeded 150 grains in the twenty-four hours. In the case
of ulcer of the stomach, on the other hand, the amount
of urea ranged from 250 to 500 grains, and never fell
below 225 grains per diem. The author had verified
these conclusions in a general way, yet they were not
entirely reliable as a means of diagnosis. He had had a
patient in whom the daily amount of urea excreted was
but 45 grains, and had therefore concluded chat the
disease was cancer, but found at the autopsy that the
tumor was an h)'datid cyst. There was stiLl another
procedure which might be of assistance in establishing a
diagnosis. He had procured an amelioration, and even
a temporary lull, in the symptoms by regular and methodi-
cal washing out of the stomach in the case of carcinoma.
In the case of dilatation, however, no improvement was
obtained by this practice.
Upon the conclusion of this paper the Society ad*
journed.
586
THE MEDICAL RECORD.
THE THERAPEUTICAL SOCIETY OF PARIS,
Siaied Meeting, Juiy 2 ^y 1S84.
M» Delpech, President, in the Chair.
ISpecA] Rcpcui for The Mkimcal Recoup.)
When the Society had been called to order there arose
a short
DISCtJSEION ON ANTISEPTICS.
M, Di;jaroin-Beaumetz thought that the toxic nature
of any substance should be considered as well as its
antiseptic powers, A drug might be a perfect micro-
bicide^ but might also be practically useless because of
Us strongly poisonous quaUties. The best antiseptic
was undoubtedly that which was the least harmful to
man in the dose required for asepsis. He regarded
boracic acid and borax as the best microbicides for in-
ternal use that we possessed, as they combined at the
same time a high degree of antiseptic power with an
almost complete absence of injurious properties to the
human subject.
M, BRf MOND spoke in glowing terms of
OZONE
as the best disinfectant of the air in sleeping apartments
and other enclosed spaces. A sufficient quantity of this
substance may be produced with great ease by using a
spray of spirits of tuq>entine,
M, Limousin stated that by making a mixture of per-
manganate of potash and bisulphate of potash and ex-
posing it to the action of damp air we could obtain a con-
stant formation of oione. The making of ozone by pouring
sulphuric acid upon the permanganate of potash was liable
to cause an explosion, especially if a closed flask were
used. The mixture recommended by him was firee from
danger of this kind- When ozone was prepared by
means of the electric spark, an odor was noticeable
which was absent when the permanganate and the bisul-
phate of potash were usedj yet the substance was un-
doubtedly obtained equally well by the latter method.
M, Djjardin-Beaumetz gave the substance of a com-
municadon which he had presented to the Bureau of
Hygiene on the best method of preparing
A drink: for school-children DURING THE HOT
WEATHER.
A beverage of this kind should be healthful, cheap, and
at the same time not very pleasant to the taste, as it
might then be consumed in too large quantities. These
qualities were possessed by a liquid containing gentian
or quassia, licorice, mint, sugar, and citric acid. Its
preparation cost about a cent a quart.
M» Campardon said that thirst might be easily as-
suaged by chewing shavings of quassia wood occasionally.
M. Blonde AU made a statement concerning the
value of
SULPHURIC ACID IN CHOLERA*
He said that during the last epidemic in England very
general use was made in some places of sulphuric acid
lemonade flavored with tincture of orange peel, and not
one of those who took this regularly was attacked by
cholera,
M^ Limousin said that there were several chemically
incompatible formula published by the Bureau of Hy-
giene. Sweet and bitter substances were added to acids
and alkalies in a hap-hazard sort of way. It would seem
as though such mixtures ought to be useless. Vet if, in
practice, the desired result is obtained, we ought to be
satisfied.
M. BucQUOY regretted to hear the use of boiled water
recommended. This was not healthful and was hable to
cause digestive troubles.
M. JJujardin-Beaumetz said that the boiled water
could be recharged with air by shaking it, but it was
evident that jn this process it would also become charged
with the germs tloating in the atmosphere.
This was the last meeting Fof the Society before tiie
summer vacation, but the President announced that
special meetings would be called from time to. time, if
events of importance requiring discussion should arise.
The Society then adjourned subject to the call of the
President.
THE SURGICAL SOCIETY OF PARIS.
Stated Meeting, July 23, 1884.
M. Marc Si:E, President, in the Chair.
(Specul Ropcirt fbr TttK Medical Rkcosd.)
The Society having been called to order by the Presi-
dent, M. MoNOD recalled a paper, read at the last meet-
ing, on exostoses of the frontal sinus, and related an
instance in which an
OSSEOUS CVST OF THE FRONTAL SINUS
had been taken for an exostosis. Dr. Rouge, thinking
that such was the case^ cut down upon it and was sur-
prised to find himself in a cavity with very thick bony
walls, at the bottom of which was a little tumor about
the size of a cherry. The tumor was not disturbed, and
had not increased any in size in the fourteen years whid
had since elapsed.
M. Tr^lat requested that further details of this case
be obtained, so that a certain diagnosis might be estab-
lished
M. CHAtJVEL then read a report upon a monograph of
Dr. Poulet on the subject of
TUBERCULAR AND SYPHILITIC OSTEITES OF THE SKULU
The author passed briefly in review the subject of simple
traumatic osteitis, the characters of which it is easy to
reproduce experimentally in animals, and then took up
the question of the specific forms of osteitis, especially
the tubercular and the syphilitic. Although osseous
tuberculosis is a common enough affection, tubercle of
the cranial bones is, if one may judge from the number
of reported cases, a very rare condition. M. Poulet,
however, claimed to have found two instances of this
disease among the specimens in the museum of Val-de-
Grace, but the reporter took the liberty of doubting this
until further proof should be forthcoming. The author
endeavored to show that this affection was most truly
specific, as well in its symptoms as in its pathological
characteristic's. The specific nature of the second
variety of osteitis, the syphilitic, was incontestable. M,
Poulet was able to show from a careful examination of
numerous pathological specimens that the course of the
disease was always the same. Starting from the peri-
cranium, the gummy process invades the bone in the
form of a spiral the turns of which become constantly
larger. In tiie skull this spiral increases laterally like a
watch-spring, while in the long bones of the extremities
it increases in depth like a corkscrew. The border of
this spiral is formed of very dense, eburnated bone. The
monograph was accompanied wiA a number of well-exe-
cuted designs showing the lesions referred to.
M. BouiLLY then read the history of a case of
PAROVARIAN CYST OF THE RIGHT SIDE
reported by Dr. Jeaunel. The patient, thirty-five years
of age, in a good state of health, presented the signs of
a monolocular cyst of the ovary. The aspirator was
introduced and nearly sixty ounces of a perfectly clear
fluid were withdrawn. Three months later a second op-
eration was necessitated by reason of a reaccumulation
of fluid. After aspiration of about seventy ounces of
fluid, the sac was washed out with thirty ounces of a one
per cent, carbolic acid solution. Then an injection of a
warm solution of tincture of iodine and water, equal
parts, was thrown into the cavity £of the cysL When
nearly nineteen ounces of this mixture had been injected,
the action of the aspirator was reversed in order to draw
October 4, 1884.]
THE MEDICAL RECORD.
387
the fluid back ; but not a drop returned. At the same
time the patient became unconscious, though very rest-
less; the face was blue, the pulse at the wrist was almost
imperceptible, and the body was covered with a sticky
perspiration. The respirations were slow, irregular, and
noisy. The woman was suffering most evidently from
ACUTE IODINE-POISONING.
The aspirator needle was withdrawn and reintroduced
several times but no fluid could be drawn off. Numerous
hypodermic injections of ether were made, mustard
plasters were applied to the chest, and an electric bat-
tery of forty cells was employed. But the patient did
not recover cpnsciousness and the power of speech until
thirty-five hours had elapsed. She then suflfered from
very marked symptoms of iodism in all the mucous
membranes, the symptoms persbting for two weeks or
more.
The author emphasized the fact, as shown by this case,
that very grave accidents may follow an operation appar-
ently so simple as this. He thought it would have been
better for the patient had ovariotomy been performed in
the first place. M. Bouilly agreed with him in this last
conclusion, and remarked that this case proved that, con-
trary to the generally received opinion, parovarian cysts
were not always cured by a single puncture.
M. TiLLAUX could not understand why the aspirator
should be used in cases of this kind, for it only favored
an arrest of the stream, as happened in this instance, by
sucking the wall of the cyst against the point of the
needle. He thought the amount of tincture of iodine
injected (over nine ounces) was enormous. The formula
that had been recommended for use in such injections
was one part tincture of iodine to two parts of water.
M. Lucas ChampioniIsre favored operation in the
treatment of parovarian cysts. In the case cited by M.
Jeaunel, the patient had undergone a number of opera-
tions more serious in the aggregate than ovariotomy, and
yet she was not radically cured.
M. BouiLLY thought that the amount of iodine used
was certainly too great, but he thought the symptoms
were not those of poisoning, but were caused rather by
the traumatism of the operative measures employed. He
did not agree with the last speaker in his preference for
ovariotomy. He thought it better to make one or two
ponctures at least before resorting to operation.
He then read another report on a paper by Dr. Leriche,
entitled
THREE SUCCESSFUL OVARIOTOMIES.
In two of the cases the pedicle was fastened externally,
instead of being abandoned in the abdominal cavities, as
is usually done. He did not favor catgut for ligatures, as
it could not be drawn tightly enough.
M. TiLLAUX had formerly used catgut, but had aban-
doned it for silk after having lost a patient from hemor-
rhage caused by the slipping of the ligature.
After some further discussion on the relative merits of
catgut and carbolized silk, M. Verneuil related a case of
naso-pharyngeal polypus.
The patient had been exhibited at a meeting of the
Society four months ago. He was then suffering from
an enormous recurrent tumor, the first operation (removal
of the upper jaw) having been performed one year before.
The tumor was exceedingly vascular, and a bruit was
distinctly audible. The attempt was first made to treat
it by means of irritant injections, but these were without
result It was then decided to tie the common carotid.
This was easily done and was followed by reduction in
aze of the tumor, subsidence of inflammation, and relief
from pain. A small abscess formed, however, at the point
of incision, and was opened by M. Kirmisson, and a
drainage-tube was inserted. The opening did not cica-
trize, and six weeks after the ligation of the artery the
pat cnt had an attack of erysipelas. This was recovered
froii, but the wound began to slough, and a number of
hemorrhages occurred from which the patient finally suc-
cumbed.
At the autopsy there was found to be perforation at the
bottom of the sphenoidal fossa, through which a lobe of
the tumor had passed into the cranial cavity. There
had, however, never been any cerebral symptoms. The
peripheral extremity of the carotid artery was completely
occluded, but it required a long search before the string-
like remains of the cardiac extremity could be found.
M. TRiLAT thought that palliative operations might lead
to a perfect cure of naso-pharyngeal polypi, as many of
these tumors underwent spontaneous disappearance m
the course of time.
M. Lucas Championi^re said that, accordmg to Lis-
ter, arteries should never be tied with silk, but with ^me
substance which is capable of being absorbed m the
tissues. The case just related emphasized the wisdom of
this procedure, for no wound in which a silk ligature
remains can be with absolute certainty aseptic.
M. TiLLAUX presented a patient upon whom he had
performed
RESECTION OF THE SUPERIOR MAXILLA
on account of a sarcomatous tumor, the size of a small
ostrich egg, filling the entire zygomatic fossa. The pa-
tient made an excellent recovery, and, by means of an
apparatus made by M. Beauregard, could masticate with
great ease.
The meeting then adjourned.
%nt0vxmtianva |PejflicaX (S^ugkzss.
EIGHTH SESSION.
Held at Copenhagen, Denmark, August 10-16, 1884.
REPORTS OF SECTIONS.
(Special Report for Thb Mbdical Rbcord.)
SECTION ON OPHTHALMOLOGY.
Dr. Samelsohn, of Cologne, read a paper on the
PRACTICAL VALUE OF LIGHT SENSE IN OPHTHALMOLOGY.
If the examination of the light sense in practical
ophthalmology has not hitherto met with the attention
it undoubtedly deserves, it is from the want of an effi-
cient mode of testing it The methods hitherto in use
depend on testing the vision either with diminishing or
with constant illumination. The first method was much
used by Forster, who formulated the law that the light
sense is only impaired in affections of the percipient
elements, while affections of the conducting elements
are indicated rather by an increased sensibility for ob-
jective light. A large number of examinations made
during the last two years have convinced the autfior
that the law of Forster has only a very limited applica-
tion.
Although disease of the percipient elements of the
retina very often results in a considerable impairment of
the light sense, yet the converse is not so often true
that one can, from the fact of the light sense being im-
paired, diagnose a disease of the percipient elements.
Indeed, inflammatory affections of the optic nerve cause
so great a diminution of the light sense that m certam
aflfections it amounts almost to torpor of the retina.
DESCRIPTION OF THE CONDITION IN CERTAIN FORMS OF
DISEASE.
From this it is seen that the li^ht sense is very much
more aflfected than the quantitative color sense ; the
latter, on the conti-ary fas shown elsewhere), stands in
the clearest numerical relation with the light sense. The
testing of the light sense is useful for differential diag-
nosis under the following circumstances : (i) In certain
forms of opacities of vitreous, which may be mistaken
for detachment of the retina ; (2) in differential diag-
m
THE MEDICAL RECORD.
[October 4, 1884.
nbsis between simple glaucoma and optic atrophy; (3)
as giving indication for diagnosis and prognosis in cer-
tain forms of cataract.
Prof. Schmidt-Rimpler, of Marburg, read a paper on
A NEW METHOD OF DETERMINING REFRACTION BY MEANS
OP THE OPHTHALMOSCOPE.
In this method he did not make use of the image of the
retina itself, but observed the image of the source of light
(lamp) thrown upon the fundus, the same image that
forms the object of investigation in so-called retinoscopy,
except that in the latter no convex lens intervenes. The
apparatus used in Professor Schmidt-Rimpler's method
consists of a convex lens, from which an ^m projects to
keep it at such a distance from the observed eye that its
focus and the first principal point of the eye coincide.
A tape measure on the opposite side of the lens deter-
mines the distance of this lens from the concave ophthal-
lyioscopic mirrors, from which data the distance between
the principal focus of the lens and the inverted image of
the source of light reflected from the concave mirrors is
known. This distance, expressed in centimetres, gives
the amount of ametropia in terras of a dioptric, myopia
to the one side of the focus of the lens, and hypermetropia
to the other. It was plain that if the eye examined were
emmetropic, and its accommodation at rest, the best de-
fined image of the source of light would be obtained when
the focus of the concave mirror coincided with that of the
contex lens, as it was at that point that the inverted
atrial image of the fundus was situated. In myopia the
focus of the concave mirror must lie nearer to the lens
' than the focal length of the lens, in order to obtain the
best definition, and in hypermetropia it must lie further
from the lens than the focus of the latter. When the
lens was so placed that its focus coincided with the prin-
cipal point of the eye, equal movements of the external
source of light along the optic axis corresponded to equal
differences of refraction in the observed eye. The strength
of lens used was 10 D, and in that case every alteration
in the refraction amounting to i D altered the position of
the aerial image of the fundus i centimetre.
Dr. Noyes, of New York, did not rely entirely upon
the ophthalmoscope ; he always tried the use of glasses in
confirming his diagnosis. He had a clip upon his own
ophthalmoscope in which he could easily place a cylindri-
cal lens for examining the fundus.
Mr. Berry, of Edinburgh, approved of Professor
Schmidt-Rimpler's method because of the difficulty of
testing by the direct method in Aigh degrees of ametropia.
He had found that the refraction of the eye was different
at the yellow-spot and the optic disk regions.
Mr. Yuler, of London, said that he should be glad to
become practically acquainted with Professor Schmidt-
Rimpler's new method. With regard to the estimation
of refraction by the direct method of ophthalmoscopic
examination, he was of the same opinion as Mr. Berry
and Dr. Noyes, viz., that in simple hypermetropia and
myopia of low degree we were able to see the yellow-
spot region, and so to estimate the refraction on the
visual axis ; but when astigmatism existed, the direct
method failed because of the paucity of vessels in the
yellow-spot region. He considered the shadow-test (re-
tinoscopy) to be the best and most exact means of esti-
mating the refraction in astigmatism, but this must be
done only when the eye is fully atropised and the patient
is looking straight at the observer's forehead. By this
means the refraction of the visual axis could be accu-
rately estimated.
Dr. Hansen Grut, Prof. Sattler, and Prof. Liebrecht
also joined in the discussion, and Prof. Schmidt-Rimpler
replied.
Dr. Edm. Hansen Grut, of Copenhagen, read a
paper on
TWO FORMS OF KERATITIS.
I. The first form was bullous keratitis following trau-
matic abrasions of the corneal epithelium. The painful
and transient attacks which come on sooner or later after
an abrasion are well known. They have been wrongly
called nervous. They are always occasioned by a me- ,
chanical cause, generally at the moment the patient
awakes. This mechanical cause is die friction of the
eyelid against the eye, owing to the moisture which comes
during sleep, and the rubbing with the fingers by the pa-
tient, who fancies that there is a foreign body in his eye.
The nerves of the epithelium remain in an unhealty con-
dition— ^perhaps the regeneration of the epithelium is de-
fective—-despite the apparently normal appearance of
the eye. A slight traumatism would suffice, then, to
provoke a bad attack. Sometimes, and oftener than
one thinks, it is real keratitis which takes place. This
keratitis always returns to the bullous form. Most fre-
quently the bulla is difficult to see directly, but can
always be seen by withdrawing the anterior surface of the
epithelium by means of iris forceps. The bulla is always
extensive, in some cases occupying more than half the
corneal surface. Bullous keratitis is not always allied to
a glaucomatous condition, or to other serious affections
of the eye.
In some cases there is a symmetrical eruption in the
other eye, even, although there is absolute certainty that
this eye has not been previously injured.
2. The second form was one of slow progress accom-
panied by very slight subjective symptoms, and having
hardly any vascular injection. There is a slight grayish
infiltration, difficult to see, having a tendency toward
serpiginous increase. It spreads by slight projectmg
nodules, which are more densely infiltrated than the rest.
The affection always remains superficial. Neither the
deep layers of the cornea nor the iris are ever invaded.
The affection is undoubtedly of mycotic origin.
On the 1 2th, Prof. Meyer presiding, Dr. Eadard, of
Paris, read an interesting paper on
THE TESTING OF VISION OF RAILWAY EMPLOYEES.
Dr. Liebrecht read a paper on the same subject, and
a third was read by Dr. Fox, of Philadelphia, for Prof.
William Thompson.
Prof. Sattler, of Erlangen, read a paper on our ac-
tual standpoint with regard to the conception of diseases
of the conjunctiva and of
THE NATURE AND THERAPEUTICAL ACTION OF JEQUIRrTY.
With regard to jequirity, Professor Battler's experience
was that the infusion of this drug was very beneficial in
granular affections of the conjunctiva. In all cases he
found the characteristic bacillus in the infusion used. In
some cases lesions of the cornea were produced, espe-
cially by frequent repetitions of the process in rapid suc-
cession. For this reason he thought it not safe to use
the drug in cases where the cornea was unaffected.
Dr. Benson, of Dublin, had used jequirity infusion in
upward of fifty cases, and had found it very beneficial in
granular conjunctivitis and pannus. In some cases he
could find no trace of the bacillus in the infusion used.
Dr. E. Meyer, of Paris, read a paper on
THE ARTIFICIAL MATURATION OF CATARACT.
The chief points of his paper were as follows : The
opacification of the whole of the lens substance, which
alone admits of its complete expulsion, is a desideratum
in the normal extraction of cataract. In cases where
extraction of incomplete senile cataract is compulsory,
this artificial maturation is indicated. The best known
method of maturation is that of massage of the crystal-
line lens through the cornea (Fttrster) after the evacua-
tion of the aqueous humor from the anterior chamber.
Iridectomy, he said, was of great importance. The
pressure should be made with an instrument (shown)
which made it general all over the cornea, and not local-
ized. He showed a rabbit (living) in which he had pro-
duced cataract by this massage two days before, in the
presence of several members of the section. The lens
• October 4, 1884.]
THE MEDICAL RECORD.
389
of the rabbit was now quite opaque in the upper part,
and partially so all ovei;. There was no marked inflam-
mation of the rabbit's eye. Prqfessor Meyer was not
prepared to state the exact pathological process by
which this opacity was brought about.
Dr. Mooren, of Diisseldorf, criticized the operation ;
he had lost one eye by this method, and was less san-
guine of its success than Dr. Meyer appeared to be.
Dr. Samelsohn, of Cologne, had tried it in a number
of cases in some of which there were only cortical opaci-
ties. Some of his cases had succeeded, some not.
Dr. Abadie, of Paris, objected to the operation be-
cause of the difficulty of inducing patients to submit to
so tedious a process.
Prof. Gayet, of Lyon, read a paper on the
RESULT OF great LOSSES OF SUBSTANCE OF THE CORNEA.
The opening of large abscesses and the constant wash-
ing of them constitute a mode of treatment more advan-
tageous, and for which one cannot be too grateful to
those who have laid down the principle of it. Unfortu-
nately, if the eye is permanently saved, it is not pro-
tected from progressive staphyloma, large adherent leu-
comas, synechia of the iris, and cataracts. Surgery has
certainly preserved the organ, but for the most part it
has preserved a useless organ, when it is not injurious,
either through the pain it causes or from sympathy which
it engenders. I think, with the help of certain facts,
that it would perhaps be possible to substitute for the
simple opening of the abscess a peripheral of the cornea
with a large iridectomy.
Dr. Boucheron, of Paris, read a paper on
THE USE OF ATROPINE AT THE COMMENCEMENT OF CON-
VERGENT SQUINT.
The chief points of this paper were as follows: At
the commencement of convergent strabismus the pro-
longed use of atropine in both eyes appeared to be the
. best means of treatment, because it counteracted the in-
stinctive and excessive efforts at accommodation in a
young ametropic child, in its flrst attempts at near vision.
The amount of atropine used must be sufficient to cause
paralysis of the accommodation and extreme dilatation
of the pupil. Atropine was only efficacious during the
period in which the strabismus was intermittent, that is
to say, during the time when secondaiy retraction of the
internal rectus was absent. This period was very short
A favorable condition to the cure by atropine is found
in the rapid growth of the infant, especially in the devel-
opment of the face^ and more particularly the enlarge-
ment of the ethmoid bone, because such development
brings about a separation of the orbital axis and a
diminution in the strength of the convergent muscles.
The advantageous result of the atropine cure being
applied from the commencement of convergent strabis-
mus is caused by the [rapid restoration of the eye from
deviation, thus often saving it from becoming amblyopic.
When it is, as we think, the consequence of an arrest in
development of the macula after birth and consecutive
to deviation of one of the eyes, electricity is often very
useful. The correcting glasses for ametropia may be
used at the same time, or after the atropine cure, to
guard against any relapse. If "amblyopic exanopsia"
has been avoided by using atropine and electricity, the
bandage or the glasses are less frequently used. Tenot-
omy is always the best treatment for permanent squint.
Inconveniences from atropine — special intolerance^
conjunctivitis — are very rare with young children ; they
are avoided by the use of the first remedies, and by
<^|^^uiging the mydriatics when ill-supported. The myo-
tics which contract the muscles of accommodation,
in suppressing also the instinctive and exaggerated ef-
forts of the accommodation equally produced, as he had
abready pointed out, very favorable results in the early
squint, but the myotics appeared to him less active than
the mydriatics.
Mr. Yuler, of London, thought there was niuch in the
paper demanding the consideration of ophthalmic sur*-
geons. With regard to the second point in Dr. Bou-
cheron*s paper, he had tried atropine in many cases of
convergence, and while it had often succeeded in curing
the intermitted cases, he had never once found it sufficient
to remove a squint which had become permanent. He
always corrected the ametropia at the time and before
discontinuing the use of the atropine.
Dr. E. Hansen Grut read a paper on
LATENT STRABISMUS, KSPfiClALLY LATENT DIVERGENCE,
Latent divergence is not far^sis^ neither is it muscular
weakness. With just as littk reason can it be attributed
to increased power in the external recti. It depends on
a defective impulse to convergence. The expression
" loss of muscular power of internal recti " is erroneous,
and does not express the true stite of the case. It is the
relation between convergence and accommodation which
chiefly determines the latent condition of the covered eye.
In order to estimate the latent position two things are
absolutely necessary: i, Accurate accommodation for
the point of fixation ; 2, an absolute condition of rest of
the eye in looking at the distance.
Fusion is possible in spite of latent divergence. Usu-
ally correct fixation can be maintained, so that generally,
even with very pronounced latent divergence, there is
no convergence asthenopia if the power of fusion is good.
A defective power of fusion renders difficult or prevents
maintenance of exact position. In this case there is no
efifort which would lead to muscular fatigue, but diplopia.
If there is good power of fusion, but great divergence
in condition of absolute rest, an effort to converge is
made, but by no means so often as is usually thoughts
Clinical experience alone can determine how often and
when muscular asthenopia is present. The frequency of
muscular asthenopia has become very great, and our
means of diagnosing its presence are somewhat defective.
In the first place the symptoms of muscular asthenopia
are extremely variable, and not nearly as easy to classify
as those of accommodative asthenopia. Numberless
cases of nervous asthenopia are erroneously diagnosed as
muscular. The relation between the available power of
adduction and the degree of latent divergence is not suffi-
cient to indicate whether muscular asthenopia is present or
not. The same is true of exclusion of one eye during work
and of the employment of prisms. The slight degrees of
latent divergence (under 16'') cause muscular asthenopia,
almost without exception. The most delicate tests for
measuring accurately the degrte of the latent divergence
are uncertain, and are moreover superfluous.
An operation is only justifiable when there is more
latent divergence in condition of absolute rest The
operation is, therefore, performed rather on account of
latent absolute squint than for insufficiency. It is in-
jurious to produce by this operation an absolute condition
of convergence in the condition of rest, even though
the power of abduction may still be sufficient to over-
come the homonymous diplopia at the time,
Mr. Yuler, of London^ gave demons tration^ in the
Section of Ophthalmology of
(l) frost's ARTIFICIAL EYE^
This is an excellent 'instrument for teachmg purposes*
It is provided with two movable retina^^ one of glass and
the other painted so as to represent the normal fundus.
By means of a delicate screw the eye can be shortened and
lengthened so as to represttnt hypermeiropia, emmetropia,
and myopia, respectively, and by then adding a cylindri-
cal glass to the front of this it becomes astigmatic. All
the characterisdc signs of einmetropia and ametropia can
be clearly taught by this instrument.
(2) M*HARDV'S PERIMETER.!
This is a self-registering instrument of excellent work-
manship. It is self-regisiering and combines the proper-
1
r
390
THE ^MEDICAL RECORD.
[October 4, 1884,
ties of Forster^s instniment It is a decided improvement
upoQ the perimeter shown at the London Congress by
Stevens,
Both Mc Hardy's perimeter and Frost's artificial eye
can be obtained o( Picard & Curry, London.
Dr. Noyes, of New York, read a paper on
ASTHENOPIA FROM
INSUFFICIENCY OF ^THE
RECTI MUSCLES.
EXTERNAL
He Spoke of the small degree of attention which had
been given to this topic in text-books and in journals.
While the varying degrees of accommodation appropriate
to given amounts of convergence had been carefully
studied by Donders and others, and that too in various
states of refraction, there had been very little study of
the degrees of muscular effort which belong to spe.cial
amounts of accommodation. The latest and best con-
tribution IS by Bissinger under the auspices of Nagel,
but this is brief and he confessedly leaves much to be
done. In the study of asthenopia Dr. Noyes attempts
to find the real conditions of muscular power, both with
and without accommodation. He tests the adduction
and abduction bath for the working distance and for six
metres. He does this in both regions with the glasses which
the patient may require. He employs Graefe's equi-
librium test in both regions, but he finds it of very un-
certain value. Inasmuch as all the cases which he
studied were asthenopic and therefore were in a patho-
logical condition, he found that the relations between
Accommodation and convergence had been in many in-
stances entirely disrupted. So frequently was this the case
that he adopied the plan of resorting to atropine in very
many cases, and in all those which were attended with se-
vere pain. He found it necessary to do this to bring to
view the real ability of the muscles in adduction and in ab-
duction, and he was also obliged to wait in many instances
for the mydriasis to subside before the ultimate and true
status could be ascertained. It is rare that one exam-
ination will suffice. By a process both of analysis and
of synthesis, that is of examining the functions separately
and in combination with each other, he found that he
could With greater certainty arrive at the truth. The
mydriatic not only aided in making a diagnosis but was
also a therapeutic measure.
Dr, Noyes had brought together 83 cases of asthen-
opia from insufficiency of the external recti. The largest
number (viz. , 30) were among hypermetropes, while em-
metropes {viz., 20) came next in frequency, then cases of
astigmatism {viz., i8), and lastly, 15 were myopes. A
number of cases included in the report were found to
consist essentially of spasm of accommodation, but this
was associated with and in reality caused by debility of
the externi. In all asthenopic cases Dr. Noyes looks
for spasm of accommodation, and if it exist in notable
degree this becomes an absolute indication for atropia
to full paralysis of A.
What degree of deficient abduction, or what dispro-
portion between abduction and adduction shall be ac-
counted abnormal cannot be dogmatically asserted.
The existence of pain in use of the eyes, not relieved
by suitable glasses or by atropia, or by attending to other
well-known concomitant conditions, was sufficient reason
to resort to the local treatment which had been most of-
ten successful, viz., the employment of prisms with the
bases outward, amounting as a total to three or six de-
grees, to be worn in most cases all the time, both for
die distance ami for the near.
Dr, Noyes clearly discriminated between the asthen-
opic cases in which the muscular trouble was entirely re-
flex and the product of remote disease, as of the uterus,
lungb, etc., and those in which there was an idiopathic
weakness of the tnuscles. In the former cases local
measures were of minor value, while in the latter they
were of notable advantage. There are also mixed cases
which are both retiex and idiopathic. In only five cases
Was tenotomy performed — in four with entire success, in
one without success.
A point to which Dr. Noyes called attention was the
latent character of insufficiency of the extemi, and espe-
cially to the fact that in some of the cases which proved
by experience to be insufficiency of the extemi, the evi-
dence furnished by Graefe's equilibrium test pointed to
insufficiency of the interni. He did not refer to myopic
cases, but to other forms of ametropia and to emme-
tropia. In these relief was secured by wearing con-
stantly, and both for near and far vision, adductive
prisms, while in a very few cases abductive prisms were
used for the near vision and adductive prisms for dis*
tance. These cases were noticed by Graefe and by
many others since his time. They have divergence for the
working distance, and convergence or perhaps equilib-
rium for the distance of six metres when examined by the
equilibrium test. Some of them are truly cases of latent
or manifest insufficiency of the extemi, and if treated as
such they recover. Dr. Noyes desired to call attention
to this mode of regarding them, which had proved of
great importance in his own experience, and which he
believed would be found to be the solution of some dif-
ficult and not infrequent cases.
Of the 83 cases the results of treatment were known
in 65.
Patients having —
Cured.
Relieved.
1
Not relieved. | Totals.
Hypermetropia, a8 cases . . .
Enunetropia, 14 *' ...
Astigmaitsin, 15 *' ...
Myopia, 8 " ...
percent
" = 39
3 = a« 5
5 = 33-3
3 = 37-5
percent.
9 == 60
5 = 6a.5
percent.
5 =B >8
2 = 18 •
1 = 6.6
0 =s 0
percent
38 = 100
14 = 100
15 = 100
8 = 100
Total, 65 cases...
aa = 34
35 = 54
8 = la 6s = 100
(SiOVXtSTpfm&sviCt,
OUR LONDON LETTER.
(From our Special Correspondent.)
THE MEDICAL ACT AND THE LICENSING BODIES — LONDON
AND EDINBURGH UNIVERSITY EXAMINATIONS — ^THE SO-
CIETIES— HOSPITAL SATURDAY — DECREASE OF SMALL-
POX— THE INVENTOR OF CHLORODYNE.
London, September 13, 1884.
The Medical act having been withdrawn by the Govern-
ment, all the examining bodies are free to pursue their
career unchecked for at least another year — probably
for several years. These comprise (within the United
Kingdom) eleven universities and nine corporations, but
as for many years past one university (St. Andrews) has
almost ceased to give degrees except to those already
qualified and on the register, and the Edinburgh Colleges
of Physicians and Surgeons have lately agreed to only
give their diplomas jointly in future, the portals by which
^he profession may be entered now only number eighteen.
These are more than enough for a profession of only
twenty-five thousand members. The mischief consists
more in the inequality of the tests imposed by these
various bodies. Even the universities vary greatly. An
M.D. Edin. is very different from an M.D. Lond. At
Edinburgh, at all except the final examination for the
M.B. degree, if a candidate fail only in one subject he
is allowed to go up again in that subject alone in a few
months' time. One or two failures in single subjects do
not, therefore, necessarily prolong his curriculum. I am
informed that even at the final examination, should a
candidate do badly at his clinical he is allowed to have
a second chance before being finally rejected. If then
unsuccessful he has to wait twelve months before going
up again.
At the examinations for the London University M.B.
degree, failure in only one subject is fatal The whole
examination has to be passed over again, including those
subjects in which the candidate was previously success-
ful. With the exception of that for matriculation, the
October 4, 1884.]
THE MEDICAL RECORD.
391
examinations are only held once a year, so each failure
involves a year's delay.
Without discussing the question of whether the London
University examinations are harder in themselves than
the Edinburgh ones, these differences obviously render
the Edinburgh degree easier of acquirement. Some
choice also is allowed at the earlier examinations there
as to what subjects to be examined in at once. At the
London the only option now allowed is in physiology,
that lately offered at the preliminary scientific examina-
tion being now rescinded. I think, though, on the whole
there cannot be much doubt that the " London " is more
exacting than its Northern sister. With all the advantages
offered in our London schools, the proportion of London
students who graduate at it is very small.
The medical societies will soon begin their meetings
again. A practitioner who attends several societies regu-
larly finds a distinct gap made in his winter evenings.
Four of them, viz., the Medico-Chirurgical, Clinical,
Pathological, and Obstetrical, meet in the same rooms on
different evenings. It has been proposed to amalgamate
these, and perhaps the Medical Society also, under the title
of the " Academy of Medicine," with of course different
sections. This arrangement wDuId have many conven-
iences, but although it has several times been proposed
nothing has come of it as yet. One practical difficulty
consists in the varying rates of subscription of the vari-
ous societies. Another would be found in arranging the
division of the property held by them. The Medico-
Chirurgical possesses what is considered to be the best
medical library in London, and its Fellows are allowed to
take the books home to read. The Obstetrical Society
also owns a very good library. The Dublin societies
have, however, united to form the " Academy of Medi-
cine in Ireland," with four sections and two sub-sections,
so perhaps the London societies may yet see their way
to follow suit.
Hospital Saturday has been so unsuccessful this year
that it is proposed to have a second one this day fortnight.
At its best it has never been as successful as the Hos-
pital Sunday Fund. Last year the " Sunday " brought in
more than three times the amount of the "Saturday" fund.
Small-pox is rapidly decreasing. Last week only twelve
deaths from it occurred in London.
Dr. Collis Browne, the so-called inventor of chloro-
djTie, has just died. Chlorodyne is perhaps the only
patent medicine and secret remedy which has been
kgely employed by medical men. The makers con-
tended that it contained a certain alkaloid which gave it
valuable properties. They declared that this could not
ie discovered by analysis. This proved to be so far
correct that many people were inclined to regard the
"alkaloid " as a myth. Several lawsuits have been waged
over chlorodyne. The final result was to leave the
iriginal inventor. Dr. Browne, in undisturbed possession
bf his rights. He derived a large income from the sale
of the preparation.
CENTRAL EUROPE IN A CHOLERA SUMMER
-THE CLEANLINESS OF PARIS AND LON-
DON— THIRD INTERNATIONAL CONGRESS
OF OTOLOGY, IN BASEL.
To THB EdITOK or THB MBDICAL RBC30KD.
Sir: I would not advise even a medical man, who
desires a vacation in Europe,' unless he is specially in-
terested in the germ theory, to choose a summer in which
Asiatic cholera is epidemic in a few places, and is about
to become epidemic in a great many more. But, to the
passengers landing at Southampton on June 26th, the
announcement that cholera had broken out in Toulon,
and that it would undoubtedly spread over France and
throughout Europe, was like thunder from a clear sky.
^tany a prophet has lost what reputation he may have
«ad by predictions as to how and where the cholera would
extend. The July ftte was to bring it to Paris. The fftte
, was held, but no cholera came. Refugees from Toulon
and Marseilles came to Paris by the hundred ; some of
them to the very hotel from which this letter is written.
No quarantine was established. People were not even
disinfected, but Paris has been kepi strictly clean, and if
the cholera has reached it at all, it has only been in a few
sporadic cases, as yet scarcely worthy of specific atten-
tion. On the other hand, poor Italy has rigidly main-
tained a quarantine extending even to the peaks of
almost inaccessible frontier moun tain tops, and maintained
it actually at the point of the bayonet. She neglected,
however, to clean Spezzia and Naples, and, as we all
know, she is suffering from an epidemic as ruthless as
that which depopulated and impoverished the cities and
villages of Southern France. The condition of Naples,
at the time of the late outbreak, was the same as that
which has given it a pre-eminence among filthy cities.
There, was not enough water for personal or ptiblic
cleanliness. Cesspools existed in nearly all the houses
in the poorer parts of the city. Their solid contents
were kept for months, whDe the fluid oozed away in
rather small channels. Their zeal in this direction was
occasioned by a desire to enrich their vine and olive
yards. A great storm, occurring just before the outbreak,
caused many of the outlets of these cesspools to over-
flow, with effects that it does not require a medical rnind
to imagine. To return to the prophets for a moment.
It is said that an English physician got a guinea early in
the season for advising an American lady, who had come
to Europe for a prolonged stay, to sail for home in the
first steamer, because, as he believed, the cholera would
soon be in England, and then the steamers to America
would cease running. As a matter of fact, traveling in
Central Europe this summer, barring the very hot
weather, has been pleasanter than usual.
It is true those who trust to the opinions and fears
of the average public must have had many misgivings*
We were warned not to go to Vienna, because the chol-
era was just about to break out there. As you know,
there has not been a single case in that city. Then,
again, we were told that Switzerland would be packed
frill of people and very unhealthy, but Switzerland was
not full, and was never healthier. Poor Cweneva was al-
most bereft of American and English visitors on account
of the repeated statements that the cholera had actually
broken out there. I think Americans, as a rule — those
who did not turn back to enjoy the earthquake — went to
Scandinavia, Ireland, Scotland, and England. Occa-
sionally one, not able to resist the blandishments of Paris,
stole over from dirty London to that most cleanly city.
We, in Central Europe, have had exceedingly good
rooms, attendance, and very civil landlords, but a very
hot summer. A few travellers have been disinfected at
Geneva, but it seems to have been rather a source of
amusement than of actual annoyance. I think it re-
mains to be proven that quarantine or disinfection are
of the slightest service. If cholera be a contagious dis-
ease, then it is very singular that the most of France, all
of Germany, Austria, and Switzerland have thus far es-
caped the epidemic, while fugitives from Toulon and
Marseilles have been running with tlieir bag and baggage
all over these countries without let or hindrance, I
suppose the ravages of the disease at Naples can hardly
be exaggerated, but if our newspapers would cease
to put panic-striking head-lines over the paragraphs in
regard to the spread of the cholera, and reserve their
rhetoric for appeals for personal and public cleanliness,
much could be done to arrest the progress of an epi-
demic, the cause of which we know to be chiefly founded
in dirt. It is possible that, despite the Berlin confer*
ence and its opinions, we shall all yet believe that cholera
Asiatica, cholera nostras, and cholera morbus are one
and the same.
The man in Tennessee about whom I read in a New
York paper, and the one in Ireland, may actually have had
cholera like that of Naples. The results of British cleanli-
ness in India seem to indicate that cholera may often be
392
THE MEDICAL RECORD.
[October 4, 1884,
expected where great heat, public and personal filth exist
in the proper combinations. As has been already inti-
mated, this letter is written from Paris. I have never
had a proper idea of how a great city may be kept clean
until I saw Paris as it is this summer. Clear water ac-
tually flows through the gutters and over the streets two
or three times a day. The poor quarters are as clean as
those in which the rich live. London bears no compar-
ison to the French capital in point of cleanliness. In
fact London seems to me, in this latter part of September,
by no means a clean city. Cleaner than New York it
certainly is, and I read in the English papers that they
are cleaning up everywhere. One of her eminent sani-
tary authorities states that cholera in England always
saves more lives than it takes, since it lessens the mor-
tality from typhoid fever for a year ; the cleaning being
too late for one purpose, but in time for the oth^r. I
hear great things of the cleansing which has been under-
taken in New York this summer. It is to be devoutly
hoped that it is all true. With the standard of cleanli-
ness that has hitherto existed among our rulers, and with
our bad pavements and our scarcity of water, I doubt
very much if New York is yet clean. Our passengers
will be convinced if, when landing from the ocean steamer,
we are not regaled with the usual sights and smells of Canal
and Christopher Streets, and Seventh Avenue. Perhaps
the medical profession of New York could not do a better
work this winter than in preparing for the cholera of next
summer by organizing a street repairing and cleansing so-
ciety. Whatever other lessons this season of cholera has
conveyed, this one stands out pre-eminently, that in clean-
liness, > personal, household, and municipal, are to be
found the only preventive means, while quarantines and
disinfections are but delusions and snares.
Many of the readers of The Record may have for-
gotten that the first International Congress of Otology
was held in New York in 1876. It was very sparsely at-
tended by Europeans. Indeed, I believe but one paper
was read for a foreigner. The Congress was held in the
same year with the International Medical Congress in
Philadelphia and the International Congress of Oph-
thalmology in New York. There was a volume of Trans-
actions published, however, and a second Congress was
held in Milan in 1880. The third has just taken place
in Basel, from the ist to the 4th of September. Basel has
a small university, but one of renown. Vesalius taught
anatomy there, and it has furnished several great teachers
to other universities. Through the efforts of Professor
Burckardt-Merian and Professor Politzer, Drs. Lowen-
berg, M6ni6re, and others of the Committee of Arrange-
ments, the Congress was a success in numbers and in
the character of the papers read. More than eighty
names were inscribed on the roll, among which were
Moos, Bezold, Pritchard, Politzer, Delatouche, M€ni6re,
Gelle, Lowenberg, Guye, CoUadon, Hartmann, Kuhn,
Sapolini, and Valentin.
The Governments of Switzerland and of Basel were very
courteous and hospitable. The social entertainments —
public breakfasts and dinners — were of a charming kind.
The speeches of the representatives of the municipal and
State authorities were even eloquent. In fact, it seemed
to me that the manner of speaking of our Continental
brethren, both in the Congress and at the social enter-
tainments, was singularly happy. Some of the speakers
read their papers while sitting, after the manner of Ger-
man professors in the lecture-room. This seemed to me
to contribute materially to the ease of the delegate read-
ing a paper. The discussions were lively in the extreme,
as well as polyglot. French was the leading language,
since no Frenchman ever appears to understand or speak
any language but his own. Burckardt-Merian, Politzer,
and Moos gave some very fine anatomical and patho-
logical demonstrations. The papers read in French
were epitomized in English and German by Guye and
Lowenberg, who were the volunteer interpreters for the
Congress. At some points the bounds at the dispersion
from the tower of Babel were possibly reproduced. 1
am sure many of the readers of The Record will be in-
terested in the volume of Transactions.
The next session of the Congress is to be held in 1888
in Brussels. A telegram was read from the mayor of
that city welcoming the meeting in advance. A propo.
sition to meet in Washington, as a part of the Interna^
tional Medical Congress, fpund no favor, otology being
considered to be a plant which requires a whole garden,
and not a mere plot, to itself. *
Paris, September xa, 1884. ^' B- St. JoHN RoOSA.
«' ON THE ARREST OF TUBAL PREGNANCY
BY GALVANISM."
To THB Editor of Thb Mbdical Rscoxd.
Sir : In reading Dr. Mund^'s interesting case, in the last
issue of The Record, entitled " A Successful Case of
Arrest of Tubal Pregnancy by Galvanism," I noted both
a point for discussion and a mistake to correct. I ani
all the more ready to avail myself of any opportunity to
extend the consideration of this subject because it is an
accident so comparatively infrequent that it is only occa-
sionally that the immense value of electricity in saving life
in this condition is brought to the attention of the profession.
Considering the number of successful cases that have
been reported, it is indeed surprising that one meets with
so many physicians who have either never heard, or who
have forgotten the fact, that electricity offers a safe and
speedy relief from this dreaded abnormality of pregnane}'.
Dr. Mund6 raises the question as to the form of cur-
rent most suitable in these cases, preferring faradism,
and basing his preference on the satisfactory use of it in
several cases by others, and on the fact that in his own
case prolonged and alarming prostration followed the use
of galvanism.
If these cases were recurring with great frequency, ex-
perience would soon decide whidi was the surer and
safer method, but as they are relatively so infrequent,
physical and physiological laws must partially guide us.
We know that galvanism is a far more potent agent than
faradism in its relation to living tissue, and more de-
structive to life, and so has an advantage over the far-
adic current. As to the effects of the application on
the mother, I am persuaded that they never need be
harmful, or especially painful, no matter which forai of
current is used.
In his own case, Dr. Mund6 made use of twenty-four
cells, giving shocks that were "quite painful," through a
stance of ten minutes. He says : '' I did not think the
current too strong, for I remembered that in one of the
successful cases reported (McBumey's), thirty-six cells
had been used." The correction that I wish to make is
that, in the case to which reference is made, but twenty-
three cells were used.
In six other cases where I successfully used electricity
(all of which were reported in this journal), and whidi ^
went to make up the eleven cases collected by Gar-
rigues, to which Dr. Mund6 refers, the current strength
was much less. In two cases onl^ twelve cells were
used, and in none of them did the slightest ill effects en- [
sue ; all of which goes to show that a much weaker cur- ;
rent of galvanism will, in all probability, prove effective
than was at hrst supposed.
My experience leads me to believe that one-half the '
number of cells used by Dr. Mund6, and with an appli- I
cation one-half as long, would have been sufficient. His
statement that thirty-six cells were used in McBumc/s
case was due, I suppose, to the fact that in the report it
was stated that my thirty-six-cell battery was brought
It is readily seen that it must be of vital importance to
use the minimum of current strength necessary to destroy
the life of the foetus, not so much perhaps on account of
the possibility, in rare instances, of its prostrating the
patient, but because the stronger the current the greater
the possibility of rupturing the already distended tube.
Scptaabcr27,.i884. A. D. RoCKWKLL, M.D.
The Medical Record
A Weekly yournal- of Medicine and Surgery
Vol. 26, No. 15
New York, October ii, 1884
Whole No. 727
dhrifliiml %xXit\ts.
CONTRIBUTIONS TO
THE ANATOMY OF THE LEMNISCUS.
W^iTH Remarks on Centripetal Conducting Tracts
IN THE Brain.
By E. C. SPITZKA, M.D.,
rtOraSSOR of NSURO-ANATOMY AHD physiology IH the MBW YORK POST-GKAD-
UATB MBDICAL SCHOOL,
I. — Introduction.
The attention of those who are interested in determin-
ing the location of special functional nerve-tracts in the
brain and spinal cord has been more particularly directed
to the one which mediates the conveyance of voluntary
impulses from the supreme centres in the cerebral cortex
to the deputy centres or outposts in the anterior cornua
of the spinal cord, and their analogues the nuclei of cer-
tain cranial nerves. Aside from this, only the internal
capsule, empirically discovered to contain a sensorial
tract in the posterior part of its posterior division,' and
the diflfcrentiated tracts in the spinal cord have received
much attention. Among the reasons which account for
this favoring, thfe greater frequency of disease of these
parts as compared with others, their easy topographical
demarcation, and systemic clearness, are the chief.
It is evident, however, to those who look beyond the
popular aspect of cerebral localization, that what was
until quite recently a terra incognita to most cerebral
pathologists — the brain axis — contains within its labyrin-
thine maze the solution of much that is enigmatical in
the cerebral mechanism. Here are found, besides the
important cranial nerve nuclei, and the tracts which bind
these into co-ordinated reflex or automatic associate
action, the great projecting fibre masses, which Meynert
first attempted to systematize. Here are the channels
for the transniission of special qualities of sensation, and
of those obscure influences which determine co-ordination.
The tracts which are more or less fused into the bifid
cylinder of the cord attain greater distinctness, and sep-
arate more widely, as they pass through the oblongata
and pons, in order to reach their mutually remote destina-
tions. Many of them are inaccessible to the experi-
menter, and so rarely the site of limited (focal) disease,
that it is improbable that their function will ever become
. y ** »urpn»me to find how uncertain, not general medical writers, but spe-
tthsts, who have furnished accounts of the cerebral architecture, appear to be on
ma important head. The tractt for the control of the motor cranial nerves (with
we probable exception of the oculo-motor series), and the pyramid tract, which
cwveys voluntary impulses to the extremities of the opposite side, as ascertained
by Flechsig, are situated in and behind the e^tmu of the internal capsule, that is
m ite anterior part of the posterior or thatamo-UHiicMlar division, not in the
anterior half or two-thuxls of the capsule" as Seguin (Lectures on Localization,
JUDICAL Rbcord, vols. xiiL and xxv.) and a few others represent it. Where
nose who are familiar with cerebral topography, who have actually manipulated
■ains, besides being active as original and laborious contributors to the subject of
orebral patholoey, err, it is not to be wondered at that compilers should foUow.
^umey (Applied Anatomy of the Nervous System, pages 44, 48, and 91) repeat-
edly makes the same erroneous statement Perhaps the loose ideas on this sub-
IKt we m part due to the &ulty conceptions of the situation and course of the in-
tenal capmile which such dugrauns as that of Daleon, copied on page aa of
Ramiey's book, are calculated to foster. Here die pyramid fibres of the capsule are
actuatty made to decussate m the pons ! It is best, in order to avoid confusion, to
speak of the anterior of the two great divisions of the capsule which lies between the
KtoHaadad slope of ^^caudatvs and the meso-cephalic slope of the /*w//Vji<Atrir,
a Ite caudo-leaticular capsule " and of the posterior, which ties between the meso-
ondad slope of the Unticnlaru and the ccto-cephalic slope of the tAalamtu. as
ae 'dMUamo-lcnticubur capsule." It is in the latter alone that the "anterior"
Mr dsvision and the /'posterior'* sensory division are located (Flechsig,
Womcke, StrOmpeU, etc). The sonalled external capsule, which lies between the
«alfaceofthe/wi/*f«i/jri*and ±a ciautiruim^ might be distinguished by the
Knn "daustio-lenticular'* capsule.
known by the empirical but crucial tests of the physiolo-
gist and pathologist Anatomical methods must supply
the deficiency, at least for the present, and a small army
of anatomists, following the lead of Gall, Meynert, Foville,
and Gratiolet, and working with the improved methods
of Stilling, Gudden, and Flechsig, are rapidly completing
the survey of the course taken by the great nerve-tracts,
discovering their ganglionic and peripheral terminations,
and enabling the physiologist to infer the r6le they play
in the machinery of thought and action.
In the course of these researches it has become noted
as one of the most significant facts, that there is a re-
markable difference in kind between the course of the
tracts of voluntary motion and those which convey sen-
sorial impressions — a discrepancy which may yet lead
to a complete revolution in the views generally enter-
tained of the central nervous functions. I refer to no
less startling an innovation on the current views than
the possible one, that certain of the tracts which are or-
dinarily regarded as sensory, and hence — almost self-evi-
dently — as centripetal, are really the seat at the same
time of centrifugal functions.
While the tract of voluntary motility directed to the
extremities runs clear of all ganglionic interruption from
the supreme centre, the cortex, to the gray matter of the
cord, not one of the sensory tracts has been traced to a
cerebral termination, without encountering a ganglionic
interruption. The columns of Burdach and Goll, for ex-
ample, terminate in the nuclei of those columns, the
direct myelo-cerebellar tract runs into the cerebellum, and
other less individualized fibre*systems, which may possibly
have a relation to sensory functions, are connected with
and provisionally at least terminate in some one or other
ganglionic way-station or terminus.
If on comparing the relative development in various
animals of the internodial ganglia connected with these
tracts, it were found that they are less developed in higher
than in lower animals, it might be inferred, as I urged
with regard to certain other ganglia and tracts, that they
represented necessary steps in phyllogenetic development,
destined like the human tail, and the notochordal relic
in the ligamentum suspensorium dentis epistrophei^ to be-
come obsolete. For nerve-tracts subservient to higher
functions do exhibit a tendency to emancipate themselves
from ganglionic interruptions, probably because a direct
telegraphic connection — cceteris paribus — is a more per-
fect mechanism than one which has to pass many inter-
rupting stations.
But this is not the case with regard to the ganglia under
consideration. Their interrupting stations, such as the
nuclei of the columns of Goll and Burdach, and the
dentated nucleus of the olive, attain their highest develop-
ment in man and the anthropoid apes. There is as much
of higher individuality in the varying contours of the last-
named body, as there is in the cerebral hemispheres them-
selves ; just as the monkeys alone resemble man in the
type of cerebral convolution, so they alone of all animals
present anything like the same character, relations, and
degree of olivary corrugation.* If there is any inference
to be drawn as to the physiological importance from rela-
* And this not as an expression of generally high cerebral development in the
anthropomorphse, but of affinity in codlogical position, and, what is practically
equivalent, of peripheral disposition, for the elephant and porpoise, with far more
complexly convoluted hemispheres than man even, have simpler olivary bodies,
resembling those of their humbler congeners, the hog and rhe sea-lion. Meynert
is utterly at sea where he refers to ttie remarkable development of the olive in
marine mammals, for the same elevation passes as the pyramids in Huguenin'^
394
THE MEDICAL RECORD.
[October ii, igg^^
tive development, these interrupting stations must be
regarded as important factors in the central laboratory.
This is almost the same tale as that which might be told
of the cerebellum ; a ganglion, which may be regarded as
a gigantic way-station, in which auditory and spinal tracts
meet, and are continued brainward, through cerebello-
cerebral fasciculi. It was not so very long ago supposed
that the cerebellum as a " lower centre " was crowded out
-by the higher cerebrum in the ascending animal series,
whereas the fact is that this ganglion is vastly larger and
more intricate in higher animals than in lower ones, and
«hows an individuality in the type of its foliated arrange-
ment, comparable to that adverted to in the case of the
olivary nuclei.
It being thus evident on structural grounds that the gan-
glionic enlargements in which certain spinal tracts appear
to terminate have an object, which could not be fulfilled
if those tracts ran directly to the cortex, we must look to
the other connections of such ganglionic masses for an
explanation of that object. To take a hypothetical case.
Suppose the cerebellum received fibres from the skin
through the " sensory tracts " in the cord, and from the
semicircular canals through the auditory nerve, and de-
spatched another tract to the cerebrum ; assuming that the
>f direction of functional transmission were in all these
tracts toward the cerebrum, there could be but one
conclusion : that the cerebellum served to co-ordinate and
fuse space sense perceptions from the skin, and such
from the semicircular canals, and acted as an informing
depot for the cerebrum ; the latter is through its inform-
ant, which spares the cerebrum the task of co-ordinating
these impressions into a united general space sense,
enabled to guide motion in accordance with the latter.*
The probable object of the intemodial or interrupting
ganglia is the mediation of some functional combination.
The manifold interruption of the tracts of sensation, as
contrasted with the direct course of the tract of voluntary
motion, hence appears as the anatomical expression of
the fact that the motor impulse is a comparatively simple
step, but that the building up of the contact and space
senses which guide such motion to a skilful purpose is a
far more intricate and laborious task, which is thrown on
the centripetal tracts, and hence requires a greater ana-
tomical complication.
I need but cite briefly a few facts recently observed by
me in an interesting case* which justify the surmise above
expressed, that certain tracts physiologically and ana-
tomically regarded as centripetal really may convey func-
tions centrifugally in a part of their course. An elderly
gentleman, after a small hemorrhage in the pons, which
caused unilateral ataxia of the opposite extremities, lived
six years, during which time an intense secondary degen-
eration developed in the descending direction, and termi-
nated after decussating in the opposite nuclei of the col-
umns of GoU and Burdach, which were likewise atrophic.
Now as far as secondary degenerations follow any law,*
it is supposed that if a ganglion degenerates together with
an appended tract, that both must belong to the same
physiological system. The columns of GoU and the
upper part of the columns of Burdach degenerate centrip-
etally, that is, upward, or toward their nuclei. The dis-
eased tract in my patient had degenerated centrifugally,
that is, cordward, and hence from an opposite direction,
also toward these nuclei. Here is an unquestionable in-
stance in which two segments of the same tract — for the
upper segment must be regarded as in part the cephalic
continuation of the lower — degenerate toward an inter.
> The (acts happen to justify this hypothesis, to some extent. As bearing on
what the wntcr said about the possibihty of tracts customarily regarded as centrip-
etal conveying centrifugal funclions» it may be well to refer to the fact that if
Flechsig s suspicion, that the direct myclo-cerebellar tract is centrifugal, turn
out to be well founded, that the cerebellum may exert a direct influence on a cer-
tain class of movements, without the intervention of the cerebrum at all. This
would but increase the force of the remarks made in the text, as to the importance
of the interrupting" and "co-ordinating" stations. The above idea has been
borroweil, with others, by Ranney.
a This case has been reported elsewhere, to be hereinafter referred to, when the
questions involved will be more fully discussed.
3 I question whether they do follow such law as invariably as some assume.
polated ganglion when diseased, justifying the assamption
that functional impressions converge toward it, though
not excluding the possibility of a continuous transmission
brainward of sensory impressions * at the same time.
I have considered it necessary to make these introduc-
tory remarks, because to me the impression seems to pre-
vail that all that is necessary to understand the anatomical
part of the cerebral mechanism is the tracing of the cen-
tripetal tracts to the muscles in which they terminate, and
the centrifugal ones to the cortical fields, from the periph-
eries, whose impressions they convey to them. This
is important and essential, but it does not exhaust the
duties of the anatomical psychologist, and is not even
feasible in the case of many fasciculi. What I said some
years ago * with regard to the functions of nerve-centres
generally, " That day is past when it could be considered
legitimate to refer every phenomenon provoked by an
intracranial experiment to an altered activity of any single
centre ! " naturally applies also to the nerve-tracts whose
connection with the nerve-centres is a factor in the func-
tion of the latter.
With these preliminary remarks, I have intended to
pave the way for the understanding of the lemniscus : a
nerve-tract of at least equal importance with that of the
pyramids, an importance which is just being recognized,
and which from its manifold, systemic, and topographical
relations offers an opportunity for the discussion of many
new or imperfectly understood features of isthmus
anatomy.
II. — External and Gross Anatomy of the Lemnis-
cus.
On the outer (lateral) face of the mesencephalon, that
isy on the slope which intervenes between the corpora
quadrigemina and the bulging /^j of the cerebral pedun-
cle of each side, there is a distinctly marked triangular
field, known as the lemniscus or laqueus.
This is not merely a surface feature of the brain-
isthmus (or axis), but the exposure of a great brain-
tract, which in this particular area is uncovered by other
nerve tissues, and elsewhere is deeply imbedded in the
substance of the thalamus region, Hait pons^ and passing
through the oblongata^ becomes intimately related with
the ganglionic elements of the great centripetal columns
of the cord, namely, the nuclei of the columns of GoU and
Burdach, as well as the dentated body of the olive. Just
as the columnar elevations of the oblongata, known as
the pyramids, represent only a small segment of that
great system, the will-tract, to which they have given
the anatomical name of *' pyramid-tract,*' so the surface
area of the lemniscus indicates but an insignificant por-
tion of the great tract which bears the same designation.
Haller ' discovered the lemniscus, describing its situa-
tion and shape, but to Reil * is owing the credit of having
recognized that the triangular field discovered by Haller
is only the surface denudation of an important system of
fibres. He found that it was not in connection with the
pyramids, though some admixture of the fibres of the fillet
and the pyramid was alleged by him, and traced it to the
situation to-day known as the stratum of the fillet
(Schleifenschicht). He later claimed that it passed be-
tween the olivary nuclei and the pyramids in the ob-
longata, and became indistinguishably fused with both of
these bodies. Rosenthal undertook to correct this latter
statement, which, as far as the pyramids are concerned,
is partly true, for my own case demonstrated the existence
* Or of hitherto unsuspected centrifugal transmission cordward. The oc^umns of
GoU may occasionaUy d^enetate downward or simultaneously with their nuclei : at
least this seems to have been so in Sioli's case (Archiv f. Psychiatrie, xi., 3, p. 693.'
This surmise would offer the explanation of possible physiological transitioB lor the
case of some rodents, like the rat, in whom, according to Fleoiiaj^, ^e fibres of the
'ivc (: ) pyramidal decussation enter the posterior columns.
> llie Architecture of the Oblongata, N. Y. Medical journal, September, 1881.
It is refreshing to find this identical conception emanatmg from another writer in
the same journal several years after. Unfortunately the context of his coodusion
furnishes no hint as to the method by which he arrived at an opinion so similar in
its phraseology to the writer's. It is in fact a disconnected plagiarized sentence,
like another previously referred to as appropriated from the same source.
' Elementa IV., p. 175. According to Burdach.)
* Reil*s Archiv, ix., p. 149.
October ii, 1884.]
THE MEDICAL RECORD.
395
of degenerated fasciculi in the otherwise healthy pyramid,
and these were connected with the degenerated inter-
ohVary field.
The discovery of Hallei was ignored by the anatomists
Hrho described the mesencephalon after his time, and
before that of Reil. Vicq d*Azyr,* whose plates are
usually singularly true to nature, represents the lateral
field of the mesencephalon as a uniform rounded surface,
and neither designates nor describes the lemniscus, while
Gall * gives an excellent illustration, particularly accurate
as regards the deeply depressed acute apex, but does
not refer to it (Plate XIII., under " 30 ").
Burdach, who mainly follows Reil's description, gives
an accurate account in his text, but his artist erroneously
represents the fourth pair as aris-
ing from each lemniscus, instead
of from the valvula (Plate IV.).
The lateral aspect is very well
represented in the fifth plate of
the same work.
Reil recognized comparatively
clearly that the lemniscus, in
passing through the pons, is dis-
tinctly separated from the trans-
verse fibres of the cerebellar M
system, and in many of the writ-
ings and illustrations of his day,
it may be seen that the so-called
" bundle from the pes to the teg-
mentum," described by Henle,'
was considered, at least in its
posterior division, a part of the
lemniscus.
One of the sharpest lines of
separation of nerve-tracts is the
one which in the pons region
separates the lemniscus and the
transverse pons fibres. This line
of separation was misinterpreted
by the older anatomists. Vicq
d'Azyr*s artist, one of the most
conscientious draughtsmen, has
permitted his artistic interpreta-
tion to encroach on anatomical
truth, more in this than in any
other detail of encephalic anat-
omy. On Plate XXV. he makes
a round nugget of the pons,
completely encasing it in a
whitish shell, of which the dor-
sal half is the bundle from the
pes to the tegmentum, while the
ventral portion represents the
superficial transverse fibres of
the pons. The joining portions
are altogether imaginary. He apparently recognized the
continuous tract of the above-mentioned bundle, but en-
graved it from memory, notes, or hasty sketches — he cer-
tainly had not the specimen before him — and confounded
the posterior longitudinal fasciculus, the stratum inter-
medium, and the tracts from the mamillary body, dupli-
cating them in one place so as to be entirely incompre-
hensible.
The bundle overlying the line of separation is very dis-
tinctly and correctly represented on Plate XII. of Gall's
atlas.
The figure reference (85) reads : '* Ligne de separation
entre les parties ant^rieures (ventral) et post^rieures
(dorsal) de la masse c6r6brale ascendante," and evidently
relates to the sharp line of demarcation which separates
this fibre mass from the transverse pons fibres. The
course of the tract as visible in sagittal sections is cor-
» Tratid d'Anatomie et de Physiolos;ie, 1786, tSmc icrc, Plates XXVI I. and
* Anatomic et Pbysiologie du Syst^me Nerveux et du Cerveau en particulier.
Paris, x8z8.
' Aiiatomie des Mcnschen, iti., Z87X.
rectly represented as being between the substantia nigra
{Ganglion Soemmeringii, E.C.S.), and the olivary region.'
I have sections in my collection which are exact reproduc-
tions of this plate, a signal confirmation of the accuracy
of Gall's delineations.
In order that the general reader may not become lost
in the obscurity of the brain-axis terminology, I may
be pardoned for digressing here to explain the meaning
of some of the terms already used, and the topography of
the parts with which we are about to deal.
The brain axis or isthmus is the continuation upward
of the spinal cord. It is the common trunk (hence the
German term "Hirnstamm" or brain trunk) from which
the two cerebral hemispheres crop out like swollen ter-
FiG. z. — Brain Axis or Isthmus, with the Obbngata nearly entirely removed, bv a sweep of the knife through the
Acusdc Stria:. M represents this cut surface, on which the contours of the raph^, olivary nuclei, pyramids, and
resttform columns are laintly mdicated. The isthmus is tilted in such a way that the lateral and superior (dorsal)
i-. •„ f 1 ?.L.-..- ,. j_ _•/•.!_ _i .. 1_ X. both (ideal) retinal planes of the observer
lus deviates from this plane forward 45",
(aces are simultaneously visible ; in other words, if the plane passing through t
_ vertical and corresponding to the page, the axis of the isthmus deviates trom this pU
and upward in the plane a/*. The following indicate the principal parts. A, of the oblongata : Af, cut surface
be regarded as '
auditoiv nerve root' B, of the pons : pB^ cut surface ^pontU brachium (middle cerebellar peduncle) ; mB^ ditto of
myeloSrachium (posterior cerebellar peduncle) : tB, tB, ditto of tegm*Hta4>rachium (anterior cerebellar peduncle) ;
those of both sides are connected by die divided vaivuia^ of which /r indicates the Jreuulum. Between the cut
edge of the oblongata section and the semicircular combined section of the cerebellar peduncles, the anterior half
of the founh ventnde is set like a picture in a frame ; xv indicates the median sulcus^ which anteriorly deepens
into the aqueduct under^, while^ indicates the fovea, from which a groove runs demarcating part of the auditory
triangle. The other references are : 6, abducens (sixth) nerve roots ; 7, ditto facial ; 5, ditto trigeminus ; *, the
iractus iuterradicularis pontis, named and described by the author in the Am. Jour, of Neur., May, 1884 : rf
the recesstu facialis^ named and described jn the same number. C, of the mesencephalon : fr^ frenulum valvula ;
ba^ anti-brachium ; 3/, 3/^, post brachium : Gi^ ganglion geniculatutn internum ; Tpt^ tracius transversus
peduncularis (crossing the pes). The corpora quadrigemina are so characteristic that they require no designation.
JD, of the thalamus segment : Tpv^ pulvinar; A, habenula ; /, cut surfaces of tf/f^A/xif (pineal gland) ; Ge^ pin^lion
grnicttlatum externum, which is really only a thalamic nucleus ; TV, optic tract : 2, optic nerve ; ♦♦, reflection of
endy ma of lateral ventricle : t, insinuation ox branch of optic tract between Gi and thalamus to pass to ba : tt, sin-
gular tract-like elevation of thalamus sHrflUx, hitherto undescribed. and not equally well devek^>ed in all brains.
minal branches, while the cerebellum is an excrescence
of the trunk itself.
In its general shape, excluding the inflections, it may be
compared to an inverted truncated cone, for as we follow
it up toward the cerebral hemispheres, it becomes wider
and deeper, enlarging progressively in all directions. The
lower small end is the spinal termination, the upper wide
end is the cerebral or thalamo-crural end. The entire
axis may be considered under the following four heads :
I. Thalamic division. 2. Mesencephalon (region of the
corpora quadrigemina). 3. Pons. 4. Oblongata. In the
main the thalamic division consists dorsally of two great
flaring-out masses, separated by the third ventricle. Ven-
trally it includes the subthalamic region and that part of
the crus which prepares to merge into the internal cap-
sule.
' The mesencephalon is marked dorsad by the four
beautiful eminences of the corpora quadrigemina, ventrad
by the symmetrical and cylindrical prominences of the
^ Respectively references 30 and a of the same plate.
396
THE MEDICAL RECORD.
[October ii, 1884.
crura (pes portion). The transverse section in adult
man exhibits a black crescentic line on each side which
sharply separates the crus proper (pes) from the dorsal
part, which merges into the corpora quadrigemina and is
known as the tegmentum. This black crescentic line is
the substantia nigra of Soemmering. It constitutes the
most important boundary line in the deep anatomy of the
brain axis.
Fig. 3. — Section flat-wise, that is, parallel to the base of the brain axis, through the Thalamic MeseHce^katcn^
P0Hty and Oblongata, extending to the Spinal Cord. It dips a little lower on the right than on the left side, and
to this the slif^ht asymmetry of the ligure is due. The following tigure references relate to the thalamic and sub-
thalamic r^ions : H, habenular tract : 7V. m.^ **, m. ('. z, and m, i, a, medullary lamina; of thalamus ; C
>m/., commusuia posterior ; ///., third ventricle. The following relate to the mesencephalon : Aq. Gr.^ aque-
duct gray matter ; pl/.^ posterior longitudinal fasciculus of the t^mentum ; <., part of the descending trigemmus
root^ G. certbli.f the du«ct tract from the cerebellum to the posterior part of the cerebrum, discovered by
Gratiolet^ confirmed by Flechsigj and which courses through the outer part of the //x ptdunculi ; Tepnt. Br.X.,
decussation of tegmenta brachium or brachium conjunctivum, also known as Wemekinck^s commissure. The
following refer to the pons : rad. and rad. 2, auditory and facial nerve roots cut across : hh, nuclei of pons
gray ; *, cerebellar origmof G.certblL; Pont, Br.^ pontis brachium^ or middle peduncle of cerebellum divided
across. The following relate to the oblongata : Pyr. X., decussation of true pyramids ; OL dent.^ dentated or
main port of olivary nucleus ; 01. int., intenud auxiliary part of same. * The other references relate to the lem-
niscus tracts, and are explained in the text.
from the brain axis of a Swede, whose brain I secured through the courtesy of ProfessOT James iJ. Little.
llie specimen was stained by carmine, being cut in my microtome
' '" ' - . - . . j^
was hardened m bichromate of potash.
The pons exhibits dorsad the upper half of the floor of
the fourth ventricle. Ventrad a bridge of nerve-substance
apparently jointing the cerebellar hemispheres.
If the beginner will conceive a conical piece of wood,
whose base is turned upward, split by an axe, while a band
is thrown around the middle of its length to prevent the
split from extending through to the apex of the cone, he
will have a crude idea of the relations of the pons as seen
at the base of the brain. The two parts on each side of
the split are the pedal crura; the split is the interpedun-
cular or intercrural depression ; the belt is constituted
by the bridging portion of the pons, below which the un-
split part represents the oblongata.
The pes and tegmentum are separated in the pons by
the sharp line of separation alluded to in the historical
introduction.
In the oblongata, it is impossible to make as clear a
division of the tegmental and pedal part of the brain axis
as in the pons and mesencep'ialon.
The pyramids are the true repre-
sentatives of the pes.
The exterior of the brain axis is
sculptured into numerous eminences
— some of them in very high relief
— and depressions. Of the emi-
nences, some, like the tudfr cine-
reum of Rolando, the olives, and
the clavas, are due to the accumula-
tion of gray matter beneath the sur-
face at that point ; others, like the
pyramids, the restiform columns,
the crura, are due to the prominence
at certain points of the surface of
the great nerve-tracts. It is to this
class that the eminence, known as
2«iif^J5>V' the lemniscus, belongs.
^ As represented in the figure L
the elevation of the lemniscus is a
flat triangular field, with one trun-
cated and two sharp angles. Of the
latter, one, the superior (dorsal),
comes in contact with the super-
ficial origin of the fourth pair of
cranial nerves. The anterior corre-
sponds to the (apparent) junction
of the crusta znd J^ost-^rachium.'
The posterior truncated angle is
overlapped by the redundant growth
of the pons. While the anterior side
of the triangle — that is, the one con-
necting the superior and anterior
angles — sinks below the post-brach-
ium, the inferior side is in contact
with the dorso-lateral edge of the
crus, and the ixjsterior (on which the
light in the figure falls) rises in bold
relief, cropping out over the tegmenta
brachium.
These surface appearances indi-
cate the actual relations of the lem-
niscus tract to some extent It may
be regarded as a flat band, which is
dragged out of the substance of the
pons to overlap the tegmenta brach-
ium^ to be overlapped itself by the
crus and the post-brachium ; in its
known course it extends from the
thalamus region to the lowest levels
of the oblongata. Unlike the pyra-
mid tract, which is a single united
system of uniform physiological rela-
tions, the lemniscus tract includes a
number of nerve-bundles having dif-
ferent destinations and dififerent gan-
glionic connections. Indeed, with
our increasing knowledge of this part
of the cerebral projection system, it will, I think, become
recognized that the includmg of all these bundles under
one generic term is improper and misleading. One feature
is found with all of them, that they are (in part, at least)
related to functions regarded as centripetal and sensorial,
as far as we may draw surmises from structure. The part
^ Arm of the posterior pair of the corpora (]uadrigemina. In the figure an in-
teresting variation is shown ; this arm exhibits iu two characteriscic divisions [h
and bj/)y and at the end of the pointer, bp', the intumescence known as the
gangiwi geniculatum mediaU. j
October ii, 1884.]
THE MEDICAL RECORD.
397
of the brain axis, in which the lemniscus tracts are seen
in their clearest relation, and where the various designa-
tions of authorities are most in accord, is exposed by a
transverse section through the posterior pair of the cor-
pora quadrigeniina or a little behind this, through the
valvular Typically each lemniscus stratum consists of
an L-shaped area, so situated that the area of each lem-
niscus stratum touches the median (line) raph6 with the
free end of the horizontal branch, thus L -I Even in
sections which are inclined to the axis more or less, as in
Figure 2, a similar appearance is noted. Here a on the
right side represents the horizontal branch, and 2 on
both sides, 3 and 4 on the right side, represent the verti-
cal portion.
This figure indicates at the same time as much of the
entire course of the lemniscus tracts as any one section
can. It is seen to extend from above the pyramidal de-
cussation at e between the olives at //, then spreading
over an immense area, along 6, 5, 4, 3, 2, i, to the thai-
ami, gradually becoming more and more remote from the
median raphe, while another detachment remains near to
it, at r, ^, and a. As in all sections of this character, the
apparent contimuity of- the fibres is accidental, the vari-
ous parts are intermingled somewhat ; but as other sec-
tions and other methods of study show, all of them ap-
pertain to the lemniscus tract. Let us proceed to dis-
cuss these in detail.
(To be continued.)
SOME POINTS ON THE USE OF HEAT AND
COLD IN THERAPEUTICS.*
By JAMES B. HUNTER, M.D.,
SURGEON TO THB W01&AN*S HOSPITAL, NEW YOKIC.
I AM well aware that the subject of the application of
heat and cold in therapeutics is a very large and com-
prehensive one, and I shall attempt no more than to
present a few points which have been suggested by my
own experience.
The use of heat and cold, in some form, for the relief
of disease is almost universal. There is hardly a disease
known in which, at some sta^e, it is not deemed neces-
sary to interfere with or modify the existing thermal con-
ditions, the interference varying between the use of the
actual cautery on the one hand and of ice or freezing mix-
tures on the other. Between these extremes the ways
and means of modifying temperature are very numer-
ous. The necessity for some interference is taken for
granted. Some of the most advanced professional minds
have for centuries past grappled with the problem of
temperature as modified in disease — while every house-
hold has its favorite theories and maxims concerning the
treatment of diseases and injuries by means involving a
change of temperature.
Yet, notwithstanding the antiquity of what may be
called the thermal method of treating disease, and its
almost universal application in some form, there exists a
surprising difference of opinion concerning the use of
heat and cold, especially as to which of these powerful
agents should be employed in any given case.
Professional opinion is assuming greater uniformity on
this point with the advance of physiological science ;
but popular opinion, which often reflects the professional
opinion of a former generation, differs very widely. But
whether heat or cold is preferred, public opinion is al-
ways in favor of the generous use of one or the other.
A gentleman of my acquaintance who was spending
some weeks in a country region, chanced to sprain his
ankle. He was carried helpless to the nearest farm-
house, where he was prescribed for by two experienced
matrons. One insisted on placing the limb under a
stream of cold water from the pump, and keeping it
there for half an hour, assuring him that he would be
able to walk the next day if her advice were? followed.
The other advised placing the injured limb in a pail of
>VaheofVieu8«en'«.
* Read before the Practitioners' Society of New York, October 3, 1884.
water nearlv boiling hot, and keeping it there for half an
hour, promising the same result on the morrow. Mean-
while a boy was despatched to the nearest village for medi-
cal aid. The doctor sent for was not at home, but his
assistant visited the patient promptly, and endorsed the
prescription of cold water, which was thoroughly carried
out. On his return in the evening, the senior physician,
thinking the patient a gentleman of some consequence,
hastened to see him, examined the ankle carefully, and
advised that very hoi water should be applied during the
whole night.
A similar difference of opinion is common both in the
profession and out of it Whether it be a sprained ankle,
an inflamed knee-joint, a bruise, a wound, a bum, a
fever, there is often a radical difference of opinion as to
whether heat or cold will give the greatest relief or ac-
complish the most good. The explanation of this dif-
ference of opinion is probably to be found in the fact
that many diseases and injuries require at different stages
the use of both heat and cold, and that the indications
for the use of either one are not always clear. In the
earliest stages of inflammation the prompt abstraction of
heat often suffices to abort or control the inflammatory
process. After inflammatory changes have taken place,
the application of heat to the same part may, by stimu-
lating capillary and lymphatic action, hasten absorption
and be eminently proper. In some cases this explana^
tion does not apply, as in the use of both hot and cold
water for the arrest of hemorrhage, or of hot and cold
applications for the relief of neuralgia, regarding which
there still exists some difference of opinion. It is safe
to say that in no given case is it a matter of indifference
whether heat is added or subtracted. The same differ-
ence of opinion exists, however, as to the use of some
medicinal agents quite opposite in their effects.
But I must necessarily pass over or allude very briefly
to manv points which suggest themselves in connection
with this subject.
I. I will first consider briefly some of the diseases in
which the abstraction of heat, generally or locally, is de-
manded.
Typhoid fever, perhaps better than any other disease,
illustrates the good effect of antipyretic treatment. Dr.
G. L. Peabody, in a valuable statistical paper read be-
fore the County Medical Association, March 17, 1884,
on the treatment of typhoid fever, says : **The effect of
high temperature is very deleterious upon normal tissues,
and its influence is distinctly evil in reference to the
possible healing of intestinal ulcers." As the result of
his own experience, and a careful examination of the
records of the treatment of typhoid fever in seventeen
large hospitals, in this city and in Europe, those of the
British army and navy, and of our own army. Dr.
Peabody emphatically endorses the use of cold water in
the treatment of that disease. He shows the mortality
to be only seven and one-fourth per cent, in a series of
over eight thousand cases ; and a series of two hundred
and eleven cases in Dr.' Brand's private practice all re-
covered under the antipyretic treatment. Dr. Peabody
laments the difficulty of introducing the practice gener-
ally, the necessary appliances being cumbersome and
expensive. The affusion of cold water he has not found
satisfactory ; the cold coil he considers unsuitable ; and
the cold bath the only really efficient method. Now, a
cold bath in the immediate proximity of a patient sick
with typhoid fever is not often obtainable. The patient
may be sick in a country house, where bath-tubs are
unknown ; in a hotel, where they are fixed and re-,
mote from the patient's room. Even in a private bouse
with all modern appliances it is not an easy matter to
transfer a patient from a sick-bed to a bath-tub and
back several times a day without a good deal of dis-
turbance to the patient, and an abundance of physical
help. I would therefore suggest as equally efficient and
far more practicable the use of the well-known, but
somewhat neglected Kibbee fever-cot, or something
398
THE MEDICAL RECORD.
[October ii, 1884.
equivalent to it. This cot, which was first devised and
used by Dr. Kibbee for the treatment of scarlet fever,
during a severe epidemic of that disease, consists essen-
tially of a common cot or frame on which is stretched
strong canvas or other material sufficiently coarse or
open to permit water to pass through it. Under this is
placed a rubber sheet, to catch and convey the water to
a pail placed at the foot of the bed. The patient lies
comfortably on this bed, on a blanket and sheet, but of
course without mattress. Such a bed can be improvised
almost anywhere at a very small expense. I once made
a very efficient one, in the country, with an old coffee
bag ; and I once used an ordinary wire mattress. Any
cot covered with canvas may be made available as a
water-cot by cutting a sufficient number of holes in the
canvas. When it is necessary to apply the cold water,
the covering of the patient is removed from the body (not
from the extremities), which is enveloped in or covered
by a sheet ; upon this sheet warm or tepid water is
poured gently from a pitcher or watering-pot ; the tem-
perature of the water is then gradually reduced until it is
sufficiently cold. The stream is kept up for ten or fifteen
minutes, a dry blanket is then thrown over the patient,
and sleep generally follows.
Having had considerable experience in the use of this
method of reducing the temperature in cases of peritonitis
and septicaemia following operations, and some expe-
rience with it in typhoid fever, I know it to be very
easily managed, to come within the skill of any intelligent
nurse or attendant ; and that by its means the temperature
can be reduced to any desired point and maintained
there. The apparatus is simple, it requires but a small
quantity of water, it involves no movement of the pa-
tient, and occasions no shock whatever. I therefore be-
lieve it to be the best means available in all cases of
fever where artificial reduction of the temperature is de-
sirable. This method was adopted very successfully by
Dr. Thomas, for peritonitis following ovariotomy, in
1876.
Next in point of efficiency, for the same purpose, I would
class the wet pack, by which I mean a folded sheet,
wrung out of tepid or cool water, and wrapped quickly
around the patient's body. In this case cooling takes
place partly as a result of evaporation. If the. attend-
ants are industrious much may be accomplished by the
use of towels wrung out of cold water placed upon the
body and limbs, and frequently changed. Least useful
of all, though very grateful to the patient, is sponging
with cold water. If done often enough some heat is
abstracted, and if alcohol is used with the water evapora-
tion aids in cooling.
Where it is necessary to effect a local reduction of
temperature, there are better means than the fever-cot.
In threatening peritonitis after laparotomy, for instance,
the use of a coil of lead or rubber tubing, through which
water of any temperature may be contmuously passed,
affords a perfectly simple and efficient means of accom-
plishing the purpose desired.
M. Galante, of Paris, in 1852, devised a rubber ap-
paratus for continuous irrigation of the eye. Dr. Petit-
gand, of Paris, had manufactured for him an apparatus
of rubber tubing for this purpose in 1859 > *"^ ^^ ^^^^
he published a description of a head-cap made of rubber
tubing for the use of cold water, and a sachet^ a flat coil
of rubber tubing precisely similar to the abdominal coil
now in use. In 1879 ^'*' Dumontpallier published a de-
scription of a series of tubular covers and mattresses, by
the use of which, according to experiment, he claimed to
be able to accomplish much iwore rapid and uniform re-
frigeration in typhoid, varioloid, and other fevers, than
could be accomplished by the cold baths of Brand.
The use of the head coil of lead or rubber is now very
general ; and the abdominal coil is likewise becoming
popular. Nothing can be simpler or less disturbing to
the patient than the use of the abdominal coil, and in
incipient peritonitis nothing that I am aware of is so
efficient. The application of the rubber coil to this
particular class of cases was suggested by Dr. A. B.
Townsend, in the Woman's Hospital, in i88t. The coil
is applied directly to the skin, or a thin towel is inter-
posed. A bandage is then placed around the body to
keep the coil in place ; a pail of water, containing a
lump of ice, stands on a table near the head of the bed,
and a pail under the bed receives the water as it passes
through. At the latter extremity, where the water es-
capes, there is a stop-cock by which the flow may be
nicely regulated or entirely stopped, as may be rendered
necessary by the temperature of the patient, as shown by
a thermometer placed in the axilla from time to time.
Unless the apparatus should be irksome to the patient,
which is seldom the case, it is not necessary to remove it
as long as there is any likelihood that it may be required.
By simply opening the stop-cock the flow of water begins,
and the cooling process may be stopped or resumed with-
out waking a sleeping patient.
I have used in the manner just described both the
rubber coil and the coil of fine leaden tube known as
Leiter's coil. The latter have not been generally in the
market, or I think they would have taken the place of
the rubber in many cases. They are not so heavy, when
full of water, as the rubber coil ; they are not liable to
become dirty, and have not the unpleasant odor of rub-
ber. They are more durable and less expensive. They
are not more liable to become clogged with dirt, if the
precaution is taken to envelope the receiving end of the
tube in a piece of gauze or coarse muslin, which should
be done in all cases. With this precaution, and one
nurse of ordinary intelligence, I have sometimes kept
the leaden apparatus in use for three days and nights
without a moment's interruption. One advantage of the
metal coil is that it requires less water, and that it is sel-
dom necessary to use ice. Being a much better con-
ductor than the rubber, the use of water at a temperature
of 45® or 50° is quite sufficient. I consider these appli-
ances of the greatest possible value where inflammation is
threatened, and most important means of limiting in-
flammation when it has developed. In case of bad
operations, where there is every reason to expect peri-
tonitis, I have the coil placed upon the patient im-
mediately after she is put to bed, so that it may be readjr
for use at any moment. In ordinary cases I wait until
the temperature rises above 100° in the axilla.
In the method spoken of the object of course is to
reduce bodily temperature ; but cold is sometimes used
as a means of impressing the nervous system. Chap-
man's ice-bags act on this principle, and have been found
useful in many nervous disorders. My own experience
with these ice-bags has been limited chiefly to their ap-
plication in cases of painful and scanty menstruation.
In a certain class of cases the application, for half an
hour at a time, of a bag of crushed ice to the region of
the lumbar vertebrae and sacrum, has the effect of pro-
moting the menstrual flow. Applied to the dorsal ver-
tebrae, in an anaemic patient with cold extremities, the
tendency of the ice-bag is to equalize the circulation and
promote warmth throughout the whole body.
Friction with ice is employed in frost-bite. The
late Dr. Peace, of Philadelphia, claimed to have had ex-
cellent results, in a cholera epidemic through which he
passed in Europe, from vigorous friction of the limbs
and body with lumps of ice. Where it is necessary to
stimulate the nervous system, the alternate application
to the spine of a flat brick of ice, and a very hot iron,
protected by flannel, is sometimes very eflfectual.
I shall merely allude to the popular and time-honored
belief in the styptic effects of cold ; to the undoubted
value of cold for the relief of pain in bums ; and to the
efficacy of ice-cold applications in the causalgia conse-
quent on injuries of the nerves from gunshot wounds.
II. Of the manifold forms in which heat is employed
as a remedy for pain and disease, I shall dwell on a few
only of the most striking, at the risk, as in what I have
October ii, 1884.]
THE MEDICAL RECORD.
399
said of cold, of telling a thrice-told tale. For the arrest
of hemorrhage a high degree of heat has been long in
vogue. The hot iron has held its place as a styptic prob-
ably for many ce^ituries ; and the cautery in some form
is still constantly employed for the same purpose. The
use of a moderate degree of heat for the arrest of a more
general hemorrhage is of recent origin. To Dr. Em-
met we are indebted for having demonstrated the haemo-
static properties of hot water. Where ice and cold
irater were formerly used, hot water is now found to
answer a better purpose. In hemorrhage from the
uterus after miscarriage, or after removal of a fibroid, or
from any other cause, injections of very hot water at the
same time arrest the hemoithage and promote contrac-
tion of that organ. This is one of the many applications
of heat where experience has placed its value beyond a
doubt. For the arrest of hemorrhage from an exposed
surface, towels dipped in very hot water and pressed
firmly on the bleeding part for a few minutes will gener-
ally act much more promptly and permanently than cold
water used in the same way. A stream of very hot water
thrown with a syringe into any bleeding cavity, if there
are no vessels of large size, will generally prevent further
flow of blood. The remarkably good e^ect of hot water
for this parpose, during and after operations, may be
witnessed every day in many of our hospitals. One great
advantage, if there were no other, in favor of the use of
hot water for exposed surfaces, or for the uterine cavity,
is that the process of boiling is purifying, and one of the
most reliable means of destroying organic matter, bacteria,
or other minute or^nisms which are believed to play so
destructive a part in the human body. A higher tem-
perature than that of boiling water has been proven to
destroy some germs which escape simple boiling. For
that reason I always, if practicable, employ for anti-
septic solutions and for surgical purposes water from
the boiler of a steam-engine, which has usually been
heated to about 250^
The beneficial effects of vaginal injections of hot water
are now generally appreciated, and form an important
part of every-day gynecological treatment So much de-
pends upon the manner in which these injections are
given, that I will venture to describe the method I con-
sider the best The patient should lie flat upon a bed
or sofa, with the hips raised upon a broad bed-pan, ca-
pable of holding four or five quarts of water. With a
Davidson's syringe, having a hard-rubber nozzle not per-
forated at the extremity, a stream of water as hot as can
be borne, fi-om 100° to 110*', should be gently thrown
into the vagina for ten or fifteen minutes, or until three
or four quarts of water have been used. The David-
son's syringe is better than the fountain ; a bed-pan with-
out pipes or openings or stop-cocks is better than a more
complicated apparatus. It is difficult to keep the sim-
plest vessel of the kind clean, and almost impossible
some of the more complicated ones.
The effect of injections given thus night and morning
is often quite surprising. The hot, swollen, congested
mucous membrane or the vagina assumes a normal ap-
pearance, the offensive discharge ceases, the extreme
tenderness disappears, the engorged cervix softens and
diminishes in size, there is a marked general improve-
ment without any medication whatever, and the patient
has made a great step toward getting well. I make a
rule of questioning a patient in detail as to whether she
has taken her injection thoroughly. A pint or two of
lukewarm water feebly thrown into the vagina, while the
patient is sitting over a basin or other vessel, is often con-
sidered sufficient and expected to yield good results ; but
such a use of hot water for this purpose resembles the
proper injection only " as the mist resembles the rain,"
and leads only to disappointment. In pelvic cellulitis the
persistent use of hot water hastens the absorption of the
plastic exudation and shortens the duration of the disease.
One of the applications of heat that may appear para-
doxical, in view of what has been said of refrigeration in
peritonitis, is the very common custom of covering the
abdomen with hot poultices for the relief of the same dis-
ease. There is really nothing antagonistic in this. The
object of the hot application is not to augment the heat
of the parts, for there is already too much heat and con-
gestion, but what the poultices and hot fomentations do
is to stimulate the- capillary circulation and that of the
underlying lymphatics, and thus relieve the engorgement
of organs more remote. Such applications are grateful
to the patient, and that they often do much good there
can be no doubt. I think that warm applications are
useful, chiefly in the forms of peritonitis that develop
rather insidiously, with pain over a large area. Where
the disease is local, and especially of traumatic origin, I
should prefer cooling measures from the beginning. There
is nothing at all inconsistent in the use of both hot and
cold applications at different stages of the same^disease,
and in the same case.
It would carry me beyond my limits even to enumer-
ate all the familiar applications of heat in therapeutics.
The value as a counter-irritant of Paquelin's cautery,
used at a white heat and brushed lightly over the sur-
face, is generally acknowledged. The application of
heat over the region of the heart as a stimulant in
threatening collapse, is often found of value, and
I have utilized the rubber coil for that purpose; the
medicinal use of hot water as a beverage reminds us
that there is fashion in everything. More than one hun-
dred and fifty years ago Le Sage, in his immortal " Dr.
Sagrado," ridiculed the routine use of hot water and
bleeding. The hot water has come back to us ; the bleed-
ing, as its adjunct, may follow.
In conclusion, I would suggest that as we have in heat
and cold agents powerful enough to destroy life, and un-
c^er proper control capable of modifying all its functions,
they should always be prescribed with a definite object
and used in a definite manner. As their use is often
intrusted to those who know nothing of the principles
on which they act, and who are influenced by custom or
prejudice, the physician should take suitable opportuni-
ties of imparting some general information to his patients
as to the most rational means of employing remedies
that, however or by whomsoever prescribed, will always
be considered the property of the household, and within
the province of domestic practice.
A RARE FORM OF LOBAR PNEUMONIA-
TUBERCULOUS CROUPOUS LOBAR PNEU-
MONIA.
By FRANCIS P. KINNICUTT, M.D.,
PHYSICIAN TO ST LUKB^S HOSPITAL, NEW YORK.
F. H , male, aged thirty-three, single, native of Eng-
land, was admitted to my service in St. Luke's Hospital
March 6, 1884. Family history not obtainable. The pa-
tient states that he has never suffered from any ])ulmonary
affection. Eighteen months ago he was injured in a rail-
way accident, and has been troubled since that time with
a continuous •* to and-fro movement of his head," which
he has been told ceases during sleep. During this period
he has lost flesh. He has had no cough or hemorrhage,
and was apparently in good health until three days before
admission to the hospital, when he had several sharp chills,
followed by cough and a thickish expectoration and ap-
parently fever. On admission to hospital patient was
fairly well nourished; temperature, 104°; pulse, 100;
respirations, 38. There was cough ; the sputa were viscid,
but not rusty. There was a constant rhythmical to-and-
fro movement of the head, which ceased during sleep.
Examination of the chest showed dulness, with feeble
respiratory murmur and abundant fine inspiratory crepita-
tion over the infra-clavicular region and upper portion of
the mammary of the right side. The urine was acid,
specific gravity 1.028, and was free from albumen and
suffar. The chest was very carefully examined by me
daily. The physical signs of consolidation of the entire
400
THE MEDICAL RECORD.
[October ii, 1884,
upper lobe of the right lung (marked dulness, bronchial
respiration, and bronchophony) rapidly supervened ; there
was continuous pyrexia ; the pulse-respiration ratio of
one to a little less than three was maintained. Until the
eighth or ninth day of the patient's illness the clinical
course of the disease in all respects corresponded with an
ordinary attack of croupous lobar pfieumonia, and was
so regarded by me. Resolution, however, did not occur
at the customary period ; there was, on the contrary, from
the ninth day after admission to hospital until death, a
gradually increasing pyrexia, pulse, and respiratory rate.
Examination of the chest, moreover, revealed a very
rapidly developing disintegration of lung tissue at differ-
ent points in the affected area. On the thirteenth day
there were the physical signs of a small cavity in the
upper portion of the consolidated lobe, corresponding to
the site at which the largest excavation was found after
death
During the last days of life slight haemoptyses occurred,
and there was effusion into the right pleural cavity. A
similar case had never before been observed by me, but
from the clinical cpurse of the disease I finally was led
to believe, and expressed the opinion, that the morbid
process might well be expressed by the term tuberculous
croupous lobai* pneumonia. The patient died on the
sixteenth day after admission to hospital, on the nine-
teenth from the first symptoms of acute illness, with the
signs of general pulmonary oedema and heart-failure.*
The autopsy was made by Dr. Ferguson in my pres-
ence. The morbid changes were confined to the brain,
the spleen, and the lungs. There was marked atrophy
of the convolutions over the vertex. The spleen was
large and soft. The right pleural cavity contained about
forty ounces of semi-purulent fluid ; the pulmonary pleura
was covered with recent fibrin. The left lung was in-
tensely congested and oedematous ; the entire upper lobe
of the right lung was hepatized. On section the solidified
portion appeared dry, smooth, and grayish in color and
homogeneous in consistency throughout. The cut sur-
face did not present the granular appearance of gray
hepatization, and the edge of the knife carried over it
did not remove the alveolar contents. Numerous miliary
tubercles could be distinguished at the periphery of the
consolidation. The middle lobe and the upper portion
of the lower lobe contained numerous miliary tubercles.
There were several small cavities in the consolidated
portion, varying in size from that of a pea to a walnut,
partially filled with material not completely disintegrated.
In sections, the alveolar walls were seen to be slightly
thickened and the alveoli to be distended with pus, a
small amount of fibrin, granular material and epithelial
cells similar in appearance to those lining the alveolar
walls in the normal state. The alveolar contents in places
had undergone cheesy degeneration. These areas of
cheesy degeneration, which were numerous through-
out the consolidated portion of the lung, were limited by
zones of small round cells of inflammatory origin. In
some of the caseous areas the alveolar septa were still
preserved, but very generally they had disappeared in
these areas, a fusion of many alveoli having occurred.
In the neighborhood of the solidified portion there were
numerous miliary tubercles and tuberculous masses with
broken-down centres ; in both, giant cells were well de-
veloped and abundant. In the interstitial tissue of the
lung surrounding the tuberculous masses numerous small
cells, both round and fusiform, were seen. Tubercles
were not found in the other organs.
The pathological changes above described would seem
to justify the application of the term tuberculous croup-
ous lobar pneumonia to the morbid process. An ap-
parently similar morbid process has been described by
pathologists, but I have been unable to find any clinical
record of such cases, with the exception of a general
' The sputa were not examined until the fourteenth day ; two specimens were
then examined, but tubercle bacilli were not found. On the fifteenth and sixteenth
^ays the spuu were m scanty that specimens could not be obtained for examina-
tion.
reference to them by Rindfleisch and a very brief report
of two cases communicated to the French Academy of
Medicine, December 4, 1883, by Professor Sde, under
the title of " Phthisis in the Form of Lobar Pneumonia."
I give the latter as reported in Le Progris MidiccUoi
December 8, 1883 :
Case I. — A young man, nineteen years of age, a hos-
pital patient, was seized on September 13th wifii a well-
marked attack of simple pneumonia, which involved the
upper two-thirds of the right lung. At the end of the
ninth day, defervescence not having taken place, the sputa
were examined and bacilli in great numbers discovered.
Early in October all the signs of an exca^vation became
apparent*
Case II. — A patient in the same hospital ward pre-
sented all the signs of a simple pneumonia, which, how-
ever, did not undergo resolution. The sputa were twice
examined, revealing only ordinary microbes in great num-
bers. A third examination established the presence of a
small number of tubercle bacilli. Shortly afterward the
local signs confirmed the diagnosis.
Rindfleisch,' under the head of ''Cheesy Lobar Pneu-
monia," describes a form of desquamative pneumonia
(Buhl) which occurs as a diffuse inflammation of an en-
tire lobe aflfected by tuberculosis. " Usually the earlier
stages of the disease have already passed by at the apex
of the lung and cavities have formed, when a sudden at-
tack of cheesy pneumonia occurs and involves at once
the rest of the upper lobe. This usually happens with
an acute exacerbation of all the clinical syniptoms, the
fever, dyspnoea, and rapid pulse, so that the impression is
given of an intercurrent croupous lobar pneumonia,
and the first glance at the lungs might seem to confirm
this opinion, for, as Virchow luis shown, there are veiy
often in the alveoli plugs of real fibrinous exudation, so
that the section of the lung looks granular. But the dis-
tinction lies in the infiltration of the alveolar walls, a con-
dition very slightly developed in croupous pneumonia,"
I prefer to regard the morbid process observed in my
own case, and which has been carefiilly described, as an ex-
ample of an intercurrent croupous pneumonia^ from the
presence in the alveoli of the usual products of such an
inflammation — /.^., pus and fibrin — which Buhl " insists
are never present in the desquamative pneumonia first
described by him. The implication of the alveolar walls
and the presence of only a small amount of fibrin among
the alveolar contents I shall again refer to.
The question of the probable period of the develop-
ment of tubercles in the above case is certainly an open
one. Personally, I am inclined to believe that a slight
deposition of tubercles occurred at some time previous to
the beginning of the patient's acute illness, but that little
or no constitutional disturbance was produced thereby.
The history of the patient, the clinical course of the
acute disease as observed by me, and finally the post-
mortem appearances, would seem to justify the opinion
that on the date of the recorded chills a true croupous
pneumonia was developed in the tuberculous lobe of the
lung ; that the pneumonic process furnished suitable soil
for a very rapid and abundant development of the bacilh
tuberculosis ; that there was a consequent equally rapid
degeneration of the tubercles of older date, and also of
the pneumonic products. The objection to considering
the pneumonic process a croupous one on account of the
serious involvement of the alveolar walls, may be met
by the argument that such an implication is believed by
many pathologists to occur in cases of croupous pneu-
monia where resolution is delayed. The presence of
only a small amount of fibrin among the alveolar con-
tents may be explained in a similar manner ; degener-
ative changes are to be expected where life is prolonged
to the nineteenth day firom the beginning of the
attack.
^ Cyclopaedia of Medicine^ von Zienuien, voL v., p> 673.
■ Buhl : Lungen Rntzflndung, Tuberkulose und Schwindfilchdj;, p. so- M"°"
chen, 187a
October II, 1884.]
THE MEDICAL RECORD.
401
MORPHIA IN CARDIAC DISEASE.
By BENJAMIN EDSON, M.D.,
BSOOKLYH, N. Y.
The following case seems to have some bearing upon the
Qse of morphia in one form of disease of the heart.
C, R , fifty-six years of age, Scotchman, merchant,
called at my office early in November, 1883, complain-
ing of a troublesome cough and shortness of breath on
exertion. He attributed his trouble to " catching cold "
^m exposure. As he was in great haste I prescribed a
cough mixture without making thorough investigation.
A few days later he called again. His cough was no
better, and his respiration so much more difficult that he
could not lie down to sleep. When I proposed an exami-
nation, he slapped his hand upon his chest, saying :
*< There is nothing the matter with me here, sir : I'm as
sound as a dollar." I found, however, that he had mi-
tral regurgitation with marked dilatation of the heart.
The cause of the cough and dyspnoea was but too appar-
ent The kidneys were not affected, and as yet there
was no oedema. A few days later the legs began to
swell. I advised him to keep strictly quiet, and at the
same time put him upon such treatment as seemed best
calcolated to give relief. I found it difficult to convince
him of the grave nature of his disease, and being of a
nervous^ active temperament, he considered it a great
hardship not to be permitted to attend to his daily busi-
ness in New York. Finally I persuaded him to consult
Dr. Armor, who confirmed my diagnosis and approved
the treatment, which ''must be palliative and on general
pfindplea."
For the next two or three weeks he continued fairly
comfortable, the oedema moderate, but he was able to sleep
only as he reclined in his chair. He was very irritable, and
urgently called for something that would enable him to
sleep in bed, I did not feel warranted in granting this
request, but still he insisted that he must have some good
sleep. Finally, through the persuasion of a relative, he
was induced to call in a distinguished homoeopathic
physician, who acceded to his request and gave him
sufficient morphia to enable him to sleep several hours
in bed. But on waking and attempting to rise he was
seized with dyspnoea that nearly terminated his life.
By vigorous efforts on the part of his attendants he
erentnally rallied somewhat, but soon after he suddenly
fell back and expired.
I have considered that death in this case was due to
the morphia used. It may have been only indirectly the
cause, by permitting the patient to assume the recumbent
position, rising from which produced over-distention or
overwhelming of the weakened heart-structure. Morphia
may have contributed to the paralysis. Bartholow ('' Ma-
teria* Medica," 5th ed., p. 524) says of lethal doses of
morphia, that " in some instances very sudden death en-
sues from paralysis of the heart" How large the dose
required to produce this untoward result obviously de-
pends much upon the condition of the heart What in
health might be but a medicinal dose of morphia, in case
of dilatation, with muscular walls greatly weakened and
nerve-distribution disturbed, might readily prove to be a
lethal or paralyzing dose. Thus in this case it is not
improbable that both these factors conduced to the sud-
den death of the patient
This man had never had rheumatism, and previous to
this illness there had never been any suspicion of cardiac
trouble.
In looking back over this case there arises a question
which leads to speculation, and which may not be wholly
devoid of interest. In the summer of 1880, through
some business complications, this man had a period of
very great mental depression. It took the form of
marked pathophobia. He was fearful that he would
drop down dead, and that his body would be unrecog-
nized and sent to the morgue, so he was very particular
to keep in every pocket papers bearing his name and
address, with minute directions as to what should be
done in case of the event he so much feared. Scores of
times daily he took out these papers and examined them
to reassure himself that, if he did drop dead, his body
could be properly identified. On one occasion, being
up-town in New York, the " feeling " came over him
that he never could get back to his store alive. His evil
genius told hhn that he must not ride, and he had not the
power to walk. In this dilemma it was finally revealed
to him that he could perchance run back. This he did,
by short runs between lamp-posts and awning-posts, to
each of which he would cling while screwing up courage
to make a bold run for the next goal. In this way he
finally reached his store, out of breath and reeking with
perspiration.
While narrating these and many other freaks of his-
malady equally ridiculous, he remarked, ** You may laugh
at them ; I do now ; but when the incubus is upon me-
I am a coward, a victim of my fancies." After a few
weeks his business troubles passed away, and with them
his morbid fear of death.
There is a possibility — indeed, is there not a strong
probability? — that at this time there was actual heart-
trouble. If so, whether it stood in the relation of cause or
of consequence is of course mere speculation. Is patho-
phobia, with the kindred affections, agoraphobia, etc.,
simply a functional derangement — a neurosis—or may it
not be associated with and possibly dependent upon
actual pathological conditions ?
§lje}j0rts of ^ospitalB.
COOK COUNTY HOSPITAL, CHICAGO, ILL.
Case of Congenital Diaphragmatic Hernia.
Reported by M. L. HARRIS, M.D., House Physician.
E. C , male, aged thirty-four, laborer, was received
into the hospital November 15, 1883, under the care of
Dr. F. Henrotin, attending physician.
On admission the patient was much prostrated and
suffered from intense dyspnoea ; hence no accurate ac-
count of his history was elicited. He said that he had
usually enjoyed good health, and that this was his first
acute illness. The case was found to be one of acute
croupous pneumonia affecting the lower lobe of the right
lung and complicated with an acute pleurisy of the same
side. November 17th the patient died suddenly and un-
expectedly.
The autopsy was held forty-eight hours after death by
Dr. W. T. Belfield, pathologist to the hospital.
Body of spare build, the abdomen markedly depressed.
After the usual incision from chin to pubes and removal
of the sternum, the appearance represented in Fig. ^
was exhibited. The heart was in about the usual posi-
tion, the apex a trifle nearer the sternum than normal.
The right pleural cavity contained some recently coagu-
lated lymph. The inferior and middle lobes of the right
lung exhibited gray hepatization ; the lower portion of
the upper lobe showed red hepatization ; the upper por-
tion of this lobe was quite oedematous.
The left pleural cavity contained, besides the left lung,
the stomach, nearly all of the small intestine, part of the
colon, and half of the pancreas. The lung, eight inches
in length, one to two inches in thickness, and two to
three inches in breadth, was crowded into the anterior
and upper portion of the left chest, resting against the
mediastinum. It appeared to consist chiefly of the upper
lobe, which, with the exception of a few cheesy nodules
in the apex and some slight oedema, was fairly normal,
crepitating well and floatmg upon water. The inferior
lobe was crowded into a small firm mass which contained
no air and sank in water.
The abdominal cavity vas shallow, containing only
402
THE MEDICAL RECORD.
[October ii, 1884.
the liver, kidneys, spleen, a small portion of the ileum
and ascending colon, and the descending colon. The
liver was slightly enlarged and fatty; the anterior border
of the right lobe extended downward four fingers'-
breadth below the margin of the ribs, its deep position
being due not to an increase in size but to a tipping for-
ward and downward of the organ. The kidneys and
spleen occupied their normal positions respectively and
appeared healthy.
Fig. 1.— I, Left lun^ ; 2, convolution of small intestine ; 3, heart in sac ; 4. Iber :
«, q>leen ; 6, descending colon ; ?» lower end of ileum ; 8, ooecum ; 9, siinnoid
flexure ; 10. bladder
- The diaphragm presented a single large opening occu-
pying its central and posterior portion, through which
the various organs — inferior vena cava, aorta, thoracic
ducty portal vein, small and large intestine, pancreas,
superior mesenteric artery, etc. — passed to or from the
thorax. This foramen was large enough to permit the
FiC a.— 1, CEsophagus; %, stomach; 3, pylorus; 4, cardia; s,
(dotted line) ; 6, pancreas (dotted line) ; 7, spleen; 8, arch of aorta; 9, pulmonary
artery ; 10^ heart (drawn to right) ; ix, descending aorta ; za, diaphragm ; 13, cut
end of portal vein ; 14, kidney ; 15. descending colon ; x6, ileum ; 17, ooecum :
18, sigmoid flexure ; 19, bladder.
passage of the closed fist. The left border of the right
cms arched to the left, forming the free margin of the
foramen ; this was round and smooth and attached to
the head of the twelfth rib and to the base of the trans-
verse process of the twelfth dorsal vertebra. There was
no left cms. The course and relations of the alimentary
canal are shown in Fig. 2. Here the lungs and liver I
have been removed, the heart drawn to the right and the
small intestine to the left, the ribs represented by the
dotted lines.
The oesophagus passed behind the arch of the aorta,
along the anterior and right side of the descending aorta,
until it reached the eighth dorsal vertebra, ¥^ere it
passed in front of the aorta, suddenly turned vertically
upward, and sSter a course of about two inches entered
the cardiac extremity of the stomach. The stomach it-
self extended from this point upward to the apex of the
thoracic cavity, then curved forward and downward, so
that the greater curvature looked backward and upward,
the lesser forward and downward. The duodenum com-
menced opposite the third intercostal space in front,
passed down through the opening in the diaphragm into
the abdomen, making a loop about eight inches in the
abdominal cavity, in which lay the head of the pancreas ;
thence it passed back through the opening into the
thorax. The remainder of the small intestine lay within
the thoracic cavity, with the exception of about twelve
inches of the inferior extremity of the ileum, which
passed through the opening in the diaphragm into the
abdomen toward the right iliac region, where it joined
the coecum, the latter occupying nearly its normal
position.
The ascending colon passed directly into the thorax in
front of the duodenum ; the transverse extended along
the left side of the stomach and entered the abdomen
again ; the descending colon occupied nearly its normal
position. The rectum descended along the centre of the
sacrum.
The pancreas lay directly in the opening, half within
the abdomen and half within the thorax. The coeliac
axis and mesenteric arteries were given off at their usual
site. The gastric branch of the former and the superior
mesenteric passed upward into the thorax, the splenic
and hepatic branches directly to their respective organs.
The portal vein descended through the opening to the
liver. The genito-urinary tract was normaL
ST. CATHERINE'S HOSPITAL, BROOKLYN, N. Y.
Case of Rupture of the Diaphragm.
Reported by JAMES L. KORTRIGHT, M.D., Cuxator.
Simon S , fifty-eight years of age; German. Patient
fell or sprang from the top of a three-story building. He
alighted upon his feet and immediately fell prone with
great force. He died three minutes after admission, and
half an hour after the receipt of the injury. At the au-
topsy there was found a contusion in the frontal region
without fracture of the skull or injury to the brain ; a
compound Colles' fracture at left wrist ; a simple fracture
at lower third of right femur ; a simple fracture of the
neck of the left femur ; fractures of the costal cartilages
of third and fourth ribs on the right side, and of the fourth,
fifth, and sixth ribs on the left side. There was a large
rent three inches in length across the muscular fibres of
the left side of the diaphragm half an inch from their
insertion into the central tendon. Through this rent
there was a hernia of the entire stomach and transverse
colon with the greater omentum. The stomach was dis-
tended with food and contused on its anterior wall. The
heart was displaced to the median line, and stood verti-
cally. Has any one ever seen a similar injury or knomi
of a case where the abdominal viscera were driven through
the diaphragm ?
A Successful Woman I'hysician. — L' Union Midi-
cale gives an account of the career of a Parisian doctress
who, after her school and hospital experience, went to
Turkey, and after many adventures was made physician
to a prince's harem, on a salary of 100,000 to 150,000
francs a year. This was " the bouquet of her adventur-
ous existence." She subsequently lost this position but
made amends by making a marriage de haute convenanct.
October ii, 1884.]
THE MEDICAL RECORD.
403
Removal of a Foreign Body from the Knee. — M.
Boadet relates the case of a child who inserted a threaded
needle into the knee at the internal border of the patella.
An attempt to extract the needle by pulling on the thread
resulted only in breaking the latter. An incision was
then made, and although the needle could be easily felt
in the tissues it could not be removed. It was finally
proposed to place the child in the same position it oc-
cupied when the object was introduced. This was done
and the needle was extracted with ease. Ambroise Par6
practised a similar manoeuvre when the King of Navarre
was wounded by a ball in the shoulder at the siege of
Rouen. The other surgeons having failed in their efforts
to extract the bullet, Par6 advised the illustrious patient
to assume the same position in which he was at the time
of receiving the wound. He did so, and the removal of
the foreign body was accomplished with facility. — Revue
Midicale, No. 32, 1884.
Treatment of Ozcena. — The following is the formula
employed by M. Vidal at the Hdpital St. Louis, in the
treatment of ozoena {Journal de Medecine et de Chi-
rurgie PratiqueSy August, 1884) : Solution of chloride of
zinc (5 per cent), 1 ounce; boracic acid, 15 grains;
water, 28 ounces ; ammonia, q. s. to neutralize the fluid.
A little of this solution is snuffed up into the nostrils
several times a day. M. Gorecki employs for the same
purpose, and in the same way, a warm saturated solution
of boracic acid. By means of one or other of these prep-
arations the fetid odor may be destroyed, in most cases,
within a few days.
Encephalic Bellows Murmur in Children. — ^This
sound, when it exists, is intermittent and isodironous with
the cerebral pulsations. It is often perceptible over the
interior fontanelle only. According to Dr. Jurasq, this
phenomenon is of no diagnostic value, but occurs at any
time between the third month and the sixth year of life.
The sound seems to be produced in the carotid canal or
in the foramen spinale. These foramina vary greatly in
diameter in children, and the bruit results from a dispro-
portion between the calibre of the osseous openings and
diat of the internal carotid or middle meningeal arteries
which traverse them. — Revue Afidicale^ August 30, 1884.
CuTROPHOBiA. — By this terra is understood a disturb-
ance of the cerebral functions, somewhat similar to
agoraphobia. The subjects of this affection have a horror
of being in any enclosed place. When shut up in a room
they experience a sensation of heat in the head, the
arteries of the temples beat forcibly, they become furious
and make frantic attempts to open the door or to leap
from the window. Clitrophobia may exist as a pure
mononiania unaccompanied by any other delirious mani-
festations, or it may occur in connection with other
psychological disturbances. It is a rare condition, and
the prognosis should, in every case, be a reserved one.
—Revue Medicale^ No. 35, 1884.
Inhalation of the Vapor of Glycerine for Cough.
—Professor Trastor employs with great benefit the vapor
of glycerine for the alleviation of a fatiguing or painful
cough. A couple of ounces of glycerine are put in a
porcelain dish and evaporated over an alcohol lamp. A
Urge quantity of vapor is thus given off which is inhaled
with great, relief by patients, especially consumptives
who are troubled with a harassing cough. — Revue Midi-
eale, August 30, 1884.
EccHVMOSis OF Nervous Origin. — In an interesting
paper published in the Revue de Mtdecine of August 10,
1&84, Dr. Keller relates a number of cases observed by
him of ecchymosis occurring, without the intervention of
traumatism, in nervous subjects. He came to the con-
clusion that, as in similar cases stated by Straus to occur
in locomotor ataxia, the ecchymoses were directly depen-
dent upon the abnormal condition of the nervous system
in these patients, and this view was strengthened by the
fact that the spots appeared less frequently in proportion
as improvement occurred in the nervous condition. The
patients were all women, and their condition varied from
simple nervousness to hysteria and melancholia. Some
were also of a rheumatic diathesis. Dr. Billod inforn*d
the author that he had observed spots of ecchymosis on
the dead bodies of persons who had suffered from melan-
cholia. This phenomenon of the spontaneous occurrence
of ecchymosis in nervous women is a fact possibly of
some importance in a medico-legal point of view.
Gummy Tumor of the Tongue occurring Forty-
three Years after Infection. — Dr. Pellizzari relates
the case of a man, sixty -five years of age, who in 1840
had a chancre, followed by pains in the head and bones,
an eruption of the skin, and mucous patches in the mouth.
He was treated with iodides and mercury, and was appar-
ently cured. He married in 1855, had four healthy chil-
dren, and enjoyed excellent health up to November, 1883.
At that time a hard nodule appeared on the left side of the
tongue anteriorly. This was followed by others, which
soon became confluent and formed an elongated tumor.
These neoplasms were at first hard, then became softened
and finally ulcerated. When the patient presented him-
self for treatment, the tip of the tongue was indurated and
showed three points of ulceration. There was no glan-
dular engorgement. Under mercury and iodide of sodium
the ulcers healed and the induration diminished very
markedly. — Journal de Mkdecine de Paris, August 30,
1884.
The Reduction of Paraphimosis. — The following is
the method successfully pursued by Dr. Zakharevich in
the reduction of a number of cases of paraphimosis
(LAbeille Midicale^ No. 32, 1884). After carefully
anointing the strangulated parts with oil or vaseline, he
places the tips of the thumb and fingers on the glans so
as to completely surround it, and then makes firm and
gradual pressure. After three or four minutes of this
steady pressure, as a rule, the glans is reduced to its nor-
mal size. Then, the pressure being maintained by the
thumb, the ring, and little fingers, the constricting ring is
grasped by the index and middle fingers and the prepuce
in this manner drawn down. Reduction is thus accom-
plished easily and quickly, the most difficult case having
required but fifteen minutes for its cure. In the cases
treated by him the ages of the patients varied from three
to fifty-seven years, and the duration of the condition
from twelve hours to thirty days.
Naphthol in the Treatment of Scabies. — Dr.
Samuel Rona has treated a number of cases of itch by a
ten to twenty per cent, solution of naphthol in oil. If
chronic eczema coexist the solution should not be
stronger than two or three per cent. In upward of a hun-
dred cases in which the remedy was tried the author
never saw any symptoms of poisoning, the only eflfect
of using too concentrated solutions being the pro-
duction of eczema. The application should be made
in the evening, all the parts affected with scabies being
thoroughly rubbed with the preparation. The next morn-
ing the patient takes a bath, and all the surface reddened
by irritation of the naphthol is dusted with rice powder.
Usually one application is sufficient for a cure. Some-
times an intense itching persists for some days, but this
was attributed to the coexisting eczema. — La France
Midicale, September 2, 1884.
The Relation between the Ankle Clonus and
THE Patellar Reflex. — In cases i^^ which the ankle
clonus is very marked, as in old hemiplegia or in tabes,
it coexists ordinarily with an exaggerated patellar tendon
reflex. Certain authors, struck with this coincidence,
have referred both phenomena to the same cause and
look upon them as of identical semeiological value. This
view is opposed by M. de Fleury {Revue de Midecine^
August, 1884), who asserts that in a large number of
404
THE MEDICAL RECORD
[October ii, 1884.
cases the foot phenomenon is met with when the patellar
reflex is normal or even abolished. He relates a number
of instances in proof of this assertion. He also made
some experiments showing that, in cases in which the
ankle clonus and exaggerated patellar reflex coexisted,
t^e former could be made to disappear while the foot and
knee tendon reflexes persisted. This was done by making
the affected member anaemic by means of an Esmarch's
bandage. He concludes, therefore, that those who main-
tain an identity of causation of these two phenomena are
in error, and that the ankle clonus is to be explained in
some other way.
The Treatment of Snake-Bites. — Mr. J. Mildred
Creed, in a paper read before the New South Wales
Branch of the British Medical Association {Australasian
Medical Gazette^ No. 10, 1884), states as his belief that
many of the alarming symptoms following a snake-bite
are due rather to fright, pure and simple, than to the
poison received from the fangs of the snake. He relates
a number of cases in support of this assertion. The bite
had been promptly excised in every case, and only two
of the patients presented any alarming symptoms. In
one of these cases the patient recovered speedily on be-
ing assured that there was no cause for fear, although
she had a short time before been apparently at death's
door. The other case was simply one of profound intoxi-
cation resulting from the large amount of brandy which
had been given as an antidote. The author also relates
several other cases of people who had died of fright after
being bitten by non-venomous reptiles. He does not
believe that there is any physiological antidote to snake
poison, and thinks that the only effectual means of
averting serious consequences is by the prevention of
the absorption of the poison. This is best done by the
early stoppage of the circulation in the wounded limb by
the application of a strong ligature, and the excision of
the bite. The reckless administration of alcohol the
author condemns as not only useless but harmful. He
recommends the administration of ether by inhalation
as answering a double indication, that of slight stimula-
tion and of removing the feeling of dread by inducing
unconsciousness. The ether should be administered for
one or two hours, when the patient may be allowed to
recover sensibility to such an extent, as to enable the
surgeon to judge of his condition. After this, should it
be necessary, he might be again brought under the influ-
ence of the anaesthetic and kept there as long as desired.
Any other symptoms which may arise are to be treated
according to general principles.
The Micrococci of Dysentery. — At a recent meet-
ing of the Medical Society of the Caucasus, Dr. Gaudelin,
of Tiflis, exhibited micro-organisms found by him in the
intestine and liver of patients dead of dysentery. The
micrococci were found in great numbers in the digestive
tube, covering the surface and penetrating all the tunics
of the intestine. They were especially numerous within
and about the veins of the sub-mucous layer and in the
muscular coat. In the liver they filled the capillaries
and the branches of the portal vein. The author also
found bacilli in the mucous and submucous layers of the
large intestine, but not elsewhere.— y^»r«tf/ de Mhdecine
de FariSy August 30, 1884.
Mild Forms of Typhoid Fever. — Laflbni thus classi-
fies the milder forms of typhoid fever : Forms slight by their
duration., forms slight by their intensity, and a third class
slight by duration and intensity. Of forms slight as to
their duration, constant symptoms are : splenic tumefac-
tion, bronchial cfttarrh, and fever. The course of this
last characterizes the different varieties. The temperature
either, as in ordinary attacks of typhoid fever, has three
well-marked stages — period of ascending oscillations, sta-
tionary period, and period of decline — or is limited to
one or two of these stages only. In some rare cases the
fever assumes the course of a quotidian intermittent, with-
out repeated rigors or sweats. Of the forms slight by
intensity, the duration may be long. These either ap-
proach the classical type, or are irregular when the fever
is subcontinuous or intermittent, or is partly continued,
partly intermittent. Splenic tumor is a constant symp.
tom. These slight forms must be considered due cither
to a small dose of the poison or to its exhausted activity,
or possibly to the mode by which it gained access to the
organism, as well as to the conditions of receptivity or
organic resistance of the patient. The anatomical altenu
tions are identical with those of ordinary typhoid fever.
There is no constant relation between their extension
and the intensity or gravity of the clinical form. The
diagnosis is very important, especially as regards prophy-
laxis. It is often very difficult. The splenic tumor,
rash, pain in the ileocaecal fossa, evening headache,
apathy of the patient, bronchial catarrh, often good
appetite, notwithstanding the fever, pulse small, and very
often dicrotic, are the chief elements of a sure diagnosis.
The prognosis in children is good; in adults it is sub-
ordinated to the docility of the patients and to the possibil-
ity of complication ; in old people, it is always more doubt-
ful. As to treatment, the author recommends calomel for
the first three or four days, then mineral acids or benzoic
acid. Except the general or partial cold bath, antipy-
retics, especially in cases of long duration, are harmful or
useless.
Abscess of the Cerebellum Consbcutive to Otitis
Media. — In a communication addressed to the Society
of Anatomy and Physiology of Bordeaux (Journal de
Medicine de Bordeaux^ August 24, 1884), Dr. E. Cap-
deville relates the case of a woman, twenty-tour years of
age, admitted to hospital suffering from obscure cerebral
symptoms. She lay, always on the left side, in a state of
semi stupor, vomiting occasionally, and complaining of
an intense general cephalalgia. She had a discharge from
the right ear dating back seven months, and recently an
abscess had formed and opened spontaneously over the
tip of the right mastoid process. At the autopsy the le-
sions of otitis media with condensing osteitis of the mas-
toid process were found. The meninges, cerebrum, and
sinuses of the brain were all normal, but in the right
lobe of the cerebellum was an abscess containing over
three ounces of pus. The mode of propagation of the
inflammation from the ear to the cerebellum could not
be discovered, and possibly the latter may have been
merely coincidental and independent of the otitis.
Iodine Injections in Hydrarthrosis of the Knee-
JoiNT. — Dr. Douglas Morton, in The Americdn Prac-
titioner^ July, 1884, speaks very highly of iodine injec-
tions into the knee-joint for the cure of hydrarthrosis.
He bases his favorable opinion on the excellent results
obtained in four recent cases of this kind. The views of
most surgical authorities are against all such procedures,
as may be seen from the following extracts : *'* I have
not been so bold as to use injections for the permanent
cure of this affection, convinced that the practice must
be fraught with danger " (Gross). " Tapping, iodine
injections, etc., notwithstanding considerable testimony
in their favor, are remedies of doubtful propriety"
(Hamilton). " This mode of treatment has been used
with great success by several European surgeons; as,
however, the plan is necessarily attended by some risk,
it should not be employed except in very chronic cases
which have resisted other modes of treatment . . •
Even the simple use of the aspirator in these cases is at-
tended with some danger, as shown by fatal results
which have occurred in the hands of Dubreuil, and of
McDonnell, of Dublin" (Ashhurst). '* In very chronic
and obstinate cases paracentesis of the joint by means of
the aspirator has been employed with marvellous success.
Sir J. Fayrer was one of the strongest advocates " (Bry-
ant). " But when these (the usual remedies) have failed
. . . the joint must be injected with iodine. Care
must be taken to exclude air. . . . The case may
be converted into one of acute abscess. But generally
October 1 1, 1884.]
THE MEDICAL RECORD.
405
it does well, and the patient recovers with more or less
rtiffening" (Holmes), "The results of this operation
Hnjecting iodine) may be divided into four classes : (i)
Complete cure with preservation of mobility; (2) cure
with certain amount of stiffness ; (3) complete failure ;
(4) suppuration and injury to joint. The first and fourth
classes are uncommon, l^e operation should not be
done except after trial and failure of other remedies'*
(Panas, quoted in Holmes* " Surgery **). " Dangerous
both to life and limb, and can very rarely be justifiable **
(Keedey). " If these means fail, and the absence of false
bodies and osteophytes has been verified, the joint may
be mjected with iodine " (Barwell). " If these means
fail, we have a very powerful method of cure at our com-
mand in the injection of the joint with tincture of iodine.
This plan, a sufficiently bold one, has been much em-
ployed by Jobert, Velpeau, and Bonnet. . . . Ac-
cording to the statement of the French surgeons, it has
in no case been followed by any serious consequences,
but in several instances by a complete cure without an-
kylosis. ... In one case of hydrarthrosis of the
knee in an old man, in which I employed it, about six
ounces of thin synovia were drawn off and a drachm of
strong tincture of iodine was injected. Slight inflamma-
tion ensued, and the disease, which was of two years'
standing, was completely cured. The chief points that
appear to require attention are that no inflammation be
going on at the time, there being no tenderness or pain
in moving the joint, the effusion being quite passive and
of a very chronic character, and above all that no air be
allowed to enter with the injected fluid" (Erichsen).
" Iodine injections in hydrarthrus are made by few sur-
geons. I have seen them made three times and have
made two, always with good results. . . . Cases
have also occurred where severe inflammations of the
joint have resulted after these iodine injections, which
have been inost used in France because they are a
French invention (of Bonnet and Velpeau) ; as so often
happens in traumatic articular inflammations, the acute
serous s3movitis often becomes purulent. . . . It is
always dangerous to joint and to life, and hence should
be done as rarely as possible *' (Billroth).
Dr. Morton believes that the prejudice against the
operation prevailing in the minds of most surgeons con-
sists of the too lingering remains of a belief long domi-
nant in the professional mind, that the joints, and particu-
larly the knee-joint, could not be surgically interfered
with except at great risk. Now that we have learned,
especially from McEwen and Ogston, how very tolerant
are the joints of the knife and the saw ; and since we
hold it to be so light a matter to throw iodine into the
tunica vaginalis, it does appear anomalous that any one,
on any supposed general principles, should consider it
highly dangerous to inject iodine into the synovial sac
of the knee-joint.
Stress has been put upon the danger of admitting air.
The author can understand how importance should have
been attached to such an accident before the days of
antiseptic surgery. But now he cannot, and in his own
operations air was admitted freely — so much so, that
when the injected iodine was forced out by pressure a
multitude of air-bubbles would come with it. He took
pains to bring the iodine in contact with as much of the
membrane as had been touched by air, and by this, he
believes its admission was rendered perfectly harmless,
and therefore made no special effort to prevent it. With-
out the use of iodine or some other powerful disinfect-
ant, he should regard admission of air into the joint
dangerous, and believe it very probable that the fatality
occurring in the practice of McDonnell and Dubreuil,
mentioned by Ashhurst, was due to this cause. It was
sjud by Volkmann, in his address on antiseptic surgery
before the International Congress in London, that results
m sargei^ were no longer involved in the uncertainty of
former times. Then the work of the surgeon was like
that of the agriculturist, dependent in its issue upon con-
ditions which he could neither anticipate nor control ;
bnt now, it is rather like that of the skilled mechanic,
the conditions of whose work are largely subject to his
control and from whom we may confidently expect re-
sults. Dr. Morton does not know that this is true to
the full extent of the analogy, but this is certain,
that the striking statement places surgery downrightly
upon the basis of the inductive method, upon which
alone substantial progress is possible. In making a
practical application of this method of reasoning to the
question before us, he thinks we may safely conclude
that two points are definitely and finally settled : first,
air may be freely admitted into a synovial sac and no
harm result ; and, second, undiluted officinal compoimd
tincture of iodine may be safely injected. Any doubt as
to these particular points may be regarded as forever
eliminated from the question, which is now narrowed
down to conditions belonging to the patient's state of
health and to his surroundings. Diseased kidneys or
bad hygienic conditions rendering the result of any sur-
gical operation doubtful may lead to disaster here. But
these conditions may be ascertained by reasonably care-
ful investigation ; and, after failing to find any unfavor-
able condition, we may operate with the expectation of
a good result.
The Detection of Mercury in the Urine. — Ac-
cording to Dr. Schuster the ordinary tests are of no value
in the detection of very minute quantities of mercury in
the urine. He recommends the treatment of the fluid to
be examined according to the plan proposed^by the
chemist Herr Schridde. The urine is acidulated by mu-
riatic acid and submitted to a current of sulphuretted
hydrogen and then set aside to stand for twenty-four
hours. The sediment which forms contains sulphide of
mercury, uric acid, mucus, etc This is separated by
filtration, and both the filter and the sediment which it
retains are treated by nitro-muriatic acid, and then dried
until no more nitric vapors arc given off. The residue
is then dissolved in a small amount of water and the
solution, slightly acidulated, is treated by the ordinary
method of Furbringer. By this procedure it is possible,
Dr. Schuster says, to detect ^ ^]f^ ^ grain of mercury.
Archives M^dicales Beiges ^ July, 1884.
Typhoid Ulcerations of the Throat. — ^The follow-
ing are the conclusions of a memoir read by Dr. £. Rapin
before the Medical Society of Geneva: i, the frequency
of the occurrence of typhoid lesions in the fauces is greater
than most authors admit ; 2, typhoid fever may begin with
a sore throat accompanied by indolent ulcerations ; 3, the
ulcers are superficial, rounded or oval, with slightly ele-
vated borders, and indolent, their seat of predilection is
on the anterior surface of the uvula and the anterior
pillars of the fauces ; 4, the diagnosis is usually difficult,
and can only be determined with certainty by observing
the general symptoms and the course of the disease ; 5,
the lesions which characterize them are referable to the
lymphatic system ; 6, these lesions are identical with those
observed in other organs in this disease, and they indicate
an identical pathogenesis ; 7, they are due to the direct
penetration of the micro-organisms of typhoid fever into
the follicles of this region. — Rei/isia de Medicina y Ci-
rurgia Prdticas^ August 7, 1884.
Fracture of Inferior Maxilla Treated with Sil-
ver-wire Suture. — Dr. J. Craig Miller, of Lake City,
writes : " John R , a miner at the U16 mine, was
thrown from the bucket and fell about fifteen feet. His
inferior maxillary bone was fractured at the symphysis.
I was sent for (four miles) and arrived about two hours
after the accident ; found the left half displaced down-
ward about half an inch. It was replaced without diffi-
culty and the teeth firmly fastened together with silver
wire, and lead-water and laudanum applied. No other
treatment. I thought the wire would be sufficient, as the
seat of the fracture was directly in the centre, and it
has proved so. The man is over forty years of age."
4o6
THE MEDICAL RECORD.
[October ii, 1884.
The Medical Record:
A Weekly journal of Medicine and Surgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD & Co.. Nos. 56 and 58 Ufayette Place.
New York, October ii, 1884.
THE AMERICAN PUBLIC HEALTH ASSOCIA-
TION.
This body is to meet in its twelfth Annual Session at St.
LouiSy Mo., on October 14th inst. The session promises to
be one of unusual interest, both on account of the locality
where the meeting is held, and the importance of the sub-
jects which will be discussed. It is the first time that the
Association has held a meeting in what may properly be
called '* the West," If we may judge by the busy note of
preparation for the meeting which reaches us, and the
past reputation of the great metropolis of the West for
munificent hospitality, the forthcoming session of the
Association, at St. Louis, will be on a scale of grandeur
hitherto quite unknown to that hard-working body.
All experience proves that however royally any city
entertains this Association, it reaps one hundred-fold
benefit from the influence which the latter exerts upon
the State and the municipal governments. Public
opinion is also enlightened, and rendered more favorable
to the establishment of a well-organized sanitary adminis-
tration, and the enforcement of health laws and ordi-
nances.
' The Association meets this year at a very important
juncture of sanitary affairs, and standing as our great
National Congress of Public Hygiene, the results of its
deliberations will be of wide import. It is the only or-
ganization which, by its national character, its age, its
reputation for honest and useful work, and the high
official and scientific positions of its members, can at once
grasp the great municipal State, national, and inter-
national sanitary questions of the day, and formulate
principles which must guide the action of legislatures.
We look forward, therefore, to this meeting of the Asso-
ciation, with the expectation that, in addition to its in-
teresting daily work, some questions of pressing im-
portance which must occupy public attention during the
coming year will be duly considered and suitable action
taken thereon.
Perhaps the most important subject which can engage
the attention of the Association will be our protection
against an invasion of cholera during the next year. It
is a fortunate circumstance for us that this Oriental
plague, in its progress westward, has dallied so long
beneath the sunny skies of Italy. It has thereby given
us ample warning of its intended invasion, and enabled
the Association to consider, in the most deliberate man-
ner, the defensive measures which should be adopted.
This is the first time in the history of cholera epidemic
in this country, that there has been an organized body of
sanitarians and health authorities prepared, not only to
bring to the discussions of the questions of prevention
the latest investigations of science and the experiences
of sanitarians, but the large majority of them are them-
selves the official guardians of the public health of their
respective communities, and the appointed agents to
enforce preventive measures. The country may there-
fore reasonably expect that, before the Association closes
its session, cholera-prevention in all its phases will be
discussed by experts, definite lines of action will be de-
termined upon, and such combinations of authorities be
organized as will give concert of action in the enforce-
ment of defensive measures throughout the length and
breadth of the land.
A second subject demanding the attention of the Asso-
ciation is the condition of our system of quarantine. The
simple truth is that our so-called quarantines are a dis-
grace to the country. They are little else than gigantic
political schemes of plundering commerce and travel under
the sanction of law. At home and abroad they are the
laughing-stock of all advanced students of preventive
medicine. Thus far in the history of the Association
this great defect in our system of health organization has
been allowed to exist without even a protest. Numerous
papers have been presented to that body, discussing the
general subject of quarantines, but they have led to no
practical results. We believe the time is now opportune
for the Association to take decisive measures toward re-
forming our system of coast defences against foreign
pestilences, and the country will be disappointed if, in
this emergency, the subject is again passed over in si
lence.
Again, the relations of the general Government to the
measures of preventing the introduction of foreign epi-
demics into this country, and their spread from one Slate
to another, demands the most serious consideration of
the Association.
Through the efforts of the Association a plan was
perfected in 1879 of associating the general Govern-
ment with State and local health authorities in well-
devised and concerted methods of action to prevent the
invasion and spread of epidemics. For three years that
plan worked admirably and effectually, and the country
was protected, as never before, from the most dreaded
of exotic plagues. The system of co-operation then
established, with so much prudence and wisdom, has
finally been destroyed by the reckless ambition of men
intent only on wielding that power which comes of ex-
pending the public funds. The National Board of
Health, selected with so much care by the President and
Senate, as the agent of the Government in its fiiture san*
itary work, has been superseded by an officer of the
Treasury Department without law or appointment The
laws, so carefully drawn to guard against the encroach*
ment of National upon State and Municipal authority,
and secure the judicious and economical use of the pub-
lic money, have been purposely allowed to lapse, that
there might be no restrictions upon the self-constituted
agent who usurped the office and functions of the Board
of Health. To-day, therefore, the field of National san-
itary legislation is a blank, and it is for the Association
October ii, 1884*]
THE MEDICAL RECORD.
407
to detcnninc whether the interests of the public health
will be best subserved by a well-organized Health De-
partment at the capital, acting under the restrictions of
suitable laws, or by an irresponsible bureau oflScer with-
out sanitary knowledge or experience, and governed by
DO other law than his own.
Bearing upon the same subject is a question of far
wider application, which the Association ought to con-
sider. We refer to international co-operation in the fre-^
veniion of contagious and infectious diseases. There can
never be any radical measures adopted and enforced
which will strike at the very source of the propagation
and spread of epidemic diseases until the great commer-
cial nations of the world combine in good faith, and each
in its respective sphere of operations fulfil its whole duty,
whatever that may be. And this co-operation can never
be established without an International Conference to
which these commercial powers shall send delegates.
The National Board of Health succeeded in securing one
International Conference, by act of Congress, and so
popular was the project that twenty-eight nationalities
I sent delegates. The informal discussions in this body of
the measures of international co-operation proved that
another conference, the delegates to which were em-
powered to agree definitely upon propositions to be sub-
mitted to their respective Governments, could effect an
international sanitary league, offensive and defensive,
which would eventually suppress such pestilences as
I cholera.
The Public Health Association is capable of influen-
1 dng Congress to take the initial step in calling another
I conference of commercial nations, and the result could
i scarcely fail to be an agreement upon the terms of a
treaty which would bind these nations to the rigid en-
; forcement of adequate regulations to prevent the trans-
[ portation of infectious and contagious matters or dis-
I eases.
During the present session of the Association the State
Boards of Health are to meet in conference. The
tendency of this meeting will be to review the project of
a separate Association of State Boards of Health. The
result of such a step would prove eminently disastrous to
public health reform in this country. The Public Health
• Association stands to-day the foremost of our great na-
tional bodies, and is the recognized embodiment of scien-
tific and practical sanitary knowledge and experience in
this country. During the twelve years of its existence it
has published a series of annual volumes Which are un-
surpassed by any other Association for real merit. Its
influence on public thought and opinion, and on legisla-
tion, both State and national, is powerfiil, and when con-
centrated on practical reforms, is decisive. Any such
dismemberment of the Association as this movement
of the State Boards of Health seems to contemplate
would be a most inglorious suicide. Far better will it
be for the future of sanitary reform and administration
in the United States to enlarge the scope and plan of
the original organization, so that, while there may be the
greatest diversity of discussion, there shall be unity of
action, and the voice that shall pronounce the judgment
and conclusions of the assembled congress of health
authorities shall continue to be that of the American
Public Health Association.
THE FIFTH VOLUME OF THE INDEX CATALOGUE.*
Th£ appearance of the fifth volume of the Index Cata-
logue of the Library of the Surgeon- General's office will be
hailed with the greatest satisfaction by the writers and
workers of the profession, as adding another volume to the
admirably exhaustive series which have opened such won-
derful treasures of information and reference. Under no
other auspices and under no other management could such
work be accomplished, than those which centre in the Sur-
geon-General's office under the direction of the talented
librarian, Dr. John S. Billings. In fact in no other
country has such a thing been attempted, and it is safe to
say, backed by the testimony of those who ought to know,
that in no other place has the foundation for such work
been laid. The present volume embraces an equal scope
with the others, is of equal size, and comprises, as might
be anticipated, an almost fabulous amount of references
within its limits, viz., from Flaccus to Hearth. In brief
it includes 15,555 author-titles, 5,755 volumes, and
13,596 pamphlets, also 8^069 subject-titles of separate
books and pamphlets, and 341 127 titles of articles in
periodicals.
The utility of the series proves itself more and more
with each volume, and correspondingly indicates the
hearty professional endorsement of governmental patron-
age. The best that can be said is that the good work is
likely to go on, and every scholar in the profession will
wish it Godspeed
THE NEW CIVIL SERVICE REGULATIONS AND THE
MEDICAL PROFESSION.
An advertisement appears in the daily papers to the
effect that "an open competitive examination, under
the New York State Civil Service rules, will be held Oc-
tober 2 2d, at the New York Academy of Medicine, to
fill vacancies in the regular medical staff of the Hudson
River State Hospital for the Insane, at Poughkeepsie,
N. Y." It is further stated, that the examination is open
to all graduates of reputable medical colleges.
This announcement, already indicated in a previous
issue of The Medical Record, is, we believe, the
first application to medical, positions of the New York
Civil Service regulations, which went into effect last
August.
The regulations that have been adopted by this city
show the general scope of those for the whole State, and
as a knowledge of them may prove of some value to
physicians who intend to become connected with the
public service we venture to give some of the details
here.
The positions which are obtainable now only after
competitive examination are those of physician, surgeon,
chief of staff of hospital, medical ofiicer, medical super-
intendent and assistant medical superintendent, inspector
of vaccination, or sanitary inspector, and those posi-
tions in the Health Department requiring a medical edu-
cation and experience.
The rules also require an examination of all applicants
for the positions of principal matron, head of training-
school for nurses, orderly, nurse, and hospital attendant
These positions are included mainly under " Schedule
> Index Catalogue of the Library of tlie Suiyeon-General's Office, U. S. Anny.
Attthon and Subjects. Vol. t., Flaocu»-Hearth. Washington, 1884.
4o8
THE MEDICAL RECORD.
[October ii, i
D," which includes all persons for whose duty special
expert knowledge is required ; and " Schedule E," which
includes physicians, chemists, nurses, orderlies, and
other hospital and asylum attendants.
Applicants for medical positions must address a letter
to the Secretary of the Municipal Service Boards, New
York city, stating their age, residence, nativity, etc ;
they must furnish a certificate of good character, and
must give evidence that they have been duly authorized
to practise njedicine and surgery. The examination
takes place before one of the three Examining Boards
appointed by the mayor, and composed of three citizens.
The examination, besides requiring evidence of physical
and moral qualifications, includes the following, with the
relative weight given to each : medical knowledge, 50 ;
experience, 20; efficiency and accuracy in work, 15;
character for maintaining discipline, 15. Naturally, cer-
tain variations from this are made in accordance with
the character of the position.
It is in the power of the Advisory Board to institute
non-competitive examinations for positions in the De-
partment of Charities and Correction.
In regulation 30 it is stated that competitors for ** the
superior positions in Schedule D " are not obliged to
produce a diploma, but a certificate from some reputable
institution of having studied two years, or a certificate
from a professional man of having studied for three years
will suffice.
This provision, as will be seen, furnishes a possible
opening for politicians to get in their friends who have
not been regularly qualified as physicians. '
The Civil Service regulations, if carried out thoroughly,
will no doubt assist to raise the character of the medical
service. Yet it must be admitted that the character of
this service was on the whole very good under the old
system. Rumors of late, however, that politics has too
much influence in the Health and Police Departments,
lead us to look forward with pleasure to anything that
promises to remedy these existing or impending evils.
RECOGNITION OF HARD PREPARATORY WORK.
One of the earliest observations which a young physician
learns to make is that of the enormous disparity which
exists in the education, skill, manners, and general char-
acter of physicians. A young man has graduated from a
classical or scientific college, has spent three or four
years at a leading medical school, has walked the hospitals,
has perhaps subsequently taken special courses or stud-
ied in £urope. He then settles in practice and finds that
he must meet as a brother, and must be estimated by the
public in the same rank with a person who, without pre-
liminary training, graduated at some provincial institu-
tion, after a course of study lasting practically about two
years. He hears derisive comments on this brother's ig-
norance or on that colleague's offensive ways, he hears
the profession ridiculed for its incapacity and various
standard weaknesses, and has to take his share of the
obloquy, although he can feel without vanity that he is
working intelligently and with some success in his chosen
art. There seems to him to be something wrong.
There are some evidences that the profession every-
where feels that these differences between doctors and
doctors are very great, and diat the ill*repute which
should fall on the careless and half-educated, should not
have to be shared so completely by those who have
trained themselves thoroughly, and who are working with
an honest ambition.
Some time ago it was proposed in France that a spe-
cial class of physicians should be established, composed
only of those who had shown some evidence of unasaal
capacity.
In England and this country there is a tendency to
indicate, in giving the medical title, the college which
bestowed it, provided that institution was one whose
character deserved such special designation. Certainly
the degree of M.D., in this country, has a very unequal
signification, perhaps to a greater extent even than that
of A.M.
The establishment and success of the American Acad-
emy of Medicine helps'also, in a measure, to give credit
to those who have taken more than the usual pains to
prepare themselves for a learned calling.
We are inclined to favor these plans which aim to give
recognition to hard preparatory work. It may be said
that such ideas are not *' democratic,'' and that the hum-
ble graduate of an obscure school may become a better
physician than he who is trained by the most elaborate
methods. While this may be true in some cases, certain
exceptions do not invalidate the general principle laid
down. Hard preliminary work deserves a little recognir
tion other than the slow and uncertain recompense fiir-
nished by the public.
THE PATHOLOGY OF SERPENT-POISONING.
A TRULY scientific account of the lesions produced bj
snake-poison is so rarely met with that the contribution to
this subject by Dr. Romiti, of Sienne, in the Archives
lialiennes de Biologic (tom. v., fasc. i.), is of great interest.
The victim was a man forty years of age. Within a few
moment after receiving the bite, from the viper cupis^ he
fell into a syncopal condition, the heart became ex-
tremely slow, and death took place by asphyxia in four
hours after the injury. 'At the autopsy, twenty-three
hours post mortem, the body was still in a state of cada-
veric rigidity ; but it was noticeable that the injured arm
was less rigid than the other. The abdomen was enor-
mously distended; and the pupils dilated. The cellu-
lar tissue around the wounded surface was infiltrated
with a sanguinolent serous fluid, which also invaded the
muscular tissue. The neighboring veins were filled widi
black fluid blood, though the wounds had not entered
any vein. The superficial cerebral veins were filled with
blood of the same nature, and the pons, cerebellum, and
medulla were very much congested. The puknonarj
vessels were full of blackish blood, as were those of the
abdominal organs ; and the intestines were enormously
distended with gas. The spinal meninges were con-
gested, and the vessels of the cord engorged.
The most interesting phenomena, however, were those
found on histological examination of the blood. Two
series of preparations were made of venous blood taken
from the vessels of the injured arm. The first, of a single
drop of the blood, without any reagent ; the second, of
blood treated by Bizzozero's method, that of mixing the
October ii, 1884.]
THE MEDICAL RECORD.
409
blood with a seventy-five per cent, solution of common
salt, slightly coloring with methylene violet, and pro-
tecting with paraffine. Preparations were also made of
blood taken from other parts of the body. The best re-
sults were obtained from the examination of unmixed
blood, and simply colored with methylene violet. The
red blood-globules were normal as to form, but were
pale, and the coloring-matter was diffused in the plasma ;
they had, moreover, no tendency to form rolls, as in the
normal condition. Here and there were groups of leu-
cocytes, and in their midst a granular substance. Under
a 1,500-power, it was seen that the granular masses were
formed of piastrine (Bizzozero), or haematoblasts(Hayem).
The red disks were rapidly dissociated on the addition of
dfstilled water.
In examining blood which had been preserved the
same results were obtained as with fresh blood. The
blood which had been kept in vessels remained fluid, of a
syrupy aspect, dense, and wine-colored. Three months
afler death it had the same characteristics, never emitting
the peculiar odor of putrefaction, but only a strong em-
pyreumatic odor, very like Liebig's meat extract.
The liver, spleen, and pancreas were examined histo-
logically. The kidneys were in a state of commencing
interstitial nephritis. In the liver, the capillaries near
the interlobular vein were markedly engorged. The
pancreas was extremely soft, and of a pale yellow color ;
there was complete fatty infiltration of the granular
cells, which accounted for the macroscopic appearance
of the organ, but this condition may have existed before
the injury which caused death.
It is interesting to note here the experiments of Bufa-
lini, in which he injected 30 c.c. of blood from the inferior
vena cava of this man into the peritoneal cavity of a
guinea-pig ; it had no noxious effect whatever. This con-
firais the results obtained by Albertoni, from which he
concluded that the active and poisonous substance of a
serpent may be considered as a true poison, and its ac^
tion may be compared to that of an alkaloid.
BATHS FOR THE POOR IN WINTER.
Th« communication by Dr. Tauszky in the present issue
is one of much interest to all who may have at heart the
improvement of the sanitary condition of the poorer
classes. The proposition to provide bathing facilities
at all times, for the great unwashed, is one which needs
only to be mentioned to be commended. It is impos-
-sible to estimate the amount of sickness which may be
prevented thereby, aside from the individual comfort which
is sure to result to such as may be brought to enjoy this
very necessary measure. We do not care at present to
speak of the details of the plan ; these are calculated to
take care of themselves when once the soundness of the
principles are fully appreciated by the authorities. It is
pre-eminently a subject which deserves the attention of
the civic authorities, and it is to be hoped that his
Honor the Mayor and the Board of Aldermen will give
some direct and practical turn to the suggestion. The
medical profession can be counted as a unit in favor of
it In fact, we fail to see how any argument can be
used against it, except the comparatively trivial one of
the expenditure of a small amount of money with a little
trouble in the necessary organization. It is, however,
one thing to say what the poor should do, but another
thing to help them in doing it The end to be attained
by keeping them clean justifies itself beyond argument,
and, fortunately, the means are easy of adoption and
comparatively inexpensive.
^ettTB of tlie WSi6zk.
American Gynecological Society, — By the omis-
sion of two words in the transmission of our telegraphic
report, it was made to appear that the President's ad-
dress was not delivered. It should have read, was post-
poned un/il tO'day (Thursday) on account of sickness.
On Thursday morning Dr. Albert H. Smith, of Phila-
delphia, delivered the President's address, entitled, '*The
Present Aspect of the Puerperal Diseases,*' in which he
reviewed the literature, the theoretical, and the clinical
aspects of the subject, and then devoted considerable
space to criticisms on the germ theory of the diseases as
set forth by Pasteur.
Malarial HiEMATURiA and Pernicious Intermit-
tent Fever. — Dr. Thomas J. Moore, of Richmond, Va.,
desires us to make some slight changes in the report of his
remarks on malarial fever before the Medical Society of
Virginia, at its late session (see The Medical Record,
September 20, 1884, p. 328). He did not say that he had
frequently met with cases of malarial haematuria in North
Carolina, where he had practised, but in the practice of
his brother practitioners in the northern part of Ala-
bama. He is made, in the report, to say that he uses
quinine hypodermically in ordinary malarial fever, where-
as he said that he was in the habit of using the salt in
that manner in cases oi pernicious intermittent fever.
The Examination to Fill the Position on the
House Staff of the Presbyterian Hospital will be
held at the Hospital on November 3d, at 2.30 p.m. For
particulars address Rev. Thomas G. Wall, Superinten-
dent
Remedies for Cholera. — M. Vulpian has made a
report to the Academie des Sciences upon two hundred
and fifty remedies for cholera, which have been sent by
persons desiring to obtain the Bryant prize of 100,000
francs. Some of the discoveries modestly ask that they
may be sent to Marseilles in order to test their remedies.
The Washington International Medical Con-
GRESS.^-The Committee on Organization of this Congress
has been constituted as follows : Drs. Austin Flint, of
New York ; I. Minis Hayes, of Philadelphia ; Lewis A.
Sayre, of New York ; Christopher Johnston, of Baltimore ;
George J. Engelmann, of St. Louis ; J. S. Brown, U. S.
Navy, and J. S. Billings, U. S. Army.
Significant. — ^The British Journal of Hotnceopaihyy
one of the oldest journals of its class, will cease to be
published after this year.
An Investigation by the New York State Board
of Health. — The New York State Board of Health is
said to be about to undertake a collective investigation
upon the question as to when a patient convalescent
from an infectious disease ceases to be capable of con-
veying the infection.
4IO
THE MEDICAL RECORD.
[October ii, 1884,
The Vermont State Medical Society holds its
seventy-first annual meeting at Montpelier on October
15 and 16, 1884, The presiding officer is Dr. S, S.
Clark, of St Albans, Papers are to be read upon " Diph-
theria," "Rupture of the Uterus," "Laceration of the Cer-
vix," and other subjects. Dr. J. S. Richmond, of Wood-
stock, Vt, is Secretary.
Responsibility for Payment of a Consulting
Physician. — A test case, says the Canada Lancet^ was
recently tried in Belleville, Ontario, to determine whether
or not a patient is liable for the fees of a medical man
who is called by a friend or relative. In this case the
brother of the patient summoned the consulting physician,
who assisted in the amputation of a finger. The patient
refused to pay the consulting physician, on the ground
that he had not engaged him, and told him to look to the
attending physician for his fee. The judge who tried the
case ordered a non-suit, holding that the patient was
responsible only to the physician he engaged.
Mr. Lawson Tait, while at Hamilton, Ontario, opened
the abdomen for supposed gall-stones and found car-
cinoma instead.
Infectious Disease may Render a Lease Void.
— A decision was recently rendered in England by Mr.
Justice Field in a case where a claim was made for rent
for furnished apartments for the term of the lease, the les-
sor refusing to occupy the house because, after the lease
was made and before the lessee vacated the apartments,
a case of an infectious disease appeared in [the rooms.
The defendant claimed that the existence of a contagious
disease in a house rendered it uninhabitable, and the
justice rendered a decision favorable to the defendant
The New York Neurological Society held its first
regular meeting for the season, on October 6th. A paper
on " Gastric Neurasthenia" was read by Dr. L. Weber, and
one on " Pseudo-bulbar Paralysis " by Dr, W. Browning.
The Medical Section of the French Congress
FOR THE Advancement of Science. — Among papers of
interest read before this section, was one by M. Chaumier
on " The Epidemic and Contagious Nature of Acute Pneu-
monia." The author thought that pneumonia was a con-
stitutional infectious endemic disease, sometimes, though
rarely, propagated by direct contagion. It had a germ
which could retain vitality more or less long in dwelling-
houses. M. Chaumier thought it wrong to poison with
drugs persons already poisoned with disease, and advo-
cated the treatment of pneumonia by baths alone.
M. August Ollivier read a paper upon the " Pathogeny
of Herpetic Angina," in which he sought to establish the
view that it was a neurosis generally of the middle branch
of the trigeminus.
M. Bessette urged the use of the thermocautery to
the entire exclusion of the scalpel in the treatment of
spontaneous gangrene.
The Cholera. — It is seventeen weeks since the chol-
era first appeared in France and over eleven weeks since
it appeared in Italy. The deaths from the disease in
France have averaged about 375 per week, while in Italy
the average has been 1,000 a week. A Roman paper
estimates the total number of deaths up to October ist
at 10,800. There is every indication that the force of
the epidemic is now spent, in Italy as well as in France
and Spain. The total number of deaths from cholera in
Italy on October 7th was only 44, in France 8, in Spain
I. A correspondent of the New York Times writes that
the mastery of the plague in Genoa is really the first fine
medical feature of the whole siege. Immediately after
the pest broke out with virulence in that city, a fortnighl
ago, the authorities had the water supply analyzed, and
they discovered that of the three sources of supply, that
of the Nicolai Company was awful. The municipal
works' supply was pretty bad, and that of the Gerzenti
Company was pure. Immense and costly efforts were
promptly made to shut off the first two sources and to turn
the latter water into all the pipes. An immediate im-
provement was noticed, and the mortality declined after
eight days, instead of advancing for weeks, as has usually
been the case. We learn by cable also that the commis-
sion sent to Marseilles has made an elaborate report of
many experiments with microbes, all of which were failures,
and that Dr. Klein has shown contempt for the microbe
theory by swallowing a quantity of bacilli without harm-
ful result. The Marseilles commission found it could
mathematically trace a cholera patient's condition by an
hourly examination of the blood, the healthy globules re-
maining stationary and the unhealthy ones flomng be-
tween columns formed by others and taking them gradu-
ally off until the column is ruptured. The commission
affirms that cholera is not contagious, and it concludes
that while we know better than our predecessors what
the cholera is not, we do not know what it is.
The Acad^mie de MtoECiNE met September 9th.
M. Morel read a paper upon the '' Cause of the Normal
Evening Rise of Temperature." This was due to three
things : food, light, and exercise, of which food was the
chief factor. Animals fed during the night had the nor-
mal rise of temperature in the morning. M. Dujardin-
Beaumetz reported the results of his study of disinfect-
ants. He had reached the conclusion that sulphurous
acid is the most efficient and convenient germicide. To
obviate the objection that it attacks metals he had re-
course to sulphurous acid made from liquid sulphurous
acid by the method of Raoul Pictet
Medicine Takes Curious Freaks in some of the
States beyond the Father of Waters. In Nebraska, for
example, there is a State University with a Medical De-
partment. Said Medical Department has been taken
possession of by certain eclectics, who naturally have
started a medical organ, the Nebraska Medical JoumdL
The State evidently supports the Department, for we are
told that tuition is free and expenses light. We are
pleased to observe also that this free Medical Depart-
ment has joined the cause of higher education, and will
hereafter require attendance upon three courses instead
of two. Meanwhile the organ is publishing various dis-
cussions as to whether electricity is the cause of the
heart's movements.
Mistakes in Words. — A Philadelphia contemporary
publishes a newspaper clipping concerning the word
"^microbe." This word, it states, was coined by M,
Charles S^dillot, of Strasbourg, in 1878. The truth is,
however, that Professor Pacini used the word " micro-
bio "in 1854, applying it to a micro-organism of cholera.
October ii, 1884.]
THE MEDICAL RECORD.
411
Valuable Articles Stolen from Physicians' Of-
fiCKS.— At the Tenth Police Precinct Station-house,
Brooklyn, N. Y., there are several valuable articles re-
cently stolen by an office-thief, whose operations were
very extensive in New York. These articles consist of
microscopes, instruments, umbrellas, clothing, etc, still
unclaimed, and which evidently belong to New York
physicians. The captain is anxious that they be identi-
fied and taken away. The station-house is at the comer
of Flatbush and Sixth Avenues, Brooklyn.
Subscriptions Asked for a Statue to Dr. Joseph
GuiSLAiN. — We publish with pleasure the following notice
sent to us by Dr. Lewis D. Mason, of Brooklyn : " An
effort is being made to secure subscriptions for the erec-
tion of a statue to Dr. Joseph Guislain. The members
of the Society of Mental Medicine, of Belgium, are ac-
tively interested in promoting this object, and desire that
all specialists in this department of medicine have an
opportunity to subscribe, and that the statue represent
the combined subscriptions of the specialists in mental
diseases of the world, rather than of any given district.
To this end, subscriptions have been received from Eng-
land, France, Russia, Germany, Italy, Holland, and
Sweden, in sums varying from five, to twenty-five ^ancs.
The United States, as yet, is not represented. We hope
the subscriptions from America toward the erection of
this statue will compare favorably with those of other
countries. Subscriptions may be sent to Dr. B. C. Ingels,
MMicin de THospice-Guislain i Gaud, Belgium. List
of acknowledgments will be sent to subscribers."
The Limits of Legitimate Advertising. — We com-
mend to our readers' attention the following from the
Iowa Afedual Monthly, The limitations which are here
suggested contrast strongly with the sordid and commer-
cial view which allows the unlimited distribution of pro-
fessional cards with the' specialty obliquely indicated
thereon. Says the Monthly : " Is there such a thing as
legitimate advertising, that the physician may u^e with-
out violating the spirit of the Code ? We would answer
unqualifiedly, yes, and that its dimensions begin with a
good education, gentlemanly conduct, social qualities, in-
dustry, and end with the moral eflfect in the community
of his good deeds, distributed by word of mouth, from
his friends. This mode of advertising, together with that
invaluable quality, tact or good judgment, will always
bring success."
Objects and Membership of the American Acad-
emy OF Medicine. — We have been requested by Dr.
Richard J. Dunglison, Secretary, to announce the objects
aimed at by the American Academy of Medicine, and
also the qualifications necessary for membership. The
Academy is growing yearly in members and influence,
but it is desired that it embrace in its membership all the
physicians in the country qualified therefor. The Con-
stitution says that the objects of the Academy shall be :
I. To bring those who are Alumni of Classical, Scien-
tific, and Medical Schools into closer relations with each
other. 2. To encourage young men to pursue regular
courses of study in classical and scientific institutions
before entering upon the study of medicine. 3. To ex-
tend the bounds of medical science, to elevate the pro-
fession, to relieve human suffering, and to prevent dis-
ease. The Membership of the Academy shall consist of
Fellows and Honorary Members. The Fellows shall be
Alumni of respectable institutions of learning, having
received therefrom : i. The degree of Bachelor of Arts,
or Master of Arts, after a systematic course of study,
preparatory and collegiate. 2. The degree of Doctor of
Medicine, after a regular course of study, not less than
three years, under the direction and instruction of pre-
ceptors and professors. 3. When a candidate is an
alumnus of a foreign institution not granting the degree
of Bachelor of Arts or Master of Arts, a certificate or
certificates, which shall be considered as equivalent by
the Council an4 Academy, may be accepted in lieu
thereof, provided he shall have subsequently received the
degree of Doctor of Medicine. 4. The Fellows shall
also have had an experience of three years in the Prac-
tice of Medicine, in one or more of its recognized depart-
ments, and shall have a good moral and professional
character.
The French Association for the Advancement
OF Science. — This association, which now numbers four
thousand members, held its annual meeting at Blois, be-
ginning September 4th. It has a Medical Section which
is, we believe, the nearest approach to a National Medi-
cal Society that France possesses. The meetings of this
Section have not heretofore been productive of any very
valuable work, and have not attracted many of the leading
members of the profession. The last meeting at BloiS|
however, seems to have been rather more notable. It
was presided over by M. Nicaise, and among those pres-
ent were MM. OUivier, Bouchard, and Vemeuil.
The New York City Board of Health. — ^The
Sanitary Engineer censures our city Board of Health on
account of its inefficient action in cleaning out the
" slums." The practice of dealing with these places by
turning the wretched inhabitants temporarily into the
streets and then ''squirting copperas-water over the
filth," is denounced as a weak and useless measure.
The Sanitary Engineer believes that all these rookeries
should be torn down, if we do not wish the cholera here.
The Nebraska State Medical Society and Pre-
liminary Education. — We learn from The J^rnal of
the American Medical Association that the Nebraska
State Medical Society has made arrangements for secur-
ing a preliminary education to all persons intending to
study medicine with physicians of the State. No member
of the Society will accept a student of medicine unless
he has given evidence of having a certain amount of
preliminary education. This is a step that has abready
been taken by some smaller societies and we trust the
example will continue to be imitated, and the practice
honestly carried out. Dr. Davis says : ** We have seen
parties, who in medical society meetings and addresses
would advocate the most rigid exaction of a fair standard
of general education, take students into their own offices
who had not even a respectable common or district
school education, and then advise them to attend medical
colleges where not only no standard of general educa-
tion was required, but where a diploma could be obtained
for an expenditure of the smallest amount of [time and
money."
412
THE MEDICAL RECORD.
[October ii. 1884.
The International Otological Congress. — ^The
Third International Otological Congress was held at Basel,
Switzerland, from the ist to the 5th of September, under
the presidency of Dr. A. Burckhardt-Merian, of Basel. We
learn from The British Medical Journal that the pro-
ceedings were opened on Monday at the hall of the
University, by addresses from Dr. Sapolini, of Milan, the
retiring president, and Dr. Burckhardt-Merian, the presi-
dent-elect. Addresses of welcome to the town of Basel
were delivered by Counsellor Schenck, on the part of the
Swiss Federation, and by a delegate from the Canton of
Basel. A breakfast, given by the Swiss surgeons to the
members of the Congress, followed. \Oxi Wednesday
the members of the Congress were entertained at a
banquet. During the three following days about forty
papers were read, and demonstrations were given on sub-
jects bearing on otological science, all of a most in-
teresting, instructive, and original nature. The principal
contributors were Politzer, of Vienna ; Moos, of Heidel-
berg ; Guye, of Amsterdam ; Sapolini, of Milan ; Gelle,
of Paris ; His, of Leipzig ; Hartmann, of Vienna ; Lowen-
berg, of Paris ; Kuhn, of Strasburg ; Albrecht and Del-
stanche, of Brussels ; and Pritchard, of London. It has
been arranged that the next Otological Congress be held
in Brussels in 1888 ; and an organizing committee has
been nominated, Dr. Urban Pritchard representing Eng*
land.
Dr. Thaddeus Johnson has resigned the Chair of
Surgery in the Southern Medical College, on account of
his health. He is succeeded by Dr. J. McF. Gaston,
formerly of Columbia, S. C.
A Text Book of Practical Medicine : Designed for
the Use of Students and Practitioners of Medicine. By
Alfred I* Loomis, M.D., LL.D., Professor of Pathol-
ogy and Practical Medicine in the Medical Depart-
ment of the University of the City of New York, Visit-
ing Physician to Bellevue Hospital, etc. With two
hundred and eleven illustrations. 8vo, pp. 1,102.
New York : William Wood & Co. 1884.
The popularity of Professor Loomis as a medical teacher
will of itsi^lf do a great deal toward making this book a
success. But it need not rely on this. Independent of
the author^s reputation the volume can speak for itself,
as a comprehensive and practical treatise on general
medicine. The first thing which impresses the reader is
the systematic arrangement of the various diseases dis-
cussed. In so far, the author stamps his work with the
results of his experience as a clinician. His aim appar-
ently is to draw the outline of general principles with a
rigidity and distinctness which admits of no question.
This is, however, rather a virtue than a fault, considering
the aim of the book. It brings out the strong individu-
ality of the author. It is a positive book from bepn-
ning to end, bringing out the strong views of a practical
man. The style is terse and perspicuous, the descrip-
tions of diseases and the indications for treatment are
direct, practical, and force upon the reader the convic-
tion that the author not only understands his subject
in all its bearings, but has the faculty of taking others with
him.
While it may be difficult to conceive ^he possibility of
originality in a work like this, there is enough of such an
element about it, in arrangement and general treatment,
to make it different from any of its kind, and propor-
tionately valuable. Dr. Loomis is particularly happy in
making clear the indications for treatment of the different
diseases as based upon pathological conditions. He is
seen at his best in his discussion of fevers and chest and
kidney diseases. It is safe to say that the chapters on
these subjects have no equal for practical worth in
any language. His divisions are natural, scientifically
systematic, and thoroughly practical, really leaving
nothing to be desired on the part of the learner who
wishes for a broad and solid foundation, upon which he
can base his facts of past and future experiences. The
difficult subject of auscultation is made strikingly simple
not only by word description, but by means of diagrammatic
representations. The latter are of the greatest value to
the student in making out the relation of the auscultatory
signs to the different pathological changes in the lungs
and heart. It is difficult to conceive how they could be
indicated more satisfactorily.
The chapters on fevers are, as already intimated, of
great value. Typhoid fever receives the attention which
its great frequency of occurrence demands. There is
scarcely any acute disease the treatment of which gives the
practitioner more anxiety than this. There are so many
circumstances to be taken into account, and so many
conditions to be fulfilled, that he cannot study them too
thoroughly, or cannot be too well prepared for emergen-
cies. Professor Loomis treats this disease as he does all
others, from a clinical standpoint, and the rules which he
lays (k>wn are eminently safe, and will commend them-
selves accordingly to the good sense and experience of
every one who has seen much practice in that line.
These remarks will be found to apply specially to
reduction of temperature by cold baths and by quinine.
The latter in large doses is a favorite with the author,
and his reasons for the practice are very intelligibly
given.
The division of fevers is the same as that adopted by
most authors, with the exception that the typho-malarial
type is treated under the head of continued malarial
fever. The author believes that the latter is caused by
the combined influence of a malarial and a septic ele-
ment. His treatment, however, does not differ essen-
tially from that advocated by observers who first studied
the disease during the late war. We are inclined to be-
lieve that the new name is a good one, and will be gen-
erally adopted as best expressing the general features of
the disease.
Bright's diseases are treated of under three leading
heads : First, the form in which the morbid* changes
commence in the uriniferous tubules, designated par-
enchymatous nephritis ; second, the form in which the
change commences in the intertubular tissue, the cir-
rhotic kidney ; and third, the variety in which the blood-
vessels are first diseased, viz., the amyloid kidney. This
division is simple and founded on advanced pathology.
While speaking of this disease we wish to refer to die
admirable rules laid down for treatment, and congratu-
late the author on the masterly manner in which he has
simplified the whole subject.
The figures showing microscopical changes of organs
are admirably drawn, and were specially prepared for the
work by Dr. M. N. Miller, of the University Laboratory.
Of these there is a large number, giving all the leading
pathological changes in the tissues of the different in-
ternal organs.
In summing up our conclusions in regard to the book
as a whole, we repeat that it is the best of its kind and is
destined to be the most popular work on practical medi-
cine yet published It is a matter for great congratulation
that by means of his admirable book the distinguished
author can now reach thousands who, unfortunately for
them, have not had the opportunity of enjoying his
teaching in the class-room or hospital ward, and learn-
ing those methods of diagnosis and treatment which have
tended to make him a successful practitioner in every
sense of ♦^^^e term.
October ii, 1884,]
THE MEDICAL RECORD.
413
^epovts ot S^acUtUs.
PRACTITIONERS' SOCIETY OF NEW YORK.
Stated Meeting, October 3, 1884.
Dr. a. Brayton Ball, President, in the Chair.
Dr. James B. Hunter read a paper (see page 397) en-
titled
SOME POINTS IN THE THERAPEUTIC APPLICATION OF HEAT
AND COLD.
Dr. George F. Shrady was ready to endorse Dr.
Hunter in his remarks on the relative value of hot and
cold applications in the treatment of surgical cases.
There was no question in his mind as to the value of the
cold coil, as recommended by the author of the paper, in
the treatment of traumatic peritonitis. In such cases
cold was used as a preventive or arrester of a formidable
and rapidly spreading inflammation. In general, how-
ever, in the treatment of surgical injuries, when an at-
tempt was made to fulfil these indications, there was often
a failure, for the reason that the cases were not seen suf-
ficiently early. This was certainly so in hospital practice.
And from other contra-indications these applications
were frequently painful to the patients, especially those
who were suffering from synovitis and sprains. Conse-
quently he was getting into the habit of using hot appli-
cations in preference, particularly for joint sprains, ac-
companying such treatment with rest and following it
with a firmly supporting bandage. In many cases of
recent sprain he used nothing but the bandage and rest.
When inflammation was fairly under way and incapable
of arrest, hot applications were indicated; even in trau-
matic peritonitis, especially if these were combined with
the internal administration of opium in full doses.
In regard to the application of cloths soaked in hot
water to oozing wounds there could be no doubt of its
value, nor of that of the injection of hot water into
stumps in a like condition. Rubber bags filled with hot
water formed a very useful means of marking hot applicar
tions to limited inflammatorv troubles.
Dr. Samuel Sexton saia that the paper called to his
mind an early experience in the use of hot water, which
had started him to using it a great deal. In 1870 he met
a gentleman in the wash-room of the Union League who
was unsuccessfully trying to stop a severe nose-bleed by
the use of cold water. Dr. Sexton recommended him to
snuff hot water up the nose. This was done and the at-
tack stopped almost instantly. Since then the speaker
had used hot water as a haemostatic in all cases, after re-
moving polypi ; also as a gargle after tonsillotomy.
With regard to the use of cold, in the early years of
his practice he had used freezing applications in the am-
putation of fingers, as a local anaesthetic. They had
prevented suflfering and acted very well.
Dr. a. a. Smith had used both rubber and
lead coils in pyrexia.
In some cases of typhoid fever, with a temperature of
105° to 105^® F., a single application of the lead coil
had reduced the temperature to below 100° F. The
coil used had been considerably smaller than those shown
hy Dr. Hunter. It would not only reduce the tempera-
ture but keep it down. In one case of typhoid fever the
coil had been kept on continuously for nine days, the
temperature being kept below 100".
Dr. Smith had noticed that the pulse was not always
reduced in rapidity correspondingly with the temperature,
and he thought that, as a rule, when the temperature is
reduced rapidly the pulse is reduced in a much less de-
gree.
He had been for a long time a very strong believer in
the reduction of temperature by cold as a therapeutic
measure in the pyrexiae ; but he also believed that it was
capable of doing much harm. He did not believe in the
heroic application of cold in typhoid fever after the tenth
or fourteenth day, or when there was a tendency to heart
failure, for it might then cause nervous shock. tHe believed
that the applications of cold acted in much the same way
as the various antipyretics, referring especially to
KAIRIN and ANTIPYRIN.
These will reduce temperature, but they also reduce the
force of the pulse. The new agent, antipyrin, reduces
temperature very powerfully, but it weakens the heart
also. The speaker doubted if Americans had the con-
stitutions which would stand the powerful antipyretic
measures to which the more stolid Germans are sub-
jected. He felt, therefore, that the safest means of ap-
plying cold was the
kibbee's cot.
He had been much pleased, however, with the action of
the coils, and they seemed to furnish a safe way of apply-
ing cold. The speaker recalled the introduction of cold
applications in fever at Bellevue Hospital, in 1870-71.
The impression received then was that the application of
cold locally in the form of ice-bags, in pneumonia, seemed
to increase the tendency to involve new lung tissue.
Dr. Kinnicutt had found that the most satisfactory way
of applying cold in typhoid fever was by means of the
Kibbee cot. He had given it a very thorough trial in St.
Luke's Hospital. He had succeeded in obtaining all the
good results of the full-length bath without the discom-
fort to the patient of the latter and the increased labor
entailed upon the attendants. A large receptacle for the
water was placed upon a stand above the patient's head ;
a rubber tube was attached, ending in a numerously
perforated nozzle. The patient, uncovered or covered
simply with a sheet, was then continuously sprinkled
from head to foot, for a time corresponding to that
usually employed in giving the full-length bath.
Dr. Kinnicutt*s experience differed from Dr. Smith's
in that, as a rule, he had found, by either the full-length
bath or by the application of cold by means of Kibbee'scot,
with a reduction of temperature there had been a corre-
sponding reduction in the frequency of the heart's action.
Was it not possible that the coil acted in a somewhat
diflerent way in lowering temperature from cold water
bathing ?
Dr. a. Brayton Ball said, that when he went upon
his service at Bellevue Hospital, he had been told that
the cold coils had been tried in typhoid fever, and that
they had failed. He, therefore, had not tried to use them.
Dr. Fordyce Barker said that he had been studying
clinically the subject of the antipyretic use of cold ever
since Dr. Wilson Fox's paper appeared on the " Use of
Heat and Cold in Hyperpyrexia." By hyperpyrexia
he meant a condition in which the temperature rose to
107° or 112° F. This was an essential fever and a rare
one. He had seen but very few cases.
He had thought that in the use of cold as an antipy-
retic one point had been overlooked in practice, and
that was the looking at the pyrexia as the essential dis-
ease, instead of regarding it as one of the, perhaps, inci-
dental symptoms, which might or might not demand
treatment.
Two or three years ago there beean to be a great deal
of interest in regard to the use of cold in arresting or
preventing and even curing peritonitis. That treatment
was most enthusiastically advocated by several surgeons,
notably by Dr. Thomas. The speaker, however, was
obb'ged to say that he had reached conclusions in some
respects quite different from what he had expected.
He was not certain but that there was a very essential
difference between surgical peritonitis and idiopathic, or
what he would call, for want of a better term,
OBSTETRICAL PERITONITIS.
He saw quite a number of these cases treated by cold
applications. He had studied them with a perfectly im-
414
THE MEDICAL RECORD.
[October ii, 1884.
partial mind, and he had been disappointed in the re-
sults. In many cases he found no such results as Dr.
Thomas and others had claimed. There were two cases
in particular, which he had in mind, where the coil had
been used most thoroughly. At first its influence had
been to reduce the temperature and pulse, but after a
time the temperature ran up to 104° or 105° F., and the
pulse became quick, while associated with it was a very
bad general condition. He had found symptoms of
general depression and impending pneumonia or bron-
chitis. The whole abdomen was pale, the capillary cir-
culation almost arrested, with doubtless, in consequence,
a hypera^niia of the deeper-seated organs. After remov-
ing the coil and the administration of stimulants, and ap-
plication of turpentine to the abdomen, the most marked
improvement occurred. The temperature fell, and the
pulse became slower and stronger.
These experiences surprised him, because he had pre-
viously seen a remarkable result from cold, and one
which led him to expect a great deal from its use.
Two years ago, on one of the worst nights of the
winter, he was summoned to see a lady who had been
taken suddenly very ill. She had been to the opera that
evening, and after it was over had been obliged to stand
in the doorway, exposed to the air, while waiting for her
carriage. She was menstruating at the time. The
menses stopped, and when she got home she was seized
with a most violent and prolonged chill. This was
followed by intense pain throughout the abdomen.
Ginger tea was given, and hot applications made, but
the pain went on increasing until, when the speaker ar-
rived, she was nearly frantic. The patient was of a
self-possessed and calm temperament, but suffering such
agony that she could hardly bear a sheet upon her. The
abdomen was puffed up and very sensitive. Dr. Barker
gave a hypodermic of fifteen minims of Magendie's solu-
tion. After waiting half an hour, there being no abate-
ment in the pain, he sent for an ether-spray apparatus, and
at the same time gave her another hypodennic injection
of fifteen minims. He thought that there was an in-
cipient peritonitis, and that the cold might act favorably
upon that as well as have a direct anaesthetic action.
The patient meanwhile had commenced vomiting. He
then
SPRAYED THE WHOLE ABDOMINAL SURFACE
until it was very cold, as if it had been covered with ice.
The relief was remarkable; the pain disappeared, the
hand could be pressed firmly upon the abdomen without
causing pain, and the patient went to sleep. The pulse
became quite natural also.
Next day the menstruation came on again, and the
patient seemed very welL Dr. Barker thought that he
had very possibly aborted an attack of peritonitis by the
use of the cold.
This case had naturally prepared him to expect much
from the treatment of obstetrical peritonitis by cold.
But the question was whether, as he had said, the condi-
tions were the same here as in surgical peritonitis. In
puerperal peritonitis we have a natural and necessary
wasting of tissue. This is not the fact in traumatic peri-
tonitis. The prolonged application of cold has a paral-
yzing and depressing effect. It reduces temperature, but
does it relieve the disease ?
The speaker thought that the use of cold in puerperal
peritonitis was a measure of doubtful utility, especially
its prolonged use. In incipient cases it is extremely
useful, but in advanced cases it has a merely temporary
effect.
Dr. Barker was led by a recent experience to speak
of another point, viz. :
THE SAFETY OF HOT INJECTIONS IN ABORTION.
A lady who had been confined last spring, had made a
good recovery, and had spent the summer at a watering-
place, came to the city a few days before in order to
make some purchases for a new house which her husband,
a wealthy man, was building. She had only menstruated
once since her confinement, and was at the present time
eight weeks advanced in her second pregnancy. She
had finished her work and was expecting to start on the
next morning for Chicago. In the night (October 2d)
she was taken with flooding and pain. Dr. Katzenbach
was called in to see her. There was not much hemor-
rhage, but the pains were severe. An examination
showed that there was no protrusion of membranes. To-
ward morning, therefore. Dr. Katzenbach began to use
vaginal injections of not very hot water. He used a
Davidson syringe with a nozzle having only lateral open-
ings. While ^ving the second injection, the patient
suddenly went into a state of collapse and appeared as
if she were going to die at once. Stimulants were given,
and Dr. Barker was summoned. They had been fighting
all day to keep her alive. Toward night she had become
better and seemed to be reacting from the collapse.
The patient was of a fine, sensitive temperament ; and
the speaker believed that she had suffered from nervous
shock. There was no evidence at all that air had pa^ed
into the uterus or Fallopian tubes, and the wami injec-
tions had been given very carefully. During the day the
membranes and foetus came away and there was no more
hemorrhage, nor had she lost enough blood to account
for her collapse.
Dr. Barker had never had an experience like this be-
fore. In response to a question he said that he did not
think that this case showed that it was dangerous to use
hot vaginal injections in abortion. He admitted that the
relation between the injections and the shock might have
been one of coincidence.
Dr. William M. Polk said that there were three
points in the therapeutic use of heat and cold of especial
interest, viz., the use of cold in high temperatures, the
use of heat in post-partum hemorrhage, and the use of
heat as a vaginal application in cases of pelvic inflam-
mation.
With regard to the use of
COLD IN HYPERPYREXIA,
it was capable of doing a great deal of harm. In other
words, the mere fact of a high temperature does not it-
self indicate the use of cold. Several years ago, while
visiting the general medical service at Bellevue Hospital,
he had used cold applications a great deal. Upon the
class of cases which we come in contact with in the hos-
pital it did not act very well. It reduced the temperature,
but at the expense of the vitality of the patient. He had
found, too, that it was a matter of great importance to
look into the condition of the kidneys, because in cases
where there is much degeneration, cold is liable to act
badly. Such a contingency is to be looked for in typhoid
fever and post-partum peritonitis more than after ovan-
otomy.
As to
POST-PARTUM HEMORRHAGE,
he was much more disposed to rely upon the use of heat
than of cold in its treatment. It had seemed to him that
when he had used cold there had been such an amount of
after-depression as to add very much to the danger of the
patient. He had found hot-water injections quite as
efficacious in checking post-partum hemorrhage as cold.'
As to the use of hot injections in pelvic inflammations,
he had found them very valuable. The infianiroatory
exudation differs, however, in its absorbability in differ-
ent persons. There is a class of cases belonging to
what we used to call the strumous diathesis, and with
these the exudations about the uterus are very slow m
being absorbed, while the long-continued use of hot water
seems to retard rather than help. .
Dr. Hunter said that he entirely agreed with Dr.
Barker in his opinion as to the use of cold after cwxin^
ment. He did not think that the cold coil was so good
{n obstetrical as in surgical peritonitis.
October ii, 1884.]
THE MEDICAL RECORD.
415
With regard to the fall of the temperature and not of
the pulse, Dr. Hunter said that while this might accom-
pany attempts to reduce fever rapidly, he had generally
advised a slow reduction.
Dr. Polk referred to a case of scarlet fever where the
HIGH TEMPERATURE WAS REDUCED BY HOT APPLICATIONS.
It was that of a boy who had been showing most un-
fevorable symptoms. His temperature ran up to 106°,
and there seemed little hope of effecting any relief. Dr.
Metcalfe advised that cloths be wrung out in hot mustard
and water and placed about the patient In half an
hour the temperature began to fall and favorable symp-
toms set in. It was the only measure that seemed to do
any good whatever.
Dr. Smffh referred to a case in his own experience
almost identical, where a child suffering from scarlet fever
received no benefit from cold applications. Hot cloths
wrong out in mustard-water produced a fall in the tem-
perature and the development of favorable symptoms.
Dr. C. L. Dana asked if there were yet any trust-
worthy statistics from American practice showing the
efficacy of
COLD APPLICATIONS IN TYPHOID FEVER.
Since the beginning of his practice he had been greatly
interested in this subject, having, while an interne at
Bellcvue Hospital, seen it extensively tried, and with
doubtful results. Shortly after leaving Bellevue he had
collected statistics of the cold-water treatment of typhoid
fever in that hospital, and they had not made a favorable
showing. The statistics quoted from Dr. Peabody by
Dr. Hunter, as to the results of cold applications in
typhoid, were of hospital cases and contained many
sources of error. The statistics compiled by Brand had
in particular been shown to be most fallacious. The
speaker said that the result of the long debates on ty-
phoid fever at the Acad^mie de M^decine of Paris had
been unfavorable to the use of cold applications. In
England, too, the sentiment and evidence against it were
very strong. In Germany, recently, an opposition to the
once popular use of cold was apparently developing.
The speaker only contended that experience had not yet
jnstificd the routine use of antipyretics.
Dr. Kinnicutt thought that the statistics of the cold-
water treatment of t)rphoid fever in this country were
not sufficiently large to judge from them of*its efficacy.
In Gemiany the belief in its efficiency was still fully main-
tained, he thought. A careful study of the last debate
on this subject by London hospital physicians and the
statistics furnished by them, led to different conclusions,
it seemed to him, from those obtained by Dr. Dana. In
France, the opinion of at least the Lyons physicians,
was all in favor of the cold-water treatment.
Wound of Abdomen— Protrusion of Intestine —
Rapid Recovery without Peritonitis. — The following
case, reported to us by Dr. E. B. Ward, of Greensborough,
Ala., illustrates the immunity against inflammation which
the peritoneum sometimes shows. In a "rough and
tumble " fight a man received a wound in the left in-
guinal region just above Poupart's ligament. After re-
ceiving the wound he mounted a horse, rode one mile,
put up his horse, and then walked another mile to a
friend's house. " When I saw him," writes Dr. Ward,
"he was very much exhausted. I found the outer open-
ing about two inches in length, and the inner, penetrating
the abdominal walls to the cavity, about one inch. Sev-
eral folds of intestine with omentum protruded, and they
were only returned after anaesthetizing the patient. I
first closed the inner opening with interrupted sutures,
including ^^ peritoneum in the sutures. I then closed the
outer integumental wound in the same way, dressing the
woand with carbolized dressing, and awaited the result.
The patient progressed splendidly without a rise of tem-
perature above 100®, and in less than a week from the
date of injury he was up and about his work."
THE NEW YORK ACADEMY OF MEDICINE.
Stated Meetings October 2, 1884.
Fordyce Barker, M.D., LL.D., President, in the
Chair.
Dr. F. H. Bosworth read a paper (see page 365) on
the three tonsils — SOME PRACTICAL SUGGESTIOl^S IN
REGARD TO THEIR STRUCTURE, FUNCTION, AND DIS-
EASES.
The President called upon several gentlemen, not
specialists in diseases of the throat, to discuss the paper,
because of their experience with certain points contained
in it. He first said, with regard to his use of the bicar-
bonate of soda in quinsy, mentioned by the author, that
he had been in the habit of seeing a few cases of this dis-
ease each year, and until some years ago they almost in-
variably ended in suppuration ; but since he had begun
the local application of bicarbonate of soda in not a few
of the cases the disease was aborted. A marked instance
of the kind occurred in a patient seen with Dr. Bosworth,
a gentleman of eminence in literature, who was suffering
greatly from threatening abscess. The next morning
after the use of the remedy he was found at the breakfast-
table.
Dr. Douglas would agree with the author on most
points, but there were a few to which he must take ex-
ception. He would agree with him, for example, that
quinsy was a manifestation of rheumatism, or, especially,
of gout, and the treatment which he had employed for
this affection was largely that used by the President,
namely, bicarbonate of soda. At the same time he gave
the ordinary remedies against gout. He had found the
gargle and spray of bicarbonate of soda also useful in
cases of enlarged tonsil, but one of the most beneficial
remedies for this class of cases was a powder composed
of one part of menthol to a hundred parts of sugar of
milk. He would not always resort to the knife for the
removal of the enlarged tonsil ; it could be slowly, but
surely reduced in size by the persistent use of a powder
composed of salt, camphor, ammonia, and sugar of milk.
Dr. F. H. Hamilton was inclined to agree with Dr.
Bosworth that the enlarged tonsil should be removed by
the knife ; yet he had often observed that the enlarged
tonsil of childhood disappeared before the twentieth
year. He supposed the author, when he said there was
no danger connected with the operation, meant not in
the acute or engorged stage, and not in those of the
hemorrhagic diathesis. The question had been raised
whether aill or only a part of the tonsil should be removed :
he should say all that the knife would include.
Dr. Jacobi believed that the only efficient treatment
for the enlarged tonsil was removal ; applications would
not reduce its size, and where they had apparently done
so the reduction was due to some other cause. The en-
larged tonsil might remain stationary and appear smaller
after the lapse of years, because of the growth of the
fauces. As to the danger of hemorrhage, there usually
was but little loss of blood, but it might be profuse from
cutting into the soft palate — an accident which could
not always be avoided. The most efficient means for
stopping hemorrhage when it occurred was digital com-
pression, applied, perhaps, for an hour or more. He
could not agree with the author*s view that follicular ton-
sillitis was an essential fever ; he looked upon it as a
local disease. What Dr. Bosworth took to be an essen-
tial fever was probably diphtheria, for cases of diphtheria
were often overlooked or mistaken for some other affec-
tion. It was a great mistake to suppose that every pa-
tient sick with diphtheria must necessarily die ; there
were many mild cases which went unrecognized, and
which were all the more dangerous for that reason, as
they were the more likely to spread the disease. Dr.
Jacobi laid particular stress upon this point because of
its importance to the public health.
Dr. Weber had not yet seen a case which went to
4i6
THE MEDICAL RECORD.
[October ii, 1884.
substantiate the view that a phlegmonous inflammation
around the tonsils was due to the gouty habit. He had
found it most frequently in patients of poor general
health.
The President remarked that guaiacum had once
been strongly recommended in the treatment of quinsy,
on account of the supposed gouty origin of the affection ;
but he had not obtained the results with it which he had
been led to anticipate from reading certain articles in the
medical journals.
Dr. Post thought the best treatment for the enlarged
tonsil was extirpation.
Dr. Hamilton had found the external application of
ice or snow the best means for checking hemorrhage
after removal of the tonsil.
Dr. Fruitnight had aborted some cases of quinsy by
the administration of the tincture of aconite.
Dr. Jarvis again called attention to a distinction
which he had made between the soft and hard, or in-
durated enlarged tonsil, the latter being found in the
syphilitic. If the scirrhous tonsil were cut it would surely
give rise to hemorrhage, and might result fatally. He
employed the knife in the removal of the sofl enlarged
tonsil, and the cautery or snare in the removal of the in-
durated tonsil. He did not think any more of the tonsil
should be removed than was necessary, for it doubtless
served some physiological purpose, as the lubricating of
the fauces and protecting the carotid artery.
Dr. Brandeis said he believed in the Darwinian
theory of the survival of the fittest : the tonsils had sur-
vived some thousand years, had fulfilled some physio-
logical purpose, and he doubted not that they performed
their function well, whatever it might be. But the ton-
sils, like other structures, were liable to disease, and
diseased tonsils might be worse than no tonsils at all,
and therefore he believed they should in proper cases be
extirpated. He then pointed out the advantages of the
tonsillilome over the knife in certain cases. Contrary to
the experience of Dr. Bosworth, he had found hemorrhage
in young subjects rather than in the adult, although not
extreme. To prevent hemorrhage, he allowed the pa-
tient to sip a solution of tannic acid, and if necessary, he
applied pressure. Dr. Bosworth's description of quinsy
corresponded with that in Ziemssen's *' Encyclopsedia,"
there called peritonsillitis, but Dr. Brandeis could not ac-
cept the view that it was always an inflammation of the
peritonsular sheath. He recommended aconite and the
ammoniated tincture of guaiacum in its treatment until an
abscess should have formed.
Dr. Corning had arrested a severe hemorrhage after
tonsillotomy in one case by the use of his carotid com-
pressor.
Dr. Bosworth, in closing the discussion, said, with
regard to the possibility of reducing the size of the ton-
sils by astringents, that he believed it could not be donei
Their size, however, might be reduced in the young, in
whom they were in a state of chronic inflammation, by
the new tissue undergoing contracture. This would ac-
count for the diminished size of the tonsils on reaching
adult life. As to hemorrhage in the young, it was only
an oozing ; considerable hemorrhage only occurred in
the adult. That tonsillotomy was not dangerous was
apparent from the fact that in all medical literature not
a single fatal case was recorded. The cases in which
the carotid artery had been wounded were excepted ;
this accident could never occur in the hands of a surgeon.
In arresting hemorrhage with the actual cautery, the iron
should be applied from above downward, that it might
not be cooled by the flow of blood before coming in con-
tact with the bleeding vessel. He regarded periton-
sillitis a very good name for quinsy, but he did not
believe there was a peritonsular capsule proper. As to
the tonsils performing their function, he did not think
they existed in the normal state, but that they were the
result of disease.
The Academy then adjourned.
®0rr«5V0ttdeti«.
OUR LONDON LETTER.
(From our Special Correspondent.)
THE CHOLERA — DR. LEWIS ON THE COMMA BACILLUS AND
ITS NON-SPECIFICITY — CANNIBALISM AMONG AN ING-
LISH SHIPWRECKED CREW — HOSPITAL SATURDAY— THK
HEALTH EXHIBITION AND THE HOSPITALS — DEATH OP
MR. NETTEN RADCLIFFE.
London, September ao, 1884.*.
Despite the prophets of evil, the dreaded cholera has
not yet visited us. All possible precautions have been
taken to prevent the introduction of a case into the
kingdom. Steps have been taken to prevent cargoes of
rags from Marseilles and other places from being landed
at British ports in cases where there is any possibility of
their bringing infection.
With regard to the pathology of cholera, an interesting
memorandum has just been issued on the subject by Dr.
T. R. Lewis, Assistant Professor of Pathology at the
Army Medical School, Netley. Dr. Lewis has lately
visited Marseilles for the purpose of studying the subject
practically. He criticises Koch's published reports rather
closely, but the most startling point in his paper is the
statement that comma-shaped bacilli have been found by
him frequently in the salivary secretions from the mouths
of healthy persons. This is evidently a very importanl
observation, and should it be confirmed by further in-
vestigations, will ^o far to wholly discredit Koch's views
on the bacillar origin of cholera. Dr. Lewis is a skilled
microscopist and a laborious and patient worker in the
field of pathology. Dr. Lewis has also studied cholera
practically in India, where he served many years as an
army surgeon. His former studies on the filaria son-
guinis hominis did much to elucidate the pathology of
those organisms, and are probably known to many of
your readers.
While the story of the Greely Arctic expedition is sliD
fresh in our memories, another horrible tale of cannibal-
ism has just come to light. Three men and a boy going
from England to Australia in charge of a yacht, were
shipwrecked and drifted about in an open boat for nearly
four weeks. As a last resort they killed the boy, and
after drinking his blood ate his flesh. His heart and liver
were devoured while still warm. It is right to state that
the boy was apparently dying. They continued to eat
his flesh for several days, when they were picked up by
a passing vessel. There is no doubt whatever as to the
facts, as the men confess what they have done, and have
been arraigned for murder. None of the injurious eflfects
alleged to occur from cannibalism appear to have fol-
lowed in this case, as, despite their prolonged suflferings,
the men seem now to have recovered a large measure of
health. Much sympathy is expressed for them in their
present position.
Hospital Saturday has realized more than was at first
thought, and the total will be more than last year. The
workshop contribution is still very small.
The council of the Health Exhibition have handed
^4,000 to the Lord Mayor for distribution among the
London hospitals.
Mr. Netten Radcliffe has just died after a long illness.
He was well known as a sanitary worker, and was for
some time assistant medical officer to the local govern-
ment board.
Menthol Pencils. — These pencils or cones, whose
therapeutic value is very limited at best, have become so
popular that great adulterations or substitutions are ikow
practised. The ordinary oil of peppermint is probabl/
substituted for the menthol, in large part at least.
October ii, 1884.]
THE MEDICAL RECORD.
417
THE OPHTHALMOLOGIC AL CONGRESS IN
^ HEIDELBERG.
(From our Special CoRcspondenL)
MURIATE OF COCAINE AS A LOCAL ANiBSTHETlC TO THE
CORNEA— NO RADIATING MUSCULAR FIBRES IN THE
IRIS— ACTUAL CAUTERY IN SUPERFICIAL CORNEAL UL-
CERATIONS— OPTICO-CILIARY NEURECTOMY — IS CATA-
RACT THE RESULT OF CHRONIC BRIGHT'S DISEASE ? —
PROFESSOR ARLT AND HIS RECENT WORK IN GLAU-
COMA.
Kbbuzmach, Gebaiany, September 19^ 1884.
Sir : The usual Ophthalmological Congress in Heidelberg
has just closed its session, and a few cursory notes at
this early date may interest some readers. At this meet-
ing elaborate papers are not read, but condensed state-
Dients are presented of the subjects introduced. The
notable feature of this Society is that only new things
or new phases of old topics are presented. This is
not from any expressed rule, but is from the tacit under-
standing which controls men who are so diligently inves-
tigating the unknown in science as are these eager
workers. These men havie no patience with mere reiter-
ations. Perhaps the most notable thing which was pre-
sented was the exhibition to the Congress upon one of
the patients of the Heidelberg Eye Clinic, of the extra-
ordinary anaesthetic power which a two per cent, solution
of muriate of cocaine has upon the cornea and conjunc-
tiva when it is dropped into the eye. Two drops of the
solution were dropped into the eye of the patient at the
first experiment, and after an interval of ten minutes it
was evident that the sensitiveness of the surface was be-
bw the normal, then two drops more were instilled and
after waiting ten minutes longer there was entire absence
of sensibility, a probe was pressed upon the cornea until
its surface was indented, it was rubbed lightly over the
sarface of the cornea, it was rubbed over the surface of
the conjunctiva bulbi,and of the conjunctiva palpebrarum ;
a speculum was introduced to separate the lids and they
were stretched apart to the uttermost ; the conjunctiva
bulbi was seized by fixation forceps and the globe moved
in various directions. In all this handling the patient de-
dared (hat he felt no unpleasant sensation, except that
the speculum stretched the lids so widely asunder as to
give a little discomfort at the outer canthus. Before the
experiment his eye was shown to possess the normal
sensitiveness, and the other eye, which was not exi>eri-
mented on, was in this respect perfectly normal. The
solution caused no irritation of any kind, nor did it at
all influence the pupil. The anaesthetic influence seemed
to be complete on the surface of the eye, and it lasted for
about fift^n minutes and the parts then resumed their
usual condition. This first experiment was done in the
presence of Professor Arlt, of Professor Becker, of the
clinical siaffi of Dr. Ferrer of San Francisco, of some
other physicians, and of the writer. The next day the
same experiment was performed on the same patient in
the presence of the Congress and with the same results.
This application of the muriate of cocaine is a discovery
by a very young physician, or he is ])erhaps not yet a
physician, but is pursuing his studies in Vienna, where he
also lives. His name is Dr. KoUer, and he gave to Dr.
Brettauer, of Trieste, a vial of the solution, to be used in
the presence of the Congress by Dr. Brettauer. Dr.
K.oller had but very recently become aware of this nota-
ble effect of cocaine, and had made but very few trials
with it. These he had been led to make from his knowl
edge of the entirely similar effect which it has for some
year or more been shown to have over the sensibility of
the vocal cords, and because of which laryngologists pen-
cil it upon their surface to facilitate examinations.
The future which this discovery opens up in ophthalmic
surgery and in ophthalmic medication is obvious. The
momentous value of the discovery seems likely to prove
to be in eye practice of more significance than has been
the discovery of anaesthesia by chloroform and ether in
general surgery and medicine, because it will have thera-
peutic uses as well as surgical uses. It remains, how-
ever, to investigate all the characteristics of this sub-
stance, and we may yet find that there is a shadow side
as well as a brilliant side in the discovery. Professor
Kiihne, who in the Heidelberg Physiological Laboratory
worked out the details of Boll's discovery of the visual
purple of the retina, received the news of this new dis-
covery with the liveliest interest We may, i>erhaps, get
from him a further investigation into its properties. The
substance makes a clear solution, and is found in Merck's
catalogue.
Another notable statement came from Dr. Eversburch,
of Munich, as the result of very exact and elaborate
studies, to the effect that there are no radiating muscular
fibres in the iris ; in other words, that the dUator iridis
has no existence in man. It is found, he says, in some
animals, and especially in those which have oblong pupils,
whether vertical or horizontal, and in the form of fasciculi
at the extremities of the slit. He absolutely denies the
existence of such fibres in the human eye, and asserts
that the fibres hitherto described under this name are
nerve-fibres. These revolutionary assertions were re-
ceived with respect and attention, because the investi-
gator was known to be a careful and competent anato-
mist. If his ded:larations should be confirmed, and they
will not be lightly accepted, we must find out a new
theory for the active dilatation of the pupil. A good deal
of physiology will have to be cast into a new form. It
is true that the anatomical discussion has not been closed
on this point, but in favor of the existence of the dilator
stand the names of Merkel, Henle, and Iwanoff among re-
cent investigators. Eversburch has in his possession the
preparations of Iwanoff, who died a few years ago, and
he knows the nature of the contest into which he en-
ters.
The uses of the actual cautery in superficial forms of
corneal ulceration and in some other superficial pro-
cesses, especially in those of micrococcic origin, were dis-
cussed both here and in Copenhagen. There seems to
be a general consensus as to the usefulness of this treat-
ment in selected cases of superficial corneal disease, viz.,
in ulcus rodens, in superficial suppurative processes, in
atonic ulcers, and by Nieden in xerophthalmus. Nieden
will shortly announce his views in full in an article in the
Archives for Ophthalmology, He presented a most
delicate and elegant form of galvano-cautery which he
had devised, and to which he had applied a very delicate
and promptly acting key invented by Professor Sattler.
Another form of cautery is in use in the Heidelberg Eye
Clinic, which has been devised by Professor Becker, and
is a very small and utilizable Paquelin cautery. Both
these instruments can be handled with nicety and deli-
cacy, and without frightening the patient, and also in
most cases without giving him any pain. This treatment,
as well as the scraping of such ulcers by a sharp spoon,
as does Meyer, of Paris, is founded on tlie micrococcic
theory of the pathology of these processes, and marks
another forward step in ophthalmic therapeutics.
Optico-ciliary neurectomy as a preventive of sympa-
thetic ophthalmia has not passed out of practice, as to a
considerable degree has become the case among us. So
able an observer and logical a reasoner as Professor
Schweigger, of Berlin, recommends its performance and
holds it in higher esteem than enucleation. He divides
the internal rectus muscle to gain easy approach to the
nerve, and he lifts it from its bed by a sharp double
hook and excises lo mm. of it. He is said to be ex-
tremely skilful in this proceeding, and the very small dis-
turbance which he causes in the structures of the orbit
may perhaps explain the success which he has had and
the confidence which he expresses in its prophylactic
virtue. Among over a hundred cases which furnished
the material for his conclusions, in two cases he saw occur
in the opposite eye an acute neuro-retinitis, with opalescent
infiltration, etc. There was no reduction of vision either
central or peripheral. In two weeks the appearance
4i8
THE MEDICAL RECORD.
[October ii,
had entirely passed away without treatment. He regards
this inflammation as coming to pass, because neurectomy
had beep attended by unusual effusion of blood into the
sheath of the divided nerve — that this had obstructed the
lymph channels, and a process had thus been set up
which travelled around by the chiasma to the opposite
eye, and there expressed itself in a lymphatic neuro-
retinitis such as is well known to occur. The explanation
is very plausible. Another most peculiar observation
among his cases was, that in one of them the anterior
part of the eye was normal, and when the nerve was
excised the pupil at once expanded to an extreme
degree, more widely than it is possible for atropine to
produce. He put eserine into the eye and found that
by it the pupil at once became contracted, as is usual
with this drug. To this Professor Laqueur justly re-
marked that absolute proof was thus afforded that, as has
been before claimed, the action of eserine is not upon
the nerves of the iris, but is directly upon the muscular
fibres. A beautiful experiment in physiology was thus
made with conclusive result.
A most laborious statistical paper was presented by
Professor Becker to elucidate the question whether it is
true, as has lately been averred by Deutschmann, that
cataract is the result in many cases of chronic Brighf s
disease. To arrive at a trustworthy conclusion, Professor
Becker summed up the results of a most exhaustive and
exacting series of studies, first of patients with cataract,
whether they liad albuminuria; then of persons within
the limits of age when both cataract and albuminuria
chronica may occur, who were not aware of an^ trouble
of sight or of the kidneys, as to whether they might have
incipient cataract with or without kidney trouble, and
these persons he found in insane asylums, in poor-houses,
in retreats, and among the patients in his clinic and else-
where ; thirdly, he went through the records of 250,000
autopsies which had been made in Vienna of cases of
Bright' s disease, to see how often cataract had been noted
to exist. The hnal sum of this vast amount of labor was
treated according to the principles of the mathematics
of the doctrine of probabilities, and the outcome of it all
was found in the conclusion that Deutschmann was not
justified in his assertions, and that cataract cannot with
reasonable and just probability be declared to be an ef-
fect of, although it may occur with, degeneration of the
kidneys.
It was a delightful feature of this meeting, the presence
of the simple-minded and clear- thinking Professor Arlt,
who, because he had passed the statutory line of seventy
^ears, had been retired from the chair of ophthalmology
in Vienna two years ago. The loving and pious respect
in which he was held was delightful to observe. He rose
to his feet several times when clinical themes were being
discussed, and the range of his memory of facts and
cases, and his clear utterances, showed that the edge of his
intellect had not been blunted. As a proof of his mental
activity, he brought with him a treatise on ** Glaucoma,"
which had just come through the press and in which, in
[42 pages, he sets forth with characteristic clearness and
acumen, and with great wealth of knowledge both of
books and of cases, his views on this disputed theme.
Certain I am, from what I have read of it, and from con-
fidential and candid conversation with him, that we shall
owe to him much valuable instruction on this subject.
His views are sure to make a deep impression and to
gain wide acceptance. I hope the book may be elabo-
rately reviewed in some American journal, so as to get
the marrow of it in English.
It were hardly modest to speak of the kindly way in
which American visitors are treated in these meetings ; a
man afflicted with less than the average modicum, of van-
ity runs great risk of an acute exacerbation of his frailty,
while the average man with average self-esteem simply
loses his head.
With much regard, very sincerely,
Henry D. Noves, M.D.
A SUGGESTION TO ESTABLISH FREE BATHS
AND WASHING-HOUSES FOR USE DURING
THE YEAR.
To THE Editor op The Medical Rccoro.
Sir : In my reports to the New York Board of Health, dur-
ing the years 1868, 1869, and 1870, when I made a survey
of the Twentieth Sanitary Inspection District, in my ca-
pacity of Assistant Sanitary Inspector, I already advo.
cated the establishment of free baths as a sanitary measuie
for the improvement of the condition of the poor. Since
then free baths have been supplied by the authorities in
this city during the summer months, but no provision has
been made for this luxury during eight months of the
year, viz. : from.October ist, to about June ist. To sup-
ply this deficiency, I have recently again laid this mat-
ter before the Board of Health and the Mayor of this
city, who kindly approved and indorsed my views re-
garding the establishment of free baths and washing-
houses, and promised to co-operate with me to carry out
my suggestions, as far as lay in their power.
Regarding the usefulness of such institutions, for ob-
vious reasons, hardly anything needs to be said. But,
being a measure of general utility, as a preventive
against so-called zymotic diseases — which I would term
filth-diseases — I herewith make some suggestions as to
how the means could be supplied wherewith to provide
these establishments.
T. Part of the excise moneys could be used for this
purpose, besides private contributions, if the attention of
the public were called to the necessity of such buildings,
wherein the poor could bathe and wash their linen free
of charge. I am already assured by Mayor Edson, as
stated above, that as the head of the Board of Apportion-
ment and of all the city departments he would use his
influence for securing from the city the necessary build-
ing lots, whereupon these proposed establishments could
be erected.
2. The Legislature should pass a law — ^additional 10
the Tenement-House Law — whereby every owner of a
house should be taxed, say, one dollar annually, addi*
tional to the present taxes, for every tenant occupying
his house.
3. I would suggest that every emigrant coming to this
country should be advised, if deemed necessary by the
examining physician at the place of landing, to make use
of these cleansing establishments on entering the terri-
tory of the United States.
4. Every prison and police station and other public
institution should have a bath attached for the use of
the inmates.
5. The lower classes, employed by the city, county,
or State, should be requested by their superiors to avail
themselves of the use of the free baths and washing-
houses. Proprietors of large establishments, factories,
stores, stables, etc., would follow the example of the au-
thorities by employing by preference, all other conditions
being equal, clean and, therefore, healthier people. Con-
sequently a moral pressure could be exercised over ser-
vants and employes generally for their own good.
6. While I was stationed on the fi-ontier, and at other
military posts, as Post Surgeon in the United States Army,
I have often regretted the absence of baths, for the use of
the soldiers, connected with their barracks or quarters.
The United States Government would no doubt greatly
ameliorate the sanitary condition of our soldiers and
sailors by erecting free baths for them wherever prac-
ticable.
If means were provided by the public authorities or
philanthropists for facilitating the constant washing and
cleansing of persons and dwellings, I think we would
have less of cholera, yellow fever, and other epidemics of
filth- diseases, and the germs of many diseases would be,
in part at least if not effectually, eradicated.
In closing these remarks and suggestions, written for
the consideration and with a view of enlisting the co-
October n, 1884.]
THE MEDICAL RECORD.
419
operation of some of the readers of The Record, and
m bono publico^ I will only add that the plan of estab-
Usbiog cheap, though not free, baths and washing-houses
has been tried in London, £ng., within the past four or
five years I believe. These are situated in the following
parishes : (i) Paddington, (2) Marylebone, (3) St. Pan-
eras, (4) St. Giles, (5) Lambeth, etc. The general ar-
raogemenl there is : A private bath costs twopence
(about four cents) a head, including towels ; a higher-
class bath, twelve cents ; swimming bath, the same price ;
privilege of use of large room for washing, drying, iron-
ing, etc., at nominal rates. The baths are generally
self-sapporting and very extensive. Some houses have
several swimming baths, each swimmer having a separate
hox to dress in, etc. Rupolph Tauszky, M.D.
6<0 LSXIMGTON AVBNUB, NbW YoRK.
NO MEDICAL HISTORIES OBTAINABLE FROM
ST. LUKE'S HOSPITAL, NEW YORK.
To THK Editor op Thb Medical Record.
Sir : Will you be so kind as to publish the enclosed
correspondence, which speaks for itself.
1 was called to see a gentleman under the circum-
stances as stated in my letter, and believing that some
inforaiation in regard to his former sickness would ma-
terially aid me in his case, I addressed a communication
to Rev. George S. Baker, making inquiries to that end.
The enclosed letters are the one I received from him
and my answer. I think it should be known, to the medi-
cal community at least, that no physician can gain any
information in relation to a party who has been a patient
in St. Luke's Hospital.
Jos. P. FESSENDENy M.D.,
Member Medical Staffs Salem Hospital.
Salxm, Mass., October 4^ 1884.
P.S. — I thought it best upon the whole to ask you to
give place to the correspondence, instead of the public
journals.
St. Luke's Hospital, New Yokk, September ao, 2884.
Dr. J. P. Fessenden, Salem, Mass. :
Dear Sir : It is positively against the rules of tliis hos-
pital to communicate what we learn with regard to the
diseases of our patients to any one, save to the patients
themselves, if they request it, or to the District Attorney,
if he demands it for purposes of justice. We shall not
deviate from this nile in the case of Mr. B . Prob-
ably you are not aware that your own is the third letter
which has been written me on the same subject.
Yours truly, Geo. S. Baker,
Pastor and Superintendent,
Dear Sir : I was exceedingly surprised to learn from
your communication, received this morning, that no in-
formation relating to ihe sickness of a patient who had
been in your hospital could be imparted to the attending
physician of the patient after he left your hands. We
have an idea in this vicinity that we have some pretty
good hospitals, such as the
Massachusetts General and
Boston City, both of which
are ready to extend such
courtesies to the family physician and both of which
would receive the condemnation of the public if they re-
fused so to do. The patient, after an absence of six
jears, without any knowledge of him coming to his sister
during that time, suddenly appeared at her home (she is
a widow and in straitened circumstances), penniless,
poorly clothed, much emaciated, and mentally unsound.
I was called to see him and had and now have no doubt
bat that some information in regard to his sickness in St.
Luke's Hospital would aid me in the treatment of the
case. You are probably aware that any information con-
veyed by patient, family, or friends, is held sacred by the
attending physician, and you refuse positively to com-
municate such information for the benefit of the patient
whose welfare is entrusted to me. It seems to me to be
an unheard-of procedure. I do not know that the fact
that you have been written to, asking for information
three times, concerns me in the least, even did I know it,
which I do not.
If I can elicit ho facts from you, I shall publish your
letter in the New York papers, with an explanation in
regard to it. I think the public should be made ac-
quainted with such a rule of the hospital for its guidance.
Very respectfully yours,
J. P. Fessenden, M.D.,
Member Medical Staffs Salem Hospital.
Salem, Mass., September, 1884.
[It is difficult to understand upon what grounds any
public hospital can refuse to give to a medical gentleman
in charge of a patient such information as was solicited by
our correspondent. We should like to have some explana-
tion on this point from the hospital authorities. — Ed.]
^ew Ittstrumetxts*
A NEW NEEDLE FOR CONTINUOUS OR IN-
TERRUPTED SUTURE.
By G. WACKERHAGEN, M.D.,
BROOKLYN, N. Y.]
The under surface of this needle is grooved to within
three-eighths of an inch from the point, when the channel
is crossed by a narrow depressed bridge ; under this the
thread is passed, and returning over the bridge again falls
into the groove of the needle, thereby preventing ob-
struction to its passage through the tissues. There is
%:iX»KNMi liC^.
also an eye near the blunt end so that it may be used for
continuous suture.
The special advantage claimed for this needle is that
it is not necessary to remove *the needle-holder while
operating by interrupted suture. The needle having
passed through the flaps, the thread is caught by dressing-
forceps and the needle withdrawn.
A NEW BULLET FORCEPS.
By WILLIAM R. LEONARD, M.D.,
NEW YORK.
The accompanying cut represents a new and improved
bullet forceps. For the last twenty years nothing has
been done to improve the method of extracting bullets. All
instruments in use for this purpose up to the present
time are deficient in many respects, and are apt to slip
after they have engaged the bullet. The instrument here
presented consists of a steel cylinder inclosing a steel sty-
let riveted to two jaws, which are hinged and terminate
in short steel teeth, which take a firm hold upon any part
of the bullet by burying themselves in its substance.
The instrument is introduced closed. When the bullet
is reached the jaws are opened by turning the screw at
the proximal end, and the instrument is then pushed up
so that the jaws grasp the bullet ; a few tiums of the screw
bury the teeth in the bullet firmly and make it part and
parcel of the instrument.
420
THE MEDICAL RECORD.
[October ii, 1884.
Official List of Changfs in the Stations and Duties cf Officers
serving in the Medical Department ^ United Slates Army^
from September 28 to October 4, 1884.
Bentley, Edwin, Major and Surgeon. Granted two
months* leave of absence, with permission to apply for
two months' extension — to take eflfect upon assignment
to duty in the Department of Texas of .Surgeon F. L.
Town. S. O. 121, Headquarters Division of the Mis-
souri, September 30, 1884,
Bartholf, John H., Captain and Assistant Surgeon.
Assigned to duty at Fort Ringgold, Texas, as Post Sur-
geon. S. O. 129, par. 5, Headquarters Department of
Texas, September 25, 1884.
Crampton, L. W., Captain and Assistant Surgeon.
Granted leave of absence for one month and ten days.
S. O. 60, Headquarters Division of the Atlantic, Oc-
tober 2, 1884.
Gibson, R. J., First Lieutenant and Assistant Surgeon.
Assigned to duty as Post Surgeon, Fort Winfield Scott,
California, relieving Assistant Surgeon A. S. Polhemus.
S. O. 115, par. I, Headquarters Department of Cali-
fornia, September 23, 1884.
Polhemus, A. S., First I^ieutenant and Assistant Sur-
geon. Upon being relieved, to report to commanding
officer Fort McDermit, Nevada, for duty as Post Sur-
geon. S. O. 1 1 5, par. i. Headquarters Department of
California, September 23, 1884.
White, R. H., Captain and Assistant Surgeon. To
report to commanding officer Angel Island, California,
as Post Surgeon, relieving Assistant Surgeon C. K. Winne.
S. O. 115, par. I, Headquarters Department of Cali-
fornia, September 23, 1884.
Winne, C. K., Captain and Assistant Surgeon. Upon
being relieved, to report to commanding officer Benicia
Barracks, California, for duty as Post Surgeon, relieving
Surgeon C. C. Byrne. S. O. 115, par. i. Headquarters
Department of California, September 23, 1884.
Everts, Edward, First Lieutenant and Assistant Sur-
geon. Granted leave of absence for one month, with
permission to leave the limits of the Department. S. O.
145, Headquarters Department of Colorado, Septem-
ber 24, 1884.
Official List of Changes in the Medical Corps of the U. S.
Navy^ during the week ending October 4, 1884*
Stewart, Henry, Surgeon. Granted leave of absence
for one year, with permission to leave the United States.
October 15, 1884.
Edgar, John M., Passed Assistant Surgeon. De-
tached from the Nantucket and placed on waiting orders.
September 29, 1884.
Harmon, G. E. H,, Passed Assistant Surgeon. To
the Ifaval Academy. September 30, 1884.
Bertolette, D. N., Passed Assistant Surgeon. From
the Naval Academy to the Dolphin. October 4, 1884.
Rogers, Benjamin F., Passed Assistant Surgeon. To
the Naval Academy. September 30, 1884.
CooKE, George H., Surgeon. From the Naval
Academy, and placed on waiting orders. October 2,
1884.
Whiting, Robert, Passed Assistant Surgeon. From
the Naval Academy and placed on waiting orders. Octo-
ber 4, 1884.
Breakfast. — In the time of Henry VIII., the Queen's
Maids of Honor had each a chet loaf, a manchet, a
gallon of ale, and a chine of beef for their breakfasts.
What did they have for dinner ?
^edicaX |tmuB.
C0MTA010U8 Diseases — Weekly STATBMENT.->Re-
port of cases and deaths from contagions diseaies re.
ported to the Sanitary Bureau, Health Department, for
the week ending October 4, 1884 :
Week Ending
Cas4s,
September 27, 1884.
October 4, 1884
Deaths,
September 27, 1884.
October 4, 1884
13 I 3
13 o
I
O 0
O 0
LovAGE. — The levisticum of botany has, on Dr. John-
son's authority, a virtue in the relief of rheumatism. He
says: ''Take equal quantites of flour of sulphur and
flour of mustard seed, make them into an electuary with
honey or treacle, and take a bolus as big as a nutmeg
several times a day, drinking after it a quarter of a pint
of the infusion of the root of lovage. The relief is speedy
and lasting." But perhaps sulphur will answer alone.
Lovage, like sassafras, belongs to a large class of plants
contaming an essential oil, which have always been em-
ployed as carminatives, diuretics, emmenagogues, and
digestive stimulants, in flatulent dyspepsia, amenorrhoea,
dropsy, and rheumatism.
For Hvperhidrosis of the Feet Dr. Duhring has
used the following with good results :
15. Zinci oleati 3 ij.
Amyli,
Talci aa 3 Hj.
M. Sig. — Dusting powder.
This was applied to the feet after they had been washed
with a lotion of tincture of belladonna.
Thincs to Try. — Dr. Robert A. Reid, of Boston, in
his Eclectic Journal^ suggests the following " things to
try'* when ordinary measures fail: Try pop-corn for
nausea and vomiting of pregnancy ; try sun-bath for
rheumatism; try cranberry poultice for erysipelas; try
lager beer as a gargle for sore throat ; try eating fresh
radishes and yellow turnips for gravel ; ti^ eating onions
and horse-radish to relieve dropsical sweUmgs ; try taking
cod-liver oil in tomato cat.sup if you want to make it
palatable ; try snuffing powdered borax up the nose for
" cold in the head ;** try hard cider— one glassful three
times a day — ^for ague or rheumatism ; try breathing the
fumes of turpentine or carbolic acid to relieve whooping
cough ; try a cloth wrung out of 'cold water put about
the neck at night, for sore throat ; try planting sun-
flowers in your garden if you live in a malarial region
and the travelling is bad.
A Case of Rose Cold. — Dr. F. B Streeter sends a
history of a case of "rose cold," as suggested by Dr.
Mackenzie : " Mrs. William B , aged thirty-five years,
native of this State, of Dutch descent, married, and bar-
ren. With the exception of an uterine disease, which is
the probable cause of her sterility, she is in a fair state
of health. I first saw her some three years since. She
was suffering from an intense coryza, and attributed it
to the fact that while walking in the dark she had acci-
dentally brushed against a bush laden with full-blown
roses. She explained that she had been aflected thus
by roses since her childhood, and as she is a lady oi in-
telligence her case seems to be clearly one of ^ rose cold'
She has no catarrh or any other disease of the respir-
atory system, nor is she similarly affected by the pollen
of any other flower or plant."
The Medical Rec
A Weekly yournal of Medicine and Surgery
C#iCAL [%
rrr.-
CITY IIO^'^
Vol. a6, No. x6
New York, October i8, 1884
Whole No. 798
^trigiimX li^rttcleB.
CONTRIBUTIONS TO
THE ANATOMY OF THE LEMNISCUS.
^ITH RkM ARKS ON CeNTRIPKTAL CONDUCTING TRACTS
IN THE Brain.
By E. C. SPITZKA. M.D.,
nranasoK op nkuko-anatomy and physiology in ths new york post-cxad-
UATB UBDICAL ilCHOOL.
(Continued from page 3S^>)
II.
III. — ^The Component of the Lemniscus which
PASSES THROUGH THE InTEROLIVARY LAYER.
In the sequel it is my intention to discuss only a por-
tion of the axial fibre-systems which have been by vari-
ous authors ' designated as lemniscus, under that name,
leaving the critique of this designation to the concluding
remarks. In the lower (caudal) part of the oblongata
these tracts are found in such relations as to enable us
most readily to understand their connections with the
important spinal tracts, and the older authorities and
some of the more recent ones include the olivary fascicu-
lus, which is larger than the mterolivary layer.
A section made at the level indicated in the accom^
panying figure reveals the following prominent gray
stance surrounding the central canal, in whose distal por-
tions the hypoglossal and vagus (yago-accessorius?) nuclei
begin to appear ; fourth, the reticular gray substance in
»C
Fig. 3.
(ganglionic) substances : First, the nuclei of the columns
of Burdach and Goll ; second, the ganglionic substance of
the column of Rolando ; • third, the gelatinous gray sub-
*5»«IJt liie one in which the term is employed by Meynert in hi» last work,
rsychiame, Part I., which is over-amok, and evidently intended to just^ cer-
**?•?[• older and untenable views, whidi he seems disinclined to abandon.
"This contains three categories of ganglionic substance, viz., the convoluted
amnia corresponding to the gelatinous head of the posterior horn of the spinal
Sny, the subjacent paler staining spongy gray substance, and the intercabted
py istaads m the root itseli; conuinmg cells like those of the nuclei of Goll and
Bwdacfa. The absence of the gelatinous head in reptiles would seem to indicate
a rdaoon to one of the specialized forms of sensation, whether of conuct or tem-
perature, more likely the latter.
Fig 4-
the field intermediate to the bridge of gray matter (which
unites those nuclei which, for brevity's sake, I shall term
the nuclei of Goll, Burdach, and Rolando^, the central
gelatinous substance, ana the lemnis-
cus ; fifth, the olivary nucleus, which in
this level is represented only by that
portion which is known as the inter-
nal accessory olive {p) ; sixth, the small
nuclei interpolated in the external ar-
ciform fibres (na\ Of these various
gray substances the nuclei of Burdach
and Goll and the olive have relations
Ikttf to the lemniscus, thus indicating what
an extensive territory this fibre agglom-
eration occupies.
Surrounding on its medial and dorsal
confines the nucleus of Goll, and cap-
ping dorsad the nucleus of Burdach,
are the fibre-tracts of the columns of
the same name. As we proceed ceph-
alad we find that the mass of these col-
umns undergoes a gradual reduction.
In the main this reduction appears to
be effected by the entry of the fibres
into the nuclei. These are fielded off
by intersecting delicate fasciculi into nu-
merous subnuclei. The nearer the spi-
nal cord, the more compact (and smsdl)
is the nucleus of Goll {nucleus funiculus
gracilis) ; the nearer the middle of the
middle olivary altitude, the more scat-
tered and subdivided are its cell-groups,
and the more distinctly does it appear as if the whole
mass of the column of Goll broke through the nucleus to
separate into the strands of the internal arciform fibres
(Fig. 4). Much as the anatomical appearances suggest
the existence of a direct connection between the column
of Goll and the internal arcuate fibres mentioned, a
study of the phenomena of secondary degeneration does
not sustain the existence of such a connection as a
direct one.
In the case of secondary degeneration to which I have
422
THE MEDICAL RECORD.
[October i8, 1884.
aUndedf I found ^'that 'the fasciculi interpolated in the
nuclei of GoU and Burdach showed a reduction in size
on the side opposite to the degenerated lemniscus field.
The third and fourth figures accompanying this paper il-
lustrate this relation. In Fig. 3, the dark field Da^ Z>x*,
Z>y which represents the descending defeneration, con-
nects by diagonal raphe strands {Dr) with degenerated
arciform bundles {Darc)^ which pass into the degener-
ated fields Zyi, Zyi*, and -Q/j, and these in turn con-
nect with the degenerated intemuclear fasciculi in the
nuclei of GoU and Burdach.
The part of the lemniscus degenerated in the above
case corresponds to Flechsig's interolivary stratum.*
In a section of the level, shown in Fig. 4, this stratum is
L-shaped (the dark area D, Dsy Da\ consisting of a
vertical field (Z>) which fills up the interval between the
raphe (r), the internal accessory olive, and the pyramid
tract, and a nearly horizontal field {Ds) which lies be-
tween the halo of the denticulate (main) olivary nucleus
and the pyramid ; it extends with an angular swelling to
the point of emergence of the hypoglossal nerve-roots
Da (see corresponding designations of Fig. 3). Inas-
much as the degeneration can not be traced into the
tracts included in Burdach's and GoU's columns, but only
4nto the nuclei of these columns, it is to be inferred that
the latter are interpolated between two divisions of one
and the same tract. In other words, that the spinal col-
umns of GoU and Burdach terminate, anatomically
speaking, in their nuclei, and that from these '* inter-
rupting " nuclei a physiologically continuous tract arises
which passes through the fields /i,/2 (Fig. 3) into the
arcuate fasciculi (arc^ Figs. 3 and ^), decussating in the
piniform decussation,' and after crossing the median line
continuing brainward, in the interolivary stratum of the
oblongata and pons (/, Fig. 3).
As m cases of prolonged typical locomotor ataxia the
columns of GoU undergo secondary degeneration, it is
to be assumed that the essential primary lesion of that
disease affects the nutrition of those columns secondarily
either by the involvement of the posterior rootlets or of
the gray substance in which they terminate or through
which they pass.' The connection of the column of
GoU with the sensory nerves of the inferior extremity has
been positively established. It is evident, then, that the
column of GoU conveys brainward certain impressions
which occur in the posterior (inferior) half of the body.
It is exceedingly probable that those impressions which
are most regularly affected in locomotor ataxia, namely,
diose informing the subject of the position of his lower
limbs in space, which enable him to regulate their mus-
cular movements in conformity with the resistance to be
overcome, and which are ordinarily classed under the
head "muscular sense," are the ones conducted by these
columns. In order to become appreciated, however,
these columns must be connected with higher centres
than the nuclei of GoU and Burdach ; the regulation of
these movements which are most constantly affected in
locomotor ataxia, while not altogether removed from
cerebellar control,* is a function of the cerebral hemi-
spheres. It is evident, therefore, that after interruption —
for some thus far inscrutable purpose — in the nuclei of
Burdach and GoU, another tract must leave these sta-
tions to reach the cerebrum. This tract is the one just
described and visible in its decussation in Figs. 3 and 4,
that is, the interolivary layer of Flechsig.
Meynert long ago recognized the necessity of estab-
Ushing a connection between the posterior columns of
> From the supposed connection with Meynert*s stratum tHtermedium I ap-
plied that nsune to the interolivary extension. I have resolved for the present to
discontinue its emplojnnent, as the same designation has been employed in
such different ways by Wernicke and Meynert hunself.
sup-
■ Upper fine-bundled or sensory decussation of the pyramids of Meynert
* It has been lately shown that the columns of Clarke, which are by F lechsie __^
posed to have a reUiion to the posterior rootlets, are similarly involved m ad<
vanced cases of this disease.
^ On oomparinc a number of types of this disease it will be found that in some
the ataxia has an actual cerebellar character, hut in others noL In the latter the
same complaint found in cortical ataxia^ that distance is misjudged or the length
«f the limb or a segment of it seems increased or decreased, is made.
the spinal cord and the cerebrum. The method he foU
lowed in delineating his projection system was to take
physiological and pathological facts as so many guides in
the labyrinth of cerebral fibre-tracts, and then to fit the
demonstrable nerve-strands that happened to corre-
spond, as he supposed, to the required physiological
paths into the maps thus constructed. Knowing that the
posterior part of the internal capsule conveyed sensory
functions, and that the posterior columns of the cord did
likewise, he traced the required connection between them
through his so-called upper or sensory pyramidal decus-
sation into the lateral part of the pyramids, along these
into the lateral part of the pes pedunculij and thence by
an easy transition into the posterior division of the in-
ternal capsule. A diagram representing this supposed
tract is extant in Huguenin, whose work is in the mam a
popularization of Meynert's system, and in many places
evidently inspired l)y the black-board diagrams which
this great master of modern cerebral anatomy iUustrated
his lectures with.
Grossly erroneous as Meynert's representation just
detailed is now known to be, in many features it is cor-
rect ; and this has been (intentionally or uninteiitionally)
overlooked by those who have condemned his views.
It is a fact that the continuation of certain portions o(
the sensory tract from the cord to the brain decussates,
in the upper fine-bundled decussation called by Meynert
the "upper decussation of the pyramids." The view
held to-day differs from Meynert's chiefly in regard to
topographical nomenclature*: i. As the decussation m
question is not connected with the pyramid tract proper,
it is no longer called che upper " pyramidal " decussa-
tion. Flechsig's followers might perhaps term it the
** decussation of the interolivary stratum." In want of
any other brief designation, and recognizing that it could
no longer be considered a part of the pyramidal decussa-
tion, I termed it the piniform decussation.' Certainly it
resembles in section nothing so much as a fir-cone (Fig.
4, near r \ Fig. 3, near Dr). 2. Meynert was partly
correct in tracing the fibres of this decussation to the
lateral part of the pyramids, as these bodies were consid-
ered at the time he wrote his treatise. The pyramid
tract of to-day covers a much more limited area than the
one assigned to it by anatomists of the last decade.
Even Henle, who wrote after Meynert, represents them
as extending dorsad, between the raphe and the roots of
the twelfth pair, nearly to the floor of the fourth ventri-
cle, making them include the strata interolivaria and the
inner division of the reticular field of Mc3mert.* 3. Even
as the pyramids are demarcated to-day there is some
little justification for Meynert'^s theorem. Fibres frm
the nuclei of GoU and Burdach do pass into a field con-
nected with the true pyramid tract I expressed a sur-
mise to this effect in the description of the case of sec-
ondary degeneration repeatedly referred to in the course
of this paper. It was doubtful to me then whether the
fibres thus traced by their degeneration {Ds*^ Fig. 3) rep-
resented a communication of the interolivary and the
pyramidal tracts, or whether they were the fibres which,
leaving the pyramids, pass to the hypoglossal nuclei, and
(subjected to the pressure of the shrinking field of the
interolivary layer through which they passed?) under-
went a slight retrograde degeneration.' Opposed as this
latter alternative appeared to be by the general rule sup-
posed to govern secondary degenerations, it became defi-
nitely disposed of to my mind after a complementary
study of secondary degeneration of the pyramidal tracts.
Not only is it impossible to trace degenerated fibres io
the hypoglossal nuclei in any such situation as that indi-
cated by Ds*, but the very fasciculi within the pyramid
» Architecture and Mechanism of the Brain, Chicago Toornal of Nenwos sad
Mental Diseases, 1879, 1880, j-
« It is only on this assumption that his desipation of the mesal aocessonrow*
as a " nucleus pyramidalis ^' is comprehensible. ^^,
• A Coniribution to the Morbid Anatomy of Pons Lesions : being No^ ?«»
III., of Contributions to Neuropathology, based on researches cooduettj" "J
author's laboratory. Reprinted from the American Journal of NeoromT ■»
Psychiatry for November, x883.»!
October i8, 1884.]
THE MEDICAL RECORD.'^
•423
field which are affected in degeneration of the interolivary
stratum were found comparatively normal in a case of
intense double descending -, degeneration of the pyramid
tracts.^ Whether these fibres, after leaving the inter-
olivary layer, re-enter it, abandoning their intra-pyramidal
course, I am at present unable to determine. But the
fact here stated shows that -there was much more basis
for Meynert's view than . Flechsig seem to have been
aware of.
Flechsig assumes, for the sake of simplifpng matters,
that the fibres of the posterior columns which represent
the cephalic continuation of the posterior roots of the
spinal nerves abut in the nuclei of the columns of Goll
and Burdach, without committing himself directly to the
view that all of them do so. If we believe that the laws
of'secondary degeneration are invariable, that the course of
such degeneration is always in the direction of functional
transmission,* then, undoubtedly, the columns of Goll and
Burdach must terminate in the nuclei named after them,
with that portion of their fibres which, in my opinion,
represent Flechsig's interolivary layer continued down
Rafter nuclei interruption) ; for in my case of a secondary
degeneration of six years' duration not a degenerated
6bre could be traced beyond the nuclei, though these
themselves were atrophic.
In speaking of these fibres, Flechsig battles with an
imaginary opponent. He says,* " The view that the pos-
terior columns pass to the cerebrum chiefly through the
mediation of the interolivary layer (and the longitudinal
fibres of the reticular formation ?) has much more in its
favor than the view that the posterior columns are exclu-
sively connected with the cerebellum." He does not
inform us who announces such a view. The one gener-
ally held up to the time of Flechsig's writings, was that
of Meynert, who traced a part of the posterior columns
(correctly) to the cerebellum, and another portion to the
cerebrum, through his so-called '* tipper fine-bundled de-
cussation of the pyramids." Flechsig was destined to
confirm this view of Meynert's, with some toponomical
corrections above referred to, to demonstrate much more
satisfactorily than Meynert ever dreamed of doing that
this decussation embodied the continuation of posterior
column fibres, and to correct some erroneous details in
Meynert's scheme. All this does not justify his repeated
innuendoes against the latter on the one hand, and the
suppression of its meritorious features on the other. In-
deed, it would not be difficult 'to show that if Flechsig
does not owe to Meynert the hint which led to his follow-
ing the embryological method with such signal and ac-
knowledged success, he would be compelled to confess
to having had but an imperfect knowledge of the cerebral
anatomical literature extant when he undertook his great
work.*
The ** atrophy method," and the "development
method " of Flechsig have undoubtedly cleared up much
in the cerebral labyrinth which other methods were in-
adequate to imravel ; and if it be true, as I have repeat-
edly stated to my class, that the progress made in cere-
bral anatomy during the last ten years, quantitatively
speaking, exceeds that made during the previous one
hundred and fifty years, it is to these two methods that
the credit is chiefly due. But while recognizing the ser-
vice which Gudden, Flechsig, and their pupils have
done and are doing, it is not yet demonstrated that their
^ This I found to b« as described in sfwcimens of another's unpublished case of
descending degeneration of both pyramid tracts, and in a unilateral case of my
#wn.
• Which is not the case. » Plan of the Human Brain, p. aa.
^ For in the following lines is contained the suggestion and essential feature of
Fkcfasig's method, and one of his conclusions unperfcctly expressed ; indeed,
Flechsig knew of them, referring to them in his book ; recognizing that Meynert
IS the first to suggest that the development of myelin m the nerve-tracts was des-
tined to reveal important features of the development and structure of the central
nervous sjrstenu "The absence of the striae acusttci in all animals does not
mdicate an absence of its nervous bundles, but only the invisibility of these due to
thdr axis cylinders being unprovided with the myelin sheath. The development
of myeUn corresponds to the acme of cerebral evolution, hence their absence in the
new-born and their greater frequency, according to J. Engels, in the bodies of
adults. For the same reason the pes pedunculi of the new-bom is gray instead
•fwkiU. The Mnsimultanetms development of the medullary white in dijffer-
■**' Pnrts 0/ the brain is indeed a mast important subject ^or searching'
study " (Stridcer's Collection, vol. ii., pp. 770-71).
methods are as exact as their advocates allege. To
show the justice of this doubt it would suffice for me to
refer to the various controversies which Mayser and Forel,
on the part of the Gudden school, and Flechsig have in-
dulged in. The results derived by both methods ought
to be identical, if both were absolutely correct. They
differ, however, in some respects and several details ;
and notwithstanding that it has been implied — and par-
ticularly by one who has undertaken to interpret and re-
port the results of industrious continental laborers, after
a hurried visit to their laboratories — that the day of mi-
croscopic sections is past, I believe that neither the re-
sults of the atrophy method nor those of the embryonic
method should be accepted unless they are gauged by a
study of sections and made to harmonize with their rev-
elations.*
In order to show that those who have most severely
criticised Meynert, and at the same time most sedulously
belittled the extent of our indebtedness to him, are not
themselves free from errors, often far more serious than
those committed by that authority, I will refer for a
moment to the latest proclamations made by Flechsig
regarding the cerebellum.
Flechsig is undoubtedly justified in attaching great im-
portance to the peculiarities of tract development, ob-
served in a child born without a cerebellum. It is diffi-
cult to understand, however, how he can state : " This
brain united the advantages of developmental and degen-
erative differentiation of the central white masses, inas-
much as all fibre-tracts connected with the cerebellum
were absent or atrophic, while all others were developed
to an extent corresponding to the end of the period of
foetal life, being partly myelinic and in part amyelinic."
The cerebellum is too important an ingredient of the
central mechanism to be eliminated without producing
far-reaching defects in development -elsewhere. It is not
probable that the remote centres connected with the
cerebellum were, as such, normally developed ; the men-
tal disturbance noted with defective development of the
cerebellum is probably to be explained on the ground
that its absence is associated with other defects, indeed,
that it is only an intensified expression of a general defect
in cerebral development. This is the proper explana-
tion of the intellectual deficiency noted with cerebellar
atrophy, and not the wild and startling tentative sugges-
tion of Flechsig,* who asks whether the existence of the
commisural cortical gray of the cerebellum does not ex-
plain (by vicariation) the absence of mental disturbance
noted in cases where the corpus callosum is absent !
This suggestion exceeds in fancifulness, and in lack of
foundation, anything ventured by Meynert, who is harshly
criticised by Flechsig, but who rarely abandoned the
channels of logi il reasoning based on the facts as
known, or supposed to be known, in his day, to such a
grievous extent, at least not before Flechsig wrote.
It is an interesting and important question, one requir-
ing great care and a comparison of numerous anatomical
and experimental facts to determine, what qualities of sen-
sation are transferred to the brain by the piniform, or
upper (sensory) decussation of the interolivary stratum.
Wernicke " first formally considered the inconsistency be-
tween the well-known phenomenon^ of crossed hemi-
anaesthesia in spinal hemisection and the assumption of
a redecussation in the oblongata. Many who have neve r
published their doubts probably raised the above questio i
in their minds. More recently Starr * has reviewed th •
entire question and collected a number of valuable an I
not generally accessible cases, which justify his arriving rt
^ I refer here only to studies made on the human subject, when speaking of a*. -
tual discrepancies.
* Plan of the Human Brain, page 4a, foot-ndte. It may serve to show that the
day of speculation as to this terra incognita of hnin anatomy is far firom waning,
that while Flechsig suggests a possible vicariation of the cerebellum for deficiency
of the intellectual of^an par ejccellence, Starr* with all the well-established facts
elucidated by Flrchsig at his disposal, concludes that it is in part a centre con-
nected with vegetative life (The Sensory Tract in the Central Nervous System,
Alumni Prize Essay, College of Physicians and Surgeons, by M. Allen Starr).
* Lehrbuch der Gehimkrankheiten, ed.|I., x88i. Not in American hands till
1883. * Ix)c. cit., p. 52.
424
THE MEDICAL RECORD.
[October i8, 1884.
conclusions, as he supposes, very dififerent from those of
Wernicke and my own ; * my own position having been to
some extent misapprehended by Starr, as he has since
recognized in a note to the Journal of Nervous and Men-
tal Diseases^ in which his article appeared. With regard
to Wernicke, I think he has fallen into a similar misun-
derstanding. He 8a3rs that his results of a study ot cases
is opposed to the course of the sensory tracts as described
by Wernicke, for several reasons, among them, because
« these tracts are supposed to leave the medulla and to
pass by way of the cerebellum to the pons." The further
text of his article shows that Starr attributes to Wernicke
the view that all sensory tracts pass by way of the cere-
bellum, and none by way of the pons. In reality Wernicke's
position is very conservative, he discusses the entire
question, and concludes that there are several possible
channels by which sensory paths may reach the cerebrum,
which he details under the headings I. and II., A. (a and
b)y B. {a^ b, c). Of these, all but the first are enumerated
by Statr, who implies that Wernicke rejects the alterna-
tive under I., namely: a path of single decussation (running
through) the most lateral portion of fibres of the lateral
"motor" field of the tegmental part (of the oblongata and
pons), then above the exit-level of the trigeminus in the
neighborhood of the ascending trigeminus root, (situated)
in the spinal cord, in the ** lateral layer bounding the gray
substance," (then) "decussation in the gray substance im-
mediately above the respective posterior roots.*
I do not think that the language of Wernicke on page
262, where he discusses his own and Kahler's case,
necessarily implies the interpretation Starr has given to
it. If so, it is difficult to see why Wernicke should enu-
merate the above tract in his conclusions. He simply
discusses a number of " important considerations and
doubts," ■ which are encountered by him in his attempt
to consider the tract mentioned as the one. In the very
paragraph where he expresses these doubts he says that
'* there must be separate (distinct) sensory paths in the
oblongata," a conclusion at which I arrived some years
ago,* and which seems to me to-day to be the only one
that can be harmonized with those facts stated in the in-
roductory remarks of the present paper. Starr's con-
clusion as to the course of the tracts for tactile perception
repeats the hypothetical tract deduced by Wernicke in
very many particulars. The doubts which troubled Wer-
nicke are based on facts which have not been disputed
to this day. They are as much a subject for considera-
tion now as then.
The collection of cases made by Starr is accompanied
by the following conclusions (p. 61) : "Those sensory
impulses which have not decussated in the spinal cord
cross the median line in the sensory decussation of the
medulla, and pass upward through the interolivary tract
to the lemniscus, in which they ascend to the internal
capsule. These are the sensations included under the
term muscular sense." This proposition would seem to
be as well based as the dictum that lesion of the motor
tract in the internal capsule produces contralateral pa-
ralysis. The cases of K abler and Pick, Meyer, Senator,
and my own, cited, prove that lesion of one interolivary
layer produces contralateral ataxia ; indeed, in my case
the anatomical proof of the decussation — the degenera-
tion crossing in the direction of functional involvement —
was as complete as the clinical evidence. This fact is
furthermore in harmony with a statement of Brown S6-
quard, that in his puzzling symptoms of spinal hemisection
the muscular sense does not follow the rule of spinal de-
cussation, but suffers on the same side with the motor
function. If Ferrier's recent contradiction * of Brown-
> The Sensory Tract to the Fore-brain, note in the Chicago Medical Review,
July 13, z88z ; and Morpholos^ical Relations of the Cerebellum, ibid., July 5th.
• Wernicke : Loc. dt, vol. 1., p. 265, lines ia-17.
• ** Wichtige Bedenken/* *'Bedenken'' is best rendered as a mixture of ** reflec-
tion" and '*aouDt,*' for which there is no accurate equivalent in English ; it implies
« Architecture of the Oblongata, New York Medical Journal, September. i88z.
The view of separate tracts tor muscular and -tactile sense is expressed m this
articl«^ but has been much modified in detail since.
* He claims that the muscular sense path decussates in the cord.
S^uard's theorem stands, then we are in the same qoan.
dary as before with regard to the alternative stated by
Wernicke, that if the sensory paths all decussate in the
oblongata, they must redecussate twice in the cord, if the
facts of capsular and spinal hemianaesthesia are to be
harmonized.
Fig. 5.
As far as the tract we are now considering is traced
from the nuclei of Burdach and Goll to the anterior
(cephalic) end of the pons is concerned, our knowledge
is very satisfactory. Above this point it is involved in
some obscurity. Flechsig believes that a part of the
men '
%IS@» 7 He
IFiG. 7.
Fig. 6.
lemniscus, as far as I can glean, the one he believes to
correspond to our tract, passes directly into the interoal
capsule. This would appear to be the simplest solution.
Elsewhere he states that fibres derived from the puta-
and the nucleus caudatus, after coursing through
_ _ the internal capsule, pass
j^^Bfew^ ^rf-f^ff^ through the dorsal part of the
g- ■ ^^^^-m^^- ^'\ p^g pedunculi, being crowd-
against and pressed be-
tween the ventro-lateral pro-
cesses of the substantia nigra.
He considers it possible that
this fasciculus is connected
with the substantia nigra,
for a large portion of it be-
comes lost here. The remainder he traces cordward
as a ventro-medial accompaniment of the lemniscus
layer, and supposes that it is ultimately united with the
gray matter of the pons. This tract degenerates in the
descending direction when diseased in
the adult. Elsewhere * he speaks of
the same fibres as intruding themselves
between the lemniscus layer and the
raphe "lower down," and as leaving
the pes to enter the tegmentum. Cer-
tainly his first declaration, as to a prob-
able connection with the nucleos
pontis, is contradicted, not alone by
the second statement, viz., that it passes into the teg-
mentum, but also by the course of the tract as indicate
in his diagram, which is made to run quite parallel with
his " interolivary layer," and into it.
The interolivary layer of Flechsig is, according to him,
the continuation of the interolivary
layer upward. Two-thirds of this fibre
system is represented in that part of
the interolivary layer which is in im-
mediate contact with the olives. He
adds, with a query of his own, "aiid
Fig. 9. has no (?) connection with the upper
pyramidal decussation." This query was certainly a sav-
ing afterthought The secondary degeneration described
» The outer of the three (or four, and in some subjects five) " artknli " of the !«■•
tkular nucleus. ^ Plan of the Human Brain, p. so>
Fig. 8.
October i8, 1884.]
THE MEDICAL RECORD.
425
in a case of pons lesion by myself appears to dispose of
this question. In it the degeneration was limited to that
very portion of the interolivary layer, and the corre-
sponding half of the upper pyramidal decussation was al*
most entirely eliminated.
Another statement of Flechsig's demonstrates that he
has confounded the relations of the two divisions he
has made. He says the smaller division — that is, the
part remaining of the lemniscus after
the larger portion adjacent to the olive
is subtracted — is connected with the
upper p)rramidal decussation, and that
its fibres do not degenerate for any
distance downward." Now, it is the
very part which does connect with the
pyramids, but which lies adjacent to
the olives, which degenerates down-
ward (cordward) for its entire ana-
tomical extent, as shown in the dia-
grams and fac-similes on the opposite
page. Flechsig is also wrong in as-
serting that the greater part of the
lemniscus (two-thirds) degenerates
downward,* giving, as he does, the im-
pression that this is an invariable rule.
In my case the ascending degenera-
tion monopolized by far the larger lem-
niscus field, all of it, in fact, with the
exception of that innermost portion
which some authors fail to include in
the lemniscus proper, and an outer part
whose position is not well set « led.
Monakow produced descending de-
generation of apparently the same
field which Flechsig terms inter-olivary
layer, in the cat. As in my human
case, this degeneration underwent a
decussation, chiefly in the lower oli-
vary' plane and passed into the nuclei
of the columns of Goll, which, as in my case also, were
atrophic. Monakow's description ■ of this tract, which de-
generated after destruction of the parietal lobe,* following a
course through the external and posteriornucleiof thethal*
amus into the dorsal part of the subthalatiiic region, cor-
responds more closely to the appearances found in my
case than do any of Flechsig's delineations and declara*
tions. The correspondence between the results obtained
by the atrophy method in the cat, and previously by my
self in a case of secondary degeneration, herein repeatedly
referred to, are so close that I may be permitted to de-
tail some anatomical facts observed in the lion, the dog,
and the cat, in sections prepared by means of the bi-
chromate of potash hardening, microtome cutting, and
carmine staining methods, as bearing on the presumable
course of this part of the lemniscus tract in man. The
advantage of a study of these animals is that the pyramid,
pons, and pes are small, and particularly that the pons
fibres do not, as in man, crowd the tegmentum dorsad,
compelling certain of its tracts to follow as arched a
course as in man ; this is a source of much confusion to
the topographical anatomist.
In a section made flat-wise through the brain axis, that
is, parallel to the basi-cranial ideal plane, in the dog, the
intricate relations indicated in Fig. lo are exposed,' In
the latitude of the trapezium (23) a faint sagittal streak
»Loc dt^p. a6.
' In speakinif of the olive, I refer to the olive par exc^U^nct^ the one in the oh-
wnKMa ; tfie so-called *• upi>er olive," I term the nucleus of the trapeduto.
' Kxperimental Contributions to Our Knowledge of the ryramid and LemisiE-
ai« Tractm by v. Monakow, Correspondenzblatt f. Sdiweiier Aente, 1884, Nos* 6
and 7, per Mendel's Centralblatt, May i,. 1884.
^ Hot necessarily homologous with Uie same lobe in man.
•There is a comical resemUanoe between the figure wnen Inverted^ and <he
bead of a bull or bear, and when upri[|^ht that of an elephant. The former may
v^itate a topographical understandmg. The snout of the hull is ihe oiivt?-
pyramidal region, toe nostrils being represented by the m^iln or d tula re niicleua
«f the olive (a8), the eyes with the lids are represented by the nuclei of the tx^
PCBum or superior olives (aj, aa), the ears by the p0HUi brackiunt or middle
jwebdlar peduncle (aO, and for horns, lovers of the fanciful may tate their choice
Mtveen 17 and iq. The bulk of the head comprises the Erapcjium and pt>n&» tht^
nedc IS equivalent to the mesencephalo-crural region.
on either side indicates the interolivary layer fax), the
oblongata portion of which is seen (27) mesad of the
dentoliva (28). There appears to be a ganglionic inter-
polation between it and the major part of the lemniscus
(26). Now, instead of sweeping to the side in the pons,
lo pass into the L shaped lemniscus field of the mesen-
cephalon ^ the interohvary layer is seen to occupy a dis-
tinct field, buried in the nuclear substance of the pons
(15), and clearly traceable into a field which, containing
the roots of the oculo-moCor nerve (7), must lie ventrad
of the ocLilo-motor nuclei, indeed, very near the basis
cruris. This fit;ld {5, 6, 7, 8, 9, on the left side) is one
that has yet to be studied. It would appear to pass, in
part directly, in part indirectly, into the internal capsule
(so, r, 15, indicating the course of the outer part of the
crus toward it). A direct fasciculus is seen at 11* Be-
sides the direct tract from the interolivary layer (15, 9)
it receives fibres from the inverted forceps-shaped field
(14), Whether all the fibres continue uninterruptedly
through the entire extent of the large area covered by
this section cannot, of course, be determined. But the
appearances are very much that way. The intimate
connection between the pyramid tract and the inter-
olivary layer, which I indicated, finds its repetition in
an apparent anastomosis of pedal fibres with the inter-
olivary continuation upward (the unnamed pale field
crossed by pointer 14 on the right side, symmetrical to
end of pointer 8)* The relations of this part to the sub-
stantia nigra is interesting, but the main part certainly
passes through without interruption.
In the human brain, owin^ to the causes mentioned,
the relations arc not so sim]>le. The appearances are,
however, against the view that the interolivary layer
passes exclusively into the field known as the lemniscus ;
the bundle from the pes to the tegmentum appears lo be,
in part at least, connected with it. In Fig. 11, which
represents a section taken in a plane, slightly raised dor-
sally in front, as compared with Fig, 10, the interolivary
layer is shown in as complete a continuity as it can be,
without preliminary distortion of the brain axis. It is
here seen that the interolivary lay er, beginning just above
the pyramid decussation at e^ passes on either side of the
raphe « r, b^ a) detaching (apparently) fibres (at 7 and 6),
which, moving out more and more laterad (5), reach the
lemniscus field of the mesencephalon (4). But the fibres
426
THE MEDICAL RECORD.
[October i8, 1884,
hugging the middle line do not pass into this field at a^
they dip ventrad apparently ; this is the locality where
so much confusion prevails, which can be cleared up by
filling in the required gap with the tracts 9 and 14 of
Fig. 10.
Fig. zi.—Section in Basilar Plane of the Brain Axis of a Sj'philidc Subject. (Autopsy and case by Prof. James
L. Little.) The numerals i to 7 relate to the lemniscus tracts in ffeneral : the letters a to /, to the mesal contin-
uation of the interolivary layer, bundle from pts to tegmentum of Henle (see Part ID: ///, posterior part of
third rentricle: C.post,^ posterior commissure ; Aq, Gr,^ gray matter surrounding the aqueduct : //, habenu*
lar bundle : mi t and a, tnalamic laminse ; **, unnamed tract, firom analogy with a and 4 of Ki^. 10, possiU^
the capsule seeking j»art of the interolivary (muscular sense) tract ; pl/.^ fKMterior longitudinal fasciculus : C
cerebu,^ Gratiole^s direct &sciculus firom the cerebellum to the cerebrum : *• iu cerebellar origin (nearly) ; Tegntt.
_ . ,. . Tegmtt.
Br. X.^ Wemekinck's commissure (?) decussation of tfgmenta brackium {brackium c^mt'tmcthmm) ; Pant.
'the seventh and eighth cranial
r nucleus ; />r. A'., decussation of trua
cranial nerves ;
,., „ , C#IK/«I
Br.^ pientis brackium^ middle cerebellar peduncle ; rad., roots of the seventh and eighth
Oi. int,, internal accessory olive; OL dent.^ dentate or main olivary nucleus ; Fyr, JC., Ate
pyramids ; pointer 5 is in Uie direction of the transverse pons fibres, a thin veneer of which has been cut.
The almost direct passage of the main part of the lem-
niscus toward the internal capsule is well seen at 2 and i.
If my surmise as to the equivalence of the unnamed
tracty indicated by the double asterisk, with those indi-
cated by the numerals 2 and 4 in Fig. 10 be correct, it
becomes comparatively easy to complete the channel of
the muscular sense. In the accompanying section from
a monkey (Fig. 12 ') the numerals 9 and 8 indicate this
tract exposed lengthwise ; its direction is clearly to the
parietal lobe. It becomes apparent how Meynert could
erroneously trace this bundle to the occipital lobes, in
less fortunate sections, inasmuch as it closely skirts the
optic radiation of Gratiolet. The direction of the main
(lateral and middle) part of the lemniscus is indicated by
1 For this animal as well as the lion, I aai indebltd to Dr. Cooklin of the General
Park Zoobgical Department.
the numerals 25, 27, and 28. If, as is surmised, the tract
for muscular sense (9, 6) separate from the cutaneous
tract (25, 27) in its course through the medulla and pons,
becomes united to or intermingled with it in the thalamo-
lenticular division of the capsule, we can readily under-
stand why all qualities of sensation
would be affected in capsular be-
mianassthesia, while they may be
separately involved in the pons and
oblongata. The close proximity of
the former and the motor tract 10
would be consistent with the fre-
quently overlooked disturbance of
the muscular sense in hemiplegia.
The tract-course here supposed is
I consistent with v. Monakow's ex-
frf wr periments, and justifies the designa-
^ tion of Rinden-Schleife (cortex lem-
nisais), which he has given the in-
terolivary tract
As satisfactory as the picture of
the interolivary layer is in sagittal
jft/w/lfiVji^ sections taken through its pontine
course, as difficult is it to identify
every corresponding area of that
course in transverse sections. In
sagittal section, the stratum inter-
medium (interolivare) is a beautiful
arched fasciculus, covering Gall's
ligne de separation already referred
to (Part II.). At one point it does
not appear to adhere to that line,
but to be broken up, and where not
broken up to take a more dorsal
course. This portion, however, re-
sumes the characteristic relations in
the caudal half of the pons. The
deviation corresponds to a gangli-
onic intercalation described by Rol«
ler, which is reticular, like a trellis-
work. It is found at the point
where the tegmentum is most re*
duced in its dorso-ventral diameter
(owing to the exclusion of the teg-
menta brachium and the inferior
cerebellar peduncles from this field).*
In transverse sections at this level
a distinct field is seen, dorsad of
and encroaching on the trellis-work ;
it extends to the raphe and overlaps
the mesal end of the horizontal
lemniscus field ; this is probably the
(diverted) dorsal part of the inter-
mediate tract.
Every specimen in my possession
indicates that a large part of this
fasciculus becomes lost in the sub-
stantia nigra. At the same time a
portion continues directly forward
as in the dog. This part has been
regarded by Wernicke * as a bundle from the pes to the
lemniscus. It is accurately represented in Figs. XIII., 50,.
52, and 53 (pip')j but there is a curious inconsistency..
In Fig. 48 he represents this fasciculus as giving oflf the
most anterior transverse pons fibres, as if it exhausted
itself in their formation, while in the level above and be-
low this one he has the fasciculus divided transversely
and occupying identical situations. He has undoubtedly
confounded it with another bundle in this section. This
bundle, correctly named by Wernicke, lies on the latero-
dorsal aspect of the prepontine fossa, where the pes is
free of the pons, it occupies the slope on each side of
the interpeduncular depression. As Wernicke in Fig.
> The projectioii'system of the brain axis is reduced here, through the
to the cerebellum of certain tracts from above and bdow.
•Lehrbucfa.
r .
hi
October i8, 1884.]
THE MEDICAL RECORD.
427
XII* (ix 39) terms a bundle occupying a correspondini^
situation the ansa lenticularis (Linsenkernschlinge), it is
possible that through the intervention of this fasciculus
Fig. la.— Section Diagonal to the Sagittal Plane, Deviating Laterad above, through a Monkey's Brain.
(X »X') '» post-coniu ; a. 4, optic radiations of Gratiolet (hemianopsia tract) : 3, comu ammonis ; 5, tail
of caudate nucleus {cauiiex corj^ris stria ti) ; d, 9, muscular sense tract (?) : 8, to, posterior part of
volunnry motor tract (the reader must not be misled by its apparent relation to the posterior part of the
lenticular nucleus, which is not touched in this section and extends, avoiding this plane, mudi farther
bock)*: iz, la, lenticular nucleus (putamenand middle articulus) : 14, optic chiasm : 18, ao, as, lemniscus,
Sdds : aa, direct myelo-cerebellar tract : a^ dentate nucleus of cerebeUum ; a6, geniculatum mtemum :
7, geniculatum externum ; ay, radiations of lemniscus into thalamic laminx.
it reaches the higher destination. The optical appeax-
ance of the two bundles in their designable course is dif-
ferent
(To be continued.)
CORYZA VASOMOTORIA PERIODICA ("HAY
ASTHMA ") IN THE NEGRO.
Wrra SOME Remarks on the Etiology of the Disease.*
By JOHN N. MACKENZIE, M.D.,
SUBCBON TO THE I'ALTIMORK SVB, BAK, AND THROAT CHARITY HOSPITAL.
The absence of so-called '^ hay asthma " in the negro has
been brought into prominence by recent writers on the
subject, and notably by Beard, as an argument in favor
of the important rdle which race is supposed to play in
the etiology of the disease. The following case derives
its peculiar interest from the fact that, so far as I am
aware, it is the first recorded instance of the afiection in
a race in which the possibility of its occurrence has been
denied.
J. M , aged thirty-five, unmarried, a tall, well-
proportioned, respectable colored man, came, September
6, 1884, to my clinic at the hospital to be treated for
"hay asthma." His history may be briefly summed up
as follows : He has always been remarkably healthy, with
the exception of a tendency to catch cold upon exposure
to the most trivial exciting causes. Ever since his ear-
liest recollection, the emanations from hay have invari-
ably excited a coryza of great severity, lasting from three
to seven days and then subsiding. Handling hay at any
season of the year, or even unpacking articles enveloped
in straw, always bring on sneezing, lachrymation, flushing
of the conjunctivae, and obstruction of the nostrils. For
the past four years has had an almost constant sensation
of " stufl^ness " in the nostrils, with dyspnoea on exertion
accompanied by a slight posf-nasal discharge, and the
attacks of coryza have become much more frequent and
have been associated with distressing asthma.
The attack is ushered in sometimes by a tickling or
itching sensation in the upper and back portion of the
throat and nose, sometimes by violent sternutation. The
> Read before the Clinical Society of Maryland, October 3, 1884.
nostrils become suddenly obstructed, a* profuse watery
discharge is excited, the eyes become red, swollen, and
painful, and the lids slightly puffed. There is always in-
creased lachrymation. Cough is some-
times present, but forms an unimpor-
tant feature of the paroxysm. In a short
while, generally in the course of an hour,
the asthmatic symptoms supervene. The
extreme dyspnoea thereby produced ren-
ders him perfectly helpless. The asthma
is worse at night, so that during the pe-
riod of his attack he gets very little sleep,
the dyspnoea often amounting to or-
thopnoea. The latter is relieved after
an hour or more by violent sneezing, fol-
^i lowed by a copious watery discharge from
the nose. After this he falls asleep, to
be awakened in a short while by another
attack of asthma, which is in turn re-
lieved by sternutation. He sleeps ha-
bitually on his right side, with the head
elevated. This state of affairs lasts
from the second week in August to late
in September, when the coryza and asth-
ma disappear, leaving him m a state of
nervous prostration and with a slight
nasal discharge. During the period of
" cold " the apex and sides of the nose
frequently become excessively vascular,
and the skin is cast off as die disease
subsides. During the past four years,
the paroxysms have been increasing in
severity, the present attack having com-
pelled him to give up his position as a waiter in one of the
hotels of the city. The disease may come on at any season
of the year, if he is exposed to its exciting causes, but he
rarely suffers between April ist and the second week in
August. At the latter period he never escapes. Among
the exciting causes in his case, apart from the emanations
from hay, are exposure to sudden atmospheric changes,
coal dust, the use of tobacco, the inhalation of tobacco
smoke, and the greasy smell of the kitchen. The dust
from cleaning various articles, dusting carpets, door-mats,
etc., invariably provokes coryza. The odor or presence
of flowers, light, and diet have no effect at any season of
the year. He has never had any symptoms referable to
a disordered nervous system before the appearance of the
asthmatic feature of his disease. Since then has become
restless and irritable and is subject to attacks of nervous
debility.
The only relief he has ever gotten, apart from the
natural termination of the paroxysm by sternutation, has
been from the inhalation through the nostrils of the
fumes of some proprietary pastils.
Physical examination, — No disease of lower respiratory
apparatus. Simple congestion of nasal and lower phar-
ynx. Posterior extremities of the lower turbinated
bones engorged, swollen, bright red, and covered with a
translucent film of mucus. Posterior nares symmetrical.
Hypertrophic enlargement of the erectile tissue of the
posterior part of septum on right side. Anterior extremi-
ties of inferior turbinated bodies slightly swollen, bright
red, and present the appearance of two little rounded
prominences jutting out from the outer half of the nasal
floor. The interval between them and the middle is
considerable, and the latter are remarkably prominent,
running in an oblique direction from behind, upward
and forward. Septum straight, face S3rmmetrical. The
mucous membrane covering the anterior end of the
middle turbinated body especially swollen, but the swell-
ing can be readily reduced with the probe, the action
awakening no reflex.
Systematic exploration of all accessible portions of
the nasal chambers with the probe gave rise to no re-
flex except at one spot. Along the inner edge of the
left inferior turbinated body, about one and one-fourth
428
THE MEDICAL RECORD.
[October i8, 1884.
inch by measurement within the nostril, the most ex-
quisite paroxysm of ctsthma followed the simple contact
of the exploring probe. The sonorous and sibilant rilles
were loud enough to be heard in the adjoining room.
The conjunctivae became flushed, painful, and covered
with tears, and a thin watery discharge accumulated in
the nostrils. These symptoms lasted for a few moments
and passed away, leaving the condition as described
above.*
My views in regard to the predisposing and exciting
causes of the disease popularly known as *' hay asthma,"
have been given in a condensed form elsewhere,' and
the design of the present article is to supplement these
by calling attention to some additional facts derived
from personal study of the affection.
While the majority of cases that apply for treatment
come from the educated classes, and from those of fair
intellectual development, it must not be forgotten that it
is precisely this class that seek intelligent medical ad-
vice, or are likely to come within the range of circulars
distributed by those investigating the complaint. Look-
ing upon the disease as, to all intents and purposes, a
coryza, generally dependent upon abnormal excitabilitv
of the vaso-motor centres, it does not seem to me justi-
fiable to confine the operation of its causes within the
limits of a particular century, or to explain its phenomena
on the hypothesis of national or race peculiarities. I
meet with it at all ages and in every condition of life, in
private and in hospital practice. I find it more com-
mon among women than is generally supposed, and am
inclined to think that the question of sex is one of un-
important etiological significance. 1 have twice observed
the disease in several members of the same family, and it
is possible that a peculiar excitability or deranged condi-
tion of the vaso-motor system may descend from father
to son, and detennine the appearance of the affection in
the latter ; bu: it is difficult to say how far the influence
of inheritance, as originally suggested by Wyman, enters
as a factor into its causation.
In the majority of cases that have come directly or in-
directly under my observation, the paroxysms are induced
by a variety of agencies differing entirely in their character
and mode of operation. In others there is apparently
only one exciting cause. The latter may be in operation
only during certain periods of the year, or may provoke
an attack, without regard to season, whenever applied.
It may be said, in general, that the exciting cause may
produce its effect, (i) by direct or indirect (reflex) irrita-
tion of the sensitive nerves of the nasal mucous mem-
brane; (2) through olfactory impression (so-called
•* idiosyncrasy " of olfaction); or (3) through simple
association of ideas ; or the same result may be brought
about (4) by ph3fsical or mental overexertion, or (5)
emotional excitement.
Typical paroxysms occur in some persons at any sea-
son of the year, from sudden changes in the temperature
or from electrical disturbance of the atmosphere, and so
far as my observation goes, a prominent position should
be accorded to meteorological conditions among the ex-
citing causes.
Pollen is only one of a host of exciting causes, and
there is reason to believe that in some cases in which it
is supposed to be the excitant, it has little or no influence
at all. The paroxysm may be produced as a reflex
phenomenon from irritation of a distant organ,' and a case
has been brought to my notice by a distinguished medical
friend, in which the ingestion of a few grains of quinia is
sufficient to produce a group of symptoms which, if they
were excited by smelling a rose, would be called " rose
> The Mnsitive tpot was destroyed by a stellate incision with the small knife of
the galrano^autery. On the night of the operatiOD the patient had a slight attadc
of asthma, which passed off, however* in the course of an hour. For the next five
days he enjoyed perfect immunity from the disease. He then went on a fiiiting
expeditioa with a oarty of gentlemen, and the first night out contracted a violent
cold in the head trom sleeping on the damp ji^und, and with the corysa the at-
tacks of asthma returned. At the present writing treatment has been suspended
until the attack of cor>'a subsides.
. * This journal, July 19, 1884. * See paper referred to above.
cold." More accurate observations are necessary to the
formulation of definite conclusions concerning the oc-
currence of this disease in the inferior races. While it is
doubtless true, that the physical and moral forces of
civilization encourage its development in the higher
walks of life, they probably do so only in so far as they
predispose to abnormal excitability of the nervous system
in general, or to catarrhal and asthmatic afiections.
In the black race, the exquisite delicacy of the sense
of smell, the prominent development of the turbinated
bones, and the consequent increased amount of surface
exposed, would seem to invite the paroxysm in those
surrounded by the conditions that provoke it. I have
several times met with reflected phenomena in the negro
referable to disease of the nose, and belonging to the
same category of reflex affections ; and it is possible that
a fair proportion of cases of the convulsive asthma which
occur in that race may have a similar origin.
While the above case is the only instance of the oc-
currence of the disease in the negro that has come under
my personal observation, it is quite possible that, if looked
for, it may be more frequently found.
DANGER FROM PLASTER-OF-PARIS JACKETS.
Wfth a Description of the Woven-wire Jacket.
By SAMUEL W. SMITH. M.D.,
NBW YORK CITY.
In the science of medicine, as in other sciences, there is
a tendency to follow certain recognized plans or systems
of procedure, to the ignoring; of original methods, and a
tendency to forget that while all may have advantages,
and promise good, all must have in some case disadvan-
tages that tend to evil. This fact has been forcibly iin-
pressed upon my mind in the use of the plaster-of-Paris
jacket in cases of Potf s disease of the spine.
The following cases will illustrate my meaning :
Case I. — Daisie D , aged seven. Born of healthy
parents, her own health was good until she reached her
fifth year, when it was observed that she constantly rested
her head upon her hands when not at play. She soon
became very irritable, and refused to play with other
children. At this time she was taken to the family phy-
sician who discovered an angular curvature of the spine,
including the last cervical and first and second dorsal
vertebrae. In the course of time a Tiemann & Co.'s splint
with jury-mast was put on. The child did well and re-
turned to its amusements as usual. Within about a year
the child had grown so much that the splint could not be
worn without a slight change being made in it. At this
time the patient came under my care for a bronchial af-
fection, which disappeared after appropriate treatment of
two or three weeks' duration. In accordance with the
advice of friends she was taken by the parents to a sur-
geon of this city, by whom a plaster-of-Paris jacket was
substituted for the Tiemann & Co.'s splint. For a day or
two the child appeared to be quite as comfortable as with
the former apparatus, but within a week I was again
called to see her. I found her suffering from capillary
bronchitis. The attendance of the surgeon who had pot
on the plaster jacket was requested by me, and he at
once removed it On the third day the little patient died
of capillary bronchitis. My own opinion is, that the pri-
mary cause of death in this case was due to the sudden
cooling of the body of the child which was effected by the
hardening and drying process of the plaster composing
the jacket.
Case II. — Nellie R , fourteen years of age, fifom
Connecticut Came to the Demilt Dispensary in the
spring of 1 88 1, suffering from lateral curvature of the
spine. Bom of healthy parents ; her own general bealdi
good ; no bronchial disease. I put on a plaster-of-Paris
jacket and ordered daily exercise with the pulley and
chin support. In three weeks she returned to my office
October i8, 1884.]
THE MEDICAL RECORD.
429
suffering from a severe bronchitis, loss of appetite, and
irritable cough. I removed the jacket, and in a few
weeks the patient returned entirely recovered from the
bronchial difficulty. I then applied a second jacket, do-
ing so at my office, where die room was properly warmed
to prevent the likelihood of " catching cold." In two
months she returned and informed me that during all
this time she had suffered from a troublesome cough ;
but so anxious was she to get rid of her deformity, that
she had preferred to endure the cough rather than have
the jacket removed ! However, I removed it, and or-
dered a corset, made over a slight untempered steel
frame, and covered with firm material, something after
the plan of Professor L. A. Sayre's spinal wire cor-
set. The corset was easily made by taking the removed
plaster jacket and filling it with plaster prepared for the
purpose. This gave me a complete cast of the deform-
ity. The suspension treatment
was still continued, and with the
greater ease and comfort of the
corset, my patient steadily im-
proved. The bronchitis and
cough disappeared in a short
time.
During my service at the De-
milt Dispensary several other pa-
tients to whom I had applied the
plaster jacket gave me the same
kind of trouble ; so that about
two years ago I abandoned the
use of it, excepting in such cases
of Dispensary patients as were
unable, through poverty, to pay
for the corset In all cases in
which I was thus obliged to use
the plaster jacket, I opened the
front and so arranged it that re-
moval at bedtime could be easily
accomplished, as also the replac-
ing of it before arising.
The corset which I.have used
instead of the plaster-of-Paris
jacket can be made of any strong, pliable material, over
the untempered steel frame ; but that which I have
more recently had made is of light tinned wire, interwo-
ven in the iron frame, and shaped over the plaster cast
of the deformed patient. Professor F. H. Hamilton's
" Wire Gauze,Hip Splint " suggested to me the use of the
same material -for my corset. It is easily arranged for
the use of the jury-mast when needed, by means of screw
loops on the two steel rods which give support to the
back. The legs of the jurj-mast having slits in them can
easily be made fast by a screw.
In addition to the disadvantages of wearing a plaster-
of-Paris jacket for consecutive months, alluded to above,
it seems but reasonable to suppose that by this long-con-
tinued pressure of the chest walls, their natural growth
should be stunted, their capacity for lung expansion much
lessened, and a road laid out which may lead on to
phthisis.
40 Wbst Twenty-fii-tii Strkkt,
Back View"of Corset. ;
Treating Tape-Worm with Chloroform. — Dr. I..
E. Borcheim, of Atlanta, Ga., writes that he has treated
two patients suffering from taenia solium, with chloro-
form, etc., according to the method of Dr. J. G. Brooks
(Medical Record, Vol. 26, Nos. 4 and 11). In both
cases he was unsuccessful. The patients complained of
feelings of intoxication, the pulse rose, purging was brisk,
but no tape-worm. On the other hand. Dr. N. S. Dar-
ling, of La Forte, Ind., states that he administerec^ after
a Oast of twenty-four hours, chloroform 3 j., with castor-
oil 5 iJ-> to an adult male, with the result of expelling a
tape-worm thirty-seven feet in length. The head, it is
believed, was brought away with the mass.
A CURIOUS INJURY FROM A PITCHFORK.
By a. A. ELLIOTT, M.D.,
STEUBBNVILLB, O.
On August 19th I saw, in consultation with Drs. G. A.
Shane and J. F. Whittaker, the following case :
William P , a farmer, thirty years of age, weighing
about one hundred and fifty pounds, muscular develop-
ment good, while sliding from a hay- mow came in con-
tact with a pitchfork which was standing tines upward
against the contents of the mow. One of the prongs
penetrated the right hip, at a point behind and on a level
with the greater trochanter, and broke off close to tjie
socket.
Found him lying on the porch of the house, to which
he had been taken, complaining of severe pain in his hip,
abdomen, and back, and greatly frightened. On exami-
nation we found a penetrating wound in the right hip,
and just beneath the surface a metallic substance was
detected and removed, being the lower portion of the
fork-tine, one and three-quarter inch in length, and fit-
ting accurately at its larger end, the stump remaining on
the handle. Measurement of the remaining tine showed
it to be thirteen inches in length, leaving about eleven
inches yet to be accounted for.
The patient complained greatly of his back, and a view
of it disclosed an enlargement on the right side of the
spinal column in the lumbar region, which was exquisitely
sensitive. This apparent swelling showed no bruising or
evidence of recent contusion, and inquiry elicited no
history of its existence previous to this time.
We proceeded, under an anaesthetic, to further explore
for the missing steel, and found the direction of the wound
to be upward, inward, and forward, and succeeded in fol-
lowing its track for about five inches with a probe, but
without detecting any foreign body, nor could we by en-
larging the wound and making deep pressure determine ,
its presence.
He was allowed to come out from under the influence
of the ether in order to get the benefit of his sensations
under our manipulations, and his thigh was flexed on his
abdomen, deep pressure again made, together with ab-
duction and adduction of the thigh, producing no increase
of pain in any region.
After several hours he was again etherized, and the
most critical examination made in the wound and by the
rectum, and the swelling on the back laid open and
thoroughly explored ; all to no purpose, and the wounds
were left unclosed and dressed with water dressing.
The case resolved itself into the following conditions :
I. Head of the fork-tine penetrated and lodged in the
body of the man ; if so, could it be removed ? 2. If in
his body, had it penetrated the pelvic cavity or was it
buried in the dense muscular structure of the hip ? 3.
Could it be possible that the first portion of the tine had,
by the force of the falling body, broken off and by its
elasticity flew away, and, the fall being unbroken, the
fork again came in contact with the body and penetrated
with the remainder? These questions were taken up
and concluded upon : i. There was no positive evidence
furnished by the examination that the tine was lodged in
his body, and, were it positive, an operation for its re-
moval would involve a dissection of the muscular struct-
ure of the hip, and perhaps an opening of the abdominal
cavity, both under the circumstances unjustifiable opera-
tions. 2. The abdominal pain was taken as suspicious
at least, and the bladder and rectum had not as yet acted,
leaving their injury in doubt. 3. The possibility of this
condition was acted upon, and the bam most thoroughly
searched for the missing tine, but it was not found.
We now concluded to leave the case to nature, and
the patient went on doing well, his bowels and bladder
performing their functions normally. After a few days,
when his fright had subsided, he remembered that the in-
jury to his back was of lon^ ago, and always gave him
trouble, and that his abdommal pain had preceded the
430
THE MEDICAL RECORD.
' [October 18^ 1848.
injory several days and had been accompanied with diar-
rhoea, which continued. The wound in the back healed
kindly, but the one in the hip continued to discharge
profusely, and in the fourth week the whole limb became
swollen, and later fluctuation was detected below the
sore, which increased in size and extended down the pos-
terior aspect of the thi^h^ and on October ist, forty-
three days after the accident, it (the tine) was removed,
large end first, from the upper portion of the popliteal
, space. It was eleven inches in length.
The tine was evidently lodged either in the hip or had
penetrated the pelvis, the heavy end being depend-
ent, and the muscular action produced by the patient's
walking across the floor daily caused it to descend and
appear as described.
Since its removal he is doing well, and the indications
are that he will make a good recovery.
SOME REMARKS ON THE ASSOCIATION OF
i. TUBERCULOSIS AND ACUTE PNEUMONIA.
By EDMUND C. WENDT, M.D.,
CURATOR TO ST. FRANCIS HOSPITAL, NEW YORK.
The highly interesting case of tuberculous pneumonia,
reported by Dr. Kinnicutt in the last issue of The Rec-
6rd^ prompts the writer to offer a few remarks on the
sjmchronous occurrence of tuberculosis and pneumonia,
particularly so as a case came under his observation four
years ago, which was, in some respects at least, similar
to the one observed by Dr. Kinnicutt. The writer con-
sidered it at the time a rather puzzling instance of rapidly
fatal croupous pneumonia, of an atypical kind. Having
occurred before the era of the bacillus tuberculosis and
the pneumonia-micrococcus, it will scarcely seem, in the
light of our present knowledge, or at least widespread
belief, a case observed with sufficient scientific accuracy
to warrant any concise deductions. But it should not be
foiFgotten that, despite the rapidly progressive researches
of positive experimental pathology, the entire subject of
pneumonia, and for that matter of tuberculosis as well, is
still a debatable one.
The writer's case, then, is to be regarded merely as a
casuistical contribution to a subject of universal interest
to the profession in the past, the present, and, it is to be
hoped, the future.
Quite briefly stated the case was as follows : A. M ,
male, aged tliirty-six, married, the father of healthy
children, himself the chDd of healthy parents, was seized
with a rigor on a Monday, in March, 1880. He posi-
tively denied any previous serious illness, but admitted a
tendency to " take cold " easily during changeable
weather. He also stated that he had lost one sister
from phthisis, at the age of twenty-two. Soon after the
chill the patient developed the signs of croupous pneu-
monia on the right side, which soon spread throughout
the entire middle and lower lobes. It was thought to
be even encroaching on the upper lobe, when, on the
third day, after the rigor had marked the incipience of
severe illness, he suddenly died. Clinically the unusual
signs had been an excessively high temperature (io6f°
to 107° F., in the rectum), associated with a pronounced
typhoid condition. On the last day of his illness the
patient also became intensely jaundiced.
At the autopsy the right lung was found hepatized in
the middle and lower lobes. The hepatization, however,
was grayish only in a few places, the prevailing color
being a dark maroon. In the upper lobe, there was
merely moderate congestion, some firm old pleuritic ad-
hesions, a few slate-colored nodules with chalky centres,
and a rather abundant crop of miliary tubercles. Besides
this there were in both lungs quite a number of purulent foci,
resembling the well-known multiple abscesses of pyaemia.
The left lung was congested, oedematous, and showed
in its upper lobe a condition quite similar to what ob-
tained on the right side, ^except that there were relatively
fewer miliary tubercles and purulent collections. The
latter in no instance exceeded in size that of a cherry-pit.
The abdominal organs were in general much cbngested,
especially the spleen, which was soft, large, and pulpy.
The liver was found in the first stage of icteric hepatitis.
The intestines were only moderately hyperamic, other-
wise noritoal. The common bile-duct was easily per-
vious. The brain was not examined. There were no
miliary tubercles in any other organs, save those already
mentioned, viz., the upper lobes of both lungs.
The questions that suggest themselves in this case, as
well as in the one reported by Dr. Kinnicutt, are these :
Was there a latent unrecognized tuberculosis upon which,
as a suitable soil, a fatal croupous pneumonia became
engrafted? or was there rather a primary lobar pneu-
monia, that afforded a fertile soil for the rapid develop-
ment of acute tuberculosis ? Without stopping to weigh
arguments pro and contra, the writer would simply stale
his belief that in his own case the tuberculosis preceded,
for weeks or months, the pneumonia ; but that the latter
would not have proved so rapidly fatal without the coexist-
ence of the former. In Dr. Kinnicutt's case the se-
quence of events seems less clear. And it is much to be
regretted that the microscopical examination of the spu-
tum failed to make matters any clearer.
One thing may be learned from these cases. If croup-
ous pneumonia is an infectious disease, caused by the in-
vasion of a specific micro-organism, and if pulmonary
tuberculosis similarly depends upon the entrance into the
lungs of peculiar bacilli, then it follows that the growth
and multiplication of these two typical and vastly dis-
similar varieties of germs within the same organ, so far
from being mutually antagonistic, may be reciprocally
stimulating, and thus prove doubly dangerous to the host
carrying the parasites.
In conclusion, the writer may be permitted to suc<
cinctly refer to a case of so-called *' mixed infection
through tubercular bacilli and pneumonia-micrococci,"
which was recently reported by Dr. Samter (Berliner
Klin, Wochenschrift, June 23, 1884), and which seems
to have escaped Dr. Kinnicutt's notice.
A weak and marantic-looking old man, aged sixty-five,
was admitted to the Posen hospit^ on March 13, 1884.
The patient had a slight, innocent-seeming cough, and
a physical examination led only to the diagnosis of senile
bronchitis. The patient improved visibly at first But
on April 19th he began to complain of great weakness,
and showed an increased tendency to cough. His tem-
perature, however, was below the normal. The scanty
viscid sputum resembled somewhat that of ordinary lobar
pneumonia. Microscopical examination, however, elic-
ited the interesting fact that, in addition to the abundant
presence of tubercle bacilli, the sputum contained a few
of the characteristic micrococci of pneumonia. The
physical signs of the latter affection subsequently became
more marked, and the patient died in a few days from
heart-failure. From the record of the post-mortem ex-
amination the following points, having a direct bearing
on the subject under discussion, may be cited : In the
apex of the left lung there were some old cheesy de-
posits, the entire right lung was intensely congested and
in the first stage of^neumonia.
Scattered throughout all the lobes of this lung there
was found an abundant crop of recent miliary tubercles,
but not a single cheesy or purulent mass was discover-
able in that lung. In the small intestine numerous ul-
cers existed, but there was no evidence there of miliaiy
tuberculosis. It would seem, therefore, that this case
resembled my own in several important respects. Dr.
Samter is inclined to believe that his patient had latent
tuberculosis ; and further, that a sudden invasion of the
specific germs of pneumonia wrought such changes in al-
ready damaged lungs that, an acute miliary tuberculosis
was lit up where before there had only existed the slowly
smouldering process of chronic tuberculosis.
In the light of the experience of his own case, the
writer would fully concur in the above opinion.
10a East Fifty-skventh Stkbbt, October 14, 1884.
<v:;:»r : • /• • i-'; '
October i8, 1884.]
THE MEDICAL RECORD.
431
fr00r«B« at P^jetf ijcal ^jcience.
Adynamic Dilatation of the Stomach. — Dr. Enrique
de Argaez has lately published a niODOgraph on the above
subject (Paris: Asselin & Co., 1884), which embodies a
few novel points touching the pathogenesis and treat-
ment of this interesting disease. In typical cases the
author has usually found, on inspection, abnormal prom-
inence of the epigastrium, and, more rarely, visible
peristaltic movements of the stomach. The varying
quality of resonance obtained by percussion over the
colon, the small intestine, and the stomach, enables the
observer to define the boundaries of the dilated organ.
Succussion yields a characteristic sound, due to the simul-
taneous presence of g;as and liquid in the stomach, and
sometimes a metallic tinkling. M. G^main S^e, in whose
service, at the H6telDieu, most of the cases observed
by Dr. de Argaez were observed, finds proof of the ex-
istence of adynamic dilatation in the presence of gastric
resonance at a distance greater than twelve or fifteen
centimetres beyond the left mamillary line, or the pres-
ence of the gastric succussion sound six hours after eat-
ing. Under the head of symptomatology the familiar
phenomena of epigastric pain, flatulence, emesis, and
constipation are described. The principal causes of the
dilatation are general weakness, disturbed local innerva-
tion, and excessive ingestion of aliment. The differential
diagnosis involves the exclusion of gastralgia in ataxic
patients, whose stomachs are not, however, found dilated,
and of gastric ulcer. In the latter disease, blood, either
pure or partially digested, and presenting the familiar
coffee-ground aspect, is often present. This feature is al-
ways absent in atonic gastric dilatation. Other diseases
to be excluded are alcoholic gastritis, fibrous stenosis of
the pylorus, and carcinoma. In pyloric stenosis, whether
of a benign or of a malignant character, the entire con-
tents of the stomach are rejected by vomiting, which is
not the case in adynamic dilatation. Under the head of
treatment the author suggests a diet calculated to leave
no undigested residue in the stomach, such as eggs, and
tender meats, moderate exercise, gentle laxatives, and
the use of Kussmaul's pump and Fancher's siphon- tube,
to evacuate the distended stomach. The gastric pain is
best relieved by chloroform, administered in small doses
by the mouth, and by the continuous galvanic current.
The author is in the habit of placing the positive pole at
the centre of the epigastrium, and the negative over the
sternum. The current is allowed to pass ten or twelve
minutes at each sitting.
Why Negroes are Black. — Surgeon-Major Alcock
has contributed to Nature a communication on the reason
why tropical man is black, in which he suggests that, as
in the lowest animals pigment-cells placed behind a trans-
parent nerve-termination exalt its vibration to the highest
pitch, the reverse takes place when, as in the negro, the
pigment-cells are placed in front of the nerve-termina-
tions, and that the black pigment in the skin serves to
lessen the intensity of the nerve-vibrations that would be
caused in a naked human body by exposure to a tropical
sun. In fact, he thinks that the pigment plays about the
same part as a piece of smoked glass held between the sun
and the eye.
The Treatment of Psoriasis. — In the treatment of
psoriasis, Professor Neumann, of Vienna, recommends
arsenic in the form of the so-called *' Asiatic pills," which
are composed thus : Arsenious acid, gramme i.o ; black
pepper, grammes 5.0; acacia gum, gramme 1.5; with a
sufficiency of distilled water. The ingredients must be
thoroughly pulverized and mixed, then enough gum arabic
must be added to make two hundred pills. Each pill con-
tains 0.005 gramme of arsenic. These are to be taken
each day at first, and gradually increased till ten or twelve
are taken. The soft-soap course, as an external remedy,
in the form of the ** Pfeuffer'schen Cyclus," is strongly
recommended in cases^of universal psoriasis, and is thus
carried out : The patient, undressed, is )aid between
blankets and is rubbed twice a day for six days, and once ^
a day for three more days, with the ordinary soft soap^ one
hundred grammes being used each time. The rubbing is
conducted in such a manner that the whole of the affected
skin is well rubbed each time, and, at each application, a
fresh portion is rubbed in with a hard brush in such a man*-
ner that the surface commences to bleed. The patient
remains in woollen cloths night and day, and on no ac-
count is bathing allowed till the fourteenth day, and the
longer this is delayed the more easily will the dried skin
and soap be separated, and the less pain and sense of.
stretching will be experienced. In case the bath is taken
too early, the skin will feel too short and tight, movement
will be difficult or impossible, and rhagades are very
likely to occur.
Essential ANiEMiA. — Dr. Rosenbach, of . Breslan
{Deutsche Med, Wochenschrift), points out three charac-
teristics of this disease, i. It recurs at certain seasons
of the year, so that we can distinguish a spring, a summer,
and an autumn form. Cases occurring in winter are ex-
tremely rare, and those belonging to the height of sum-
mer seem to be the most severe. 2. A peculiar craving
for acids is displayed by the patients, which must not be ,
supposed to indicate merely a deficiency of hydrochloric
acid. in digestion, as any other acid, and even fresh fruit,
may supply the want. The desire for acids ought to be
gratified, as it is the assimilation of the patient that is at
fault, and the organism instinctively demands what is
needed. 3. Instead of feeling strongest in the mornings
the patients are at their best in the late afternoon and
evening, or sometimes even far into the night Their
desire for food follows the same rule, and it is best to let
them eat at the times when they feel most appetite, irre-
spectively of ordinary meal times. It is also of no use to
try to ensure brightness and freshness in the morning
by making them go early to bed, as they do not sleep
until their time of feeUng strong has passed oS. They
ought to be as much in the sun and fresh air as possible,
but ought not to fatigue themselves with walking. The
anaemia of puberty is not included in these remarks. Dr.
Rosenbach has found that the prognosis of the cases of
essential anaemia is more favorable when the weakness
and want of appetite are periodical, than when the
patients are always tired, and refuse all kinds of food'
alike.
Medicinal Treatment of Habitual Constipation
— Dr. Mortimer Granville, in -the British Medical Jour- .
nal^ gives three prescriptions for habitual constipation.
Where there is a lax and torpid condition of the muscular
coat of the intestine, the following is recommended :
3. Sodas valerianatis, gr. xxxvj.; tinct. nuc. vpm., 3j. ;
tinct. capsici, TTlxlviij.; syrupi aurantii, Sjss. ; aq. ad
3 vj., I ss. ; water half an hour before meals. Where
there is a deficiency of glandular secretion throughout
the intestine the following is useful : ft. Aluminis, 3 iij. ;
tinct. quassiae, |j.; infusi quassias, ad |viij. ; f j. after
meals. A third form of ^constipation, which depends
chiefly on interruption of the natural habit of periodic
discharge, is benefited by directing a regular attempt to
go to stool, and to take the following draught the first
thing after rising from bed : Ammon. carb., 3 j. ; tinct.
Valerianae, 5J-; aq. camph. ad 5 vj. ; take a sixth part
as directed
Generalized Sarcoma of the Skin Cured by Sub-
cutaneous Injections of Arsenic. — Generalized sar-
coma of the skin occurs very rarely. Professor Kobner's
patient {Berliner Klinische lVochenschrift\ was a girl
eight ana a half years of age. The tumors, which were
exceedingly numerous, existed over the whole surface of
the body, except the nose and abdomen. They were
bluish-red in color, and mostly of the size of a lentil to a
split pea. They were hard and almost painless on
pressure. The larger ones were of the size of a haricot
bean. The lymphatic glands were swollen, and the liver
432
THE MEDICAL RECORD.
[October .18, 1884.
and spleen were slightly enlarged. There was no fever^
but a feeble appetite and generally defective nutrition.
The diagnosis was confirmed by an examination of two
tumors which were e^tciscd for that purpose. The treat-
ment adopted was subcutaneous injection of Fowler's
solution of arsenic, diluted with two parts of disnlled
water to one of the solution. A dose equivalent to two
and a half to four drops of Fowler's solution was injected
daily ; and between September 12 th and December 9thj
eight grammes of Fowler's solution had been injected* It
had been necessary to occasionally suspend the injections,
so that in three months only fifty injections had been
made. From December i oth the dose of Fowler's solu-
tion was raised gradually to nine drops (diluted always in
proportion). The result of the arsenical treatment was
ihe gradual dispersion of the tumors^ and the diminution
of the enlarged lymphatic glands. Pigmented spots ex-
isted for some time over the seat of the tumors, and in
November (1882) the skin had become pliant and
smooth. Only on the legs were there some small papules
of lichen pilaris, and a very few similar papules on the
arms. All the cicatrices had become pale, and on the
limbs in particular a great number had entirely disap-
peared.
Warts.— In a course of lectures on dermatology, re-
ported in the Medical Ntws^ Dr. Uuhring says that ver-
niers, or warts, either hard or soft, consist of variously
sized and shaped papillary formations. Verruca vulgaris^
or common wart, occurs about the hands, especially on
the fingers. Verruca plana^ or flat wart, is found on the
back and about the shoulders. Verruca filiformis^ con-
sisting of a thin thread like formation, is encountered on
the eyelids and neck. Verruca digiiaia^ a broad excres-
cence with finger-like processes springing from the bor-
ders, is found upon the scalp. Verruca acuminafa^ also
called cauliflower excrescence and venereal wart, is a
pinkish, violaceous, or bright-red fleshy vegetation occur-
ing usuallj' about the genitalia of either sex, and often
accompanies venereal disease, being caused by purulent
secretion or excessive heat and moisture* It may also
occar independent of any venereal disease. It takes on
various forms, and, as a rule, appears like the head of a
cauliflower or a cock's comb. It consists of a proJifera-
lion of the epidermis, the development being rapid ; the
papilla? of the corium and the corium itself are also greatly
hypertrophied, and the blood-vessels dilated, rendering
the growth exceedingly vascular. The most satisfactory
treatment of these growths is excision, and cauterii^ing
their bases. The galvano-caustic ligature, chromic or
nitric acid, or acid nitrate of mercury may be used. The
oleate of arsenic is also said to act very- well. In the
treatment of venereal warts astringent lotions together with
some dusting powder are highly useful. The writer has
ein ployed with satisfaction the method of touching these
warts with nitrate of silver and covering with absorbent
cotton,
Chronu: Intestinal Catarrh.— Professor Noth-
nagel, at a recent meeting of the Royal and Imperial
Society of Physicians at Vienna {Wiener Med. B/dUer),
spoke on the subject of chronic intestinal catarrh^which he
said had been but little mentioned in text-books. There
is also no explanation given, in physiological manuals,
of the fact that healthy individuals have generally only
one stool in the twenty-four hours, Nothnagel thinks
that no explanation can be given, but that it is one of
those arrangements, depending partly on the anatomical
relations of the parts, and partly on innervation, for which
we cannot account. Chronic intestinal catarrh may be
considered to be present when uuicus appears in the
motions, although the absence of mucus must not be re-
garded as conclusive evidence against the existence of
catarrh, Nothnagel divides the cases of chronic intes-
tinal catarrh into four classes i i. Those patients who
have a stool every second or third day, often produced
artificially ; this is the type of primary chronic catarrh of
the large intestine, and depends, accordiDg to Nothnagel,
on diminished anatomical activity of the ganglion-cells.
2. Cases where a stool is passed daily, but each time thin,
pulpy, and mixed with mucus. 3. Cases with irregularity
in the state of the bowels, sometimes constipation, some-
times diarrhcea, and sometimes an alternation between the
two ; the diminished activity of the nerve-cells explains
the constipation, and the irritation of the faeces causes
eventually the diarrhoea^ which may also be excited by a
very small error in diet- 4, Cases with continued diar-
rhcea. Here, however^ chronic ulceration of the bowels
must be distinguished from catarrh. Where diarrhoea is
present without ulceration of the large intestine, Noth-
nagel has always found an afi'ection of the small intestine
as well. When the food does not undergo its normal
changes in the small intestine, it acts as an irritant on the
mucous menibrane of the colon, and causes the diarrhoea.
Some patients have a stool after each meal, some after a
mid-day meal only, and some after an evening meal only.
Nothnagel would explain this by referring it to nervous
influence*
Freckles, — Freckles, or lentigo, may sometimes be
made to disapt>ear by an application of citrid acid night
and morning. The method employed by dermatologists,
and attended with considerable success, is to apply a
solution of corrosive sublimate, one to three grains to
the ounce of water, or emulsion of almonds night and
morning. Dr. Duhring reports. the latter as the most
satisfactory^ and advises its application until a slight
^nount of desquamation takes place.
Loosen iNG of the Teeth. — Dr. Sewill, British Med-
ical Journal^ alludes to a disease which appears to be
on the increase at the present time, and is characterized
by a chronic wasting of the alveoli. The symptoms com-
nvence with inflammation of the free edge of the gums
and the alveolar periosteum. The gums and alveoli
slowly waste until the teeth are lost. The teeth are
commonly of good structure and free from caries.
There is in many cases deposits of tartar on the denuded
surface of the root, and beneath the swollen and loos-
ened margin of the gums. As a rule, several teeth are
affected at the same time. The disease commonly
shows itself about middle life. It sometimes accom-
panies diabetes, and also gout, and cases of debility and
an.^nua. The treatment consists in periodically removing
the tartar, and swabbing the necks of the teeth beneath
the loosened gums twice a week with pure carbolic acid.
Foreign Bodies in the Bladder. — In the "Mittheil-
ungen aus der Chirurgischen Klinik zu Tiibingen " is con-
tained a paper on foreign bodies in the bladder, based on
thirteen cases that have been treated in the Tubingen
clinic in the course of the last thirty years. The term
foreign body is used in a restricted sense, so as to ex-
clude stone and such bodies as are formed within the
organism. In by far the most cases the foreign body
enters the bladder by the urethra. According to the sta-
tistics on this subject published in 1856 by Denuc6, of
Bordeaux, males and females constitute the subjects of
this injury in almost equal numbers. In males, the for-
eign bodies are most frequently pieces of stalk or straw,
wire, lead-pencil, and in females any of the different
forms of needle and needle-case. The female patients
are for the most part young, while most of the men are
advanced in years. In six of the thirteen cases recorded
by the author of this iiaiier, the foreign body had passed
into the bladder by the urethra. The patients in three
cases were males, and aged resi)cctively, forty-five, forty-
nine, and fifty-four. Of the three females one was aged
sixteen, one twenty-four, and the last twenty-five. A
much smaller group is that of cases in which the foreign
body consists of a broken and detached piece of some
surgical instrument, as, for instance, a catheter, bougie,
or sound, a lit hot rite, caustic-holder, etc Catheters of
German-silver become very fragile after having been
kept long, and ought not then to be used. Of elasdc
October i8, i884,]
THE MEDICAL RECORD.
433
catheters and boiijB^es, Nilaton's catheter of vulcanized
caoutchouc, after it has been kept long unused, becomes
extremely fragile, while the ordinary elastic bougies be-
come dan|;erous only after frequent use and prolonged
retention m the bladder. Gutta-percha catheter s^ it is
pointed out, are particularly dangerous. In niu^t of the
cases of this group the accident is owing to a fault rather
of the patient than of the surgeon, and is the result of
loo frequent and prolonged use m catheterization of a
worn-out instrument. The author's list includes five of
such cases. In two instances the foreign body was the
end of a metal catheter, and in the other three the end
of an elastic catheter. The second way in which foreign
bodies may reach the bladder is through a wound in the
wall of this organ. The injury in such cases is either a
penetrating or a gunshot wound The penetrating
wound through which the foreign body is passed ts usu-
ally caused by some blunt instrument driven into the
bladder from the perineum or anus. The retention of
foreign bodies in the bladder occurs much n)ore fre-
quently after gunshot wounds. Of zS^ cases of gunshot
wound of the bladder collected by Bartels, St were
complicated by retention of foreign bodies, consisting
of portions of the fire-ami, or a fragment of bone, or a
small portion of the clothing. Associated with the
above injuries are those rare instances of ruptured blad-
der complicated by fracture of the pelvis, in which one
or more loose fragments of bone are driven into the vesi-
cal cavity.
The third and least frequent way in which a foreign
body ckn reach the bladder is through a pathological
communication between the bladder and neighboring
organs. The foreign body in such cases is usually some-
thing that has been swallowed, and has ultimately passed
into the bladder from the ileum or rectum after adhesion
and ulceration of their walls. By perforating ulceration,
also, foetal remains of extra-uterine pregnancy, sequestra
from necrosis of the pelvis, and the contents (teeth, hair)
of dermoid cysts of the ovary, have penetrated into the
bladder. The foreign body is seldom expelled sponta-
neously by the urethra. Of 391 cases of foreign body in
the bladder collected by Denuc6, 13 only terminated in
this way. In 2 of the 13 Tubingen cases there was a
spontaneous discharge. The foreign body in one case
was a long piece of metal catheter which had been four
weeks in the bladder, in the other a straw. The foreign
body, after prolonged detention in the bladder, becomes
invariably incrusted with linie<salts, and may form the
nucleus of a vesical calculus. Small and round bodies
are soon completely incrusted, while long Lhin bodies
are incrusted only in the middle, and are quite free at
their ends. If a fragile body, a straw for instance, be
broken up in the bladder, each of the fragmenis may
form the nucleus of a distinct stone. The rapidity of
the incnistation and the si^e of any calculus that may be
formed depends on the nature of the substance forming
the nucleus. Vegetable material becomes rapidly in-
crusted, and of hard materials silver and gold and glass
are less readily incrusted than iron. Beyond this in-
crustation and formation of stone, the presence of a
foreign body in the bladder very seldom gives rise to any
special complication. In six only of the many cases col-
lected by Denuc6 was death due to the direct action of
the foreign body on the wall of the bladder. Some few
instances have been recorded of the foreign body in the
bladder of the female having penetrated into the vagina.
The surgeon having assured himself of the presence of
a foreign body in the bladder, it becomes very necessary
for him, before deciding as to the means of removing it,
to make out its size, form, consistence, position, and
mobility. This may be done by digital exploration from
the rectum, by bimanual examination by the rectum and
anterior wall of the abdomen, and by the use of lit ho*
triptic instruments. The endoscope, Ur. KnoUer thinks,
is not likely to prove of much service in these cases.
The last and most difficult problem is the removal of the
foreign body iy the readiest and least dangerous way.
If the body be of small size, and have not been long in
the bladder, the surgeon may await for some rime the
chance of its being passed spontaneously with the urine.
To favor this, a large thick bougie may be passed into a
distended bladder, and then withdrawn so as to allow the
urine to rush out in a full stream. Extraction by the
natural passage is indicated when the circumference of
the foreign body does not exceed the cahbre of the
urethra, and when it can be broken up within the blad-
der. Since the introduction of UthotritVj and with the
progressive improvement in the instruments used in this
operation, the extraction of the foreign body by lithotomy
has been less frequently performed. The statistics of
Denuc^ show that, while before 1S30 extraction was per-
formed in aj^and lithotomy in 100, out of 127 cases;
since this year, out of 122 cases, extraction was practised
in TO I and lithotomy in 21. In dealing with a foreign
body in the bladder of a female, Dr. Kndller vt^ouM
advocate forcible dilatation of the urethra, introduction
of the finger, and extraction by means of *ilender forceps-
— London Medical Rec&nf, August 15, 18S4.
Treatment of Acute Inflammation of the Knek-
Jot NT. — Dr. Barwell draws attention to a method of
treating severe inflammations of joints, and more espe-
cially those of the knee. In a sprain or wrench of a
previously healthy joint, a severe attack of synovitis fol-
lows, with pain and swelling, but if dislocation takes
place, no such symptoms follow, for the torn and syno-
vial membrane permits the hypersecretion of the in-
flamed membrane to drain away, and thus relieve the
tension. Acting on this doctrine, the method adopted
by the author is as follows : Suppose the knee to be the
injured joint, it is to be enveloped in a broad bandage
of elastic webbing \ or, if that be at the time unattaiD*
able, an ordinary calico bandage will answer the purpose,
care being taken to leave between two of the turns a
little interval on ihe inner side on a level with the upper
margin of the |jatella. At this point there is passed into
the joint a tubular needle, thoroughly cleansed and asep-
ticised. The fluid runs away as a rule easily^ and when
the flow has ceased the needle is withdrawn, the puncture
covered with strapping-plaster, made adherent by spread-
ing on it turpentine (a potent aseptic), and this is to be
painted over with collodion. Pressure by means of
strapping-plaster must then be applied and the limb
placed at rest on a splint for a few days. Dr. Barwell
strongly urges that, in all cases, joints which show evi-
dent marks of tension should be evacuated in the above
manner. Four cases are cited in which puncture was
performed, the results being that in a few days the pa-
tients were convalescent. — London LanccL
• ,
HOMIEOPATHV AND THE TREATMENT OF DVSENTERV.
— ^Dr. D, A, Baldwin, of Englewood^ N, J,, writes us con-
cerning the methodof treating dysentery with small doses
of corrosive sublimate, as recommended again recently
by Dr. S, B, Childs, Medical Recokd, August 23d.
He says : ** ' Hull's Jahr,' for thirty years a leading man-
ual of homoeopathic practicej gives^ under treatment of
dysentery, mercurius bichlo. for painful bloody stools,
and colocynth for the griping pains and tenesmus- The
editor says : ^ A successful procedure in our practice is
the alternate administration of colocynth and mercury
for many forms of dysentery. Coldcynth first, trit., alter-
nate with the mercury^ when the griping pains and tenes-
mus are intense,* Every work of homoeopathic practice
published since recommends the same/' Dr. Baldwin
makes the extraordinary charge of *^ gross plagiarism,'^
based upon the above. The charge, however, will fit
better against Jahr. At any rate, mercury in small doses
was recommended in Trousseau's *' Treatise on Thera-
peutics/^ and was used more than thirty years ago by
Leclerc,
m^^K::
'4m'
THE MEDICAL RECORD.
[October i8, 1884.
i ■'
The Medical Record:
u4 Weekly Journal of Medicine and Surgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
PUBLISHRD BY
WM.'WOOD & Co.. Nos. 56 and 58 Ufayette Place.
^ ^ . .. . ... , s
New York, October x8, 1884.
V THE FINAL REPORT OF THE COLLECTIVE
INVESTIGATION COMMITTEE ON ACUTE
LOBAR PNEUMONIA.
We have received the second volume of the " Collective
Investigation Record," edited by the Collective Investi-
gation Committee of the British Medical Association. It
is larger than the first volume, and distinctly superior to
It in the value of its contents. These relate to the sub-
jects of acute pneumonia and puerperal pyrexia. The
report on pneumonia supplements the preliminary report
upon this subject made in the previous volume. At that
time the Committee had received only 350 returns, while
the present volume contains the analyses of 715 more,
making 1,065 cases in all. Of this large number it was
found that the returns in fourteen cases only were de-
*fective. There was left, then, an unprecedentedly large
mass of data upon which to base conclusions. Never-
theless, the committee in their final summing up of results
• is wisely cautious in estimating the value of the infer-
ences drawn. A good deal of the report has, as is ad-
mitted, only a negative value ; while many of the points
elicited were already known. It could hardly be ex-
pected, indeed^ that any extraordinary facts should be
brought out regarding a disease which has for centuries
been tirelessly watched by so many competent investiga-
tors.
There are, however, some facts of fundamental impor-
tance presented, as well as many minor details of con-
siderable practical interest.
The value of the Committee's report is much enhanced
' by several original communications upon the subject of
the alleged zymotic and infectious nature of pneumonia.
Dr. Octavius Sturges presents a concise and lucid histor-
ical paper upon epidemics of pneumonia in Great Britain.
Dr. Sidney Coupland contributes a still more elaborate
article upon foreign epidemics. A report of two epi-
demics of pneumonia in the Punjab is made by Surgeon-
Major S. R Maunsell, and an original contribution to
the subject of the micro-organism of pneumonia is fur-
nished by Mr. George M. Giles.
Taken altogether, the material given in this volume of
the *' Investigation Record " marks a decided advance in
our knowledge of pneumonia, and future clinical writers
or lecturers must levy tribute upon its pages.
We present some of the main facts of the report, fur-
nished by the Committee and its individual members.
It is evident that there is an inclination to adopt the
conclusion that acute lobar pneumonia is not the simple
and single entity which it was once believed to be. Thus
Dr. Sturges refers to the various forms of epidemic and
contagious pneumonia under three heads, viz. :
1. Epidemic pneumonia, occurring in districts or
houses after the manner of epidemic catarrh.
2. Pythogenic pneumonia, occasioned by sewer gas,
fecal accumulation, and over-crowding.
3. Infectious pneumonia, imported into a house or
district, and spreading from person to person. Dr. Stur-
ges gives a brief review of the cases which have been re-
ported in Great Britain, favoring the view that pneumonia
appears under the forms above enumerated. These cases
alone are not numerous enough to be of any great value,
nor is it pretended that they form more than a link in
the chain of evidence. Dr. Coupland reviews the for-
eign literature covering this same subject, and furnishes a
great deal that is more positive. In the same line with
these papers are tlie reports of epidemic pneumonia in
the Punjab, and the article by Dr. Giles on the miGro-
organisms of pneumonia. This latter gentleman has
made microscopical examinations and inoculation experi-
ments, which, while not perfectly in harmony with those
of Friedlander, do on the whole, he believes, corrobo-
rate that observer.
The evidence as to the infectious, and occasionally
contagious character of pneumonia, furnished by the re-
turns, supports, though only in a measure, the views dis-
cussed by the individual contributors. Out of the 1,065
cases, five observers only speak of epidemics of pneumo-
nia attributable to atmospheric or meteorological condi-
tions similar in character to influenza epidemics. Only
three observers speak of '* pathogenic cases.'* Nine in-
dependent observers express the opinion that pneumonia
is, under certain circumstances, capable of transference
from one person to another. Yet these gentlemen make
the reservation that, possibly, in their cases it was only a
similarity of conditions which caused the apparendy con-
tagious attacks. Despite this, as it appears to us, some-
what meagre evidence, the Committee feel warranted in
believing that the infectious character of pneumonia in
some cases is established, and that it, in very rare in-
stances, is contagious. We reach the conclusion, from a
survey of the whole evidence here furnished, that pneu-
monia may be, and generally is, simply a local inflam-
mation ; that in other cases it is a true infectious disease,
a pneumonic fever ; and that, Anally, in rare cases this
infectious fever is transmissible from person to person.
It is shown further that the local disease, pneumonia,
may be primarily excited by exposure to cold, etc. ; or
it may develop secondarily in the course of infectious
fevers, or as the result of some poison or other de-
pressing condition acting upon the vascular or nervous
system.
Such are the more striking points suggested in the In-
vestigation Record. But in addition a good many other
things were brought out by the analysis of the returns.
Thus it was found that pneumonia frequently attacks
more than one member of a household at the same time ;
that when unusually prevalent the mortality is exception-
ally low ; and that defective house drainage and sewer-
gas poisoning may both cause and favor the spread of
the disease. It was also shown that alcoholic excess not
October i8, 1884.]
THE MEDICAL RECORD.
435
only favors the .development of pneumonia, but may
actually directly cause it; and that fatigue. and mental
depression rank next to alcohol in making the prognosis
unfavorable.
The total mortality among the i«o65 cases was 192, or
I in 5^. Subtracting from these the 105 alcoholic cases^
the 14 cases produced by mental and physical depression,
and the 22 infectious cases, and the mortality among the
remainder was 108, or i in 8.
Aboat one patient out of every ten had suffered from
previous attacks of pneumonia, and it seems to the Com-
mittee safe to conclude that one attack predisposes to
another. The mortality from second attacks is not
greater tha:n from first, but the same cannot be said of
third attacks.
As regards heredity, there is no evidence that the dis-
ease runs in families, or that any other form of lung dis-
eases is met with in excess in the families of those who
have suffered from pneumonia.
In double pneumonia the disease runs a longer course,
and is more liable to have a gradual termination.
Apex pneumonias were found to be as favorable in
duration and mortality as other forms ; when occurring
in phthisical families they show no tendency to degen-
erate into phthisis, and phthisical families show no ten-
dency to have apex pneumonias. These conclusions
ran somewhat counter to the received views on this
point.
In another respect, also, the returns are at variance
with the usual views, and that is as to the mode of ter*
luination of the attacks. Sudden remission is not the
nile in pneumonia, and the only law which obtains in
this regard is that, when the pneumonic pyrexia has
lasted over eight days, its sudden subsidence is improb-
able. We are inclined to think that many physicians, in
recalling their past experiences, will not be surprised at
this conclusion of the returns.
As regards treatment, one cannot but feel some disap-
pointmeut at the indefiniteness and valuelessness of the
data given.
At the most we only learn what are the most popular
measures among British physicians, without in the least
being able to say which are the most effective, or whether
any of them do any good. As regards local treatment,
among 1,037 there were 287 who used poultices to the
chest; 1 1 7, counter-irritants ; 18, leeches; 2, wet-cup-
ping; 9, cold sponging; 4, wet-pack; 3, warm baths,
and 2 vapor baths.
As to internal or general treatment, 134 report having
used the '' expectant" plan — a, rather small percentage
for so excellent a method. Ninety-four used the ^< support*
ing " and roborant measures, carbonate of ammonia being
one of the drugs most relied upon. Indeed, carbonate of
ammonia w&s used by 250, and appears to be more uni-
formly given by British physicians than any other single
remedy, excluding alcohol. In 94 cases antimonials were
prescribed^ Various expectorants were used in 2 14 cases,
opium in 60, and bromides in 14 cases. Antipyretic
drugs are rather in favor. Quinine was found in 143 re-
turns, aconite in 125, digitalis in 65, salicylic acid in
4 1) vcratria in 4. Ergot was given in 9 cases, bella-
donna b 3, phosphorus in 2, pilocarpin in i, and colchi-
cumin i.
Alcohol was used in 424 cases, while in 104 it is ex-
pressly stated that no stimulants were used.
It must be confessed that an examination of the re-
turns of treatment leaves one with a poor opinion of the
value of British skill in treating pneumonia. Either they
are much misrepresented, or the professional practice is
to a large extent hap-hazard, and dependent on the pe-
culiar education ' or bias of the practitioner. It is cer-
tainly strange that at this day it is found necessary to
use from twenty-five to thirty drugs in pneumonia, be-
sides ** antiphlogistic" or "antipyretic" measures.
THE NEW LOCAL ANAESTHETIC.
When we have heard and seen what the local appli-
cation of cocaine hydrochlorate has done in abolishing
pain, we are in danger of over-reaching the bounds
of reasonable enthusiasm regarding its merits as an
anaesthetic Such of, the ophthalmologists as have
tried the salt cannot speak too highly of its wonderful
power. Since the letter of Dr. Noyes appeared in our
last issue, the ophthalmic surgeons have been vieing with
each other to put the new anaesthetic to the severest
test. As to what can actually be accomplished through
its agency by the mere instillation of a few drops upon
the most sensitive conjunctiva, is perhaps best appre-
ciated by the perusal of the cases reported in the pres-
ent issue by Drs, Agnew, Moore, and Minor.
So far as used it has been a great success, and there is
possibly a future for its more extended application, not
only in ophthalmic operations, but in general surgery. But
this can only be determined by actual experience. The
test for its still wider'range of usefulness is yet ta be made
in ophthalmic practice. If its power to control pain in the
operation of iridectomy can be established, the impor-
tance of the discovery of this anaesthetic will, in eye sur-
gery at least, rank second only to that of ether itself. On
general principles, it is fair to assume that, by increasing
the strength of the salt and allowing more time for the
manifestation of its effects, operations of the class men-
tioned may be performed without pain to the patient.
At least it appears to us that a fair trial is warrantable
on the rational presumptions offered.
It is not reasonable to suppose that, even from the
present aspect of the question, we shall stop here. It is
quite certain that in those numerous cases in which local
anaesthesia is necessary for minor operations in surgery,
gynecology, laryngology, otology, and even dentistry,
this anaesthetic will be tested. Especially would it seem
to be indicated in those parts of the body which are
covered by mucous membranes and plentifully supplied
with sensitive nerves.
As yet we know little or nothing of its possibly poi-
sonous effects in large doses, and it is to be hoped that
no rashness in experimentation will demonstrate them.
With this introduction, cocaine takes its place in the Une
of new remedies, and awaits the verdict of aft impartial
trial.
THE ORIGIN OF YELLOW FEVER.
The unique, mysterious, and at the same time deadly,
character of yellow fever, by which it is separated sa
markedly from all other fevers, has led to the most zealous
investigations of its pathology. Hardly any disease has
»# ■-.••^rv
436
THE MEDICAL RECORD.
[October
18, 1884.
called forth so many robustly defended and statistically
fortified theories ; in fact, yellow fever seems, like spir-
itualism, to have a tendency to unsettle the mind of the
inquirer and turn him into a fanatic over his own spe-
cial pathogenesis. Yellow fever, unlike other infectious
fevers, lives only in certain regions where salt water,
vegetable and animal decay, and tropical warmth exist ;
even these do not furnish all the elements for its suste-
nance. It exists only in the sea-ports of the tropical
Atlantic and Western Mediterranean, from which places
it stalks forth in the summer to attack other regions.
Since 1647 outbreaks of the disease have occurred, and
it has been a terror to all ships trading in the West In-
dies and Gulf of Mexico. In many of these West In-
dian ports it has become practically endemic.
Some modern sanitarians have been disposed to treat
the subject of the origin of this disease lightly, and to deny
the possibility or need of ever knowing how yellow fever
came into being. Dr. Chaille, of New Orleans, once com-
pared this inquiry to that of " the origin of a cat," which
after all is a very respectable and not entirely hopeless
object of research. Most of our more recent writers of
text-books evade the question of pathogenesis altogether,
or give the vaguest information about it.
. If it were entirely accepted now that yellow fever does
not rise i/e novoy the question of its origin would indeed
have little mo]:e than an historical or scientific interest.
Thus those who, like Dr. Hargis and Mr. Gamgee in late
years, have claimed that the disease arises in ships, can-
not deny that the conditions for producing it arise anew
each year. The general tendency of opinion, however,
is certainly against the ship origin or the de novo origin
of yellow fever.
In the October number of the North American Review,
^T. C. Creighton gives a very interesting and vigorous
exposition of another hypothesis, first put forward by
Audouard. This hypothesis is that yellow fever arose
from the slave-ships which carried on their traffic in the
last and the early part of the present century.
The arguments put forth are briefly these : Yellow
fever is a disease of tropical sea-ports, but limited only
to a few of them. These ports of yellow fever are mostly
the old ports of debarkation in the slave trade, its first
appearance being at Bridgetown, twenty years after slaves
began to be imported. The exacerbations of the fever
have, as a rule, corresponded with the most lawless per-
iods of the traffic.
These slave-ships contained hundreds of negroes crowd-
ed together in the hold, where they lived in filth and de-
veloped unspeakable stenches from the accumulated
excretions of their bodies. Cases are related, showing
that under these conditions a form of cjiarrhoea broke out
among the negroes, and that then yellow fever broke out
among the crew, the negro himself being rarely affected.
These slavers having arrived at port with their crew and
cargo, discharged the latter and then cleaned out their
ships, pumping the bilge-water and the accumulated filth
of the voyage into the harbor. This being done for years
in the almost tideless harbor of Havana, for example, the
bed and shores have become infected with the specific
germs, by which the disease is kept endemic and the
port a distributing centre. This fatal nmd, says Dr.
Creighton, has long been washed away from the Dela-
ware, from Charleston, and all other Atlantic ports. It
would have disappeared from the Gulf ports but for the
sluggishness of the waters. It may long stay in the West
Indies as a kind of Nemesis for the horrors and cruelties
of the " middle passage."
Audouard's theory, thus revived and eloquently de-
fended by Dr. Creighton, contains much that is plausible.
Certain it is that if the filth, heat, and effluvia gen-
erated by human crowding could ever originate a new
disease, a specific fever, the old slavers furnished the
conditions.
The objections which will be raised are that the theory
is too narrow.' A single case well substantiated might
upset it. The old slavers might well have originated
yellow fever, but can we say that they were its only
source ?
THi:: COMMA-BACILLUS OF CHOLERA NOSTRAS.
At the meeting of German Naturalists and Physicians
at Magdeburg, September 18 to 23, Professor Finkler,of
Bonn, made a most important communication regarding
the cholera bacillus. He announced that as the result
of a series of experiments made by Professor Prior and
himself, they had discovered a comma-bacillus in the
stools of cholera nostras. They had cultivated this or-
ganism on gelatine and other substances, and had studied
carefully its life-history. Microscopically it was identical,
or nearly so, with Koch's comma-bacillus. In its growth,
however, it finally develops spores, and after a time only
micrococci are to be seen in place of the bacilli. It is
claimed that these spores are the " resting-state " of the
bacillus. Cholera stools two weeks old were taken. No
bacilli, but only micrococci and other forms were found
in them. Cultivations were made, and the comma-
bacilli developed.
Specimens of the bacillus of cholera-nostras have been
taken to Berlin and shown to Dr. Koch, who acknowl-
edges the similarity of their appearance to the bacilli of
Asiatic cholera.
Inoculations of the cultivated bacilli, made by Prior
and Finkler in dogs and rabbits, have as yet given no
decided results.
Prior is positive that the disease from which he ob-
tained the organisms was cholera nostras.
The significance of the discovery is certainly very
great, but we abstain from comment until further partic-
ulars reach us.
Dr. Samuel Morgan Valentine, born in New York
City, and a resident thereof, died in Lucerne, Switzer-
land, August 7, 1884, after a short illness, resulting from
disease of the heart He was graduated from the College
of Physicians and Surgeons in 1838, and after a thorough
course of study in Europe for two years, returned to this
country, and engaged actively in practice, till other mat-
ters requiring his attention he was obliged to relinquish
his professional duties. Though long living a retired
life, Dr. Valentine always retained his interest in medi-
cine, was well known to the prominent physicians of the
city, and was respected for his sound judgment and his
many kindly qualities of character. At the time of his
death he was still a member of the New York County
Medical Society.
October i8, 1884.]
THE MEDICAL RECORD.
437
lw)s of the IMeck.
The Mississippi Valley Medical Association, at
its annual meeting, September 23-2 5th, at Springfield,
111., elected the following officers : President — Dr. F.
W. Beard, of Indiana. Vice-Presidents— Dr. A. B. Mil-
ler, of Missouri ; Dr. J. A. Sutcliffe, of Indiana ; Dr. E.
H. Luckett, of Kentucky. Secretary^Dv. G. W. Bur-
ton, of Indiana. Assistant Secretary — Dr. H. J. B.
Wright, of Illinois. Treasurer — Dr. A. M. Owen, of
Indiana. It was decided to hold the next meeting at
Evans^alle, Ind., on the second Tuesday of June, to con-
tinue three days.
The Successor to the Late Professor Cohnheim.
—The candidates for the vacant position of Professor of
Pathological Anatomy at Leipsic are Rindfleisch, Klebs,
Ziegler, and Weigert. Dr. Koch's name has also been
mentioned, but we learn by cable that he has declined
the proffered chair.
Dr. Alexander H, Stevens. — Dr. A. C. Post writes :
" Allow me to correct an error in The Record of October
4th. Alexander H. Stephens was a distinguished politi-
cian of Georgia. Alexander H. Stevens was the eminent
New York surgeon.'*
t Cremation of Paupers. — It is proposed as a measure
of economy to burn the dead paupers of Brooklyn, in-
1 stead of, as is at present the practice, burying them in
' two-dollar soap-boxes. However admirable this scheme
might be, practical men will see the futility of trying to
' carry it out, since it would prevent the Brooklyn politi-
I cians from making their usual percentage on each coffin.
f A Field for Ophthalmology. — Professor Mosely
has discovered an animal — a mollusc — which has 11,000
eyes. " If only men and women were thus poly-ocularly
; endowed," sighs the young ophthalmologist.
A Case of Scarlet Fever in a Canary is reported
by Dr. Frank Ogston, of Aberdeen, in the British Medi-
cal Journal. The bird was ip a room where two children
^ lay sick with the same disease. The animal's skin was
bright scarlet, its throat apparently sore, and it finally
died.
" Vienna '* Surgery. — This is the term popularly ap-
plied in this city to "bold" surgery, 1.^., such as is done
for the benefit of the surgeon rather than the patient.
We are glad to say that there is not much of it just now.
A Proposed Electro-therapeutical Association.
—It is proposed to hold a convention of physicians at
Waco, Texas, on October 30th, for the purpose of form-
ing an Electro-therapeutical Association.
Berlin News. — The Berlin correspondent of the
Allgemeiner Wiener Medizinische Zeitung writes that
Prince Bismarck recently asserted in the Reichstag that
medicine had made no progress in two thousand years !
The same correspondent writes that the week in Berlin
has been a very quiet one ; Professor Schweninger had
received no new decoration.
A Medical President. — Dr. Don Rafael Zaldivar,
President of the Republic of San Salvador, is said to be
a very accomplished physician. He has just been chosen
for a third term, and is now travelling in Europe.
The Harveian Oration was delivered this year on
October i8th, by Dr. Russell Reynolds.
The Acad6mie de MAdecine, of Paris, held a meeting
on September i6th. M. Hervieux made a report upon re-
vaccination. He gave the experiences of Surgeon-Major
Burlureau, who in 210 cases had obtained successful
vaccinations in 61.43 Ppr cent. M, Hervieux, among
312 cases, had had 66.33 per cent, of success. The
Academy then passed to the subject of the treatment of
cholera.
Ten Thousand Dollars for Prizes. — The sum of
40.000 francs has been left to the Faculty de M^decine,
Paris, to found a biennial prize in hygiene. The sum of
10,000 francs has been left for a prize in histology.
The Change of View. — ** Nearly forty years ago,"
says Dr. R. W. Matthewson in the Proceedings of the
Connecticut Medical Society, "I had the honor to re-
port the name of Fordyce Barker, a member of this
Society, for Dissertator. His subject was * Local Treat-
ment of Uterine Diseases by the Speculum.* This was
considered such an innovation on old customs that many
of his friends feared it would injure his professional
character. When Dr. Bedfprd, of New York, . first
opened his clinics, his exposure of females was severely
denounced by some of the medical journals."
MiDwivES in Detroit. — Says the Detroit Lancet:
" Since the training school for nurses has opened with a
liberal endowment, at Harper Hospital, in Detroit, the
nurses, including some of the best of the midwives, have
organized themselves into a society, by which they pro-
pose to emulate the attainments of the graduates of the
nursing school. They have procured regular instruction
from members of the medical profession proficient in the
art and science of midwifery. They are said to be quite
particular as to those whom they admit to membership."
The Autopsy upon Cohnheim. — There is a certain
grim satire in the careful accounts of the post-mortem
appearances of the great pathologist Cohnheim. Dr.
Huber, who made the autopsy, reports : Contracted gouty
kidneys, the right being the smaller and both containing
calculi, arterio-sclerosis ; extreme excentric hypertrophy
of both ventricles ; brown induration of both lungs, on
the left side hydrothorax, on the right plenritis ; infarction
necrosis in the left kidney.
The Minnesota College Hospital has had its mort-
gage foreclosed and it is financially defunct. The city
of Minneapolis is not large enough to support the insti-
tution. The college connected with it, however, con-
tinues its work.
Another Free Medical College. — The Medical
Department of the University of Colorado, at Boulder,
has begun its sessions. Tuition is free, and $6,200 have
been appropriated to build a. hospital.
Another Tri-State Society. — A movement was set
on foot at the recent meeting of the Medical Society of
Virginia to organize a Tri-State Medical Society, repre-
senting the States of Virginia, West Virginia, and North
Carolina.
The Chicago Medical Society announces that there
is now a collection of twelve hundred standard medical
works in the Public Library,
\'^
438
THE MEDICAL RECORD.
[October i8, 1884.
"1
A Slander on the Texans. — Our esteemed but fiery
contemporsiry, TAe Texas Courier- Record^ devotes two
or more pages of editorial incandescence to the wilting
and extinguishment of a Philadelphia professor who as-
serted that it was ** a common practice in Texas for the
mothers to chew the food for the children, regurgitate and
spit it out, and then feed it to them." The editor of the
Courier-Record affirms this to be a disgusting and in-
famous slander. He further expresses a deep desire to
get hold of the author of the slander and apply a coat ot
tar and feathers in a manner that would strain the most
liberal interpretation that could be put upon the Code of
Ethics* The real facts seem to be that there is a practice
existing in several Southern Slates on the part of mothers
of softening a bit of cracker or biscuit in the mouth, then
giving it to the baby. The starch in the cracker is turned
to sugar by the saliva and the infant's food partly digested.
This procedure is, therefore, claimed to be physiological
and rational.
COCAINE HYDROCHLORATE THE
LOCAL AN^:STHETIC.
NEW
{The reports of the following cases, illustrating the
surprising effects of cocaine hydrochlorate as a local an«
aesthetic in ophthalmic operations, come to us just as we
go to press. The results are certainly very encouraging,
apd will doubtless command the attention they deserve.
^Ed.]
By PkOFESSOR C. R. AGNEW, M.D.,
NBW YOBK.
In your last issue is a letter from our distinguished
colleague, Dr. H. D. Noyes, in which there is an allusion
to the new local anzesthetic, hydrochlorate of cocaine, as
recently discovered and applied in Germany. We have
to-day (October 14, 1884) used the agent in our clinic
at the College of Physicians and Surgeons, with
most astonishing and satisfactory results. If its further
use should prove to be equally satisfactory, we will be in
possession of an agent for the prevention of suffering in
ophthalmic operations of inestimable value.
^ It is difficult to avoid expressions of extreme enthusi-
asm in view of what we have to-day seen and in view of
what we may rationally expect from the further applica-
tions of the agent. The following cases, however, will
be of more value than any abstract disquisition.
Case J. — A. E , aged five ; a case of convergent
squint A two per cent, solution of the hydrochlorate of
cocaine was dropped upon the surface of each eye three
times at intervals jduring a period of fefteen minutes,
without any more irritation of the eyes than would have
been caused by drops of common water. At the end
of twenty-five minutes he walked into the operating-
theatre, laid down upon the operating- chair, and allowed
the spring speculum to be inserted between his eyelids,
the scleral conjunctiva to be seized with fixation forceps
and cut with scissors, and the rectus internus of the left
eye to be divided without complaining or showing any
signs of suffering. When we had the internus tendon
upon the strabismus hook, he said we were pulling some-
thmg.
Case II. — L. H. B , aged eleven ; convergent
squint. Solution applied as above, three times in fifteen
minutes, at the end of which time he sat erect in a chair,
resting his head upon the breast of an assistant, had the
speculum inserted, scleral conjunctiva seized with fixation
forcep?, and the internal rectus divided in the usual
manner, and when asked said the operation had given no
pain.
Case III. — Joseph McC , aged six; convergent
squint. Solution applied as above. In the delays of the
clinic somewhat more than half an hour elapsed between
the last instiUation of the agent and the attempt to oper-
ate« The youngster seemed to be much frightened by
the presence of the surgeon and students ; would not sub-
mit to the proposed strabotomy, and ether had to be ad-
ministered before it could be done. As his scleral con-
junctiva was insensible to the contact of the fixation
forceps fifteen minutes after the iirst instillation of the
solution, it is a fair inference that the anaesthetic be-
numbing had passed away before he entered the operat-
ing-theatre. His nervous apprehension was so great
that he would not have endured an operation even though
there might have been no real pain inflicted.
Case IV. — James McG , aged fifty-two, was sent
to the clinic with the statement that he had a lacerated
wound of his left eyeball involving the sclerotic. His
dread of handling and of light was so great that we could
get no view of the injured organ, as every attempt to
inspect it was instantly followed by blepharo-spasni. A
few drops of the solution were instilled, and in a few mo-
ments the patient walked into the operating-theatre with
the injured eye open and so free from irritability as to
make an examination of it before the students quite
easy.
Case V. — J , a physician, aged seventy-one, with
double cataract, corfsulted us on October 15th. His
eyes were extremely sensitive to touch. A drop of the
two per cent, solution was dropped upon the scleral
conjunctiva, and in two minutes and a half the patient
permitted me to apply the end of a forefinger to the
scleral conjunctiva without wincing.
The solution used in all these cases was a two per
cent, one, made with distilled water and with Merk's
crystals of the hydrochlorate of cocaine.
It is only by extensive gathering of the clinical facts in
regard to this new agent that we can reach just conclu-
sions as to its value, and it is important that all observers
should give the profession the benefit of their experience
The operations at the clinic alluded to above were done
with the assistance of Dr. David Webster, Dr. W. Oliver
Moore, Dr. Neil J. Hepburn, and Dr. W. A. Pierrepont,
and in the presence of the class.
By WILLIAM OLIVER MOORE, M.D.,
PROFESSOR OF BYB AND BAR DISEASES, NRW YORK POST-GRADUATE MEDICAL
SCHOOL AND HOSPITAL.
Cocaine has been known since 1855, and is the active
principle of the leaves of the Erythroxylon coca, a
South American plant, the leaves of which resemble very
much those of the tea plant. Many of the natives dur-
ing hard work use these leaves, chewing them with some
alkaline substance, going without food the entire day,
but taking their food at night. It has long been known
as a powerful stimulant. Cocaine hydrochlorate is of
more recent origin, and the anaesthetic effect of it when
brushed or dropped upon mucous surfaces has been
only known about a year, it having been used in
Germany first by the laryngologists, to produce anaes-
thesia of the vocal cords and surrounding parts to fa-
cilitate manipulation. "^ In this journal, page 417, in a
letter from Dr. H. D. Noyes, of New York, an accoimt
is given of an experiment made with this drug before the
Ophthalmological Congress at Heidelberg, where a so-
lution of the cocaine hydrochforate was dropped into
the eye, the result being complete anaesthesia of the
conjunctiva and cornea. Dr. Noyes is justly enthusiastic
on the subject, and his letter caused me to obtain some
of the drug for experimentation, the results being an-
nexed.
A two per cent, aqueous solution of the cocaine hy-
drochlorate (Merk*s) is procured and dropped into the
eye, two drops being sufficient at first ; the eye is then
closed, and in five minutes two more are instilled ; after
five minutes more have elapsed, as a rule, anaesthesia is
complete ; if not, two more drops may be used. There
is no pain attending the application. ^
October i8, 1884.]
THE MEDICAL RECOka
439
The following experiments were made with very satis-
factory results :
Case I. — Chinaman, with keratitis. Two drops of a
two per cent, solution of the cocaine hydrochlorate were
(Jropped into the left eye, then closed ; after five minutes
two more drops were used ; at the end of fifteen minutes
from the first instillation I was able to grab the ocular
conjunctiva with fixation forceps and move the eye in
any direction without pain or any disagreeable sensation.
The ulcer of the cornea was also touched and gently
saaped without sensation. In the right eye, where none
of the drug had been used, the patient made loud demon-
strations of complaint on my attempt to use the fixation
forceps, as in the first instance ; in short, there was a
marked difference in the eyes. The anaesthetic effect
in the right eye had entirely disappeared in thirty-two
minutes from the beginning of the experiment.
Case II. — Man, aged thirty-seven, with double ptery-
gium. In one eye, the left, 1 put in two drops of the so-
lution, and after waiting five minutes introduced between
the lids two drops more ; after another interval of five
minutes two more were used.
Five minutes after the last drops were used the opera-
tion was begun, the pterygium being excised by scissors,
the conjunctiva being freely cut, and the cut surfaces
brought together by three sutures. This usually painful
operation was done with the utmost ease, and without
any painful sensation, the patient being surprised at its
completion.
In the other eye the cocaine was not used, and the
pain and suffering of the patient was, as usual, when ether
is not used. The effect was very marked, and really very
surprising. The anaesthesia lasted twenty-five minutes.
Case III. — Child, seven years old, having squint (stra-
bismus convergens^. Two drops of the solution were
put into the squintmg eye, and repeated as in the other
cases till six drops in all had been used during the space
of fifteen minutes ; at the end of which time the con-
junctiva was sufficiently quiet to allow of the tenotomy
of the internal rectus muscle, the usual operation being
performed, the spring speculum being used. The little
boy made no complaint of pain, and simply said the
speculum stretched the lids, but was painless. That it
is unusual for a child of this age to allow an operation of
this sort to be done without ether is at least a marvel,
and to show that the patient, though young, had not
" pure grit " the other eye (the ope in which no cocaine
had been used) was tried, and found to have the normal
sensations.
I have tried it in other cases, yet this will suffice to
bring it before the notice of the profession at once. Sev-
eral of my confreres at the New York Eye and Ear In-
firmary and elsewhere have used the same solution with
good effect. Much more will be written on this subject,
as it has a wide application, and we have yet to learn
much of the properties of the alkaloid. The introducer
of this new and truly magical preparation is a student in
Vieima, Dr. KoUer, vide Dr. Noyes' letter above referred
to. I hope to say more of its practical value at another
time, i
By JAMES L. MINOR, M.D.,
ASSISTANT SURCBON, MBW YORK EYB AND BAR INFIRMARY.
The last number of The Record contained a short
account of the proceedings of the Heidelberg Ophthalmo-
logical Congress, by Dr. H. D. Noyes. He speaks of
the anaesthetic effects of the muriate of cocaine, and of
its probable future in ophthalmology.
I have had an opportunity of using the drug on several
cases, and with such beneficial effect, that I deem it im-
portant enough to lay before the readers of The Rec-
ord.
I used a two per cent, solution, kindly furnished me by
Dr. Moore, after the manner described by Dr. Noyes —
viz. : two drops were dropped into the conjunctivad sac.
and in ten minutes this was repeated, and the operation
was performed ten minutes later.
Case I. — A nervous boy, aged ten, upon whom I had
operated for squint in the left eye three days before,
presented himself on October 13th) with the conjuncti-
val stitches still in situ. The solution of cocaine was
instilled as above described. The cornea and the con-
junctiva could be brushed with the end of the finger,
without causing any uncomfortable sensation. The
speculum was introduced, the stitches removed, the con-
junctiva was grasped with fixation forceps, and the globe
was pulled around by them. The child complained of
no pain, and when asked after it was over if he had been
hurt, he replied in the negative. The other eye retained
ils sensibility, and it could not be handled in the least.
Case II. — A woman, aged fifty, upon whom I had per-
formed a preliminary iridectomy a few weeks before,
came for the extraction of the cataract on October 13th.
She was nervous and very resentful of anything disagree^
able or painful. When the iridectomy was performed, I
attempted to do it without an anaesthetic, but found it
utterly impossible to even retain the speculum between
the lidS; and resorted to ether. I decided to use the
cocaine, and dropped it in the eye, on which she shrank
back and closed the eye as tight as possible — resenting
even this much handling of the eye — for the solution is
non-irritating to the conjunctiva. The second applicatron
was made without difficulty, and I could rub my finger
over the conjunctiva and cornea without causing discom-
fort. The speculum was introduced, the conjunctiva was
grasped with fixation forceps, and the globe thus pulled
in position. A large section of the cornea was made,
and cystotomy and delivery of the lens were easily ac-
complished. The patient complained of no pain, and
after the operation, and on the following day, declared that
she had not been hurt in the least She was even sur-
prised when told that the operation had been performed.
Immediately after the operation I tested the sensibility
of the conjunctiva of the other eye, by lightly touching
it with my finger. She shrank and closed the eye so
quickly and violently that I feared the other eye would
suffer from the violent contraction of the lids. The case
has progressed, so far, as satisfactorily as could be de-
sired.
Should cocaine in the hands of others meet with the
same success that I have attained, it will mark an era in
ophthalmology unsurpassed by any in modem times. Its
use in other branches of medicine and surgery may be
almost as important as in ophthalmology.
233 Madison Avbmub, Nbw York, October 15, 1884.
AMERICAN PUBLIC HEALTH ASSOCIATION.
Twelfth Annual Session, held at St. Zouisy Mo.^
October 14, 15, 16, and 17, 1884.
(By Telegraph to The Mboicai. Rbcoro.)
Tuesday, October 14TH — First Day.
The session was called to order at 10 a.m. Dr. Albert
C. Ghion, presiding. About one hundred and fifty mem-
bers were present.
Dr. J. Spiegelhalter, of the Local Committee, wel-
comed the members and announced the programme for
the session.
An appointed committee recommended that members
residing in the District of Columbia form into a body
and secure incorporation of the Association. Adopted.
Dr. J. Zerrien Lindsley, the Treasurer, reported a
balance on hand with an admission of one hundred and
twenty-five new members.
The Committee on Necrology reported, showing four-
teen deaths.
The Conference of Charities and Corrections at present
in session was invited to attend the meetings of the Asso-
ciation.
44C
THE MEDICAL RECORD
[October i8, 1884.
Dr^ Charles W. Chancellor, of Maryland, read a
paper on
TENEMENT REFORM,
dealing with the squalid dwellings of the poor, their un-
sanitary condition, and vice resulting therefrom.
Major Samuel I. Robinson, of the District of Colum-
bia, read a paper on
THE HYGIENE OF THE HABITATION'S OF THE POOR,
abounding with practical suggestions regarding drainage,
ventilation, etc.
Dr. William K. Newton, of New Jersey, read a
paper on
THE SANITARY SURVEY OF A HOUSE,
urging that a sanitary history of all houses should be
kept by municipalities.
The above papers were discussed by Dr. Hunt, of
New Jersey ; Erastus Brooks, of New York ; Dr. Reade,
of Ohio ; Dr. Fee, of Kansas City ; Dr. A. N. Bell, of
New York ; Dr. Raymond, of Brooklyn ; Dr. Briggs, of
St. Louis ; Dr. Devron, of New Orleans ; Dr. Bryce,
of Toronto ; Dr. Cook, of Nashville.
Mr. Brooks introduced the question of
LICENSING PLUMBERS,
instancing the good results following in New York.
Dr. George H. Ronfi read a paper on
THE hygiene of OCCUPATIONS,
giving statistics of average life expectation of the various
trades and professions.
Dr. Adolph Alt, of Missouri, read a paper on
protective spectacles for workingmen,
recommending that employers be made to force men in
their employ to wear protective spectacles wherever
there is danger from flying chips.
Prof. Charles O. Curtman, of St. Louis, read a
paper on
heating and ventilation.
/ The hot air principle is considered the best for public
buildings.
Dr. VV. Thornton Parker, of the U. S. Army, read a
paper on
SANITARY management OF RAILWAY CARS AND STATIONS.
He dealt with the danger of moving sick and convales-
cents in ordinary cars, and urged sanitary inspection of
all trains and adoption of hospital cars.
The Association then adjourned.
Evening Session.
At 8 p.m. the hall was crowded with visitors, many
ladies being present.
ADDRESSES OF WELCOME
were made by the Mayor of the city, Governor of the
State, President of the State Board of Health, and others.
A band of music enlivened the occasion.
The feature of the evening was the address by the
President, Dr. A, L. Gihon, which was listened to
closely, and frequently applauded.
October 15TH — Second Day.
Papers were read on
school hygiene
as follows : " Report of Committee on Compulsory Vac-
cination," by Dr. Geo. H. Homan, of St. Louis ; " Hygiene
of Eyesight of School Children," by Dr. Stephen O.
Richey, of Washington, D. C. ; "Sanitary Survey of the
School-houses of Indiana," by Dr. E. S. Elder, of India-
napolis ; " School Hygiene," by Dr. Felix Formento, of
New Orleans, La.
THE food question
was discussed under the following heads : " Cotton-Seed
Oil as Food," by Prof. C. E. Munroe, of Annapolis, Md.-
" Poisonous Cheese, Canned Beef, Sausage, etc.," by
Prof. V. C. Vaughn, of Michigan ; " Milk Supply of Large
Cities," by Dr. Chcston Morris, of Philadelphia, Pa,
Afternoon Session.
On invitation, Dr. J. V. McCormack, of Kentucky,
read a report adopted by the Conference of States Board
of Health relating to
THE BEST MEANS OF PREVENTING THE APPEARANCE OF
CHOLERA IN THIS COUNTRY.
The report of the Conference stated that there were three
essential factors to the prevalence of cholera : i, The im-
portation of the disease by means of ships ; 2, local un-
sanitary conditions ; 3, persons sick with the disease, or
things infected by such sick persons. In view of the
threatened introduction of cholera into this country dur-
ing the coming year, it was the sense of the committee
that the Government should maintain a national health
service, which should establish an effective system of
quarantine bv the appointment of medical ofllicers at for-
eign infectea ports ; that emigrants shall be prevented
from landing until the danger of the introduction of
chplera has been ascertained. The inspection and quar-
antine service inaugurated by the National Board of
Health met with the approval of the committee, which
recommended that Congress be urged to appropriate
$500,000 to be used for the purpose of stamping out the
disease should it become epidemic.
The committee was of the opinion that State Sanitary
Inspectors should be appointed to visit all towns and
cities especially liable to the disease to consult with the
local authorities as to the best methods of prevention.
This work should be vigorously prosecuted before the
disease reached the American shores. The report also
recommended the isolation of victims of the disease, and
the destruction of their clothing and the discharges from
their bodies.
The Association unanimously endorsed the report of
the States Board of Health Conference, and a motion
was adopted that said report be printed and copies of it
sent to the United States Cabinet officers, Members
of Congress, and all State and local Boards of Health of
this county and Canada.
A motion by Dr. Hibberd, of Indiana, to appoint a
committee to report on antiseptics and germicides, was
referred to the Executive Committee. The rest of the
session was devoted to reports from the various States
on the progress of sanitation during the past year.
THE PAPERS READ AT THE EVENING SESSION.
An audience of one hundred and fifty was present, in-
cluding quite a number of ladies. Papers were read as
follows : " The Food we Eat and the Adulterations to
which we Submit," by Hon. Erastus Brooks, of New
York ; " The Hygiene of Sailors engaged in the Coast-
ing Trade," by Dr. Walter Wyman, U. S. Marine Hos-
pital Service ; '' Cremation as a Safeguard against Epi-
demics," by Rev. John D. Bengles, Chaplain U. S.
Navy; **The Ultimate Sanitation by Fire," by Hoa J.
M. Keating, of Memphis, Tenn. These papers were
discussed and the Society adjourned at 1 1 p.m.
HOW THE MEETING IS ATTENDED.
The attendance of members is quite large, but little local
interest is manifested in the proceedings. Toward the end
of the afternoon session there, were not more than twentj
members left in the hall, and these would have been left
in the dark if a non-member had not taken upon himself
the duty neglected by the local Committee of Arrange-
ments. The papers, as a rule, are carefully prepared
and of practical value, but the discussions are spiritless.
The usual social entertainments and courtesies are not
neglected.
October i8, i884,]
THE MEDICAL RECORD,
441
Reports ot SiocUtUs.
NEW YORK PATHOLOGICAL SOCIETY.
SiUfd Meetings September 24, 1884.
George F. Shrady, M.D., President, in the Chair.
SARCOMA OF THE MEDIASTINUM AND LUNG.
Dk. Van Gieson presented a specimen accompanied
by the following history, and for both he was indebted to
Dr. W. F. French, House Physician at St Catharine's
Hospital, Brooklyn, N. Y. : D. N , forty-one years
of age, married, German, was admitted September 1 1,
1884. On examination the chest revealed the following
physical signs : over the upper lobe of the right lung
there was entire absence of respiratory movement, ab-
sence of vocal fremitus, complete dulness, and absence
of respiratory sounds, unaltered by change of position.
The patient was emaciated, and had oedema of the left
apper eyelid and orbital region. There was no oedema
of the extremities. There was tympanites, dyspnoea,
cough without expectoration, nausea without vomiting.
The left side of the thorax was normal. There was no
family history of cancer. There were no symptoms re-
ferable to the uterus. The patient died September 16,
1884. The autopsy was made on the 17th. Body ema-
ciated, and rigor mortis only slight. Head and uterus
not examined. The heart was normal ; the pericardium
contained eight ounces of clear senim. Lungs : Out-
side of the pericardium, in the anterior mediastinum,
there was a mass of infiltrated glands, about the size
of the fist. In the anterior portion of the upper lobe
of the right lung was a dense infiltration in the form of
filbert-shaped nodules of a white color, and bound to-
gether with a fibrous stroma. The growth was regarded
as cancerous. The remaining portion of the right lung,
with the exception of a few adhesions at the base, was
apparently healthy. The left lung was apparently nor-
mal. The bronchial glands were involved. The right
bronchus was constricted to the size of a No. 8 English
nrethral sound. The spleen and kidneys were normal,
and the liver was slightly fatty.
Dr. Van Gieson remarked that the fact that the uterus
was not examined might give rise to doubt as to whether
or not the patient might not have had cancer of that or-
gan ; there was nothing in the clinical history, however,
which turned the attention of the house staff in that
direction.
Microscopical examination, so far as it had been
made, determined the growth in the thorax to be sar-
coma rather than cancer.
The absence of vocal fremitus was a feature of interest
in the clinical history, and it could be accounted for by
the constriction of the bronchus. In another case seen
with him by Dr. Jane way in consultation, the same con-
dition of absence of vocal fremitus was noticed, and that
fact aided somewhat in the diagnosis.
The President remarked that the new growth prob-
ably began in the mediastinum.
Dr. Van Gieson said that was the opinion of the gen-
tlemen who made the microscopical examination.
The President asked if the bones were examined.
Dr. Van Gieson thought they were not. There was
no evidence, however, of disease of either the sternum
or the ribs.
The President regarded sarcoma of either the lungs
or the mediastinum as quite rare, independent of the pre-
vious existence of the disease in some other part of the
body, especially the bones.
Dr. Van Gieson remarked that in a somewhat similar
case oedema of the eye without protrusion was noticeable,
and there was no evidence of new growth in the cellular
tissue of the orbit. In that case the oedema was ac-
counted for on the ground of pressure upon the blood-
vessels of the neck.
acute phagedenic pustular syphilidb.
Dr. John A. Wyeth presented a patient with the fol-
lowing history : Samuel J , bookkeeper, German,
thirty*five years of age. Was admitted to Mt. Sinai Hos-
pital July 1 1 , 1 884. Previous to the present attack he had
had illicit intercourse fi-equently, had had gonorrhoea many
times, the last attack being nine months ago. He had
had no urinary trouble at any time. Five weeks and a
half ago the patient had sexual intercourse with a pros-
titute, and about one week later he saw a small blister
one-fourth of an inch in diameter at the base of his
penis. This blister remained of apparently the same
size for the next ten days, when he again had sexual in-
tercourse, and a few days after the last exposure, the
sore upon the base of the penis began to enlarge and
became painful, and it had been steadily extending up
to the time of admission to the hospital. The sore has
been painful, and during the week prior to admission
prevented sleep. He had had a bubo on the right side,
that had been painted with iodine which reduced its size
somewhat, and rendered it less painful than it was at first.
The sore upon the penis had been treated with iodoform
and charcoal poultices.
The patient's general health has been good, no cough,
feet never swollen, no rheumatism. On admission,
there was found a large non-suppurating bubo in the
right groin, and a sore with indurated edges at the base
of the penis on the right side. The sore was triangular
in shape with the apex extending up the penis, one angle
at the base running into the scrotum, and the other into
the groin. The sore measured about one inch on each
side, and was deeply excavated, measuring more than an
inch in depth, and it had a sloughy base.
A papular and pustular eruption was scattered thickly
over the face, trunk, and extremities. The inguinal,
epitrochlear, and cervical glands were enlarged. There
had been a small ulceration upon the dorsum of the
tongue, which lasted about two days.
The patient's general condition was good ; his bowels
were regular ; there was no urinary trouble ; his tongue
was coated ; his mouth dark red ; and his temperature
102.2"* F.
July 15th. — The cavity of the sore was swabbed out
with deliquesced chloride of zinc, and packed with iodo-
form gauze.
July 23d. — There was still some phagedena at the
angles of the sore, which was touched with chloride of
zinc I to 4, and dressed with iodoform.
July 31st. — The eruption had gradually increased in
size, and now many of the pustules measure three-fourths
of an inch in diameter, and are covered with scabs raised
half an inch in circumference, domed and black, and sur-
rounded by a reddish areola.
August 7 th. — Ulcer now level with the surface and
looks well. The patient takes protiodide oi mercury
gr. j. t.Ld.
August 8th. — Ordered inunctions, ung. hydrarg., 3ss.
every night.
September 4th. — Scabs have nearly all fallen, leaving
ulcers which are rapidly healing.
Dr. Wyeth remarked that the case had shown pha-
gedena to a degree he had not seen before with an acute
syphilide. There was no evidence of tertiary lesion.
He regarded the case as one of acute phagedenic pus-
tular syphilide, and maintained that it illustrated the
statement of Bumstead and Taylor that a pustular syphi-
litic eruption is apt to follow a phagedenic syphilitic
ulcer on the penis, and the violence is frequently propor-
tionate to the violence of the initial lesion.
A point of interest in the treatment was the fact that
very large doses protiodide of mercury were given daily
for three or four weeks before the sores began to hea^
and no unpleasant constitutional effects belonging to the
drug were produced.
Dr. Van Gieson asked if self-inoculation was ruled
out entirely.
442
THE MEDICAL RECORD.
[October i8, 1884,
Dr. Wyeth replied that it was not absolutely, although
he was unable from the clinical history to ascertain its
existence.
Dr. Van Gieson had seen a similar case, in which
there was a mixed sore, because there was a history of
two intercourses. He regarded it as extremely difficult
to draw the border line in cases of that kind.
Dr. Wybth had recognized the difficulties attending a
complete diagnosis, and had also been convinced, the
more he studied the disease, of the great variety of the
manifestations of syphilis.
Dr. Levi referred to what Mr. Jonathan Hutchinson
had called syphilitic lupus, and had seen three cases, of
which he had been reminded by the case presented by
Dr. Wyeth. He further remarked that in Vienna syphilis
was diagnosticated by the disease attacking the root of
the nose, while lupus attacks the apex of the nose.
Dr« Wyeth remarked that in his case the disease at-
tacked not only the nose at the apex, but other portions
of the body, and was seen upon the forehead, etc. He
regarded the lesion upon the apex of the nose as due to
strangulation of the vessels.
Dr. Levi remarked that he did not doubt the correct-
ness of the diagnosis in Dr. Wyeth's case, and merelv
mentioned the point made by Mr. Hutchinson that syphi-
lis was one of the causes of lupus, of which he had seen
cases which had a striking resemblance to the one pre-
sented.
Dr. Van Gieson asked if, when the initial lesion was
pure chancre, extensive destruction of tissues at the seat
of the lesion was to be expected in ordinary cases ?
Dr. Wyeth said no : that true chancre was not apt to
be ulcerative, but there are forms which are chancroid in
type.
Dr. Van Gieson referred to one case of syphilis under
his care, which resisted all forms of treatment. The case
was also treated by Dr. Bumstead, but without effect, and
he (Dr. Bumstead) regarded it as one of the cases in
which the poisoning is so profound that it could not be
reached by ordinary remedies. The beginning of the
case was very much like that of the one presented by
Dr. Wyeth. The initial lesion was upon one labium,
which sloughed away entirely and very rapidly, and be-
fore the disease could be arrested the opposite labium
was involved and also completely destroyed. The sec-
ondary symptoms were of the most obstinate character,
were followed by iritis and the later eruptions, despite
the most active mercurial treatment. The rodent variety,
therefore, might be seen early in the history of a case.
Dr. Wyeth thought that such cases were not so rare
as they might appear to be. Some cases of syphilis re-
sist all forms of treatment and go on to a fatal termina-
tion without abatement of the disease. In other cases
the patients live for years without the recurrence of
symptoms, after having been under treatment. He re-
garded syphilis as a curable disease and not a difficult
disease (o cure. At all events he preferred to take his
risks with syphilis rather than typhoid fever or pneu*
monia. He also believed that thousands of cases of
syphilis had recovered without medicine which produced
any direct effect upon the poison of the disease.
Dr. Van Gieson remarked that the point to which he
wished to make special reference was the early appear-
ance of the phagedena. He had had a patient under
observation who was treated for syphilis ten years ago,
and it was supposed that he was cured, but at present he
was suffering from paralysis of the abducens believed to
be of syphilitic origin, without having contracted the dis-
ecue a second time.
Dr. Seguin remarked that nerve phenomena of a
syphilitic character might develop as long as twenty-five
years after the disappearance of all symptoms of the first
attack, and this also in cases in which the primary syphil-
itic attack was mild.
The President referred to cases in which syphilitic
lesions developed twenty years after the primary attack,
and the patients had been reasonably well treated at first.
Dr. Wyeth remarked that in many cases syphilis re-
mained dormant in the system for twenty or thirty years,
and then tertiary symptoms developed,
Dr. Levi remarked that the fact that the initial lesion
in Dr. Wyeth*8 case was pustular made him believe that
the general system of the patient was affected by some^
thing besides syphilis. With regard to treatment, when-
ever mercury had failed to control the disease, it had
frequently occurred that to stop all specific remedies and
resort to hygienic measures with cod-liver oil and iron
was the very best method of treatment which could be
adopted.
The President had often adopted this plan, and had
even be^n the use of cod-liver oil, iron, eta, before ad-
ministering mercurials.
The Society then went into executive session.
OUR PARIS LETTER.
(From our Own Cotropondcnt)
THE PROPOSED AMBULANCE SYSTEM IN PARIS AND DR.
NACHTEL — ^THE REPORT OF THE CHOLERA EPIDEMIC
Pakis, September tfi, 1884.
The readers of The Record may recollect that so far
back as the year 1880 Dr. Nachtel submitted a proposal
to the Academy of Medicine and to the Municipal
Council of Paris for the introduction of ambulance car-
riages to meet the requirements of this populous city in
case of street accidents, as at present nothing of the kind
exists. He even offered his services gratuitously to assist
in the organization of a system similar to what has been
so long m o])eration in New York, and which has ren-
dered such signal service. Dr. NachteFs plans were
highly approved of and accepted in principle, but, how-
ever incredible it may seem, nothing^ has as yet been
decided upon. There has been no lack of perseverance
on the part of Dr. Nachtel, for he has been unremitting
in his endeavors, and he has not left a stone unturned to
have his scheme carried out. He has paid personal
visits to officials whom he thought in a position to help
him in the matter, from the Prefect of Police to the
President of the Republic, by whom he was received with
the usual French politeness, but the affair is not a whit
more advanced than it was four years ago. Finding little
hope from official quarters, Dr. Nachtel has, from time
to time, appealed to the public through the medical and
lay press, but without any better result. He has now
published a pamphlet in which he has taken the pains to
recall the different phases through which the subject has
passed since 1880, and to reproduce the various docu-
ments he has officially submitted to the Academy OC
Medicine, to the Council of Hygiene, and to the Muni-
cipal Council of Paris, and once more makes an appeal
to all whom it may concern (and surely it concerns
everybody residing in this city or only passing through)
to have Dr. NachteVs scheme realized without further
delay, as street accidents are as rife as ever and the ex-
isting arrangements are quite inadequate to meet them.
The following statistical report just published by the
Prefect of Police will show the necessity for having am-
bulance carriages at the disposal of the population. The
report relates to accidents in Paris and in the suburbs
during the year 1883. The total number of accidents
during the year was 759. Of this number there were 20S
cases of wounds of the head and 192 cases of drowning;
there were 212 cases of wounds produced by various
causes, 59 cases of illness of various kinds, and 31 cases of
epilepsy ; 182 persons received medical aid in the eight
pavilions established along the banks of the Seine and of
the canals in Paris for succoring the drowned.
To giv^ strength to his cause, Dr. Nachtel has even
October i8, 1884.]
THE MEDICAL RECORD.
443
secured the support of Victor Hugo, whose voice he
thought, from his high standing in the favor of the nation,
irbuld attract some notice. The idea was as far-fetched
as it was a happy one, as Victor Hugo is not only a great
poet but he is also a great philanthrophist, and in the
latter capacity he expressed himself as follows : ** New
York has commenced, Paris will continue that which you
propose, and which is suggested by reason and by evi-
dence. The success of the scheme will confirm your af-
firmations ; it is clear, it is definite, it is humane. I ap-
prove of it and congratulate you." The above is a trans-
lation of Victor Hugo's autograph letter to Dr. Nachtel,
which has been reproduced in the pamphlet above re-
ferred to, but I am afraid the French will pay no more
heed to it than they would to any of the great poet's
poetical effusions.
The French are a peculiar people, they are quick in
some things and deplorably slow in others. And one of
the things they are slow in is the adoption of any innova-
tion coming from a foreigner. Moreover, they are so
tied down by red-tapeism that, even in the management
of their internal affairs, when a proposition is made by
one of their own for the public good, the course it has to
go through before it is sanctioned or pronounced upon is
so interminable and attended with such vexatious pro-
cesses that in many cases the proposition is either for-
gotten or hopelessly abandoned. In this assertion I am
Supported by an editorial in a recent number of the Pro-
gris Medical^ in which the writer, with reference to this
very question of ambulance carriages as proposed by Dr.
Nachtel, states : " Unfortunately everything is done very
slowly in France, and practical questions are long since
resolved by our friends, the Anglo-Saxons, before they are
even broached by us. In spite of our superficial love for
novelty, we are, at the bottom, great followers of routine,
and we bear with astonishing patience all the defects
of ao administration for which Europe has never envied
OS." I have translated the original paragraph as literally
as possible, in order that I may not be accused of undue
exaggeration, although it is hardly necessary to offer
any apology, as what is stated above is a proverbial fact.
I consider it highly discreditable to the country, the in-
habitants of which assume to be in the van of progress
and civilization, to be so exclusive and so adverse to
foreign intervention, even when it affects their nearest
interests, for while the scheme above referred to is long
since in operation in London and in many other manu-
facturing towns in England and Scotland, Paris is still
without its anabulance service.
I may here recall another instance of French repug-
nance to foreign innovations. It so happens that Dr.
Nachtel is here again the instigator. I refer to the
necessity of adopting some system to prevent people be-
ing run over by cabs and other vehicles moving about
\^ the city of Paris. More than a year ago the subject was
brought to the notice of the Prefect of Police and a plan
was submitted to that functionary for carrying out this
veiy desirable and philanthropic object, but nothing has
been heard of it since. The consequence^ is people are
still being run over and the victims are left to the tender
mercies of the public, as no particular arrangements are
made for attending to them. It is true that refuges in
the streets have been multiplied, but they are few and
far between and are often not to be found where they are
most required. The plan suggested was that adopted in
London and New York, but I have it on good authority
that the Paris policemen have received no particular
orders to interfere with the vehicles going to and fro, or
to render assistance to pedestrians in the streets unless
they were moved to do so by their own sense of courtesy
or humanity.
Dr. Proust, Inspector-General of the Sanitary Services
in France, has just sent in his official report to the Min-
ister of Commerce on the state of the cholera epidemic.
The report was published in the Journal Officiel in which
he states that the epidemic is evidently on the decline,
thanks to the energetic measures that have been taken
to ensure salubrity in the dwellings, as wdl as in the
streets. The progress of the present epidemic in France
and Italy demonstrates once more the futility and even
the danger of "cordons sanitaires" and the necessity for
the rigorous application of hygienic measures.
OUR LONDON LETTER.
(From our Special ConrespondenL)
BUYING PRACTICES — MEDICAL AGENTS — BACILLI AND
THEIR DISCOVERIES — ^THE ADVANCE IN ANTISEPTICS —
THE ANn-VACCINATION CRAZE.
London, September 29, 1884.
The holiday season is now fairly over, and so is the fine
weather. Most practitioners are now reassuming harness
for the winter. Among general practitioners many are
now departing to fresh localities, having sold their prac-
tices and either purchased new ones or gone elsewhere
to start. Practices are changing hands at all seasons of
the year, but the summer and autumn perhaps witness
more changes than the other seasons do. The most
usual mode of commencing general practice is — among
those possessed of sufficient capital to do so — to pur-
chase one. The prices given vary a good deal with
the class of practice acquired, but many fairly good-
class general practices can be bought for a sum equal to
the total receipts for twelve or eighteen months. The
incomer has, of course, to support himself during the first
year until his first bills have been paid. In good-class
practices little ready money is taken. Medical agents
are accustomed to gauge the character of a practice by
the amount of ready money taken, ue.y the more ready
money taken the lower is usually the class of practice.
Christmas bills, too, are often not paid until February or
March. The purchaser of a practice has usually to take
the lease of the house where the latter is lesisehold,
and is often required to purchase the furniture at a valu-
ation. During the period of introduction he has to divide
the returns with his predecessor. Bearing all this in mind
it will be seen that to purchase a practice of eight hun-
dred pounds a year requires a capital of nearly two thou-
sand pounds.
Partnerships are much more expensive than ordinary
practices, as the income is more certain and is sometimes
guaranteed. Two years' purchase is a minimuna price,
and often much more is asked. Practices in fashionable
resorts fetch more than ordinary practices. Consulting
practices are rarely to be purchased, but occasionally such
is the case. I have known several instances of special
practices changing hands, and for very large sums. The
practice of a general physician or surgeon is very rarely
to be obtained thus though, and still more rarely kept if
purchased, being so largely personal.
Most transfers of practices take place through medical
agents, who charge a commission to venders, but none to
purchasers or those seeking information. Many medical
agents are either medical men themselves or related to
medical men. From the number of them in London it
would appear to be a good business. I have often been
surprised to see so few practices advertised for sale in
American medical journals. The agents' advertisements
often occupy six or eight pages of our medical weekly
journals. The Lancet^ perhaps, has the largest number
of this class of advertisements, being the oldest medical
paper, but the other journals now have a fair share.
The bacillar origin of cholera still attracts a large
share of attention. I do not think the profession here
though are yet at all inclined to accept unquestioningly
Koch's views on the comma-bacillus and its significance^
Bacilli have been rather overdone of late years, and so
many paragraphs have appeared in the journals attribut-
ing this disease and the other disease to bacilli, that
sound physicians are getting rather incredulous as to
some of the discoveries made by means of immersion ob-
444
THE MEDICAL RECORD.
[October i8, 1884.
jectives. It is not many years since Professor Klein had
to recant some apparent discoveries he had made, and
acknovrledge that the appearances he had described
were in reality due to the method of preparation and the
reagents employed. I must give him credit for honestly
acknowledging his error.
There can be no doubt that recent studies on micro-
organisms and their relation to disease have immensely
stimulated the use of antiseptics, and this, too, among
many who by no means give in their allegiance to the
germ theories. Carbolized vaseline has to a large ex*
tent replaced the time-honored lard in obstetric practice,
and carbolic lotion is largely used in out-patient prac-
tice, even by surgeons who would never think of using
the spray, and many of whom never performed opera-
tions antiseptically.
The anti-vaccination movement at Leicester is assum-
ing serious proportions. Leicester has long been a cen-
tre of the agitation against vaccination, and for many
years returned to Parliament a gentleman of very pro-
nounced anti-vaccination views — Mr. Peter Taylor.
Leicester is by no means an average town in this respect.
In most parts of Great Britain there is practically no
great difficulty in getting the vaccination acts carried out
It is very common for the mothers of infants about to be
vaccinated to express an objection to it, on the score of
the pain inflicted, and even to say they should not have
their children done if they were not obliged to by law,
but most of them are quite ready to acknowledge the de-
sirability of having it done, even while expressing a sen-
timental objection to it. The rigid opposition of the
fervid anti- vaccinationist is of a very different type. For-
tunately such are not very numerous in ordinary English
towns. They form a very small minority of the popula-
tion, and a decreasing one. Most Englishmen have a
good deal of reverence for law, and I believe the anti-
vaccination movement would long since have died out
but for a few fanatics who fanned the flame of discontent
I must say that when a batch of anti-vaccinationists are
committed to prison for obstinate refusal to comply with
the law, their voluntary martyrdom excites a good deal
of sympathy even among those who differ from them in
opinion, and probably does more than any amount of
agitation to advance their cause among the populace at
large. There is also an increasing feeling against fining
the same parents over and over again. «• Liberty of the
subject " has always been a popular cry in England.
"DEAD TEETH IN THE JAWS."
To THB Editok or The Medical Recobix
Sir: In the editorial of this date, entitled "Dead
Teeth in the Jaws," your suggestions as to the desirabil-
ity of medical men being " better informed concerning
diseases of the jaws and mouth," strike a dentist as
quiie d propos ; for the public good, physicians should
be better able to discriminate between " numerous harm-
ful dental appliances" and modes of practice and the
legitimate conservative treatment of diseased teeth,
which is based on accurate knowledge of the anatomy
and physiology of the maxillary tissues and their ap-
pendages. You do not overestimate the importance of
instruction in oral surgery in the medical schools. But
while the medical profession is happily beginning to
realize the importance of teeth, as factors m nervous
and nutritional disturbances, they should not lose sight
of the value of teeth, nor of the possibilities of treat-
ment
'* Dead teeth,*' so called, are not in an appreciable
degree deprived of periosteal nourishment by the death
of the pulp, which occupies the central canal of the
root, and maintains the vitality of the dentine ; the pe-
ripheral tissue of the root — cementum, histological! v
analogous to bone — may still be nourished in a practi-
cally normal condition by the periosteum through a life-
time, provided the latter tissue is not permitted to suffer
from irritation, which is liable to be produced by the
mephitic products of putrefaction of the dead pulp tis-
fue, escaping through the apical foramen of the root
Inflammation and abscess as well as the more obscure
reflex phenomena, when associated with pulpless teeth,
almost invariably have the apical foramen and the peri-
osteum about it for a starting-point ; to render this point
and the root-canal aseptic and preserve them in that
condition by thoroughly filling the canal with impervious
material, which shall prevent the entrance through the
foramen of tissue fluids which would in turn become an
irritant, is the aim of all intelligent treatment ; and when
performed with the skill and thoroughness demanded,
these operations rarely fail to place the root in a per-
fectly benign condition. Want of knowledge, skill, or
conscience on the part of dentists, unfortunately, causes
too many of these operations to be harmful and often
disastrous ; but when the medical profession have given
the attention to this subject that its importance de-
mands, it will be able to do much more toward correct-
ing the evil. Dr. Sexton has rendered a notable service
to the profession, and to humanity, in making known
the results of his careful observations of diseased teeth
which, through neglect or ** ill-advised dentistry," have
become the cause of serious aural disturbances. ^
It is to be hoped that his valuable contribution and
the editorial on the subject will further stimulate interest
in this subject. J. Morgan Howe, M.D.S., M.D.
New York, October 4, 1884.
To THE Editor or Tkb Mbdical Rbcoko.
Sir : Lately Dr. Sexton has given to the profession a
number of articles describing the relation between den-
tal and aural troubles. These articles were interesting
and conclusive ; but the last article, in The Record of
October 4th, includes a series of cases, the results of
which, in several instances, are not at all conclusive.
Although Dr. Sexton is to be congratulated in bringing
forward this new line of thought, it must not be forgotten
that this conjunction of neuralgias is exceedingly rare.
That poor people have bad teeth and much wax in
the ears is the rule and not the exception ; the teeth are
allowed to decay from inability to pay a dentist ; and
the ears are not cleaned through inadvertency. This
conjuncture of circumstances may frequently obtain with-
out there being a connected correlation of symptoms in
the two organs.
Dr. Sexton did not state, for the benefit of his read-
ers, that it is only the middle, constricted, portion of the
auditory canal that secretes cerumen nominally; the
third, innermost, portion of the tube secretes cerumen
only under pathological conditions ; this might aid in
the diagnosis.
Regarding Dr. Sexton's remarks on the prevailing
practice of treating teeth, instead of extraction, we think
these remarks are too sweeping, and thereby calculated
to mislead a great many medical practitioners who have
paid no attention to dentistry, or have even endeavored
to acquire a theoretical knowledge of the dental organs.
There is a good deal of imperfect work turned out by
both classes of dentists, the cheaper and the more ex-
pensive ones ; even extraction is often clumsily and im-
perfectly done ; but all this, which is to be deplored,
does not negative the fact that, with the exception of
certain conditions (well known and rapidly diagnosed by
the practised hand), it is far preferable to leave the teeth
in the jaw, having the carious portion removed, than to
cap, fill, build, or crown. There are several objections
to extraction ; the chief one, not generally appreciated,
is that the corresponding tooth in the other jaw has now
no opposing tooth for the purpose of mastication.
Dr. Sexton's remark on wearing dental plates is 9^
posile ; besides the danger of swallowing the teeth, or
plate even (in some instances having caused instant
October i8, 1884.]
THE MEDICAL RECORD.
445
death), the pressure of the plate causes absorption of the
palatal membrane and exfoliation of the palatine process
of the superior maxillajy bone in some cases ; where mer-
cury is used in preparing the cheap, rubber plates, there
is danger of salivation, with possibly detrimentail local
results.
Dr. Sexton's remarks, that dentists leave dead teeth in,
which should be extracted, are apt to lead the inexpe-
rienced practitioner to recommend a wholesale extraction
of carious teeth, to the great detriment of the individual.
It is an undoubted fact that dentistry has made great
strides, thereby greatly benefiting the public. It is now
no longer necessary to kill a nerve before filling, neither
is it necessary to retain the nerve, as life and nutrition
can be carried on through the peridental membrane, mi-
croscopy demonstrating the continuity of vessels through
that membrane into the superfices of the fangs ; lastly,
bridging and crowning do away with plates.
Respectfully,
C. E. Nelson, M.D.
Nbw Youc.
To THK Editor or The Mbdical Recoko/
Sir : In The Medical Record of October 4, 1884, ap-
peared an editorial upon "Dead Teeth in the Jaws," in
which the practice of retaining dead or diseased teeth in
the mouth is condemned. Reference is also made to
the <* Clinical Notes on Aural Diseases," to be found in
another part of the same number of The Record, and
in which Dr. Sexton is reported as also condemning the
practice *and charging dentists with doing more harm
than good by their methods of treatment. He says:
" Since dentistry has become such a popular business,
and dead and diseased teeth have been so carefully re-
tained in the jaws through their influence, especially
among the better-to-do, nervous diseases about the head
are becoming alarmingly common. The very general
custom of wearing false teeth in the mouth attached to
vulcanite, rubber, celluloid, and other plates is also an
evil of vast proportions. Indeed, I sometimes think
that the evil done through ill-advised dentistry is greater
than the possible good arising from the work of the more
capable dendsts."
These are very sweeping statements, and I am sure
that upon a more careful investigation they cannot be sub-
stantiated by facts. The question to determine is, What
is iU-advised dentistry ? In the minds of some medical
men, it would seem to be the attempt at restoring dead
(pulseless) or diseased teeth to a healthy condition, and
that extraction of such teeth was the only safe practice.
Now, against such teaching I raise an earnest protest
The cases in which trouble arises from the retention of
dead and diseased teeth which have been treated by the
average dentist, or from the wearing of artificial teeth,
most be very small indeed in proportion to the number
treated or wearing such appliances. The cause lies
more in the neglect of dental treatment than in the re-
sult of it, as evidenced by Dr. Sexton's own cases. That
much harm is done by ignorant dentists — and they are not
a few — there is abundant proof; but that this harm out-
weighs the good done by the better class of dentists —
who are also not a few— certainly cannot be. possible.
Few specialists succeed better in the treatment of dis-
ease than the better class of dentists, and it is their
duty to remove an offending tooth when necessary ; but
their highest duty is to save it if possible.
The extraction of a tooth simply because it is pulp-
less, the cause of an abscess, badly decayed, encrusted
with tartar, the seat of pericemental inflammation, or
pyorrhoea alveolaris, etc, would be a sin against good
practice; for all such conditions are in a majority of
cases amenable to treatment, and should no more be
sacrificed on account of their condidon than that an eye
should be enucleated because it was affected with con-
junctivitis or ulceration of the cornea, or that a bone
should be resected because at one point it was affected
with caries or necrosis, or a leg or arm amputated be-
cause it was the seat of some disease which had occa^
sionally resisted intelligent treatment The duty of the
ophthalmologist, of the surgeon, and of the dentist alike
is to save the organs upon which they operate, and not
to sacrifice them. The latter procedure would be many
times less troublesome to the operator and the shortest
way out of the difficulty for the patient ; but it would not
be based upon sound surgical principles, it would not
be common sense, nor would it be right
To the minds of many people^the teeth are of but
little consequence, and I am sorry to say their value is
not properly appreciated by many physicians, if one may
judge from the advice often given to their patients, viz.,
" It a tooth troubles you, have it extracted ; " and with
equal propriety they might say, if your eye troubles you,
have it taken out — but no surgeon would be justified in
doing it, save as the last resort.
That there is great need of a higher educational stand-
ard among dentists is freely admitted. In fact, it has been
the firm conviction for years of many in the profession
that the dental surgeon should be regularly educated in
medicine before taking up the study of his specialty ;
that he should go through the same course of prelimi-
nary training insisted upon by the specialist in other
branches of medicine ; and that the purely mechanical
part of dentistry (the making of artificial teeth) as now
practised should be divorced from it and relegated to the
artisan, thus giving the dentist opportunity to devote his en-
tire time to die study and practice of the scientific depart-
ment of his calling. It is also a fact that there is great
need that medical men should be better educated in the
pathology and treatment of dental and oral diseases, for
the great majority are lamentably deficient in knowledge
upon these subjects.
To this lack of knowledge may be attributed the un-
sound advice often given in relation to the diseases of
the teeth and oral cavity, as well as very many of the fail-
ures to diagnose the cause of certain apparently obscure
disease's of the eye and ear and neuralgias of the face
and head, while, had the dental surgeon received the
proper training in this direction, he would have been
able many times to determine whether or not it was
located in an offending tooth or caused by some other
oral disease.
The formation in the American Medical Association
of a Section on Dental and Oral Surgery four years ago,
and the more recent establishment of instruction in oral
surgery in some of the medical colleges, are expressions
by the representative medical men of our country of the
value and need of better instruction upon these topics,
and an effort to supply it
It is to be hoped that the movement will receive the
encourafirement it deserves.
I am very truly yours,
John S. Marshall, M.D*
342 Wabash Avbnub, Chicago, III.
TUBAL PREGNANCY.
To THK Editor or Thb Medical Rbcoks.
Sir : Dr. Mund6 finishes his article on his case of extra-
uterine pregnancy, in the issue for September 27 of this
journal, with some considerations as to what becomes
of the incysted ovum after the foetus has been killed by
electricity. As a contribution to the answer to this ques-
tion I would state that I had the opportunity to examine
the patient upon whom 1 had performed this operation
in 1882 (see "Transactions of the American Gyneco-
logical Society," voL vii., p, 185) two years later. She
had grown considerably stouter, and had never become
pregnant She enjoyed perfect health, and the only
thing she complained of was that she had no venereal
orgasm during intercourse, although her husband is a
healthy young man and nothing abnormal with regard to
446
THE MEDICAL RECORD.
[October 18, 1884,
the act could be discovered in him. In spite of the in-
creased amount of fat in the abdominal wall, the pelvic
organs could be distinctly felt by bimanual palpation.
The uterus was found anteflexed as at the time of the
operation, but placed in the median line, and there was
no trace left of the tumor in the right Fallopian tube.
Yours truly,
H. J. Garriguss, M.D.
168 Wbst Twenty-thi«d Stkbtt, Nbw Yokk.
THE REASON WHY ST. LUKE'S HOSPITAL
DOES NOT FURNISH MEDICAL HISTO-
RIES TO OUTSIDE APPLICANTS.
To THE Editos op Thb Medical Record.
•
Sir : My attention has been called to a communication
in your is^ue of this date, from Dr. Joseph P. Fessenden,
of Salem, Mass. It contains my correspondence with
that gentleman, in which, on behalf of this hospital, I
declined to give information concerning the disease with
which a recent patient suffered while under our care.
In your editorial note on the same, you say that ** it is
difficult to understand upon what grounds any public
hospital can refuse to give to a medical gentleman such
information as was solicited," and you courteously re-
quest some explanation on this point from the hospital
authorities.
The answer to your question involves the important
> point as to the rights of patients who enter our hospitals
for treatment.
Dr. Fessenden' s position, as I understand it, is that the
confidential communications which our patients make to
our doctors concerning their own diseases and the causes
which led to them, and our physicians' diagnosis and
method of treatment (which are all matters of record
in the Medical History Books of the hospital), should in
all cases be at the disposal of any physician who asks for
them, as a guide to his own subsequent treatment. This
position, I hold, cannot be maintained.
In case's of litigation, the attempt has not infrequently
been made to obtain from this hospital voluntary in-
formation concerning the private character and diseases
of either present or former patients, for the purpose of
aiding some prosecuting attorney. Such information
has uniformly been denied, on the ground that the com-
munications of our patients to our doctors are confi-
dential, are made for purposes of intelligent treatment
by our doctors of their individual case, and are not pub-
lic property. So frequently were such requests made
that in 1881 I requested the Counsellor of the Corpo-
ration to define clearly my duty in the premises, and
received from him the following : ** In a litigation where
a patient of the hospital is a party, I do not think it
would be right for the hospital to disclose to the opposite
party, from its books, or through its physicians, facts re-
laxing to such patient learned through the connection of
such patient with the hospital, unless such disclosure be
required by process of court under the ordinary rules of
evidence relating to such matters. There might, how-
ever, be an exception to this rule in a criminal matter,
when the information was requested officially by the
District Attorney."
This has established the following rule for the ad-
ministration of this hospital : that when there is any rea-
sonable ground to question whether the information
sought would or could in any way be used to the disad-
vantage of the patient, it is to be studiously withheld, un-
less our hospital records are called regularly into court
as evidence, when we are obliged to testify to "the
truth, the whole truth, and nothing but the truth."
The facts in regard to the case referred to by Dr. Fes-
senden are that on September 9th I received a letter
from a stranger in Salem, Mass., asking, among other
things, *' the cause of Mr. B *s being in the hospital."
I replied, stating the fact that Mr. B had been a pa-
tient here, and giving the date of his entry (March 4th) and
his discharge (April 14th) as "cured," but declining to
disclose the disease from which he suffered, and giving the
reasons why such communications could not be made.
On September i6th I received a letter from Mr. B — -'s
brother in Boston, making similar inquiries, and asking if I
thought his brother's ^* brains were all right," that <<he
talked and acted very strangely." A similar reply was
sent. Again, on September 20th, I received a letter
from a Dr. Fessenden, who was unknown to me, in which
he says : " Mr. B is now with his sister in Salem,
having suddenly appeared after an absence of six )ears,
physically much emaciated, almost in rags, and mentally
unsound besides. I would like to know what was the
matter with him while at St. Luke's, and whether he was
in sound condition when he left."
Judging from all the circumstances of the case, I could
not doubt that Mr. B had proven an unwelcome guest
on his return to Salem, that it was the desire of his family
to send him to a lunatic asylum, and that the physician
who had already concluded that his patient was *^ men-
tally unsound *' sought corroborative evidence from this
hospital. This, in justice to our former patient, I felt I
must decline to give. My conclusion as to the reasons
which prompted the inquiry are reinforced by my pub-
lished letter to Dr. Fessenden, in which is stated, at least
inferentially, my willingness to communicate the facts to
Mr. B himself, or at his request to his physician.
Yours respectfully,
George S. Baker,
Pas/or and SuferiniendenL
St. Lukk's HospiTALflNswr Yokk, October ii, 1884.
Iirmij and H^w^ ^etwa.
Official List^ Changis in the StoHotis and Duiiis cf Offiun
serving in tJu Medical Department^ United States Armif^
from October 5 to October 11, 1884.
Clements, B. A., Major and Surgeon. In addition
to present duties, to take charge of the office of the Med-
ical Director of the Department during the temporary
absence of that officer. S. O. 195, par. i. Department
of the Missouri, September 29, 1884.
Happersett, John C. G., Major and Surgeon. Will
be relieved from duty in Department of the East and or-
dered for duty at Willef s Point, N. Y. S. O. 235, A. G.
O., October 7, 1884.
Woodruff, Ezra, Captain and Assistant Surgeon.
Granted leave of absence for four months. S. O. 235, A.
G. O., October 7, 1884.
Cronkhite, Henry M., Captain and Assistant Sur-
geon. Assigned to duty as Post Surgeon, Fort Reno,
Indian Territory. S. 0. 1 97, Department of the Missouri,
October 2, 1884.
Loring, Leonard Y., Captain and Assistant Surgeon.
From Department of the East to Department of Califor-
nia. S. O. 237, A. G. 0., October 9, 1884.
Harvey, Philip F., Captain and Assistant Surgeon.
From Department of Dakota to duty in Attending Sur-
geon's Office, Washington, D. C, relieving Robert W.
Shufeldt, Captain and Assistant Surgeon, who, on being
relieved, will report to Commanding Greneral Depart-
ment of the Missouri for duty. S. O. 237, A. G. O., Octo-
ber 9, 1884.
Powell, J. L., Captain and Assistant Surgeon.
Granted leave of absence for one month on surgeon's
certificate of disability. S. O. 204, Headquarters De-
partment of the East, October 8, 1884.
Spencer, Wm. G., Captain and Assistant Surgeon.
Granted leave of absence for one month. S. O. 204,
Headquarters Department of the East, October 8, 1884.
October i8, 1884.]
THE MEDICAL RECORD.
447
McCrmry, Gbo., First Lieutenant and Assistant Sur-
geon. Assigned to duty at Fort Meade, D. T. S. O.
n5, Headquarters Department of Dakota, October 6,
1884.
Taylor, A. W., First Lieutenant and Assistant Sur-
geon. Assigned to duty at Fort Omaha, Neb. S. O.
87, par. 3, Headquarters Department of the Platte, Oc-
tober 3, 1884.
Black, C. S., First Lieutenant and Assistant Surgeon.
Granted leave of absence for fifteen days, to take effect
this date. S. O. 131, par. 3, Department of Texas, Sep-
tember 29, 1884.
Official JJst of Changes of Stations and Duties of Medical
Officers of the U. S. Marine Hospital Service^ July i
to September 30^ 1884.
Bailhache, p. H., Surgeon. To proceed to Dela-
ware Breakwater Quarantine Station as inspector, Sep-
tember 10, 1884, to investigate reported poUution of
Potomac River water-supply, September 20, 1884.
Miller T. W., Surgeon. Granted leave of absence
for fourteen days, July 10, 1884. Detailed as President
Board of Examiners, September 2, 1884.
Wyman, Walter, Surgeon. Detailed as Member Board
Of Examiners, September 2, 1884.
Long, W. H., Surgeon. Granted leave of absence for
twenty days, July 30, 1884.
PuRRiANCE, George, Surgeon. Detailed as Recorder
Board of £xaminers, September 2, 1884.
Stoner, G. W., Passed Assistant Surgeon. To pro-
treed to Lewes, Del. (Delaware Breakwater), as inspector,
July 25, 1884. To act as Quarantine Officer at Dela-
ware Breakwater, July 31, 1884*
Fisher, J. C, Passed Assistant Surgeon. Granted
leave of absence for thirty days, August 21, 1884.
GoLDSBOROUGH, C. B., Passed Assistant Surgeon.
Granted leave of absence for thirty days, July 12, 1884.
Leave of absence extended thirty days on surgeon's cer-
tificate of disability, August 11, 1884. Leave of ab-
sence extended thirtydaySj^without pay, September 11,
Heath, W. H., Passed Assistant Surgeon. Granted
leave of absence for thirty days, September 8, 1884.
Gurr^RAS, John, Passed Assistant Surgeon. Granted
leave of absence for thirty days, September 24, 1884.
Banks, C. £., Passed Assistant Surgeon. Granted
leave of absence for thirty days, August 27, 1884.
Bennett, P. H., Assistant Surgeon. To proceed to
Buffalo, N. Y., for temporary duty, September 19, 1884.
Glen NAN A. H., Assistant Surgeon. To proceed to
Mobile, Ala., for temporary duty, July 7, 1884.
Fisher, J. C., Passed Assistant Surgeon. Resigna-
tion accepted, by the Secretary of the Treasury, to take
effect September 30, 1884. August 21, 1884.
ptjedical Stjema.
Contagious Diseases — ^Weekly Statement. — ^Re-
port of cases and deaths from contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the week ending October 11, 1884 :
Week Ending
Cas*s,
October 4, 1884 .
October 11, 1884
Deaths.
October 4, 1884.
October 11, 1884
I
The Pay of the Medical Department during the
Revolution is given by a writer in the Magazine of
American History as follows : " To the office of Direc-
tor of the Military Hospitals was attached the pay of
$150 per month, two rations, one for servant, and two of
forage ; to that of the chief physician and surgeon of the
army, $140 per month, two horses and wagon, and two
rations of forage ; to each of the three chief physicians
and sorgeons of the hospitals, $140 per month and two
rations; to the purveyor, $130, and his assistant, $75
per month; to the apothecary, $130 per month, and his
two assistants, $50 per month each ; to the fifteen hos-
pital physicians and surgeons, $120 per month each, and
to each of the twenty«six mates, $50 per month."
Influence of Syphilis and Mercury on Cholera.
— M. Martineau has investigated the influence of syphilis
and mercurial preparations on cholera. His inquiries
lead him to believe that syphilitic patients under mer-
curial treatment are not exempt from cholera. In 1849
and 1865 the wards of the Lourcine Hospital were full,
and the mortality from cholera was excessive there. M.
Dujardin-Beaumetz says that syphilis has a fatal influence
on typhoid fever. The patients from the Lourcine and
Midi Hospitals seized with typhoid fever are sent to the
Cochin Hospital, where it is the prevalent opinion that
syphilitic patients attacked with typhoid fever have re-
ceived their death-warrant
Peptonized Milk. — In reply to the questions raised
by Dr. N. E. Oliver in a previous issue of The Medi-
cal Record concerning peptonized milk, a correspondent
writes that there is no necessity for the use of the soda
in peptonizing milk. If two portions of milk be prepared
—one with soda and the other without — no difference
can be seen in the action of the pancreatic ferments, and
they will both be digested in the same time. The pan-
creatic ferments act upon all food substances without the
need or use of ^' alkali.'' In digesting milk it is neces-
sary to check the action at the desired stage. It was
originally proposed by Dr. Roberts to do this by bring-
ing the heat to the boiling point, thus killing the ferment
But if peptonized milk is boiled at any period short
of the complete conversion of the caseine into peptone,
it is coagulated. This coagulation is due to the pecu-
liar substance into which caseine is changed in the pro-
cess of its conversion into peptone. The addition of
soda bicarbonate was found to prevent this reaction, so
that digestion may be checked by boiling at any stage of
the digestion, when soda is used. The writer proposes
the chilling of the milk by ice to check the digestion and
maintain at any desired point, still preserving, however, the
vitality of the digestive agent. Is the soda objectionable ?
is it in " excess ?" The milk-curdling ferment acts upon
alkaline milk (up to 15 grains of soda to the pint) just the
same as upon pure milk, but not so quickly. Woman's
milk is alkaline. The stomach has two resources for the
coagulation of milk — the acid and the milk-curdling fer-
ment Therefore the soda as used can hardly be con-
sidered excessive. There is no doubt but that the coag-
ulation of the milk in the stomach places the digestion of
the albuminoids of milk upon the same footing as other
albuminoids. So it would seem a self-evident proposition
that in order to render cow's milk a fair daily food for the
average infant, as a substitute for its mother's milk, it should
first be made to quantitatively approximate thereto, and
then the caseine adequately altered. When this is done
the milk does curd in the stomach, or by the addition of
acid, precisely as does human milk — namely, in minute
flocculi. In cases of disease of the digestive tract.
448
THE MEDICAL RECORD.
[October i8, 1884.
how far it is proper to pre-digest the caseine, and how
long to continue the exhibition of thoroughly pre-di-
gested milk, is a question not within the province of the
writer. In order to use the milk at night, the peptonizing
agent can be put into a bottle with half a pint of cold
water, half a pint of cold milk, and four tablespoonfuls
of market cream. Shake, and place on ice at once.
There will be no digestive action in this situation. When
needed, pour out just enough for a feeding into a tin cup
and hold over a brisk flame for six minutes, stirring con-
stantly with a spoon and tasting often so that it does not
become too hot tp be sipped. Now pour into a nursing-
bottle and it is ready for the child. When ice cannot be
conveniently had, put four tablespoonAls of cold water
into a tin cup and the proper proportion of peptonizing
powder. Mix well and add four tablespoonfuls of cold
milk and one' of cream, and hold over a flame for six min-
utes, stirring constantly and tasting so that it does not be-
come too hot to be sipped.
What Quacks Can Do.— Dr. D. B. Smiley, of Mid-
dletown, N. Y., writes that two " eclectic" physicians in
that town recently undertook to deliver a parturient
woman, and did the work in fifteen minutes. The head
was seized with the forceps, a towel wound round the
neck, and both the quacks gave a long pull together.
Result: the head was pulled off"! The body was then
turned and delivered. The result was that the vagina
and perineum were torn to shreds, and the patient died
next day. An inquest was called, and the two quacks
testified that, though the urine had not been passed for
twenty-four hours, they had not thought it advisable to
draw the water. One of them stated that the woman's
temperature, as taken with his finger, was 93° or 94**.
This one stated that the normal healthy temperature was
76** or 80°, but might be 140°. He stated that he meant
blood-heat, not the pulse. The other was not altogether
clear, but believed 70° to 80° to be about fair, and that
it was higher in our Southern States. He used instru-
ments ; an instrument for the purpose was called a
barometer. The cause of death was given in the death
certificate as "uterine paralysis." The coroner's jury
returned a verdict that the death was caused " from child-
birth, superinduced by over-protracted labor and a want
of proper care anterior thereto, and that, in some respects,
there was had unskilful practice upon the part of the at-
tendant physicians in the case.-' The physician who gets
such surprising results with a barometer registers as hav-
ing a diploma from the Eclectic Medical Society of New
York, October 17, 1877. It would be interesting to
learn on what kind of an examination that Society grants
its diplomas, and whether the barometer is in general use
among eclectics, and under what circumstances they de-
cide that a patient has fever; also, whether they are
proud of their graduates.
Gastric Hysteria. — Dr. G. Frank Lydston, of Chi-
cago, III., sends an account of a curious case. We fear
that his diagnosis will be disputed, especially in view of the
death of the patient Hysterical vomiting or gastric hys-
teria would more likely cover the case.
"Annie K , sixteen years of age, living at home
with her relatives, who were in rather moderate circum-
stances. The young lady had always been perfectly
healthy up to the age of thirteen, when she began to
have periodical attacks of epistaxis, attended by severe
pain in the lower part of the pelvis and back. These
attacks occurred at intervals of about three weeks.
Eight weeks before I first saw the case, she had one of
her usual attacks, but in addition was affected by severe
and uncontrollable vomiting. She was seen by several
physicians, most of them, I believe, being of the homoeo-
pathic persuasion. A number of diagnoses had been
made, the most prominent being gastric ulcer, cancer of
the womb, and ulceration of the womb. It appeared
upon inquiry that an elder sister of the patient had died
from a similar sickness, the nature of which had never
been determined. On examination I found the patient
considerably emaciated (no aliment had been retained
by the stomach for eight weeks, and rectal alimentation
evidently had not been thought of) and very restless from
nervous exhaustion. On examining the ejecta, I found
them to contain a considerable quantity of bile, but no
blood. There was no pain in the epigastric or intnu
scapular regions, but a great deal of pain in the
limbs and head was complained of The temperature
was normal. Very slight tenderness over the lower part
of the abdomen, which was probably exaggerated by the
extremely nervous condition of the patient. On examin-
ing the uterus, I found it to be very small, particularly
as regards the body of the organ. There was no neo-
plasm or other morbid condition. The ovaries could be
felt very indistinctly. I accordingly made the diagnosis
of reflex uterine vomiting, dependent upon non-develop-
ment of the uterus and ovaries. On the third day after
my first visit, I succeeded in checking the vomiting, I
having meanwhile attempted to support the patient by
nutrient enemata. After the vomiting stopped, koumiss
and small quantities of brandy were retained by the stom-
ach. At my last visit on the evening of the third day,
restlessness and nervous irritability seemed to be increas-
ing, although the pulse was stronger and less frequent
Shortly after I left the house, however, the patient re-
quested her friends to leave the room for a while as she
wished to sleep. Accordingly she was left alone for
about five minutes, and when her friends returned they
found her dead. At the autopsy, which was readily ob-
tained, the stomach and other abdominal viscera were
found to be perfectly normal. The uterus and ovaries
were rudimentary, the former measuring about one and
a half inch in length, and the latter being about the dimen-
sions of good-sized beans. The sexual organs were other-
wise normal, with the exception of a peculiar ring of
dilated capillaries surrounding the os uteri externum.
This was of a bright red color, which persisted in the
specimen until placed in preservative fluid."
The Hemorrhoid Quack. — Dr. B. N. Stevens, of
Chillicothe, Mo., writes : " We have a class of 'quacks'
in this part of the country that advertise to cure hemor-
rhoids without pain, and that they meet with more or less
success is proved by their patronage. You cannot get
a patient here to submit to the knife or ligature. They
say they will go to the man who can cure them without
pain, and whose treatment does not require them to be
laid up. Now, of course, they use injections. Will you
give your experience with them, the modus operandi^
etc. ? " We can only say to this that Dr. Stevens will
find fiill descriptions of the carbolic acid treatment of
piles in recent works on surgery or diseases of the rec-
tum. The treatment is often efficient, but not entirely
firee from danger.
Not Extra-Uterine Pregnancy but a Dermoid
Cyst. — Dr. Leonard D. White, of Uxbridge, Mass.,
writes: " In your paper of August 23, 1884, 1 noticed a
short article from the pen of G. C. Park, o'f Murraysville,
Pa., and headed * Extra-Uterine Pregnancy,' etc. Judg-
ing from the description alone, I wish to ask if the tumor
under consideration might not more properly be classed
under the head of 'Dermoid Cyst.'" Dr. Park in a
subsequent note admits that the diagnosis of dermoid
cyst is probably the correct one.
The Florida Climate. — Dr. H. A. Canfield, of Gill-
more, Pa., writes that his experience regarding the value
of the Florida climate has been more in accord with that
of Florida physicians than that of Dr. Boyland. Dr.
Canfield and Dr. Boyland, fi-om the latter of whom we
have received a letter dated September 1 7th, agree in
urging the plan suggested by Dr. Lancaster, of securing
an investigation of the Florida climate by a committee
of the American Medical Association.
The Medical Record
A Weekly yournal of Medicine and Surgery
Vol. a6, No. 17
New York, October 25, 1884
Whole No. 739
t^xi^xvsCi l^rtijcljes.
CONTRIBUTIONS TO
THE ANATOMY OF THE LEMNISCUS.
With Remarks on Centripetal Conducting Tracts
IN THE Brain.
By E.'C SPITZKA, M.D.,
PKOPBSSOK or KSUKO-ANATOMY AND PHYSIOLOGY IN THE NBW YORK POST-GKAD-
UATB MBDICAL ACHOOU
(Continued from page 497.)
III.
In the carnivora the relations of the pes and the lem-
niscus are much more intimate, owing to the lesser
development of the ganglion of Soemmering and the
non-intervention of transverse pons fibres. In a set of
transverse sections from the brain of a lioness, it can
Fig. 13.— Transverse Section through Posterior Pair of Corpora Quadrigemina
and Anterior Part of Pons of a Lion. A, aqueduct ; Pa, ganglion post-optici ;
A lemniscus portion to same ; L| main part of lemniscus ; >, pes fibres ; M
pomtu^PracAimm.
be clearly seen how the middle lemniscus area'(L, Fig.
13), which is all along separated by a molecular mterval
from the lateral division (/) that goes to the post-optic lobes
(P2), constitutes a united bundle with the pes. They
are not separated even by a connective-tissue septum,
and while confirmatory sagittal sections have not been
made, it seems from the comparative area, that the lem-
niscus portion enters into some union with the substantia
ni^a and with the subjacent part of the pes. Aside from
this connection, the bundle from the pes to the lemniscus
(pedal part of the (intermediate) interolivary stratum),
represented by the 0-like areas on both sides of the
raphe, is a well-marked feature of the lion's brain.
In the cat there is a connective-tissue intercalation
between the pes and the lemniscus, and it is difficult to
decide from tranyerse sections whether the main division
of the lemniscus is in part absorbed by the ganglion of
Soemmering, or lies dorsad of it or in the pes. Certainly
there is no correspondingly well-marked field as that rep-
resented in L, of Fig. 14 (a section from the .human
mesencephalon) ; although in lower levels the lemniscus
is quite as distinct, though not as large as in man and
the apes.
Fig. Z4*
In the lion there is a slight separation between the
horizontal main lemniscus and the bundle from the pes
to the lemniscus of Wernicke (pedal part of stratum inter-
medium) ; in the cat the two approach more closely, and
the latter constitutes an angle (open dorsad and laterad)
with the horizontal expanse of the former. A fortunate
set of sagittal sections from a cat reveals a remarkable
confirmation of the course of this fasciculus in the dog,
as well as an interesting relation to the trapezium. The
main part of the stratum interolivare breaks up into nu-
merous bundles, ramifying and meandering amon^ the
transverse bundles of the trapezium, thus producmg a
beautiful wickerwork pattern,* at the cephalic end of the
trapezium field they re-collect and run exactly in the
situation of the bundle from the pes to the lemniscus (to
the " tegmentum " of Henle). The following differences
are noted firom the case of the human subject : i. The
bundle does not connect as abundantly with the ganglion
of Soemmering ; perhaps this indicates that the apparent
relation with it, in man, is a spurious appearance. 2.
But a small part joins the pes permanently ; the main
part is in juxtaposition for a part of its course only, it
leaves it to radiate under and mesad of the nucleus teg-
menti (perhaps in part entering it) to take a course
which only basi-parallel sections can expose (see dog).
In his latest work * Meynert says : " Where these bun-
dles of the internal capsule (certain intertwined fasciculi
from the cortex — in the diagram to be referred to he
changes about and derives them from the lenticular nu-
cleus) run in the same height as the opposite pes fedun-
cu/i(he means the proximal internal part), they admit pro-
cesses of the substantia nigra Soemmeringii^ with which
they are soldered into a compact layer behind the super-
ficial layers. Where this fibre layer of Soemmering* s
substance, which I term stratum intermedium peduncuiiy
covers the tegmentum of the crus, it is bulged forward
by the subjacent red nucleus of the tegmentum. In its
further course the stratum intermedium exhibits a con-
cavity applied to the biconvex deep mass of transverse
» This is one of the prettiest pictures in cerebral histo-anatomy ; the stratum in-
termediMtn fibres bear an analogous relation to the transverse lemniscus, as the
sagittal fibres of the pons bear to the transverse ones in man. There are not the
same mediating nuclear intercalations. Near the main height of the trapezium
there is a beautiful set of cells, not hitherto described, these are scattered in the
meandering fibres in the more dorsal division, and of considerable extent. Not all
the meandering fibres appertain to this stratum, the dorsal third or more, are de«
rived from the reticular field of the oblongata.
* Psychiatrie, p. 48.
4SO
THE MEDICAL RECORD.
[October 25, 1884.
fibres of the pons, and in the oblongata appears to lie
behind the pyramids as the most anterior layer of the an-
terior column, and internally to the olive." * He discon-
nects the lemniscus from the stratum intermedium, with
which I agree in thinking that it should not be confounded.
This description corresponds in many features with the
one I have attempted to give. It is singular that in the
most obscure part of this tract Meynert should agree
with the most modern authorities so nearly, and yet differ
in regard to the simplest and earliest known part of its
course in a territory with which he showed himself in his
earlier work to be thoroughly familiar. His plate of the
spinal cord (page 124, loc. cit.) only the eminence of its
author saves fron> the epithet ** puerile." He allows the
interolivary stratum intermedium to pass without any de-
cussation into the anterior column of the cord, occupying
the field correctly assigned by Flechsig to the undecus-
sated part of the true pyramids. He emphatically de-
clares that the pyramids decussate in toto, so that there
is no other explanation for his mistake than to suppose
that he sticks the (interolivary) stratum intermedium
where he loses it, to the undecussated part of the pyra-
mid tract, where he picks the latter up ; its upper origin
he either ignores or is unacquainted with. The latter
alternative is contradicted by a clause in his older (and
for its day superior) treatise in Strieker's collection.
The true course of the stratum intermedium (proven
beyond question by the secondary degeneration of my
case) in the piniform decussation still passes as a decus-
sation of external pyramid fibres, with a slight doubt.
This adhesion to the old error, worse confounded by the
attempt to implant it on more modern views, is utterly
incomprehensible.' It is true that some fibres take the
course claimed by Lockhart Clarke, and after him by
Meynert, but if the development and atrophy methods
(of which the secondary degeneration is one) are en-
titled to a moment's consideration, they prove that the
great mass of the stratum intermedium passes to the
nuclei of GoU and Burdach, and that the admixture of
pyramid fibres is slight. I have, in an earlier part of this
article, referred to the topographical misunderstanding on
this head.
There is no warrant for the designation of the direct
myelo-cerebellar tract by Meynert as 'lemniscus in-
ferior" (from the cerebellum). Meynerfs description
had been superseded by Flechsig, who is entitled to the
credit of its discovery (with Foville). His refusal to ac-
cept Flechsig's name may be a protest against the
animus of Flechsig's warfare ; if so, it is a singular one.
If we include Meynert's stratum intermedium, the
alleged pyramid tract in GoU's columns, the direct
myelo-cerebellar tract, and the outer part of the an-
terior lateral column under the term lemniscus, we cover
pretty much the entire periphery of the cord from the
bottom of the anterior fissure round to the correspond-
ing part of the posterior."
The only tract which is correctly entitled lemniscus in
Meynerfs plate is the '* lemniscus superior." It is
greatly exaggerated, however, and he who is familiar
with the results of Flechsig, which are accepted by nearly
all neurologists, must be puzzled * on seeine this superior
} The above is a specimen of Meynert's language, and may serve to indicaie the
difficulties under which the translators of his anatomy labored. In plain English
a free and logical rendition, embodying a consistent use of topographical terms,
would be : "From the cortex, a flat layer of fibres converges toward the substan-
tia nigra^ being interpolated between it and the tegmentum as an tnttrmediate
stratum. The nucleus tegmenti, dorsad of it, causes a ventrally convex depres-
sion. After an admixture with the processes of the substantia nigra^ this tract
courses over the dorsal pons fibres, being concave in correspondence with the con-
vex contour of the latter. Below (caudad oO the pons, it seems to lie immediately
over (dorsad) the pyramid in the triangular field, between the latter, the olive, and
the raphe.
^ There is not the slightest reference to the results yielded by a study of sec-
ondary degeneration, though Mayer's, Hom^n*s, and my cases were published
between one and two years prior to the appearance of Meynert's last work.
' To characterixe the diagram in question further, it may be stated that it is--
where not absolutely erroneous — imperfect and theoretiod. It does not corre-
spond to the present state of science, and must prove a serious disappointment to
the numerous students and admirers of Meynert.
^ If the abnormally diminutive pyramid oe erased, and the designations of the
lemnisd reversed^ Meynert's diagram may be turned up-side down, and will gain
by the inversion, masmuch as the uncrossed part of the pyramid, and the stratum
intermedium will then come out right, while the deeper fissure will occupy the cor-
rect dorsal (posterior) position.
lemniscus made to cover a good half of the periphery of
the cord, while the direct myelo-cerebellar tract covers
just one-tenth as great an area. In truth, the relation is
nearer the reverse. In Mayer's case there was second-
ary degeneration of the (true) lemniscus. As the case
was of but a year's standing, it may not have covered all
the area it might have ultimately extended over; it
was situated in a line of prolongation interniediate to the
lateral and anterior cornua, and at the periphery. The
myelo-cerebellar tract, on the other hand, covers a large
segment of the cord.
IV. — ^The Trinbural Fasciculus.
Several years ago' I maintained that the so-called
round bundle of Clark and solitarv bundle of Stilling was
not, as Krause claimed, directly derived from the spinal
fibres of the same side. I derived it in the main from
the piniform decussation, which, as direct anatomical ob-
servation and other n^ethods referred to in the foregoing
show, is a direct continuation of the .stratum intermedium
(interolivare). At that time, following Meynert, I regarded
a larger part of the lemniscus as derived from the ganglia
of the posterior pair of the corpora quadrigemina than is
now done, and consequently supposed that these ganglia
through the discovered connection, exerted their influence
on vegetative life. The trineural fasciculus comprises a
system of fibres imbedded in ganglionic substance, into
which numerous of the internal arciform fibres can be
traced. In the major part of its course it is constantly
in receipt of new fibres through this ganglionic medium,
and expends others which become roots of origin of the
nervus intermedius (an aberrant branch of the glosso-
pharyngeal, see Bigelow's and my own communications to
Thr Medical Record of 1880), the n.glosso-pharyngeus
and the n, vagus. Most authors add the spinal accessor
to the list. In my earlier communications I held a re-
served position on this head, but not venturing to con-
tradict what was then the unanimous opinion, allowed
but a minimum of its fibres to that nerve. Mendel, in
a discussion with Wernicke, held in Berlin, denied such a
connection in toto, not only for the accessory but also
the vagus nerve; this I think is going too fiaur. The
vagus does receive rootlets firom this fasciculus. On the
other hand, I endorse his view, as against Wernicke, that
the accessory is not so connected. I am not able to de-
clare as positively as Mendel does, and as I did in the
communications referred to, that the trineural fasciculus
ends at the level of the gustatory nerves. It is not im-
possible that a slender prolongation continues on to the
substantia femiginea (locus caeruleus), though this is a
mere suspicion with me at present.
As I maintained that the trineural fasciculus is a recur-
rent branch of the lemniscus tracts, its description is
germane to our subject My reasons for opposing Krause's
view that it is exclusively a respiratory fasciculus (Respi-
rations-Btindel) are the following :
1. It extends with undiminished diameter beyond the
level of the pneumogastric nerve and distinctly connects
with the glosso-pharyngeal and intermediate nerves."
2. If the trineural fasciculus came from the cord, its
origin would (Fig. 14) be very near the median line, in
districts which we know have other destinations.
3. The fasciculi of both sides approach each other very
closely, suggesting a decussation.
4. They or rather their ganglionic "sheaths** continu-
ally receive arciform fibres. These arciform fibres cross
the raphe, and while many running in this direction are
from the reticular formation, the majority come from the
olive and the stratum interolivare.
5. While it is not impossible that, the decussation
being established, such decussation may be from below—
1 Chicago Journal of Nervous and Mental Diseases, 187$^
* Duval discovered the connection of the M^rtms intermedius widi the aodetf
of the glosso-pharvniseal, and I deaionstrated an additional ori|;m from the tripw
ral fasciculus. Unfortunately the chief specimen was ruined u dass deaMosn-
tion, so that I am unable to test some new questions diat have aris^, as tov^
continuatioa of the fasciculus &rtfaer. or as I then tauchc, its cesMrinn at nil
level.
October 25, 1884.]
THE MEDICAL RECORD
451
that isjrom^the cord, upward, and not, as 1 maintain, from
above (cephalic), across the median line and reflected
back upward (cephalad) again — the direction of the arcu-
ate fibres is against that view.
Fig. 15. — Section Parallel to the Floor of the Fourth Ventricle of Man. (Autopsy
through Professor Little.) sv., sulcus ventriculi guarti ; Ic^ locus caeruleus cells ;
|r, the enormous raphe root of the sensory division of the trigeminus ; ^g. gtnu
fiulialis : PI/9 posterior longitudinal fasciculus (oculo-nuchal co-ordinator| ; 7a,
ascending fibres to join raphe root ; /, cerebellar myelobracliium, or posterior pe-
duncle : //, fibres of redcular formation ascending in t^mentum ; 8r, stria root
of auditory, imbedded m its (?) nuclear subsUnce; iwm, nuclear mass of mixed
system ; X2w. nucleus of hypoglossal nerve ; /r, trineural fasciculi ; .r/, ganglionic
processes, including fibres firom the piniform (sensory) decussation ; ///, biuidles
of latter divided across in their ascension.
6. Direct observation shows that the lowest demon-
strable fibres come directly from the processes of the
piniform decussation. Occasionally a process is seen
running outward, but it cannot be traced far, and trans-
verse sections show that many rootlets passing from
without inward and over the fasciculus, are only curved
around, taking an arched course from the same decussa-
tional origin. All clear appearances demonstrate a con-
nection with the decussation.
The fibres, although regarded of similar optic appear-
ance in transverse sections, show two well-characterized
varieties in lengthwise sections. The axis of the bundle
is composed of thicker fibres with broad myelin sheaths
which have a pale tint in the aggregate, absorbing little
carmine ; the surrounding fibres are finer, and in bulk
fairly well stained, resembling the bundle which passes
from the habenula to the outer peduncular ganglion * in
this histological respect. In sections of the same direc-
tion as the one represented in the figure, the core bun-
dle is not smoothly continuous, but interrupted, as if it
consisted of slightly arched fasciculi, which may emerge
at various points in the course of the fasciculus. The
difference in the character of the fibres would indicate
that the trineural fasciculus acts as a conductor for sev-
eral functions.
In the case of secondary degeneration of the stratum
intermedium, the functions of the mixed nerves, as far as
deglutition was concerned was impaired. This fasciculus
was healthy, but many of the arched fibres going to it
were not — they had undergone degeneration. One fascic-
ulus crossing out from the raphe, four or five "branches "
1 In an earlijer day of cerebral anatomy, the fact that the stratum interolivare
becomes loit in about the same region where a part of Meynert's bundle runs
Would have been regarded as suggesting a connection.
distant from the hypoglossal nucleus (that is, very near
the dorsal end of the raphe) was entirely healthy (Fig.
3, /; also Fig. 4). From the course of its bundles in the
raphe, and its freedom from degeneration, it cannot come
from the interolivary, but from the true olivary and retic-
ular field portion of the lemniscus. The fact that this
fasciculus is larger in the level of Fig. 4 than that of
^ig- 3 proves conclusively that if there is a spinal origin
for this bundle it must be a very subsidiary element.
Internal to the trineural fasciculus there are a num-
ber of separate fasciculi, continuous for as great a length
and apparently originating in a similar manner. They
are very clear in flat-wise sections and apt to be altogether
overlooked in transverse ones. They cannot in higher
levels be confounded with the longitudinal bundles run-
ning in the hypoglossal and vagus nuclei in lower levels,
referred to by Mendel, though I am not prepared to deny
a connection between them in the said lower levels.
(To be continued.)
DISEASE . GERMS. ^
By GEORGE M. STERNBERG, M.D., F.R.M.S.,
MAJOR AND SURGEON U. S. A.
It is but a few years since ''disease germs" were hypo-
thetical things, in regard to the origin, nature, form, and
modus Ciperandi of which we fpossessed only vague and
uncertain notions.
In this pre-scientific peroid of etiological inquiry, a
favorite idea with those who assumed the existence of
disease germs on theoretical grounds was that they are
living particles detached from the diseased organism, ca-
pable, perhaps, in some instances, of self-multiplication
external to the body, and having the power, when intro-
duced into the body of a susceptible individual, of induc-
ing morbid phenomena identical with those which, in a
preceding case, were the cause of their origin. In other
words, that they are both the cause and the result of the
morbid phenomena which characterize the specific infec-
tious diseases.
No experimental evidence has thus far been adduced
in favor of this conception of disease germs, which is evi-
dently unphilosophical, and is unsupported by observa-
tion or analogy. The only detached living particles
known to science which are thrown oflf from the bodies
of plants and animals, and which are capable of subse-
quent development, are the reproductive elements, the
function of which is to preserve the species and not to
destroy it ; and observation teaches that as a general law
disease is due to agents introduced from without, whereas
the view above referred to would necessitate a belief in
the intrinsic origin of the specific infectious diseases.
For there could be no disease germs detached if there
were no diseased organism to throw them oflf.
But the progress of science has made us acquainted
with disease germs of another kind, which being vegetable
parasites must in the first instance have been of extrinsic
origin, even if at present they have, in certain cases, no
other habitat than within the body of the animal in which
they produce specific morbid symptoms.
Thus, if it be demonstrated — a very diflicult matter,
by the way — that the tubercle bacillus is found only in
the tubercular products which result from its invasion of
the bodies of man and the susceptible lower animals, it
will be none the less improbable that this has always been
the case. We must admit that this bacillus existed in
nature before there was any tuberculosis, or we are forced
to one of two conclusions : either the disease tubercu-
losis at one time occurred independently of the bacillus,
or the parasite was created as it now is and implanted
in the bodies of animals especially to produce this dis-
ease. The second alternative involves the acceptance
of a theoretical conception which cannot be discussed
from a scientific standpoint. It is evidently opposed to
» Read at the meeting of the American|Public Health Association in St Louis
October 17, Z884.
452
THE MEDICAL RECORD.
[October 25, 1884.
the scientific conception which has forced itself upon
careful students of nature in all parts of the world, and
which is expressed in the word evolution.
If at any time in the past the disease tuberculosis ex-
isted independently of the tubercle bacillus, or of any
other micro-organism, then we must deny that this para-
site has any etiological import, or must at least assign it
a secondary r6le, viz., that of carrying a non-living tu-
bercle virus from a diseased organism and implanting it
in a new soil. In this case the infectious character of
the disease would depend upon the living parasite ; but
inasmuch as the disease must at some time have orig-
inated independently of the parasite, we could scarcely
deny the possibility of its intrinsic origin at the present
day. There is much to be said in favor of this view of
the etiology of the infectious diseases ; but it is opposed
by the experimental evidence, which shows that " pure
cultures " of known disease germs are as potent in pro-
ducing the specific morbid phenomena as is material de-
rived directly from the diseased organism.
In the case of anthrax there can be no doubt that this
is true, and that living anthrax spores may produce the
most virulent form of the disease independently of any
non-living material derived from a preceding case. The
experiments of Koch seem to have established the same
as regards the tubercle bacillus, pure cultures of which
are said to produce tuberculosis in rabbits and in guinea-
pigs as certainly and as promptly as do inoculations with
sputum or other material derived directly from the dis-
eased organism. These experiments have been repeated
by Watson Cheyne, of London, with the same result.
I cannot doubt that these gentlemen have obtained
the results reported by them from inoculations with pure
cultures in the sense that no other micro-organism was
present in these cultures. The only possible question is
whether these cultures were pure in the sense that they
did not contain any remnant of a non-living tubercle vi-
rus. How many successive cultures must be made in
order to insure this result we cannot definitely determine,
but evidently more are required when cultivation is con-
ducted upon the surface of a solid culture medium, than in
fluid cultures in which a considerable amount of fluid serves
to dilute the non-living material which in the diseased
organism is associated with the living microbe. There
can be no question, however, that a non-living poison
which originated in the diseased organism independently
of the parasite would, in the end, be excluded by the
method of successive cultures, whether these are made
in a fluid or upon a solid substratum. On the other
hand, a virus produced by the parasite as a result of its
normal physiological processes would be present with it
in each successive culture.
It may well be that all of the different pathogenic bac-
teria produce special poisons to which their specific
action is due. But a poison produced by the parasite
itself, whether grown in an animal body or in a culture
fluid, is evidently secondary as an etiological agent,
although it may be an essential factor in giving the par-
asite pathogenic power. We may suppose that such a
poison secreted by the invading micro-organism prepares
the soil for its future growth ; just as the abnormal
growths upon various plants known as galls are supposed
to be produced by the irritant action of some poisonous
liquid introduced by the sting of an insect, which at the
same time deposits an ^gg, A virus, on the other hand,
which was produced in the diseased organism independ-
ently of any parasite, but which furnished the soil suit-
able for the development of a particular microbe, would
be the essential etiological agent in the production of the
morbid phenomena, and the parasite, if not a mere epi-
phenomenon without etiological import, would at least be
only a secondary factor, capable, perhaps, of doing harm
by inducing changes in morbid products, as, for example,
the cheesy degeneration of tubercle nodules, and of
transporting the virus to new localities and thus giving
the disease an infectious character.
As heretofore remarked, this hypothesis must give way
before the evidence furnished by pure cultures. And it
must be admitted that the experiments of Koch leave
very little ground for believing that it is true as regards
tuberculosis. It is not safe yet to generalize, however,
and it does not follow that it is not true for small-pox
and other diseases in which pure cultures of the parasite
present in diseased tissues have not been proved to be
potent in the perpetuation of the morbid phenomena in
other individuals.
We need a non-living poison or virus in order to ex-
plain the action of the tubercle bacillus ; for I do not
feel prepared to admit that the effects which follow in-
oculations with pure cultures of this microbe are due to
mechanical irritation alone. I have recently repeated
the experiments of Formad, of Philadelphia, in which he
claims to produce tuberculosis by inoculations with finely
powdered inorganic material suspended in water. My
experiments have satisfied me that, when the material is
thoroughly sterilized, and no tubercle bacilli are intro-
duced at the same time, tuberculosis does not result
from such inoculations. We know that the lungs of man
are very commonly loaded with particles of carbon, and
that these angular particles, which are much larger
than the tubercle bacillus, do not give rise to the devel-
opment of miliary nodules. Therefore, I say, we need
something more than the bacillus to account for the for-
mation of these nodules, in which the parasite finds a
suitable soil for its development^
If tuberculosis was originally of extrinsic origin and is
to-day produced by "pure cultures" of the bacillus,
there can be no question that this something else is ex-
creted by the parasite, and is consequently ever present
with it ready to produce its specific effect when in con-
tact with susceptible animal tissues. Not all vegetable
tissues react in the same way to the sting of the various
species of gall-insects, and in like manner we have differ-
ences in susceptibility to disease poisons among animals
of different species, and among different individuals of
the same species. The supposition that the different
pathogenic organisms give off different kinds of poisonous
products as a result of their normal but severally distinct
physiological processes, is sustained by what is known of
the action of non-pathogenic organisms of the same class
in various processes of fermentation and putrefaction,
and by the facts which relate to the influence of protec-
tive inoculations and the non-recurrence of the specific
infectious diseases in the same individual. I have else-
where discussed this subject (see my work on " Bacteria,"
p. 246), and cannot at present give my reasons for believ-
ing that insusceptibility results from acquired tolerance
to the poisonous products evolved by pathogenic organ-
isms, rather than to a change in the system which has
rendered the soil unsuited to their development.
The question whether pathogenic bacteria are distinct
species having permanent physiological characters upon
which their pathogenic power depends, or whether they
are varieties of common and usually harmless species
which acquire this power temporarily as a result of special
conditions relating to their environment, is one of the
greatest importance, and one which is at present prom-
inent in the minds of the leading investigators in this
field.
Buchner's claim' that the anthrax bacillus is simply a
variety of the common hay bacillus, and that one may be
transformed into the other by special methods of cultiva-
tion, has, upon fuller investigation by Koch, Klein, and
others, been shown to be without foundation. We now
recognize not only that these species have distinct physi-
ological characters of a permanent kind, but also that
during certain stages of their development they differ
morphologically. Indeed, the specific distinction is suffi-
ciently well marked by morphological characters alone.
But it does not follow that there is nowhere in nature a
non-pathogenic variety of the anthrax bacillus from which
the pathogenic variety known to us has been derived.
October 25, 1884,]
THE MEDICAL RECORD.
453
So, too, in the case of the tubercle bacillus we are not
acquainted with any harmless bacillus having exactly the
same form and color reactions, and amon^ known species
the bacillus of leprosy is the only one which very closely
resembles it But it must be remembered that we have
only just commenced the study of this extensive class of
micro-organisms, and that thus far it is the pathogenic
species which have received the greatest attention. When
we come to know more of the bacterial flora of the ex-
terior world, we may find that all of the species which
invade the bodies of animals as harmful parasites are
represented by harmless species which cannot be distin-
guished from them except by the test of inoculating sus-
ceptible animals.
. In the case of an organism like the anthrax bacillus,
which grows readily in a variety of culture fluids, and
within comparatively wide temperature limits, it seems
altogether probable that the conditions necessary for its
growth may be found external to the bodies of animals
and outside of our laboratories. But it would be an un-
warranted assumption to suppose that its continuous de-
velopment in this way must necessarily modify its patho-
genic power. For this is retained in full force through
any number of successive generations in laboratory ex-
periments, except when the cultures are subjected to the
special conditions which have been shown to modify this
power, and which, following Pasteur, we speak of as ef-
fecting an " attenuation of virulence." The question is
whether a similar attenuation may^not be effected by nat-
ural conditions, and whether the attenuation may not be
carried to the vanishing point. This is possible, but we
have at present no evidence that it is true.
In the case of the tubercle bacillus, it has been shown
that the conditions of development are so restricted as to
soil and temperature required that it may be doubted
whether these conditions are ever found in nature. It
grows slowly upon blood-serum prepared by Koch's
method, and not at all unless the temperature is very
carefully regulated to about 38° C. Evidently if in a
tropical country the temperature were sufficiently ele-
vated and uniform to insure its development, the proper
pabulum mi^ht be wanting ; or if this were present other
bacteria which multiply more rapidly would most cer-
tainly take possession of it, in the absence of artificial pre-
cautions for their exclusion, before the tubercle bacillus
had fairly commenced to grow. It seems probable, there-
fore, that this bacillus, as we know it, has no external
habitat, and that it depends for its existence upon the
conditions which it finds within the bodies of animals sub-
ject to the disease tuberculosis.
But, for reasons already given, we are forced to the
conclusion that at some time in the past this bacillus had
an external habitat ; else we must concede that the dis-
ease tuberculosis was originally of intrinsic origin and
must relegate Koch's bacillus to a secondary place in its
etiology. We have among the higher animal parasites a
certain number which have the power to shift for them-
selves and to bring up a family independently of the
host upon which they habitually depend for their susten-
ance. Others depend entirely upon their host, and
students of biology are familiar with the singular mbdifi-
cations which many of these have undergone to fit them
for their parasitic existence, and which make it impossi-
ble for them to exist independently of the animal which
they infest. No doubt is any longer entertained with re-
gard to the fact that the structural anomalies exhibited
by these parasites are due to modifications which have
been effected gradually, and that useless organs have dis-
appeared and useful ones have attained a special de-
velopment under the influence of conditions relating to
the environment of the parasite and in accordance with
the laws of natural selection.
It is probable that the minute vegetable parasites
which we know as '< disease germs " have in like manner
ttndef|^ne various modifications, if not in form at least
in their physiological characters ; and it may be that some
of them have thus lost the power of independent exist-
ence under natural conditions. Others may find the
conditions essential to their development both within and
without the bodies of animals. Indeed, we know that
such is the fact as regards several species which have
been shown by laboratory experiments to have the power
of inducing infectious and fatal forms of disease in cer-
tain animals, and which, nevertheless, exist widely dis-
tributed in nature. Koch's bacillus of induced septicae-
mia in the mouse, the bacillus of malignant oedema, which
is much larger and closely resembles the anthrax bacillus,
and the micrococcus of induced septicaemia in rabbits,
which I have especially studied, are all disease germs of
this kind. Their pathogenic power is not a temporary
character, but is limited to certain species of animals in
the bodies of which they find conditions favorable for their
development ; and, so far as we know, the infectious dis-
eases which they induce do not arise spontaneously in
these animals.
Other disease germs, such as the micrococcus of fowl
cholera and that of swine plague, are only known to us
because they induce these forms of disease, and the ques-
tion whether they exist in nature, independently of the
animals which they infest, has not been definitely settled.
If they do, we should expect to hear of the development
of these diseases independently of infection directly trace-
able to a similarly diseased animal. I am not sufficiently
familiar with the evidence to say whether it supports this
view of the case or not But as regards the ^erm of
typhoid fever, which we can scarcely fail to believe in,
although there has been no satisfactory scientific demon-
stration of its existence, and as regards th^ cholera bacillus
— or spirillum — of Koch, which, there is good reason to
believe, bears an essential etiological relation to the Asi-
atic pestilence, there seems to be ample evidence of power
of multiplication external to and independently of the
human organism. We have known for some time that
the germs of these diseases are sown in the discharges of
those suffering from them ; that certain conditions as to
organic pabulum and temperature are necessary for the
germination and rapid multiplication of this kind of seed ;
and that the evidence of such germination and multiplica-
tion is found in an abundant harvest of fresh victims.
But do these germs in their external development
undergo modifications which cause them to lose or to
gain in pathogenic power, and are they ever harmless
organisms which may be introduced into the human
intestine with impunity? The wide difference in the
malignancy of different epidemics and the fact that dur-
'ing the same epidemic the disease may at first assume
a mild form and subsequently develop a most malignant
character, indicates that the germ, if it be in truth the
essential factor in the production of the disease, must
undergo modincations of its pathogenic power. And
once having admitted the possibility of such modifications,
it is hard to place a limit upon them.
There are two infectious diseases of man, one of which
has been lately proved to be due to an invasion of the
affected tissues by micro-organisms, and the other of
which I can scarcely doubt has a similar etiology, which
seem to me strongly to support the view that bacteria
which are ordinarily harmless may, as a result of special
conditions relating to their environment, acquire patho-
genic power. These diseases are erysipelas and hospital
gangrene. It seems to me beyond question that these
diseases may, under certain circumstances, originate de
novo, that is, without direct or indirect infection from a
preceding case. And hospital gangrene especially is so
rare a disease that we can hardly suppose that the out-
breaks which occasionally occur at widely remote locali-
ties are necessarily connected with preceding cases, al-
though these diseases are known to be highly infectious
and to cling to infected hospital wards with great tena^
city.
I have in mind an outbreak of hospital gangrene which
occurred under such circumstances as seem to me to
454
THE MEDICAL RECORD.
[October 25, 1884.
justify the belief that the epidepiic was of local origin. In
the summer of 1862 a large number of sick and wounded
men from the army of the Potomac were placed upon a
transport vessel at Harrison's Landing, Va., and brought
directly to Portsmouth Grove, R. I. This location pos-
sessed great natural advantages both from a sanitary and
from an aesthetic point of view, and, before the arrival '
of this ship-load of sick and wounded soldiers enjoyed a
high reputation for salubrity. A quiet summer hotel,
looking out upon the waters of Narraganset Bay, formed
the nucleus of the general hospital which was quickly
built. Until this was completed the patients were cared
for in hospital tents. Soon after the completion of the
hospital building I was ordered to Portsmouth Grove, and
upon my arrival there was placed in charge of the sur-
gical wards. These were detached frame buildings,
made of new lumber and constructed upon the plan
which had been adopted for our barrack hospitals, and
which is generally conceded to have been excellent. My
wards were full of cases of suppurating gunshot wounds.
This was before the days of carbolic acid, at a time when
we had no positive knowledge of disease germs, and be-
fore we had learned to look upon a sponge as an abomina-
tion not to be admitted to a surgical ward. My patients
were treated in the usual manner with cold-water dress-
ings to recent wounds, and frequently renewed absorbent
dressings and ablutions with warm water when suppura-
tion was fairly established and there was no inflammation.
I dare say the saucers for giving off chlorine gas, which
were in those days supposed to be an important element
in maintaining the purity of the atmosphere in the wards
of our military hospitals, were duly arranged beneath the
several beds. Whether they were or were not, a matter
in which my memory does not now serve me, is of small
importance; for we now know that it is impossible to
disinfect the air of an occupied apartment, and that the
presence of chlorine gas or of carbolic acid in respirable
amounts has no terrors for disease germs.
Up to a certain point my patients continued to do
well, but after a time 1 recognized the presence of some
malign influence in the wards which was counteracting
the vis medicatrix natura upon which I relied for the
cure of these gunshot wounds, and which caused
wounds that had previously been healing kindly to as-
sume an angry look and Co discharge an undue amount
of unhealthy pus. Very soon the condition of some
of these suppurating wounds became still more alarm-
ing. Instead of a simple arrest of the healing process
and an unhealthy discharge, I had to deal with a rapidly
extending necrosis of the tissues. The most trifling
wounds in robust young men which were cicatrizing
in a most satisfactory manner, as well as those more
serious injuries which had necessarily given rise to pro-
tracted suppuration and depression of the vital powers,
would suddenly commence to extend by sloughing,
and a superficial wound the size of a twenty-five-cent
piece was liable within two or three days to become an
ugly and deep sloughing ulcer the size of my hand or
larger. In a word, I had to deal with that dread disease
hospital gangrene. I can hardly doubt that this rapidly
developed necrosis of tissue, extending from the wound
as a centre, was due to invasion by some micro-organism,
and I infer that the pathogenic power exhibited by this
h3rpothetical organism was developed in my wards as a
result of exceptional conditions of environment by some
omnipresent and usually harmless microbe. Otherwise,
how is it that solitary cases of suppurating wounds scat-
tered far and wide over the country never become affected
with this disease, which only occurs where numbers of
wounded men are massed in hospitals ? That the disease
was a local one, due to some noxious agent which in-
vaded the wound, and which was transmissible from
one to another, and was not due simply to a depressed
condition of the general health of those attacked, was
evident. This was especially shown by the results at-
tained by vigorous local treatment in connection with the
segregation of patients and general measures of disinfec-
tion, when by the thorough use of the actual cautery or of
fuming nitric acid the entire wound was thoroughly and
deeply cauterized, the infectious agent was destroyed, and
the vis medicatrix natura proved sufficient to efiect a
speedy cicatrization of the deep and broad ulcers which
resulted from the rapid sloughing and the heroic treat-
ment required to arrest it. Facts of this kind, taken in
connection with circumstances relating to the gradual
development of malignancy in local epidemics of other
infectious diseases, such as diphtheria and scarlet fever^
and the evidence relating to attenuation of pathogenic
power in known disease germs, cause me to give more
weight to the supposition that this pathogenic power may
in certain cases be an acquired physiological character,
rather than an inherent and specific one, than is ac-
corded to it by Koch and some other leading investigators
in this field. I believe, however, that Koch admits the
possibility that his cholera bacillus may be a pathogenic
variety of a harmless organism. At least he has submitted
the question for discussion.
Klein, of London, also favors the idea that pathogenic
power is a specific and constant character belonging to
the micro-organisms which exhibit it We must admit
that this is true in the case of such diseases as small-poz
and measles, if they are in truth germ diseases, for we
have no evidence that these diseases ever originate in-
dependently of preceding cases, or that the infectious
principle is capable of multiplication external to the
human body. But I am very much inclined to believe,
for reasons already given, that it is not true as regards
the various septic organisms which are known to us by
laboratory experiments. I am convinced, however, that
there are among these lowly plants a large number of
distinct species, each having its own independent life-
history, and each subject to modifications of function,
and possibly of form, as a result of gradual changes in its
environment.
Billroth and some of the earlier observers maintained
that the various forms of bacteria which are found in
organic infusions belong to a single species of plants —
the coccobacteria septica of the author named. But this
view is no longer tenable. Nor can I agree with Nageli
that there exist but a small number of species, each of
which may assume a variety of forms. This author has
said : *' Each of the veritable species of schizomycetes is
not limited to presenting itself under the different forms
of micrococcus^ bacterium^ vibrio^ and spirillum^ but can
also show itself as the agent of the acidification of milk,
of putrefaction, and as the agent producing several mala-
dies.'' My own observations have convinced me that there
are, for example, numerous species of micrococci, and
that micrococci never under any circumstances develop
into elongated or spiral bacteria, and do not form en-
dogenous spores, their life-history consisting in multi-
plication by binary division. I have had in cultivation
at different times several different species of these minute
plants, and have found that by proper precautions pure
cultures may be maintained through successive genera-
tions. In other words, that the several species " breed
true." Thus the yellow micrococcus — M. luteus — ^pro-
duces successive generations of yellow micrococci ; and
although the individual cocci cannot be distinguished by
their form alone from other micrococci having a different
color, yet this character being constant is a sufficient
specific distinction. The known species of bacilli which
may be distinguished from each other by form, dimen-
sions, or physiological reactions, are already sufficiently
numerous, and I cannot doubt that the number of un-
known species is far greater. Our knowledge of this
extensive microscopic flora is still very incomplete, and
is obscured by erroneous observations and the confusion
which has arisen from the minute size of these micro-
scopic plants and the intermingling of numerous species
in the same organic infusions. Methods of isolating and
maintaining pure cultures of the several species which
October 25, 1884.]
THE MEDICAL RECORD.
455
have been devised, and especially Koch's method of
sur£Eu:e cultivation, together with improvements in tech-
nique and in optical appliances which have been made
within the past few years, have, however, opened the way
for rapid progress in the future, and we may hope that
before many years we will know much more abput disease
germs than we know to-day, and that the important
questions to which I have briefly referred relating to
their origin, relationships, and modus operandi will finally
be settled by the experimental method.
Unless, however, the few individuals in this country
who have endeavored to take part in these researches
receive more encouragement and substantial assistance
from some source in the future than they have received
in the past, we shall have the humiliation of still receiv-
ing our knowledge of disease germs at second hand, and
of knowing that this great nation, which has taken the
lead in so many branches of scientific research, has con-
tributed little or nothing to this important subject.
I ^shall now endeavor to make you familiar with the
morphology of a few disease germs, and with that of some,
harmless organisms of the same class, by projecting upon
the screen some of my photographs from nature — photo-
micrographs. Should any gentlemen of the press be
present,! beg that they will not refer to the objects which
they are about to see upon the screen as " bugs," as did
an intelligent reporter in New Orleans in giving an ac-
count of a lecture illustrated 'in the same way which I
delivered in that city some years since. By the way, the
popular idea of a disease germ in the city referred to at
the time mentioned seems to have been that it is a bug
of some kind ; for in the Mardi Gras procession of the
same year, an honored member and vice-president of
this association, whose death we were soon after called
upon to mourn, made his appearance in papier-macht
upon one of the flats, as engaged in fishing for germs. In
his hands was a slender fishing-rod furnished with a hook
and line, and from the hook dangled a nondescript
creature which represented a recently captured germ,
and which resembled a Louisiana mosquito more than
anything else; perhaps this was the most pestiferous
creature with which the inventor of this tableau was ac-
quainted. At that time a '^ germ-hunter " was thought
by many good citizens, and by not a few of our own pro-
fession, to be a crank who deserved no encouragement,
and was a fair subject for the shafts of ridicule and scorn*
But the world moves, and many of these honest citizens,
including some of the then scornful members of our own
profession, are now prepared to swallow germs served up
in any style, so long as they are imported. And, indeed,
they may, in my opinion, swallow with impunity some of
these imported germs, as for example the bacillus malaria
of Klebs and Tomassi-Crudeli, or the yellow fever germ of
Domingos Freir6, of Brazil.
Although I object to my disease germs being called
bugs, I cannot find fault with another gentleman of the
press, who, on a different occasion, gave his impressions
of the morphology of the objects which he had seen upon
Ac screen by telling the readers of the journal which he
represented that some of these objects looked like
Bologna sausages and some like oysters on the half
shell. You will at once recognize the Bologna sausages
when the photo-micrograph of a chain consisting of four
bacilli is projected upon the screen, but I am still in
doubt which of my photographs from nature suggested
oysters on the half shell.
NASO - PHARYNGEAL FIBRO - SARCOMA RE-
MOVED WITH GALVANO-CAUTERY feCRA-
SEUR.'
By R. p. LINCOLN, M.D.,
NBW YORK.
State Medical Examiners in Pennsylvania.— At
a stated meeting of the Philadelphia County Medical
Society, held October ist, resolutions approving of the
appointment of a State Board of Examiners, and direct-
ing the appointment of a committee to draft a law for the
creation of such a Board, were unanimously adopted.
M. Charcot has been elected a member of the French
Academy of Sciences, in place of the late Baron Cloquet.
The specimen I present to the Society to-night, I removed,
July 22d, from a boy sixteen years of age. The history
of the case is in brief as follows : The patient is of Irish
parentage, never very strong and always a suflferer from
nasal catarrh. He first noticed obstruction to nasal res-
piration in the autumn of 1881. At that time, and ever
since, he has had frequent hemorrhages, the blood flowing
first from the right nostril, but soon from both nostrils
and the mouth. The quantity must have been consider-
able, for he described it as at times amounting to bowl-
fuls.
It was usually excited by active exercise, as running ;
latterly stooping would start it. Sometimes he would be
awakened at night by a hemorrhage.
In the spring of 1882 the right nostril was stopped up,
and within a year of this time both were occluded. About
a year ago the tumor appeared to view at the margin of
the right nostril, and at about the same time it could be.
seen in the pharynx when the mouth was opened.
In November, 1882, an attempt was made to remove
the tumor by means of ordinary polypus-forceps, but was
abandoned without accomplishing the desired result I
first saw saw the patient July 12, when he was referred to
me by Dr. Satterthwaite. At that time there was a slight
but noticeable fulness of the right side of the nose. The
right nostril was filled to its margin with a growth
covered with mucous membrane of a pink color. The
septum nasi was crowded well over to the left. On ex-
amining through the mouth, the soft palate was seen
deflected to a perpendicular, extending a little below its
border, and filling the post-nasal space and pharynx was
a tumor of the same appearance as that in the nostril, but
with its inferior pear-shaped base rough and ulcerated in
spots.
A further examination proved that the two presenting
masses were parts of the same tumor, and attached to the
vault of the pharynx and roof of the right nostril with a
large pedicle and extensive attachment. As the growth was
very large, exceedingly vascular, and evidently growing
rapidly, I advised an immediate operation with the gal-
vano-cautery 6craseur, without the preliminary treatment
by electrolysis, which I have heretofore practised in
similar cases treated and reported by me. I also insisted
that subsequently the stump should be thoroughly de-
stroyed by means of the galvano-cautery. Other reasons
that influenced me in deciding to operate at once was,
that I had prepared to leave the city till September, and
I feared that a delay till my return would find the patient
still more reduced physically than at this time. More-
over, a fatal termination was liable to happen.
July 2 2d. — With the kind assistance of Drs. Satter*
thwaite, Goodwillie, and McCarroll, I proceeded to oper-
ate, at the hospital of the New York Post-Graduate Medi-
cal School, in the following manner : The patient having
been anaesthetized I passed along the floor of the right
nostril a looped platinum wire, protected by a double
canula, the two parts of which could be disengaged fron»
each other without removal, for the greater facility of
carrying the wire around the base of the tumor. The
loop being brought to the margin of the palate, was drawn
backward, opened, and carried below and behind the
pendulous portion of the tumor up to its attachment at
the base of the skull. This was accomplished by the
conjoined manipulation of the fingers of one hand, while
the two parts of the canula, now separated, were operated
by the other hand, and at the same time withdrawn, leav-
ing the wire surrounding the pedicle at its base. The
terminals of the wire were next passed through the
1 Presented at the New York Patholopcal Society, October 8, 1884.
456
THE MEDICAL RECORD.
[October 25, 1884,
leader of the galvano-cautery handle, and having been
tightened and connected to the battery, the pedicle was
slowly cut through without hemorrhage. The tumor was
then withdrawn through the mouth. It measured in its
greatest length four inches, and two and a half in thick-
ness, the latter being the portion that extended into the
pharynx, while the form^f was the part that protruded
into the nostril. The cauterized surface measured two
inches by one and three-fourths. Its weight, five days
after the operation, was two ounces and three-fourths.
Its freshly cut surface presented a bluish-white fibrous
appearance, mottled here and there with a purple color
marking the seat of interstitial hemorrhages.
Dr. George R. Elliott kindly made a microscopic ex-
amination of the tumor and pronounced it a fibro-
sarcoma.
On account of the interest attached to this case, I will
quote in full Dr. Elliott's report.
" There are round and spindle cells, having large gran-
ular nuclei; there are also branching cells distributed
throughout the entire mass, and in places these cells are
^gregated together. In many portions of the tumor
true fibrillated tissue is present. The above tissue ele-
ments are present in the following order as regards bulk :
First, fibrous tissue ; second, sarcomatous tissue (round
and spindle cells) ; third, myxomatous tissue (round and
spindle cells). The tumor is quite vascular, and numerous
sites of hemorrhage, old and recent, exist. In the fibrous
portions the walls of the blood-vessels are greatly thick-
ened. In the truly cellular portions of the growth the
vessels have no distinct walls, and appear to be mere
vascular channels running throughout the cellular sub-
stance."
A week after the operation I examined the patient at
my office, and found the cut surface well cleared off and
presenting an apparently healthy wound, and appointed
the I St of September to apply the galvano-cautery to the
seat of the growth, so as to completely destroy all abnor-
mal tissue. This practice I believe is essential to pre-
vent a recurrence of the growth. The patient neglected
to keep the appointment and I did not see him till Sep-
tember 17th, when I found the wound entirely healed
and presenting a healthy appearance, except a small por-
tion of the cicatrix near the posterior entrance to the
right nostril, where there appeared to be more vascu-
larity and a little more prominence than the surface in
general exhibited. I was anxious to carry out my plan
of treatment without delay, and appointed the following
day for that purpose, but I have not yet been able to se-
cure the co-operation of the patient.
To FACILrTATE THE PASSAGE OF THE CATHETER
WHEN THE Deeper Portion of the Urethra is Espe-
cially Sensitive. — Dr. Andrew H. Smith, of New York,
sends us the following practical hint : '* In the absence
of actual stricture an undue sensitiveness of the mem-
branous portion of the urethra often causes pain and
spasm the moment the catheter reaches that portion of
the canal. As the operation is usually performed, the
difficulty is increased by the fact that the back of the in-
strument reaches the sensitive portion of the canal in a
dry condition, that b to say, the oil or other lubricating
substance with which it was smeared, has been wiped off
by contact with the walls of the urethra before the point
is reached at which a lubricant is most needed. This
difficulty can easily be overcome in the following man-
ner : Immerse the catheter in oil, in such a way that the
oil will fill the lower third of the instrument. Then close
the upper end with the finger, and keep it closed until
the back of the catheter reaches the sensitive spot Then
remove the finger and allow the oil to flow out of the eye
of the instrument and bathe the surface of the membrane.
If, at the same moment, the catheter is carried gently on-
ward, it will often enter the bladder as easily as it has
passed the wider portion of the urethra."
A UNIQUE GLASS WOUND.
Successful Ligation of the Left Common Carotid
Artery and Internal Jugular Vein.
By R. M. stone, A.M., M.D.,
OMAHA, MBB.
At noon, on May 8, 1884, Melvin S , aged twenty-
four, while assisting in the removal of a plate glass 4 feet
by 8 feet, was precipitated into the cellar, the glass
following, and of course being broken in its descent,
S jumped to his feet unaware that he was injured,
but in the next instant saw a stream of blood shooting
up from beneath his left ear. He recognized at once that
his jugular vein was cut and that he must have assistance
within a very few moments or perish.
A few days before this occurrence his father and he
had been discussing the question of what to do for a per-
son bleeding from a wound ; Melvin then had said that
should he see such a case he should jam his thumbs deep
into the wound and try and hold the vessels till help
came. So with rare presence of mind he jerked off his
'glove, pressed the ball of his left thumb hard against his
neck below the wound, and ran south some thirty or
forty feet to the cellar stairs, then north across the street
to the nearest physician's office, not less than three hun-
dred feet from where he fell. He ran so rapidly that his
father chasing him could not catch him. Melvin rushed
into the open office, saw no one present, wildly tried the
inner doors in the vain hope that Dr. Swetnam was within,
exclaiming, " O Doctor, why are you not here ?" and
again sta^ered on to the pavement. I happened to be
standing m front of my office, quite near, and saw a friend
across the street frantically gesticulating and beckoning
me toward the corner. I ran and soon saw Melvin stag-
gering, bleeding, and gasping, a terrible torrent of arterial
and venous blood pouring side by side from his neck. I
thrust my thumb deep down into the vast opening and
with my elbows turned him on to his side on the door-step.
By pressure with my right thumb on the vessels from
below, with my left against the base of the skull being
able to feel plainly the styloid process, I was able to
check the flow almost entirely. I sent for assistance and
in a very short time had the gratification of seeing Drs.
M. A. Rebert, E, W. Lee, and Geo. B. Ayres at my side.
No surgeon was ever more happy at the sight of a silk
thread than I, when I saw Dr. Lee coming running with
one in his hand. By this time Melvin was almost gone,
his face deathly white, eyes rolled upward, jaw dropped,
and he was gasping and struggling for his apparently last
breath. We all had the one thought that he could not
live long enough to permit ligation.
The position of the wound beneath the ear showed that
the arterial blood must come from the carotid ; the depth
of the wound, which admitted my left thumb over two
inches, the fact that I could feel the styloid process and
beyond it, made it probable that the venous blood came
from both jugulars. The frightful loss of blood, the cer-
tainty that the patient would die before the severed ex-
ternal carotid could be caught in the wound and ligated,
the possibility that the internal carotid was either severed
or injured made it necessary to tie the common carotid ;
this and the internal jugular vein were then ligated above
the omohyoid by Geo. B. Ayers, M.D.
Meanwhile Dr. Rebert had taken my place, and thrust
his thumbs into the wound. After the ligation of the
carotid, he also observed that his thumb went beyond
the styloid process and apparently to or near the jugular
foramen, and the slightest removal of the thumb from the
base of the skull allowed a seemingly undiminished
stream of blood to poiu- forth.
We felt that our patient was too near death to allow
us to search for the distal ends and ligate, and that a com-
press soaked in dilute Monsell's solution was our only
resource. A pledget of cotton, followed by layers of
sheet-lint, were quickly placed in position and the hem-
orrhage was completely arrested. Several other fiace and
October 25, 1884.]
THE MEDICAL RECORD.
457
•scalp wounds were sewn up while awaiting a vehicle to
carry Melvin home.
The operation had taken place, fortunately, in the open
air, with the best of light and air, except as interfered
with at times by the anxious hundreds who stood watching.
The father had sat holding his son's hand during the
trying ordeal, and Melvin had gone through with it most
bravely, answering once or twice as we spoke, fearing he
was dead, "All right yet, father, hold my hand." He
told me afterward that the operation gave him no pain,
that the condition following the loss of blood was that ojf
anaesthesia. A stimulant had been given and the pulse,
which was at times very feeble and almost imperceptible,
became fuller and stronger, and he bore the ride home
remarkably well. Melvin had shown so much pluck,
judgment, and ^vitality that, though we dared not think
he had a ghost of a chance for final recovery, we could
not help the thought that if any one could recover from
such an injury he was the one.
Though our patient had passed safely through one of
the greatest dangers that ever befell a man, yet we knew,
and he soon learned it too, that he must face the other
dangers of secondary hemorrhage and pyaemia, none the
less to be feared.
Melvin rallied within two hours, by the aid of hot bot-
tles, became warm, and had a fair pulse of 76. He re-
ceived quinia, gr. iij., and morph., gr. one-eighth, every
two hours ; and whiskey, | j., and a glass of ^milk every
hour. We crowded the mUk to the amount of a gallon
a day, so as to make up as rapidly as possible the loss
of blood. By 7 p.m. reaction had well taken place, the
heart's action was strong, his voice clear and strong, the
milk had been assimilated and we suspended the drugs
mentioned and gave fl. ext. ergot, tTlxv. ; sodium bromide,
gr. XV., every three hours instead. We continued these
drugs for their action on the circulation at increasing
intervals for four days, suspending them as we saw in-
dication of beginning strangury, caused by the ergot,
which ceased very soon upon its withdrawal. I have a
very fVequent record of the pulse and temperature up to
convalescence, but it would onljr be tedious to insert it ;
suffice it to say that his morning temperature was be-
tween 99i° and 100**, uniformly for twenty days, and his
pulse between 70 and 80 ; his evening temperature
was between looj** and loi**, uniformly for twelve days,
except on one occasion, the night of the seventh day,
when it reached ioi}°, while his evening pulse was 82
to 84 usually, rising to 96 and 100 on three occasions
only.
Besides the medicines mentioned I gave our patient
from five to ten grains of quinia, with an equal amount of
lactopeptine, daily during the first two weeks, except on
the night of highest temperature, when we gave fijfteen
grains. I gave him one-eighth grain of morphia twice or
thrice daily by the ^nouth for three days, and, after that,
from one-eighth to one-fourth grain hypodermatically from
thrice to once daily during the next fifteen days.
The margins of the compress were kept sprinkled with
Wyeth's finely powdered boracic acid until pus began to
flow from beneath, when the compress and margins were
thoroughly and almost constantly irrigated with a solution
of the bichloride of mercury i to 2,000 or i to 4,000.
While irrigation was not going on and during sleep a
piece of sheet-lint, previously soaked in the same solu-
tion, was laid over the wound. Hunyadi Janos water
was used internally, and rectal injections of warm water
with glycerine and ox-gall added to counteract the consti-
pation caused by a milk diet
Our patient's stomacfi remained in excellent condition
during the whole time ; he drank and assimilated large
quantities of milk and two egg-nogs, with a little sherry
or port wine in, daily. Owing to the head bandage over
the compress his position was necessarily a constrained
one, and yet he rested well every night and was delirious
but a few times, and only then on waking ; he suffered
from headache on the third and fourth days only.
During the ten days following the accident I watched
most anxiously and often at the bedside, dreading the ap-
pearance of secondary hemorrhage, and had the pleasure
of seeing this dangerous period pass without the slightest
trouble from this source, or the other of pyaemia.
On the third day there was pus at the wound of liga-
tion, but no moisture whatever at the margins of the com-
press. On the sixth day I had the pleasure of a visit
from my venerable friend, Dr. Louis Bauer, Dean of the
St. Louis, Mo., College of Physicians and Surgeons, and
we were all very glad of the privilege of his counsel.
His views as to the necessity of then cutting the bandage
over the compress, loosening thus the irksome pressure,
and the very gradual removal day by day of the layers of
the lint compress coincided with our own, and this was
done. He assured us that the plug in ihs ends of the
vessels must be well organized, and we had nothing to
fear in the very cautious removal of the compress. On
the seventh day pus began to flow quite freely from be-
neath the compress, and from this time on the bichloride
solution was most assiduously used ; on this day occurred
the only notable rise of temperature, and I greatly feared
that pyaemia had indeed begun; the temperature and
pulse, however, quickly fell, the delirium subsided, and
we had no further cause for uneasiness.
Little by little I had removed the layers of the com-
press, which allowed better irrigation, and on May 1 7th
there remained but the pledget of cotton, loose, easily
moved, and adherent in a few spots only. Melvin had
now passed nine full days, had no fear whatever of sec-
ondary hemorrhage, was jovial and happy, and kept ask-
ing for a cigar.
On May 23d, the fifteenth day, the cotton pledget
came away ; though a very little traction could have re-
moved it at any time since May 1 7th it was deemed best
not to remove it and thereby possibly endanger the in-
tegrity of the clots in the mouths of the vessels. We
now could see the full size of the cavern, though granu-
lation had been goin^ on for some days ; it was, by care-
ful measurement, i^ inch in depth and 2^ inches wide at
the surface, tapering to ^ or | inch in width at the bot-
tom ; on the front wall of the cavern, near the bottom,
could be seen and felt the styloid process. On May 25th
a photograph was taken, from which the accompanying
irif^-
woodcut was made. The walls of the cavern were lined
with the most beautiful and healthy granulations, which,
under the irrigations, remained so and very rapidly filled
the cavity. On June 5th the cavity was reduced to three-
fourths of an inch in depth and width, and on June 27 th
a fine probe could hardly be inserted in the cavity, and
only a slightly more deep than normal depression existed
beneath the ear. We had expected a salivary fistula to
remain, since the parotid gland was laid wide open, but
it did not.
On June 12th, the thirty-sixth day, I removed one of
the ligatures. The other, which had previously resisted
quite strong traction, was removed on the seventy-ninth
day.
On June 24th Melvin was able to come down town
and receive the congratulations of the many friends who
had often enquired about his condition.
What condition now existed? The facial nerve hav-
ing been severed, our patient is unable to frown with the
458
THE MEDICAL RECORD.
[October 25. 1884.
left side of his forehead, cannot close his left eye, has
no motion of the muscles of the left cheek, his tongue
points far to the left when protruded, the left angle of
his mouth is one-half or three-fourths of an inch beneath
the right, and he is one of the few unfortunate individu-
als who literally laugh out of one corner of their mouths.
He has suffered considerable inconvenience from his
exposed cornea ; lachrymation has been profuse two or
three times from irritation, and this will no doubt prove
the most serious source of trouble. He is acquiring the
habit of brushing the cornea with his upper lid, and
hopes in this way to get along, but I fear that it will not
answer, and sloughing of the cornea may result.
There are a few features of the case that are unusual,
and I think worthy of special mention. Superficial glass
wounds are numerous, and wounds involving the radial
and ulnar arteries and tlie palmar arches are quite so,
but I cannot find recorded a case of a wound of the
carotid region made by glass. This was also one of the
rare cases where distal ligation was absolutely out of
the question ; any attempt in that direction would cer-
tainly have been fatal, and no surgeon of good judgment
would for a moment have thought of it.
But the most interesting and unique feature about the
case seems to me to be that the internal jugular vein
was probably shaved off close to its emergence from the
jugular foramen, and if so, rendered distal ligation abso-
lutely impossible. An autopsy alone could demonstrate
this to have been the fact ; but the great depth of the
wound, the fact that after ligation of the carotid the
slightest removal of the thumb from, at, or very near
the foramen, was followed by a terrible welling up of
venous blood, incline us to believe that this was the
case. I can find but one similar case on record, that of
Kochers, found in the " International Encyclopedia of
Surgery," vol. iii., p. 504. He had a case of a stab be-
tween the fifth and sixth cervical vertebrae. He says
that he removed clots and seized " the bleeding point
with long forceps, but it was impossible to tie any vessel
as the ligature had nothing to grip.**
Whatever was the case as regards this point, I trust
the history will prove of interest and value, and worthy
of record.
CEREBRAL LOCALIZATION— THE CENTRES
FOR VISION.
By PHILIP ZENNER, A.M., M.D.,
aNCINNATI, O.
(Continued from p. 345.)
In the three preceding papers we have given the data
from which we concluded that a limited area of the cortex
in the posterior part of the hemispheres is in close rela-
tion with the retinae, this area, therefore, possessing visual
functions. We wish now to map out, as nearly as may
be, the more precise relationship of the visual area to the
retinae in man, and to consider some other questions,
which deal more closely with the exact functions of the
cortical centres.
Relation of optic tracts to retina. — We must premise
the consideration of relationship of cortex and retina by
that of the optic tracts to the retinae, for, as will sub-
sequently appear, the optic tract is, probably, only in
relationship with the hemisphere of the same side, and,
therefore, knowing its relationship to the retinae, we will
already have acquured knowledge on the final question —
the relation of cortical centre and retina.
In quite a number of instances after destruction of one
eye, and atrophy of the corresponding optic nerve, atrophy
of fibres in both optic tracts was observed. This atrophy
in the optic tracts, always involving only a part of each,
is usually determined with some difficulty, and there is
consequently some variance in the reports of the extent
to which each tract degenerates. Mauthner,^ after care-
Gehim und Au^ p. 437.
fully examining all the reported cases, concludes that the
larger number of fibres of each optic nerve cross over
to the opposite optic tract, while a smaller number of
fibres enter the tract of the same side, the proportion of
crossed to uncrossed fibres being as three to two.
A number of cases have been reported where hemian-
opia followed lesions of an optic tract. In most of them
the entire tract was not destroyed or there were other
complications, so that they can not be utilized for our
present purpose. But in one instance, a case of Gowers/
there was complete degeneration of one optic tract with-
out involvement of any other important part, so that the
case answers our purpose admirably. In this case, ac-
cording to Gowers' report, there was **a blindness in the
symmetrical halves of both fields of vision, which reached
in each one to the median line."
There is an apparent discrepancy between the clinical
manifestations in Gowers' case, where blindness reaches
to the median line, and the pathological observations
that more fibres of the optic nerve pass into the opposite
optic tract than into that one of the same side. But this
discrepancy is only apparent For a vertical line pass-
ing through the point of fixation does not divide the
retina into two equal halves. The nasal segment is
larger than the temporal, and therefore receives a larger
number of fibres from the optic nerve.
Relation of visual area to retina. — What has already
been learned of the relations of visual areas and retins
in the lower animals, as well as the relationship of optic
nerves and tracts just mentioned, naturally lead us to
expect that in man the visual area of each hemisphere is
in relation with one half of each eye. Observations in
animals lead to this belief, because we find that the
higher the animal the more nearly each hemisphere is in
equal relation with both retinae. Thus, in rabbits one
visual area is almost alone related to the opposite eye.
In dogs about one-third of the visual area is devoted to
the eye of the same side ; while in monkeys, according
to Munk, each visual area is devoted to one-half of both
eyes.
The direct observations in man seem to justify this ex-
pectation. Of Baumgartner's case it is expressly stated
that the hemianopia reached to the point of fixation. Of
Curschman's, Marchand's, and Westphal's cases it was
said that there was complete hemianopia. In other in-
stances, as cases of Nothnagel, Wernicke, and Stenger,
the hemianopia did not reach to the point of fixation and
the loss of the field of vision was more extensive in one
e^e than in the other. But in the latter instances the
visual area of one hemisphere was, apparently, not alto-
gether destroyed. So that we may safely conclude from
the above cases that each area is in relation with one-haI(
or almost one-half" of both retinae.
One of the cases given in the previous paper, that of
Nieden, seems to throw light on the more exact relation-
ship of visual areas and retinae, and to point to the exist-
ence of the same relationship in man as Munk bad
observed in dogs, that is, that the external portion of the
visual area of one hemisphere is in relation with the tem-
poral half of the retina of the same side, while the median
portion of the visual area is in relation with the nasal half
of the opposite retina. For in Nieden' s patient the orig-
inal injury apparently involved but a small part of the
occipital lobe, that nearest the longitudinal fissure, and
there was at that time paralysis of the nasal portion of
the opposite retina. At a later period, when probably
the process of cicatrization had produced some changes
in the part of the occipital lohe l)ang more extemaUj,
there was also paralysis of a part of the temporal segment
of the retina on the same side.
Single vision with double retinal images. — Wernicke,'
taking as a basis that each visual area is devoted to the
corresponding halves of both retinae, and that the more
1 Centralblatt f. d. Med. A^scnschaften, 1878, No. 31.
* The reason for thus modifying the statoneat will appear lata-.
.* Gehimkrankheiten, vol. i., p. 236.
October 25, 1884.]
THE MEDICAL RECORD.
459
proximate relationship in man is the same as Munk had
found it to be in dogs, has thus explained the existence
of sinde vision with double retinal images. The ex-
planation is so beautiful, and, withal, so simple and
natural, that it, in itself, tempts us to accept as true the
premises upon which it is based.
According to these premises the median half of the
right visual area is devoted to the median or nasal half
of the left retina, while the temporal half of the right vis-
ual area is devoted to the temporal half of the right
retina ; and in each instance the segment of the visual
area is so related to the segment of the retina that the
central part of the latter is related to the central part of
the visual area, its peripheral parts to the peripheral parts
of the latter.
This relationship, as well as the projection of the
retinal images upon the visual areas, will become more
perspicuous by attention to the accompanying diagram :
op represents the right, m n the left retina; WPthe
right, m 0 the left visual area ; c the macula lutea. c n,
the nasal half of left retina, is projected upon C N^ the
median half of right
visual area, while c m \~ R
is projected upon CMy
c being projected upon
C, and m and n upon
ifand N respectively.
As Ct the most sensitive
part of the retina, is
projected upon C, the
central part of visual
area, the latter is the
most sensitive part of
the visual area.
act and a! c V rep-
resent the two retinal
images of an observed
object. The corre-
sponding half of each
image will be projected
upon one visual area.
Thusr b and c b' are
projected upon C B
and C B\ the central
part of the image being projected upon the centre of
die visual area, its peripheral parts in the more peripheral
parts of the visual area, each point being there doubly
represented on each side of, and probably at equal dis-
tances from the centre. This double representation ap-
pears in consciousness as one, because the corresponding
parts are very intimately bound together by associating
fibres.
Crossed amblyopia with cerebral lesions, — The above
conclusions are not altogether in accordance with the
views of two eminent men, both strenuous adherents of
the present theories of cerebral localization, Charcot and
Ferrier, I refer to the clinical observations of the one,
and the physiological experiments of the other. Their
observations and results deserve careful attention, be-
cause opposing views in such high quarters are likely to
throw doubt on the whole subject of localization.
From clinical observations in some cases of hemianaes-
thesia and amblyopia in one eye Charcot concluded that
certain lesions of the internal capsule caused blindness
in the opposite eye. Accepting the semidecussation of
the optic nerves in the chiasma, he now constructed a
new scheme of the cause and final distribution of the
optic nerves. According to this scheme those fibres of
the optic nerve which do not cross over at the chiasm,
but pass into the optic tract of the same side, do cross
over and enter into the other side of the brain at some
point beyond the corpora quadrigemina. He thus ex-
plained that, while lesions of one optic tract would pro-
duce hemianopia, lesions of the internal capsule produced
a crossed amblyopia.
When it became subsequently known that lesions of
Diagram c£ the Projective of Retinal.Im-
ages on d^eVisiial Areas.
the cortex of one hemisphere caused homonymous latend
hemianopia, this scheme being insufficient to explain
such conditions, Grasset * modified it by a third crossing
of the optic nerve-fibres at a point beyond the internsd
capsule.
The original scheme of Charcot already appeared
sufficiently unnatural to cast doubt upon its correctness,
but that of Grasset is so very artificial as to rob it of
all credence.
In this diflSculty we are led to inquire whether Char-
cot's premises, in the first instance, were correct, whether
it is true that lesions in the posterior part of the internal
capsule cause blindness in the opposite eye, and that,
therefore, all the fibres of one optic nerve pass through
the opposite internal capsule.
Many of Charcot's observations were on hysterical
cases. These we may altogether ignore, both because
the seat of the trouble is unknown and because, in these
instances, the visual disturbances are not always of the
same character.
Of the cases in which there were cerebral lesions, in
some the diagnosis crossed amblyopia doubtless rested
upon erroneous observations. In the previous paper we
called attention to the fact that it is common for
those suffering with hemianopia to state and to believe
that they are blind in one eye. They are often much
surprised to learn, after a careful examination has been
made, that both eyes are alike affected. But there are
other cases to which these objections do not apply and
which must therefore be examined more carefully.
The first two cases of this kind, with post-mortem re-
sults, were reported by Tiirck." But, inasmuch as
there was no evidence that a careful examination of
vision was made, these cases may be passed by. In
Bernhardt's * case there was, with right hemianaesthesia
complete blindness in the right eye, but there was, at the
same time, concentric narrowing of the field of vision in
the left eye,
A patient of Pitres * had left hemianaesthesia and hemi-
plegia and amblyopia in the left eye. But in this case
there was also defective vision in the right eye. In both
eyes there was concentric contraction of the field of vis-
ion. There was also discoloration of both optic nerves.
So in these two cases where post-mortem examination
was made (the same seems to be true in similar instances
without post-mortem results, whenever careful examina-
tion was made) there was not only a crossed amblyopia
but also impairment of vision in the eye of the same side ;
so that these cases do not sustain the original statements
of Charcot, or support his scheme of the course of the
optic nerve-fibres.
There is only one case, so far as I know, which directly
supports this scheme, that is one reported by Mueller.*
In diis case a small lesion was found in the posterior
part of the left internal capsule, and, during life, there
was on the right side slight paralysis and complete
anaesthesia, loss of taste, smell, and hearing in the same
side and amblyopia in the right eye. It was expressly
stated that vision in the left eye was normal, there be-
ing no narrowing of the field of vision.
Wernicke,* in reviewing this case, states that the re-
porter was evidently influenced by Charcot's previous
writings, and does not hesitate to pronounce the descrip-
tion of the visual disturbances to be due to faulty observa-
tions. This appears to be a very summary way of
disposing of what are, apparently, carefully recorded
observations, but yet it is not altoj;ether unjustifiable.
Charcot has acknowledged that his first observations
were incorrect, that visual disturbances could always be
detected in the other eye, and the same have been the
observations of others in similar instances. But of much
1 Gazette Hebdomadaire, 1883, p. 205.
* Nothnagel : Topische Dia^ttic, p. 305. |
* Berliner Klin. Wochenschnft, 187^, No. 36.
* Wernicke : Gehimkrankheiten, vol. ii, p. 82.
« Berliner Klin. Wochenschrift, 1878, No. 20. ^
* Gehimkrankheiten, vol. ii., p. aoa.
460
THE MEDICAL RECORD.
[October 25, 1884.
more consequence is the fact that a number of cases
have been reported, where, while the post-mortem ex-
amination revealed destruction of the posterior part of
the internal capsule, visual disturbances of the kind just
mentioned (crossed amblyopia) were not found. Such
are the cases of Prevost,* Pooley,* Dreschfeld," Senator
and Wernicke,* and Vetter/ In all of these cases
there was hemiansesthesia on the opposite side.
In addition to the above there are other cases of hemi-
anaesthesia where the description of the autopsy leaves
us in doubt whether the internal capsule was injured ;
and others where the symptoms lead us to believe that
there was a lesion of the internal capsule ; in all of which
there was no crossed amblyopia.
These instances are quite sufficient to satisfy us that
lesions of the internal capsule which cause loss of gen-
eral sensation in one half of the body, and may also
affect all the special senses, do not directly produce
crossed amblyopia, and that Charcot's scheme is not cor-
rect. But nevertheless it must be put down as a singu-
lar fact that lesions in the neighborhood of the internal
capsule should frequently be accompanied by visual dis-
turbances chiefly in the opposite eye. Nothing that has
been above said explains their occurrence, but it is to
be hoped that this obscure point may be cleared up by
careful observations in the future.
Experiments of Ferrier, — We must now speak of the
experiments of Ferrier. They are mentioned here, in-
stead of with the other physiological data, because he
has recently * attempted to bring them into accordance
with the above teaching of Charcot.
Ferrier's experiments were made on monkeys ; his con-
clusions (only those relating to vision are here men-
tioned) are the following : * i. Destruction or bodily
removal of one or both occipital lobes almost to the
parieto-occipital fissure produces no discernible dis-
turbance of vision. 2. Complete destruction of one
angular gyrus produces blindness in the opposite eye,
which is of only a few hours' duration. If after a few
weeks the second angular gyru$ is destroyed, there is
only very slight or transient visual disturbance. But if
both angular gyri are destroyed at the same time, there
is total blindness in both eyes of a few days' duration.
3. Destruction of the occipital lobe and angular gyrus
on one side produces homonymous lateral hemianopia.
But after a week or more there are evidences of vision
on both sides. 4. Destruction of both occipital lobes
and both angular gyri causes total and, apparently, per-
manent blindness, but the presence of one angular gyrus
or one occipital lobe is sufficient for vision in both eyes.
Ferrier supposes that each angular gyrus is connected
with the central portion of both retinae, while each occip-
ital lobe is in relation with the corresponding halves of
both retinae. He believes that crossed amblyopia at-
tends lesions of the internal capsule, because, in such
instances, those fibres are destroyed which pass from the
angular gyrus to the opposite eye. How unsatisfactory
as well as arbitrary are these conclusions it is scarcely
necessary to mention.
The above experimental results are very puzzling, and
seem to be altogether at variance with what we have
been taught by other physiologists, as well as with what
we have learned from pathological observations on man,
for instance, his observation that destruction of an entire
visual area produces only transient disturbance, and
clinical observations of permanent hemianopia following
destruction of one visual area. It seems much easier to
believe that the apparent disappearance of visual dis-
turbances in Ferrier's monkeys was due to parts of the
visual area (gray matter of the sulci, on the median sur-
face of the brain, etc) being retained, and to the ex-
treme alertness and sagacity of those animals.
1 Wilbrand : Ueber Hemianopsie, p. 133. * Archiv. C Ophth., voL v., p. 148.
s Brain, vol. iv., p. ^3. < Gehirnkrankheiteii, voL iL, p. 70.
» Deut. Achiv. f. Klin. Med., x88j, p. 507. • Brain, vol. iiL, p, 467. .,
"" Ibid., p. 430.
There are two of Ferrier's statements which cannot
be so summarily treated, and which will, perhaps, require
future and more careful observations for a positive
answer ; these are, that the visual areas include more
than the occipital lobes (also the angular gyri), and that
each visual area is in relation with the central part of
both retinae.
Luciani and Tamburini * also include the angular
gyrus in the visual area, but, like Munk, they believe
each visual area to be in relation with only one-half of
both retinae. Munk " attributes the visual disturbances
obtained by these experimenters after destruction of the
angular gyrus to direct involvement of the optic radia-
tions, which, according to Wernicke, pass immediately
beneath the angular gyrus.
Observations on man do not oppose Ferrier's views,
for the disease in all instances was too extensive to say
that the symptoms were produced by involvement of the
occipital lobe alone.
The second proposition already noted, that each
visual area is in relation with the central part of both
retinae, seems to find some support in clinical observa-
tions. We have mentioned above the clinical observap
tions which led us to conclude that each visual area is
in relation with one-half or almost one-half of both
retinae. The statement was thus modified for several
reasons. Though several cases are recorded where the
hemianopia reached to the point of fixation, such ob-
servations should be received in a guarded manner, for
it is very difficult to mark out the exact limits of vision.
In a case of right hemianopia, reported by myself^' a
skilful specialist stated that the hemianopia reached to
the point of fixation, though in several very careful ex-
aminations made by myself, with the assistance of a
medical friend, a very slight curving of the dividing line
toward the affected side was positively determined. Be-
sides, there are a number of cases with lesions of the
occipital lobe where the hemianopia did not reach to the
point of fixation. In one of them, that of Hosch,* ap-
parently the whole of one visual area was destroyed.
In others, it is true, an entire visual area did not appear
to be destroyed, so that we might thus account for the
visual defect on one side not being complete. Yet it is
a striking fact that, in such instances, just the central
part of the field was retained.
The Legal Enforcement of Study at Home.— A
novel suit, involving health questions, has recently been
decided in one of the English Appellate Courts. A
teacher in one of the public schools prescribed certain
lessons which were to be learned at home, and when these
were not satisfactorily committed to memory a difficulty
arose between the teacher and scholar, which is not fully
detailed, but which gave rise to the charge of assault and
battery against the teacher. The determination of the
charge of assault does not appear, but the court where
the case was originally tried, and the Appellate Court,
both decided that " home lessons set by teachers cannot
be enforced." This decision seems to hold that schoUxs
cannot be held responsible for the learning of lessons
at any other place than the school-room. It can hardly
prevent, however, teachers from giving lessons of such
length as to require study out of school hours, and if they
are not learned the scholar's standing will necessarily be
lowered. Such a result will, of course, modify largely the
practical results of the decision. The attention of parents
and teachers, here, as well as in England, cannot be too
emphatically called to the question whether the requi^^
ments of home study, directly or indirectly made, are not
in general too exacting for the proper development of the
health of children.
1 Cited by Ferrier and Munk.
* Ueber die Funcdonen der Grosshimrinde, p. x«5.
* Cincinnati Lancet and Clinic, April 7, 1883.
* Zehnder's Monatsblatt, 2878, p. 285.
October 25, 1884.]
THE MEDICAL RECORD.
461
HYDROCHLORATE OF COCAINE— EXPERI-
MENTS AND APPLICATION.
By H. KNAPP, M.D.,
fgonsao* or ophthalmology, medical dbpartmbmt univbksity op thb
CITY OF NEW YOSK.
As soon as I had read the very remarkable communica-
tion on cocaine, by Dr. H. D. Noyes, in The Medical
Kkcorp, October 11, 1884, p. 417, I procured speci-
mens of the new remedy from different sources — Mr. F.
W. Foucar, New York ; Dr. K R. Squibb, Brooklyn ;
and Messrs. Eimer & Amend, New York — and tried its
action on myself, some members of my family, and a num-
ber o( patients. Since that time some short communica-
tions on the same remedy have appeared by Drs. C. R,
Agnew, W. O. Moore, and J. L. Minor (The Medical
Record, October 18, 1884, PP- 43^1 439)- My obser-
vations substantially confirm the statements of these
gentlemen. The novelty and importance of the subject
may excuse the hasty publication of some experiments
and observations which I will describe without much
comment as they have suggested and presented them-
selves to me. As only Dr. Moore mentions something
about the substance itself, I looked up, in the desire for
further information, sopcke books on pharmaceutical chem-
istry. The works which I have consulted are : " The
U. S. Dispensatory," thirteenth edition, 1870, p. 1591 ;
the same, fifteenth edition, 1883, pp. 563-565 ; and
through the kindness of Messrs. Eimer & Amend, Feh-
ling's " Handwdrterbuch der Chemie," 1875, vol. ii., pp.
IS^f 753* 2tnd Hager's '' Handbuch der Pharmaceu-
tischen Praxis," 1876, First Part, pp. 903-905. From
these books I extract the following pharmacological notes,
which may not be without interest.
Cocaine is the alkaloid of the leaves of eiythroxylon
coca (Lamarck), a shrub growing wild and extensively
cultivated in South America, especially in Peru and
Bolivia. The leaves resemble those of Chinese tea, and
their action is similar to that of tea and coffee. The
alkaloid was first isolated from them in 1855 by Gar-
deke, who gave it the name erythroxyline ; but Dr. A.
Niemann, of Goslar, Germany, was the first to thoroughly
investigate the leaves in i860. He gave the alkaloid the
name cocaine. Lossen, who followed in his footsteps,
analyzed it and expressed its composition by the follow-
ing formula : C„H,^NO^. " It acts upon the lower ani-
mals much as does theine. It tetanizes frogs, or in over-
whelming doses paralyzes the sensory nerves and the
posterior columns. Rabbits and dogs are killed by it
through paralysis of the respiratory centres. In proper
doses it elevates arterial pressure by an action upon the
vaso-motor centres and the cardiac-motor system."
'* As a nerve-stimulant, coca has been used immemo-
rially by the Peruvian and Bolivian natives. Its sus-
taining powers have been strongly confirmed by various
observers both in this country and in Europe " (U. S.
Disp.).
Lossen found in the best quality of coca-leaf 0.04
per cent, of cocaine ; inferior materiad yielded only 0.016
per cent. It dissolves in 704 parts of water, but easily
in alcohol, ether, and diluted acids. Its salts are soluble
in alcohol, not in ether. They have a bitter taste, and
cause in the tongue a transient feeling of numbness at
the place of contact (Fehling).
^ The coca-leaves have been recommended for almost
all diseases, but the therapeutic results have proved un-
satisfactory and the remedy has become obsolete. The
action of cocaine is very much like that of atropine, with
the difference that it does not dilate the pupil. . . .
Extractum cocae is prepared like extractum absinthii.
It is said to have a dilating effect on the pupil " (Hager).
Dr. H. D. Noyes states in his communication (Medi-
cal Record, p. 417, middle of first column) : ''The solu-
tion [of muriate of cocaine, two per cent] caused no
irritation of any kind, nor did it at all influence the pupil.''
Experiments with Cocaine on the Eye. — In my
first experiments with a two per cent, solution upon pa-
tients during various operations I noticed no dilatation
of the pupil, but trying it afterward on a patient with
ocular neuralgia, and watching it longer, the mydriatic
effect of the drug was manifest. The same with another
patient in whom I slit a canaliculus and opened the dis-
tended lachrymal sac. Relying on Dr. Noyes' asser-
tion and my previous observations — I had at that time
not read the contradicting statements of Hager — I sus-
pected that I had contaminated my supply of cocaine
with atropine by using a dropper which had been taken
from a bottle formerly containing duboisine, though
I had carefully cleansed the dropper and used it in six
instances without noticing mydriasis. I procured fresh
supplies of cocaine in new glasses, provided with drop-
pers that had never been used. This I used upon my-
self and four members of my family, watching it a whole
afternoon and evening. The mydriatic effect of cocaine
of a two per cent, as well as of a four per cent, solution
was positive and pronounced in all. These experiments
upon myself and four other healthy persons need not be
described in extenso. The following may suffice :
The instillation of a two or four per cent, solution of
hydrochlorate of cocaine into healthy eyes produces no
pain^ nor any discomfort. During and after its action
the conjunctiva does not change its aspect ; it is neither
swollen nor congested. The appearance of the fundus
oculi, examined ophthalmoscopically, likewise remains
unchanged. The same holds with regard to the move-
ments of the eyeball. If there is any change in the ten-
sion of the globe, of which I could not positively convince
myself, it is rather toward a diminution than toward an
increase.
The diminution 0/ sensibility in the cornea and con-
junctiva varies in degree in different individuals. In most
cases it becomes manifest as early as three minutes after
the first instillation, increases for ten to twenty minutes,
then decreases, and is over in about half an hour. When
another instillation is made, from ten to twenty minutes
after the first, the anaesthesia is more intense, on super-
ficial touching mostly absolute, and lasts longer. In an
hour after the first instillation it becomes very feeble,
and in an hour and a half it disappears.
The pupil begins to dilate ten to twenty minutes after
the instillation, increases slowly, becomes in some per-
sons as large as with atropia in about thirty to forty-five
minutes, remains stationary for about thirty minutes, and
then slowly disappears. The last trace had disappeared
on the next day only.
The range of accommodation is shortened by moving
of the near point from the eye, the far point not being
appreciably influenced. The shortening of the range of
accommodation was limited and differed somewhat in dif-
ferent observers: in myself it was equivalent to^ (i D);
in my son, fifteen years of age, about the same ; in Mrs.
K , it was more. Cocaine, therefore, affects the ac-
commodation like the mydriatics. It reduces, but does
not paralyze it It may, therefore, be preferable to other
mydriatics if we want to dilate the pupil for ophthalmo-
scopic examinations of the interior of the eye, but it will
probably not be powerful enough for determinations of
refraction. It is a mydriatic which, even in producing a
maximum dilatation of the pupil, taJces away only a frac-
tion of the power of accommodation. In Mrs. K ^'s and
my own eye astigmatism manifested itself very conspicu-
ously ; the letters appeared to slant from left to right ; the
left eye of both of us was "cocainized." With her the
slanging was more perceptible in near vision, with me in
distant vision. The letter N slanted about fifteen degrees
to the right, and was turned straight by a + ^rC. ax. 110°,
also by a — t^. ax. 15° or 20°, the same wiui a + yi^c.
iio^O-ytrC. 20°.
The accommodative power was restored much sooner
than the normal size of the pupil. In one and one-fourth
or one and one-half hour we could read again as easily as
before, though our pupils were still considerably en*
larged
462
THE MEDICAL RECORD.
[October 25, 1884.
Cauterisation of a ^* cocainized" conjunctiva. — The con-
junctiva of my right eye was a little congested, and at
10.30 P.M., whDe writing this communication, I dropped
a drop of a four per cent, solution of hydrochlorate of
cocaine on the inner surface of the lower lid. Fifteen
minutes later I noticed that this inner surface had be-
come pale, paler than that of the left eye, which had been
the paler before. I dropped another drop in, holding my
head back so that the whole conjunctiva was moistened
by it. Then I painted, before a looking-glass, a good-
sized camel's-hair brushful of a two per cent, solution
(gr. X. ad I j.) of nitrate of silver into the eye, the lower
lid being everted. I left the liquid in place about twenty
seconds, then it began slightly to smart, whereas imme-
diately sifter the application I only felt the cold, no pain.
I washed the nitrate of silver away with ordinary water, and
put another drop of cocaine in. This relieved the smart
for five minutes, then it returned, but very slightly ; a
serous liquid ran from my ri^ht nostril, just as it does
when a stronger solution of nitrate of silver is put in the
eye in the ordinary way. I instilled another drop of
cocaine and continued writing. In a quarter of an hour
the eye felt hot and somewhat painful. The conjunctiva
of the lower lid was moderately, that of the adjacent
scleral conjunctiva slightly, red, and along the whole lower
fornix lay a white streak of mucus. The cornea and up-
per scleral and palpebral conjunctiva were white as if
nothing had been done. The pupil was wide, and the
accommodation somewhat weakened, not so much as to
make writing unpleasant, though the other eye had been
** cocainized " in the afternoon of the same day.
Experiments on the Effect of Cocaine on other
Mucous Membranes : i. Tlie ear, — I have made only
one experiment in this locality. It was successful ; see
later, Case VIII. I do not doubt that the remedy will
find here a large field of application, both to allay pain
and to render the parts insensible during operations in
this exceedingly sensitive cavity.
2. The mouth. — I can confirm the former observations
that the tongue and the soft palate become numb. I
sprayed and brushed my soft palate ; in ten minutes I
could pass instruments over it without pain or reflex
phenomena, reaching, etc I brushed a four per cent,
solution over the right half of my tongue from the tip to
the palate, held the tongue depressed with my finger and
immovable as long as I could endure it. In seven min-
utes I repeated the manipulation ; five minutes later the
right side of the tongue and corresponding lip felt numb.
Gentle touching was not perceived, but quite well on the
other side. Then I put, with a fine brush, some pow-
dered sugar on the insensible parts, successively from the
tip to the neighborhood of the palate. It was not per-
ceived, whereas when put in the same way on the cor-
responding places of the other half of the tongue, it was
at once tasted. The same was the case when common salt
and a one per cent, solution of sulphate of quinine were
placed on the tongue. In half an hour all was normal
again. Conclusion : Cocaine temporarily and locally de-
stroys not only the sensibility of the tongue and pharynx^
but also the fctculty of taste. In the endeavor to suspend
the sense of taste altogether, I sprayed my mouth and
palate. The taste was much reduced, but not abolished,
evidently because the remedy in this experiment had not
sufficiently acted on all the portions of surface from
which impressions of taste are received.
3. The nose. — I brushed and sprayed the nose to test
the action of the new remedy on the organ of smell. •The
experiments required a good deal of time and material
before they were successful The lower parts of the
nose soon had a numb feeling and were insensible to the
touch, but the power of smell was preserved. Bearing in
mind that olfaction is the function of the upper nasal
passages, the recesses of which are very difficult of ac-
cess, I bent my head down so as to make the vertex its
lowest part, and introduced the bent nozzle of a Rich-
ardson atomizer in such a way that the spray was directed
from the lower to the middle and upper nasal passages,
and the liquid flowed also in the same direction. This
manoeuvre had to be repeated three times before the
faculty of smell was destroyed. Perfumes of rose and
heliotrope were not perceived. Tincture of iodine, con-
centrated nitric acid, etc., produced no peculiar sensation,
whereas on the other side they felt very unpleasant and
produced coughing. Cocaine^ therefore, temporarily ren-
ders the mucous membrane of the nose insensible and de-
stroys the sense of smell. In less than half an hour the
whole effect of the remedy had vanished.
4. The larynx and treuhea. — I am just suffering from
an attack of acute bronchitis, with fits of troublesome
coughing in the morning and evening. When one ot
these fits came in the evening, I sprayed my larynx with
cocaine and inhaled it as well as I could by means of a
Richardson apparatus. The irritation was at once
allayed, and soon subsided. I had no cough, but half
an hour later I expectorated, free from irritation, a large,
compact, muco-purulent sputum. If this experiment
should be confirmed by others, and the effect be the
same or similar, cocaine will prove a great boon to
patients with pulmonary difficulties. The perfected meth-
ods of introducing medicated substances by means of
the ingenious apparatuses of Dr. Sass would relieve the
distress of coughing and its prejudicial consequences. I
may add, however, that the Richardson apparatus, which
seems inadequate for this purpose, relieved me only par-
tially in a second, and not at all in a third attack during
the night.
5. The urethra. — My urethra is very sensitive to the
introduction of instruments. I injected, by means of an
Eustachian catheter and a balloon, a four per cent solu-
tion of cocaine, and held it in for a few minutes. In
ten minutes the glans had become pale and insensible
to the touch. I repeated the injection. Seven minutes
later I introduced a catheter and other instruments into
the lu-ethra. I did not feel them at all as far as 3"; when
pushed farther I felt them very unpleasantly painful
Evidently the cocaine had not penetrated more deeply.
Before the injection of cocaine I felt the instruments
very keenly from the beginning of the urethra. To test
the loss of sensibility of the cocainized urethra in anodier
direction, I injected a one per cent, solution (gr. v. ad
5j.) of arg. nitr. into the anterior part by means of an
AneFs syringe, introduced as far as i^". I had no sen-
sation fi-om it at all. In about thirty seconds I passed
water, which caused a slight burning, disappearing in
about a minute. Since that time I have not felt anything
firom the treatment of my urethra. This experiment
shows, and I feel convinced, that cocaine will prove most
beneficial in uro-genital surgery. It not only destroys
the sensibility of the parts, and therefore admits of the
easy performance of many surgical procedures, but by
being painless these procedures will not incite reflex
phenomena, spasm, and the like.
6. The rectum. — For the sake of completeness I in-
jected also cocaine into the rectum. The sensibility,
which was not great anyhow, was reduced.
In concluding this communication I will describe the
APPLICATION OF COCAINE IN DISEASES OF THE EYE,
such as opportunities have presented themselves to me
thus far«
Case I. — A young lady, suffering from convergent
strabismus, had, October 15, 1884, two drops of a two
per cent, solution of hydrochlorate of cocaine, just ob-
tained from Mr. Foucar, dropped into her eye at 4 p.k.,
before the students of the New York Ophthalmic and
Aural Institute. Three minutes later the sensibility of
the cornea, tested with tissue paper and blunt probes,
was unmistakably diminished. Ten minutes after the
first application, when the sensibility of the cornea and
conjunctiva was greatly reduced, but not abolished, two
drops more were instilled. Five minutes later the anaes-
thesia was complete, when the cornea and conjunctiva were
October 25, 1884.]
THE MEDICAL RECORD.
463
gentlj touched, but not when the squinthook was passed
high under the upper lid. Twenty minutes after the first
instillation the wire speculum was inserted, the conjunc-
tiva grasped with forceps, cut with scissors, the hook in-
troduced, the tendon divided with scissors, and the con-
junctival wound closed with a suture. All this was felt
as pain by the patient, yet not very keenly. The sensi-
bility was not abolished, but appeared blunted.
Case II. — October 16, 1884: I instilled two drops of
the above solution into the eye of a lady who had a cin-
der in the centre of the cornea. In ten minutes the
cornea was anaesthetic. I removed the cinder by means
of a delicate gouge, with very little, yet not without, pain.
The removal was easy.
Case III. — October i6th : The same solution in-
stilled into the eye of a man having a pterygium. Ten
minutes later, instillation repeated. The cornea and
conjunctiva became insensible. During the operation —
transplantation into the lower fornix and covering the de-
fect with the adjacent conjunctiva by a stitch — the pa-
tient manifested about as much pain as this operation
usually causes when performed without an anaesthetic.
The anaesthesia in these three cases disappeared al-
most immediately after the operation.
Seeing that the effect of the new anaesthetic in these
three operations had not come up to my expectation, nor
to what was claimed for it, I asked Dr. E. R. Squibb
whether he could furnish me a two per cenL solution of the
remedy. He sent me a four per cent, solution, remark-
ing in a letter that the two per cent, solution had been
extensively tried by Dr. C. S. Bull, and proved only
partially satisfactory. He had prepared for Dr. Bull, at
his suggestion, a four per Cent.
Case IV. — Of this solution I instilled, on October
17th, at the New York Ophthalmic and Aural Institute,
in the presence of the students, a few drops into the
eye of a cataract patient, aged sixt}'-eight. In twenty-
five minutes, during which time he had held his eyes
dosed, there was complete anaesthesia of the cornea and
conjunctiva. I instilled a few drops more. Five min-
utes later I performed the extraction of cataract in the
usual manner, asking the patient at every step whether
he felt any pain. Only when the iris was drawn out and
cut he said that it hurt him. The corneal section gave
him no pain. The expulsion of the lens, which was done
by pressure with a spoon on the lower segment of the
cornea, required more force than usual, though the sec-
tion was perfectly sufficient and the capsule not thick-
ened. The eye appeared inelastic, so that the expulsive
force requisite had to be imparted by outward pressure.
The cleansing of the wound, the stroking back of the iris
out of the cornea, and the adjustment of the flap with a
S[Mitula were not felt at all. When the bandage was ap-
plied the parts were still insensible, but free from tdl
irritation. The patient had felt no pain, except when
the iris was seized and cut ; he laughed during the whole
performance, and when it was finished he exclaimed,
"What I is that aU? I have scarcely felt anything.''
He had some pain in the first thirty-six hours, but no
inflammatory irritation.
Case V.— October i8th : Mr. B , aged thirty.
Cinder in cornea, surrounded by a white ring, circum-
comeal injection marked ; since yesterday. Three drops
of four per cent solution. Removal twenty minutes
later. Cornea insensible. The dig:ging and scraping
caused no rolling of the ball, no winking with the lids, no
pain. Even when I held only the lower lid down and
left the upper free, the manipulation caused no closure
of the lids.
Cases VL and VII.— October i8th : Old trachoma.
Insensibility of cornea and conjunctiva; touched with
sulphate of copper. No pain, no irritation, scarcely any
increased congestion after the application. No discom-
fort as when touched before.
Case VIII.— October i8th : Polypi auris after re-
moval of exostosis ; very painful. The sensibility in
scraping them out was decidedly diminished in the super-
ficial layers, not in the depth after two instillations of
cocaine.
Case IX. — October 19th : Mrs. N , aged fifty-six.
Conjunctivitis of both eyes, tumor sacci lacrymalis of the
left Four per cent cocaine, six drops in conjunctival
sac and on lachrymal points ; ten minutes later cornea
and conjunctiva anaesthetic, pupil slightly dilated. Ten-
sion of globe the same. The introduction of Weber's
knife through one-half of the canaliculus is not felt, the
pushing forward into the sac and slitting the inner wall
of the sac, and passing a thick probe into the nose, are
felt painfiil, but it seems less than usual.
October 19, 1884.
THE NEW LOCAL ANESTHETIC.
By D. B. ST. JOHN ROOSA, M.D., LL.D.,
PROFBSSOK OF DISEASES OP BYB AKD BAK, NEW YORK POST-GRADUATE SCHOOL.
I HAVE been using the chloride of cocoaine, as a local
anaesthetic, for the last ten days, in operations upon the
eye, and in one case of neuralgia of the tympanum. The
preparation employed was a two per cent solution made
by Mr. Foucar. In the first case the internal rectus
muscle was divided. The subject was a young woman.
She experienced no pain until the muscle was taken up
by the hook, and then she cried out rather lustily, but
she did not become at all unmanageable. In the second
case I divided both external recti and brought forward
the internal rectus. The cocoaine was used in this case
every five minutes for fifteen or twenty minutes before
the operation, and some three or four times during its
performance. The patient was a young and healthy
man, a clergyman by profession. He said the pain was
inconsiderable, and I had no trouble during the opera-
tion from his movements. Indeed, he seemed to suffer
very little.
On the 2oth I extracted a cataractous lens, in its
capsule without an iridectomy^ while the eye was under
the influence of the new local anaesthetic None of the
stages of the operation caused anything but trifling pain.
The eye remained steady and tractable to the end of
the manipulations, and no accident occurred. The oper-
ation was witnessed by Dr. Vosburg, of this city. Dr. G.
J. Bull, Dr. Ring, and Dr. Tewksbury. October 21st I
divided the internal rectus, and employed the cocaine
in the usual way, that is, two drops every five minutes
for fifteen or twenty minutes before tlie operation, and
once during it. The patient experienced considerable
pain, and said she would take ether the next time.
As intimated above, I have used the drug locally —
upon the membrana tympani — in one case of that rare
disease, tympanic neuralgia. The patient said the pain
was relieved in ten minutes after two instillations. I
have used it for the operation of slitting up the canaliculi
and probing the nasal duct, but as yet without any alle-
viation of the pain usually caused. Except in one case,
dilatation of the pupil has always been produced in my
cases, but no other unpleasant symptom.
Since writing the above I have performed two opera-
tions upon the eye, while under the influence of the nm-
riate of cocoaine, with the most satisfactory results. In
these cases a two per cent solution was used, but it was
instilled three to four drops at a time, every three min-
utes for fifteen minutes. In one of these last cases I
divided the internal rectus of a boy of twelve years. He
declared that the operation did not cause him greater
pain than was produced by pinching the skin of his hand.
The last case was one of division of both the external
recti muscles in a man of about thirty-four years of age.
He declared that the pain was of no consequence what-
ever, and talked freely with me while I was engaged
upon his eye.
Over $7,000 have thus far been collected by The
Medical Record for the Sims Memorial Fund.
464
THE MEDICAL RECORD.
[October 25, 1884.
The Medical Record-.
A Weekly Journal of Medicine and Surgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD & Co.. Nos. 56 and 58 Lafayette Place.
New York, October 25, 1884.
A PLEA FOR THE COUNTRY DOCTOR
The best elements of our character are always brought
out by opposition. Environment determines many
points of excellence which cannot be developed by any
other means. It applies to the doctor as well as to others
of the genus homo. The rural practitioner especially is
full of controlling surroundings. If he gets the better of
them he is so much more of a man. Every one who
knows him sympathizes with him in his every-day fight,
and credits him with his well-earned successes. The
letter in another column refreshes a picture which is full
of cold shadows and rugged outline. The central figure
is the country doctor and his horse struggling through
the deep trough of a muddy road, with a background of
bleak hill, and trees bare-poled to meet the whistling
wind. No fancy sketch, as he can tell us, but full of
reality to thousands of fellow-workers. Hardly appreci-
ated, however, by the metropolitan brother in his cush-
ioned coup^, trundling over Macadamized avenues to
sick millionaires.^
But after all, taking ordinary chances, we would be
inclined to side with the country doctor in any emergency
occurring in general practice. A man who can extricate
his horse from a snow-drift on a dark road may not be
lacking in resources to dislodge an impacted foetal head,
cut the bridle of a strangulated hernia, or make a new
path for a bean in the trachea. That he is accustomed
to shoulder responsibility hardly tells against him in his
general results. His resources widen with his oppor-
tunities, and when he makes his own path up the moun-
tain he can the better appreciate the broadened view
which he gains. If he has to swim without corks he can
float with the more confidence in the deeper waters.
There is more of an education for a doctor than is
comprised in the dosage of pills or the action of powders,
and the country doctor gets it very often in his daily
contact with man and nature. Insensibly he strikes a bal-
ance between the capabilities of the one and the power of
the other. Matter-of-fact, it is true, but practical always.
He may not have time to look after the countless micro-
cocci that fill the scientific air, but he takes care that
they do not obscure the view of the end of his road.
His destination must be to cure his patient. If he fails,
his good friends in and out of the profession will know
it. Consequently he must be the general practitioner
par excellence^ as ready to brighten the headlights as to
handle the tiller.
The type of the general practitioner is the self-reliant
man on the dark countty highway, whose every instinct
teaches him to keep the road, whether it be going to a
patient or at a patient.
It is truthfully said that he cannot call for help al-
ways ; therefore he helps himself. It is not so much the
instrument as the brains behind it. A man of sound
practical sense may treat a fractured thigh sometimes
better in the backwoods with a forked stick and piece
of blanket than can another with an improved " Buck's
extension " in a metropolitan hospital. It is the dif-
ference in the man wherever he is. The doctor in the
country has the best of it because he has more chance
to develop himself, and when he does it he need not
envy the city man who steadies his professional stand-
ing by fastening intellectual guy-ropes to the bell-call of
every neighboring specialist. These dependents are not
the backbone of the profession. They can only wrig-
gle their way to patronage while they are riding the
ground-swell of the bigger fish. They could not live so
well in the country. We are speaking now of the ex-
tremes of dependents and independents in their respec-
tive types of general practitioners in and out of the cities.
If they were to change places specialism in the cities
would suffer and general practice in the country would
hardly improve. So much for the claims of the progres-
sive, wide-awake, and self-reli^int country practitioner.
Our correspondent allows the current of his enthusi-
astic advocacy of his class to take him slightly beyond his
depth when he implies that living in the city is not more
expensive than in the country, and that the metropolitan
has everything he may wish for. Stop at the hundreds
of signs on the avenue highways and side-street byways
and ask' how it is. To display such a light on a city hill is
very different from merely removing the country bushel
The yearly rental of a house on an avenue would buy a
country cottage, while the first cost of a coup^ would
cover the contract for a bam, with possibly a good horse
thrown in. Where much is spent much must be earned.
The ambitious metropolitan works as hard as the rustic,
with hardly as good a show on the grand track. They,
in fact, both need rest. Both should take it. It would
do the rural gentleman as much good to visit the city in
the winter, and exchange his muddy paths for dry pave-
ments and his snow-drifts for closed cars, his patient's
bedside for hospital ward and his saddle for the orches-
tral chair, as it would in summer for the city man to
climb the hills, to sail the lakes, cast the fly, or hunt the
deer. It is the change which gives the rest — the rustic
may study interiors, the metropolitan develop exteriors
Both would be benefited thereby and escape the eflfccts
of that continuous drudgery which too often breaks the
backbone of a noble aspiration.
THE PATHOLOGY OF LAWN-TENNIS.
For two or three years English medical journals have
had, now and then, letters about'** lawn-tennis arm,"
"lawn-tennis elbow,'* and " lawn-tennis leg." /^. Any phy-
sician ¥^0 meets many lawn-tennis players is'quite sure
to find some who complain of J a trouble with the wiist,
or forearm, or elbow. These troubles are rather more
apt to occur among the beginners, since they are due to
the very sudden and often unnecessarily violent musco-
October 25, 1884.]
THE MEDICAL RECORD.
465
lar contractions which the too ambitious player makes.
Xhey are also rather more frequent among elderly
persons. Hence we hear more of them in England,
where persons of every age play tennis.
The "lawn- tennis arm,'* so*called, appears to be gen-
erally due to a rupture of the pronator radii teres. This
is a slender muscle, and the sudden call upon it in using
the racket sometimes does it an injury. After long
practice, however, the pronating power of this muscle is
very much increased and the danger of injury is less.
When an accident to it occurs the victim feels pain on
flexing ox pronating the forearm ; there is tenderness,
and perhaps swelling and discoloration along its course.
Doubtless the muscle in question is not ruptured en-
tirely, but only as to some of its fibres, while coinci-
dently there is a good deal of stretching and perhaps
tearing of the fibrous and ligamentous tissues on the in-
ner side of the elbow, near where the muscle arises.
Another form of **Jawn-tennis arm/* appears to be due
to an injury to the musculo-spiral nerve or its posterior
interosseous branch. This nerve winds around the outer
side of the humerus beneath the triceps muscle and de-
scends between the long supinator of the wrist and the
brachialis anticus. In other words, it passes close to,
and supplies, two muscles that are brought into powerful
action in back-handed strokes. When these strokes are
made too suddenly and violently by unseasoned muscles
the contractions appear either to injure the extensors
and supinators of the arm, tearing some of their fibres,
or perhaps the nerve itself is injured by the violent
squeezing which it gets. At any rate there is a quietus
pat upon back-hand strokes for a time.
We have seen tennis players who suffered from weak-
ness of the wrist The violent Jflexing of the fingers and
wrist has in these cases stretched or torn some fibres of
the anterior annular ligament, which holds the flexor
tendons down. Sometimes a slight teno-synovitis seems
to be set up. A firm rubber band is a great help in
these cases.
Tennis players may and do suffer fi-om ordinary sprains
of the elbow or shoulder. In these there is nothing dis-
tinctive or peculiar.
Besides " tennis arms,'' we have " tennis legs." For
example : A player while serving a ball with a powerful
cut-down stroke suddenly felt a sharp pain in the calf of
his leg and the leg immediately became powerless. A
few days later large black-and-blue spots appeared on
the calf. This patient had a '' tennis leg." The trouble
was caused by a rupture of some of the calf muscles.
The English writers assume the affected muscle to be
the small and rudimentary plantaris longus. Certainly
there is more involved than this in many cases.
The treatment for all the foregoing pathological prod-
ucts of athletic activity is, in the main, rest, massage,
and elastic compression. Sometimes the use of elastic
bandages, such as Martin's, enables one to use the in-
jured arm very soon. At other times the trouble is
more obstinate, and the arm has to be given almost com-
plete rest for a long time. When the nerve is injured,
electricity is very usefiil. A bad tennis leg may require
a starch bandage and a high-heeled shoe for a time.
In conclusion, we would say that tennis players need
not feel alarmed by this description of the possible acci-
dents in the game. The proportion of tennis arms and
tennis legs is extremely small. It may even be ques-
tioned if young and perfectly healthy persons can rup-
ture their muscles in using a tennis racket. Certainly
such a thing is of rare occurrence. But non-athletes
who take up tennis after thirty should be a little carefuL
THE NEW YORK STATE MEDICAL SOCIETY.
Circulars have been issued by Dr. B. F. Sherman,
President of the New York State Medical Society, re-
questing that the titles of papers to be read at the next
meeting be sent in by the first of December. It is de-
sired that the full list should be published at that time, so
that the discussions may be full and exhaustive.
The object of the President is praiseworthy, but he will
not attain it by the method alone which he proposes. If
the titles of any large proportion of the papers could be
obtained so early as December ist, which is doubtful,
members would be very likely to forget them before Feb-
ruary. Apart from this, however, every one knows who
has attended State meetings that more radical changes
must be made in order to secure valuable discussions.
At present, there are generally too many papers for the
time of the Society. The discussions have to be cut
short, instead of being encouraged. Nor is there any
systematic attempt to get good dbcussions. Experience
with medical men and medical meetings shows that it is
only rarely that good discussions are secured without
previously canvassing members and seeing that those
who can speak instructively are present and prepared.
It is possible that at the next naeeting, with the Code
question no longer to vex us, there may be time for the
full presentation and consideration of papers. If not,
however, some radical change must be made. Sections
must be established — a measure of questionable wisdom
— or the meetings prolonged, or the number of papers ac-
cepted must be more carefully limited.
The practice of urging readers of papers to have
printed slips of an abstract for distribution to the mem«
bers sometimes increases the interest in papers that are
long or very technical, and the question of its adoption
should be borne in mind by the Business Committee.
SUITS ARISING OVER INJURIES;,
The suits arising over injuries incurred in accidents, espe-
cially those connected with railroad collisions, often bring
up the question of the skill of the attending physician or
surgeon, and the railroad companies lay great stress wher-
ever possible upon the alleged incompetence or negli-
gence of the professional attendant. If this defence were
allowed to the extent it is sometimes pushed, the poor
victim of a collision would be obliged to warrant that the
utmost skill had been exercised by the surgeon, or else he
could not recover any damages. This is not the rule
adopted by the courts, which generally hold that all that
can be legally exacted of the sufferer is ordinary care and
skill in the choice of an attendant. A recent case in
Pennsylvania states this principle, where the injury was a
broken arm, and the ruling of the judge was as follows :
'* There is evidence tending to show that, had this broken
arm received ordinar}- care and ordinary professional skill.
466
THE MEDICAL RECORD.
[October 25, 1884.
the parts would have united with little or no permanent
injury, and on this hypothesis alone appellant insists
that the matter of this false joint should have been, at
least hypothetically, excluded from the jury. We under-
stand the law on the subject to be that plaintiff cannot
hold defendant answerable for any injury caused, even in
party by the fault of plaintiff in failing to use ordinary
care or ordinary judgment, or for any injury not resulting
from the fault of defendant, but caused by some new in-
tervening cause not incident to the injury caused by
defendant's wrong. Thus, in this case, if it be conceded
that the false joint, under proper care and skill, would
not have resulted from the breaking of the arm alone,
but was brought about by the subsequent separation of
the parts- after they had been properly set, and before
nature had formed a firm union, then if this subsequent
separation of the parts had been caused by an assault
and battery by a stranger, or some foreign cause with
which appellant had no connection, and which was not
in its nature incident to a broken arm, plainly appellant
ought not to be held to answer for the false joint ; but if
appellee exercised ordinary care to keep the parts to-
gether, and used ordinary care in the selection of sur-
geons and doctors, and nurses, if needed, and employed
those of ordinary skill and care in their profession, and
still by some unskilful or negligent act of such nurses, or
doctors, or surgeons, the parts became separated and
the false joint was the result, appellant, if responsible for
the breaking of the arm, ought to answer for the injury
in the false joint. The appellee, when injured, was
bound by law to use ordinary care to render the injury
no greater than necessary. It was, therefore, his duty
to employ such surgeons and nurses as ordinary pru-
dence in his situation required, and to use ordinary judg-
ment and care in doing so, and to select only such as
were of at least ordinary skill and care in their profes-
sion. But the law does not make him an insurer in such
case that such surgeons, or doctors, or nurses, will be
guilty of no negligence, error in judgment, or want of
care. The liability to mistakes in curing is incident to
a broken arm, and where such mistakes occur (the in-
jured party using ordinary care), the injury resulting
from such mistakes is properly regarded as part of the
immediate and direct^ damages resulting from the break-
ing of the arm."
PALLIATIVE MEASURES IN RUPTURED EXTRA-
UTERINE PREGNANCY.
Another woman has passed from health to the grave in
a few hours ; another home has been made desolate ; and
another victim to delay and palliative hypodermatics of
morphia and brandy-and-water in drachm doses has been
added to the list, already too long, of cases that have
been lost for want of surgical treatment.
A case has been recently reported, in a Western medi-
cal journal, in which the symptoms of rupture of an extra-
uterine foetal sac were complete, and the diagnosis of
extra-uterine pregnancy was concurred in by three prac-
titioners, and the following treatment adopted : *' Sulphate
of morphia in one-sixth-grain doses, hypodermatically, to
control the pain, and brandy, both by the mouth and
under the skin, as a stimulant. A sinapism over the
stomach and bowels assisted in giving some measure of
relief." The patient died in sixteen hours and a halt
Nothing is said of an attempt to control the hemorrhage,
which every one must have known was draining away the
woman's life. Nothing is said of a desire to open the
abdominal cavity to stop the hemorrhage and remove the
foreign body. Is the recorded experience and the teach-
ing of the surgical leaders of the day to go for nothing?
Are there any who think that a patient in this situation
dies of aught else save hemorrhage, and controllable
hemorriiage? If the hemorrhage be not controllable,
why do the patients live for sixteen and twenty or thirty
hours after the rupture ? Are there those in the profes-
sion who do not know that the mere exposure of the ab-
dominal cavity to the air will often check a hemonhag^
which would otherwise prove fatal in the closed cavity?
Surely in these days of great and brilliant triumphs in
abdominal surgery, when patients recover after intestinal
wounds and resections, when the most desperate "forlorn
hopes " recover, one should not hesitate to open the ab-
domen in a case of this kind, when two or three ligatures
and some clean water are all that are required.
There is no palliative measure for a ruptured extra-
uterine cyst ; there is no expectant treatment ; and there
is no other way known to medicine by which a woman
in this condition can be reasonably expected to survive
save by the prompt use of the knife — and there is no
reason for thinking that she would die if this be resorted
to in time. And until she is practically dead it is never
too late to try and save her.
MR. VANDERBILTS GIFT.
The College of Physicians and Surgeons deserves warm
congratulations upon the magnificent gift of half a mil-
lion dollars which has been so generously made to it by
Mr. William H. Vanderbilt Such a donation is unpre-
cedented in the history of American medical colleges.
It places the fortunate institution among the few endowed
medical colleges in this country, and will enable it to
carry out the efforts at a higher education which it has
already shown itself desirous of making.
The medical colleges in this country which, in 1881, had
productive funds were the following : Yale Medical Col-
lege, $29,102; Harvard Medical School, $280,391; Med-
ical Department of University of Pennsylvania, $50,000,
and Johns Hopkins Medical School (not yet open). Be-
sides these, the McHarry Medical College, the Howard
University Medical School, and the Kansas City Medical
College have small endowments ; while several others,
such as Dartmouth and Bellevue, have had large sums
of money presented for specific purposes. A number of
Western medical colleges also give tuition free and are
supported entirely by the State.
The Faculty of the College of Physicians and Surgeons
of New York already has property valued at nearly
$200,000. With its recent gift, therefore, it becomes the
richest institution of the kind in America. It is an-
nounced that the money will be used, in part at least,
for the construction of a new building, which will be
erected in the northwestern part of the city, in the vicin-
ity of Roosevelt Hospital. Such a move, if made, will
be a bold one, since tradition has heretofore located
medical instruction upon the east side of the city. By
October 25, 1884.]
THE MEDICAL RECORD.
467
the enlargement of Roosevelt, the construction of a ma-
ternity hospital, and the development of dispensaries, the
part of the city referred to could probably, in time, be
made another medical centre.
Roosevelt Hospital, however, will meanwhile have to
undergo some radical and needed changes in the ar-
rangement of its visiting services. For although it is
admirably managed in a way, nevertheless in usefulness
to medical and surgical science, and for the purposes of
practical instruction, it has been falling behind.
^ews of tUi^ WCei^U.
Muriate of Cocaine in the Operation for Cata-
ract.— ^The operation for double senile cataract was
successfully performed this week at Mount Sinai Hos-
pital, muriate of cocaine being used, and no general an-
aesthetic. The patient experienced no pain.
A Journalistic Change.— It is announced that TA€
Therapeutic Gazette will be moved to Philadelphia, where
it will be edited by Professor H. C. Wood and Professor
Robert Meade Smith. The Gazette will still be pub-
lished by Mr. George S. Davis, of Detroit, whose liberal-
ity and energy have already done so much for it We
welcome Professor Wood back to the field of journalism.
His editorship insures to the profession a journal in the
interests of scientific pharmacology as. well as of practical
therapeutics.
The Hospital Saturday and Sunday Assoclation
held its first meeting for the fall during the past week.
A report was made by the general agent of the Society,
Mr. F. J. Cook, in which it was stated that the work was
well advanced, and that there was an excellent prospect.
There would, in all probability, be a larger collection
from the churches than heretofore. The members of
additional trade auxiliaries had been brought into the
work, having been organized during the summer.
The So-called Gonococcus Normally Present in
the Healthy Urethra.— Dr. E. C. Wendt, of New
York, writes that with the aid of a suitable instrument
he has examined the scrapings from different portions of
the healthy male urethra. In every instance these scrap-
ings were found to contain, in greater or less abundance,
micrococci morphologically identical with Neisser's so-
called gonococcL The inference is obvious. He intends
at a later d^e to publish the detailed results of a large
number of observations, which, in conjunction with Dr.
C. W. Allen, of New York, he has already made, and is
still engaged in making.
Washington Obstetrical and Gynecological So-
ciety.— At a regular meeting of the Washington Ob-
stetrical and Gynecological Society, held October 17, 1884,
the following officers were elected for the ensuing year:
^r^x/Vfe«/— Samuel C. Busey, M.D. ; Vice-Presidents^--
W. W. Johnston, M.D., and J. Taber Johnson, M.D. ;
Recording Secretary — C. H. A. Klineschmidt, M.D. ;
Corresponding Secretary — Samuel S. Adams, M.D. ;
7r^<M»r^r— George Byrd Harrison, M.D.
Dr. Domingo Orvananos, the Secretary of the Board
of Health of the City of Mexico, has been in this city
studying our methods of sanitary administration.
Death of Professor F. A. Ross. — Dr. F. A. Ross,
of Mobile, Ala., died October 17th, of apoplexy. He
was bom in 1821, and was graduated at several institu-
tions of learning, including the University of Virginia and
the Pennsylvania Medical College. He served as Surgeon
of the Palmetto Regiment during the Mexican war, and
during the war of the rebellion was the Medical Director
of the Department of the Gulf, under the Confederate
Government. He was at one time President of the Mobile
Medical Society and of the Alabama Medical Society,
and Professor of Therapeutics in the Mobile Medical
College.
"Dead Teeth in the Jaws." — Dr. C. E. Nelson
writes: "In my communication to you on this subject
(October 18, 1884), on page 444 of The Record, I no-
tice two important typographical errors, which I should
like corrected. In the second column, line 25 from bot-
tom, for nominally read normally. In line 8 from bot-
tom, for than read then''
The New York State Medical Association. —
The Fellows and delegates of the New York State Med-
ical Association assemble in this city on the third Tues-
day in November next (the i8th). The Association is
at present composed of 168 founders, representing 40
out of the 61 counties of the State. Half of the found-
ers come from six counties, New York having 33, Rens-
selaer County coming next with 14, and King's County
last with 7. Sixteen counties have one representative. It
has been voted to call the members Fellows. A com-
mittee, consisting of Drs. A. Flint, Jr., Van de Warker,
and Gouley, has been appointed for the purpose of se-
curing the co-operation of a medical journal in harmony
with the objects of the Association. It has been voted
that members who are to read papers shall have a synop-
sis printed for distribution. The main object of the As-
sociation is to secure to the profession in New York State
representation in the American Medical Association.
The question will, therefore, doubtless be raised whether
those counties in which medical societies have not
changed their old code and which are still entitled to
representation can send a double set
The Report of the French Cholera Commis-
sion AT Marseilles. — This commission, consisting of
seven members, of whom only five acted, viz., MM.
Sicard, Taxier, Loucel, Livon, and Chareyre, offers the
following conclusions: "i. The cholera is transmissible
to the rabbit, as demonstrated by injection into the
veins of the blood of a cholera-patient at the algid
period. The rabbit died in twenty-four hours, with
lesions entirely like those of cholera. 2. By cultivation,
this blood afrer a few hours loses its infectious properties.
3. Injections of choleraic blood in the period of reaction,
or a very advanced algid period, produce no effect 4.
The perspiration of a cholera-patient, injected into the
veins, does not transmit cholera. 5. The stomachic or
intestinal dejections, or the gastro-intestinal contents
(this last full of comma-bacilli), may, after filtration, be
injected with impunity into the cellular tissue of the
peritoneum, the windpipe, the intestines, the rectum, and
even into the blood. 6. Comma-bacilli taken from the
intestines of a cholera-patient may be introduced into
the intestines of a rabbit, and multiply there for more
468
THE MEDICAL RECORD.^
[October 25, 1884.
than eleven days, without producing any choleraic symp-
toms, and without necropsy revealing the anatomo- patho-
logical lesions characteristic of cholera. 7. There is
thus every proof of the non-specificity of the comma-
bacillus. We experimented on bacilli taken from the
intestine, and with dejections kept from two to twelve
days, the results being always negative. Everything also
proves that this bacillus does not produce in the intes-
tine toxical ptomaines which would be the cause of
poisoning — namely, the lesion of the blood. The infer-
ence from more than fifty of these experiments is the
non-contagiousness of cholera, which we maintained
from the very opening of the discussions. 8. The mi-
nute examination made by us of the heart and large ve-
nous vessels of cholera-patients enables us to affirm that
there is no phlebocarditis in cholera, as alleged by Mor-
gagni and still maintained by many enlightened phy-
sicians. 9. Bulbar and medullary lesions, or those of the
solar plexus, appear to us to be all secondary lesions.
10. In our opinion, the initial lesion of cholera takes
place in the blood. 11. It essentially consists in the
softening of the haemoglobin, which makes some cor-
puscles lose first their clear shape, the fixity of their
form, and the faculty of being indented. Those cor-
puscles adhere together, lengthen rX)ut, stick together,
and, in very rapid cases especially, some are seen which
are quite abnormal, while others appear quite healthy.
12. The entire loss of elasticity of the corpuscle (which
is shown by the preservation of the elliptic form when it
has been stretched out) is, in our view, a certain sign of
the patient's death. To stretch out a corpuscle, it is
merely needful to alter the inclination of a plate on
which a sanguineous current has been established in the
field of the microscope. The fluid column stops at one
point, whereas the rest continues to flow. An elonga-
tion of the intermediary corpuscles results, and then a
rupture of the column. In the gap thus formed are some
scattered corpuscles. If these revert to their primitive
form the patient may recover. If they keep the elliptic
form, we have seen death follow in every case, even if
the patient's symptoms were not serious at the time of
the examination of the blood. At the outset, and in the
rapid cases, which give the clearest results, corpuscles
remaining healthy are seen alongside the unhealthy ones,
and assume the shape well known in heaps of money, or
maintain their liberty. When currents are created in the
&Bld of observation, the columns of healthy, or less un-
healthy, corpuscles remain stationary, or nearly so;
whereas the unhealthy corpuscles flow between the
columns or the stationary masses like fluid lava. This
we believe to be the characteristic lesion of cholera.
By hourly examination of the blood of cholera-patients
the progress of the malady can be mathematically fol-
lowed. First some corpuscles are unhealthy, then one-
third, then half, Jhen two-thirds, and lastly death super-
venes. A very important fact in our view is that all the
corpuscles are not simultaneously affected. We debar
ourselves from substituting a fresh hypothesis for all those
we have overthrown. We confine ourselves to saying
that we know better than our predecessors what the
cholera is not, but we -do not know what it is.'*
The Ambulance Service in New York. — A corre-
spondent of the British Medical Journal writes : " Each
of the principal hospitals of New York supports one or
more ambulances, which may be called by the telegraphic
or district messenger systems, and are always accom-
panied by a surgeon. During the year ending June, 1883
Chambers Street Hospital (2 ambulances) answered 2,124
calls ; the New York Hospital (2 ambulances) answered
1,118 calls; Bellevue Hospital (4 ambulances) an-
swered 2,606 calls; Presbyterian Hospital (i ambu-
lance) answered 500 calls; Roosevelt Hospital (2
ambulances) answered 750 calls ; Ninety-ninth Street
Hospital (2 ambulances) answered 800 calls; and St
Vincent's Hospital (2 ambulances) answered 1,100 calls
— ^showing'that, during the time specified, seven hospitals,
supporting fifteen ambulances, answered 9,198 calls."
Death of Dr. Louis A. Dugas. — Dr. Louis Alex-
ander Dugas died at his home in Augusta, Ga., on Octo*
ber 19th. He was born in Washington, Ga., January 3,
1806. Then he pursued a course of study in the medical
department of the University of Maryland, from which
he graduated in 1827. He passed four years in a study
of European medical institutions, and finally settled down
to the practice of his profession in Augusta. He united
with five other physicians in 1832 in founding the Medi-
cal College of Georgia, and accepted the chair of Pro-
fessor of Surgery. He retained this position until the
close of his life. In 1834 he was elected to membership
in the Geological Society of France. The University of
Georgia conferred the degree of Doctor of Laws upon
him in 1869. He held a membership in numerous liter-
ary and scientific societies in Georgia, and was President
of the Medical Societies of the State and of the City of
Augusta respectively, for several years. During the in-
ternational Medical Congress at Philadelphia in 1876,
Dr. Dugas was one of its Vice-Presidents. He became
the editor of the Southern Medical and Surgical Journal
in 185 1 and retained the position for seven years.
Bequest to the Massachusetts General Hos-
pital.— The late Francis P. Hurd, of Wakefield, Mass.,
bequeathed $10,000 to the Massachusetts General Hos-
pital.
Hospitals at Winnepeg. — Dr. Henry H. Chown, of
Winnepeg, Manitoba, writes in an unnecessarily indignant
tone regarding an item in The Record, which says that
Winnepeg having a medical school " is about to start a
hospital." Our correspondent says that the hospital
which is about to be started is not the first but the third
in that city, and that it is doubtful if any college has
started with greater hospital advantages than the Mani-
toba Medical School. We are very glad to learn this, and
to correct any misapprehension regarding the educational
facilities of Manitoba.
. "Lady Medicals." — Such are the honeyed words
with which the Englishman refers to the women doctors.
A propos thereof says one journal: •* Although the
Medical School for Women in London has been open
some eight or nine years, only some score or so of lady
doctors have been launched upon mankind, but this
limited supply has far exceeded the demand, at least as
far as England is concerned. Only about two or three
lady doctors, I am told, can earn a living by the private
practice of their profession in this country."
October 25, i884,]
THE MEDICAL RECORD.
469
NEW YORK PATHOLOGICAL SOCIETY.
S^a/ed Meeting, October 8, 1884.
George F. Shrady, M.D., President, in the Chair.
Dr. T. Mitchell Prudden presented, in behalf of a
candidate, a specimen of chronic endocarditis^
CARCINOMA OF THE STOMACH.
Dr. Satterthwaite presented the stomach, pancreas,
kidneys, and a portion of the lungs, removed from the
body of a man fifty-three years of age. He was called on
September 7th, in consultation, to see the patient, who
had had a hemiplegic attack of moderate character, and
from which he recovered within twenty-four hours to such
an extent as to be again able to use his right upper and
right lower extremities. Attention had been called to
the fact that he had been losing strength rapidly for six
months, and on further inquiry it was found that he had
been losing flesh for two years. Up to about one month
previously he had suffered from nothing especially except
chronic gastritis with frequent attacks of vomiting and
great difficulty in taking food. There was some pain in
die epigastric region, but not severe. The urine, lungs,
and heart were normal. The epigastric difficulty increased
during the last month, but he had not vomited blood ;
nothing except the material taken. There was no tu-
mor in the epigastric region, although it was thought
that some dulness on percussion could be detected. The
patient presented a cachectic appearance, and there was
progressive emaciation with reduction of weight from 160
to a little more than 100 pounds.
Two months after his first attack of hemiplegia a sec-
ond attack occurred, in which there was some difficulty
in swallowing and speaking, but it largely disappeared,
although he never fully recovered his voice or power of
swallowing solids. During the last four or five days of
his life the patient refused to eat on account of the in-
ability to retain food and of the extreme pain which it
produced, and he said that he preferred Tto starve to
death, and he did starve to death.
On opening the abdominal cavity the stomach was
found essentially in its normal position. At the pyloric
extremity there was a patch of considerable thickening
about the size of a silver half-dollar, limited to the ante-
rior side. The pyloric orifice admitted only a lead-pencil
of ordinary size. The circular patch of thickening could
hardly be appreciated except by the touch. Although
the constriction at the pyloric orifice was not great, Dr.
Satterthwaite accounted for the gastric symptoms on the
ground that the thickened portion of tissue was limited
to one side, and was thrown over the orifice at times,
acting somewhat like a valve.
The pancreas was infiltrated with small nodules ; the
mesenteric glands were somewhat enlarged. The liver,
the lungs, and the heart were essentially normal The
kidneys were somewhat fatty and slightly enlarged.
The question to be determined was whether or not
the thickening at the pyloric extremity of the stomach
was due to malignant disease. Dr. Satterthwaite pro-
posed to examine the specimens microscopically, but he
peferrcd to exhibit them to the Society while they were
in a fresh condition.
The President asked how long after taking food the
vomiting occurred.
Dr. Satterthwaite said from twenty-four to forty-eight
hours. The spasmodic efforts during the attacks of vom-
iting were exceedingly severe, and probably during some
of these attacks cerebral hemorrhage was produced suffi-
cient to give rise to the hemiplegia.
Dr. John C. Peters asked if the thickening was con-
fined to the single patch mentioned.
Dr. Satterthwaite replied that it was confined to the
circular patch which could be felt but not seen, and in
reply to another question said that the stomach was not
especially enlarged, although we might expect dilatation
with obstruction at the pylorus, yet that does not always
occur with cancer.
The President remarked that it would seem, if it were
malignant disease, it should have made more progress
during the two years it had existed.
Dr. Satterthwaite remarked that he had the records
of a case in which a nodule at the pyloric orifice of the
stomach was felt for two years, and the history of the
tumoi; extended back of that, and at the autopsy it was
proved to be cancerous in character.
Dr. John C. Peters thought that the case might
prove to be a duplicate of the first case presented to the
Society in 1844, one of thickening of the stomach, which
was diagnosticated during life as cancer. The patient
had many of the symptoms which Dr. Satterthwaite had
mentioned, and there was found a hardness in the walls
of the stomach without tumor, and after death it was sup-
posed to be cancerous. On examination, however, it
was found to be merely a thickening of the cellular tissue.
It was regarded as a rare specimen.
The President remarked that it would be interesting
to ascertain whe.'ier or not cancer was frequently limited
to such a small portion of the stomach.
Dr. Van Gieson said the duration of the disease was
a very uncertain factor, because a malignant growth might
engraft itself upon chronic gastritis.
Dr. W. M. Carpenter referred to a case in which he
found at autopsy a cancerous nodule, about an inch and
a quarter in diameter, situated about three inches from
the pylorus, upon thf posterior surface of the stomach, which
had not given rise to symptoms. The patient entered
the hospital and died of a disease not referable to the
stomach.
Div Satterthwaite referred to a case in which he made
an autopsy and found a tumor as large as an orange,
situated in the greater curvature of the stomach, which
had discharged by a sinus leading through the abdominal
wall, and this sinus had been treated by a surgeon with
the result of producing a partial cure. The patient was
suddenly attacked with gastric symptoms and died. The
tumor was not discovered during life, nor had the patient
complained of gastric symptoms other than those which
were referable to the sinus which communicated with the
growth.
The President remarked that it was rather the rule
than the exception, when the disease was not Ibcated in one
of the extremities of the stomach, that vomiting and other
stomach symptoms did not develop, and that the growth
was discovered only at autopsy.
NASO-PHARYNGEAL FIBRO-SARCOMA.
Dr. R. p. Lincoln presented a specimen with the fol-
lowing history (see page 455) : *
The President remarked that there was no compari-
son between the operation described by Dr. Lincoln and
that with preliminary tracheotomy, tamponing the pha-
rynx, and removing the upper jaw. There could be no
argument against the success obtained in Dr. Lincoln's
case.
Dr. Howe thought that it afforded a strong argument
against the use of the knife in all of these cases.
The President remarked that in some cases the wire
could not be applied to the base of the tumor so as to
grasp it. He had had two such cases, in one of which
Dr. Howe assisted at the operation, and in which pre-
liminary tracheotomy was performed, the pharynx tam-
poned, and the upper jaw removed. It was found that
the tumor had prolongations extending up into the skull
through the foramen lacerum medius, and from this cir-
cumstance he had been enabled to explain the shock
which ultimately caused the patient's death. The tumor
was extensively attached to the basilar process and to ad-
joining portions of the base of the skull in various direc-
470
THE MEDICAL RECORD.
[October 25, 1884.
tions. In that case, however^ the application of the wire
was found to be impossible.
The second case was one in which there were almost
as extensive attachments of the growth, and the opera-
tion was followed by the same result, although death did
not take place as soon as in the first case. He also had
another patient who was begging for a similar operation,
a man twenty-two years of age, and concerning whom he
had promised himself the pleasure of a consultation with
Dr. Lincoln as to the feasibility of the use of the galvano-
cautery. The great trouble with most of these cases was
that they did not reach the general surgeon until they were
beyond all hope of removal by the wire, and they were
also in a very unfavorable general condition for the radi-
cal operation. There could, therefore, be no argument
against success in such cases, however obtained.
Dr. Howe suggested that, even in the bad cases spo-
ken of, before any attempt was made to remove the
tumor by the knife, efforts might be made to destroy it
piecemeal by means of the wire. He could not see why
it could not be done there as well as elsewhere.
The President remarked that the difficulty consisted
in the inability to get hold of pieces of sufficient size.
Within the last year he had had a patient under observa-
tion, and had sent him to a gentlem'* .1 well skilled in
this method of operating, who succeeded in removing
small pieces, but left the patient in such a deplorable
condition from subsequent inflammation that he declined
to have the operations repeated.
Dr. Satterthwaite said that it seemed to him that
Dr. Lincoln's operation was an extremely brilliant one,
and was one which required and obtained a great deal ojf
manual dexterity in preventing the mre from twisting,
and also in adjusting it to the base of the tumor. Dr.
Lincoln passed the wire all the way down to the basilar
process and removed the entire growth at one operation.
It had been said by one distinguished throat specialist
who saw the case that the operation could not be per-
formed, and that removal of the upper jaw would be
necessary. Dr. Satterthwaite thought that fact should
be borne in mind in estimating the brilliancy and feasi-
bility of the operation ; and also the additional fact should
be recollected that this was only one of three or four
cases in which Dr. Lincoln had removed large naso-
pharyngeal polypi, and in none of them had the disease
returned.
In his hospital notes he had not found the records of
a case in wh|ch the disease had not returned and the
patients had been subject to hemorrhages, etc. But the
patient upon whom Dr. Lincoln operated and removed
the specimen presented had gained flesh remarkably,
and had not had any hemorrhages whatever. In these
cases the galvano-cautery is peculiarly successful be-
cause it arrests hemorrhage and destroys the tissue to
such an extent that if (he growth return, hemorrhage is
not likely to ensue from the use of the wire. He thought
too much could not be said in favor of this mode of
operating, and he would be pleased to hear from Dr.
Lincoln as to what his success had been.
Dr. Lincoln said he had operated in six cases. Two
of the patients were still under treatment. Of the other
four cases, one was operated upon in 1874, one in 1875,
one in 1879, ^"^ o"® ^^ 1880. He thought there was
no possibility of recurrence in any of these four cases.
He had not had any fatal cases.
With regard to the operation, he would refer to the one
which he performed in 1875. ^^ seemed to be as ex-
treme a case as could possibly exist. The patient had
been operated upon by Dr. Willard Parker, and also by
Dr. Lutkins, of Jersey City, who sent him to Dr.. Lincoln.
The patient was a boy ten years of age, who, when he
saw him, weighed sixty-eight pounds, and death seemed
inevitable. The growth had caused the right eye to pro-
trude a great deal, the right nostril was very broad at the
base, the mouth was so filled that the uvula was carried
orward to aii extent that if the incisor teeth could have
been closed they would have cut it ofi*, and in general
condition he was reduced to extremis. Dr. Lincoln
made a preliminary treatment by electrolysis, with some
twenty or twenty-five applications, and the result was
arrest of the growth, preventing hemorrhages, and reduc-
ing the mass to such a size as to give the patient a chance
to recuperate preparatory for the radical operation. At
the time he operated, in 1876,'the boy weighed one hun-
dred and three pounds, and the tumor had largely dis-
appeared from the mouth. He removed the growth in
the manner already described, and without any hemor-
rhage. He made six applications with the galvano-
cautery to the stump at invervals of one or two weeks.
There had been no return of the disease. There were
extensive adhesions of the growth to the back of the
pharynx and the sides of the nostrils.
In another case there were prolongations of the growth
to such an extent that the tumor appeared under the
cheek as large as a pullet's egg. This patient was oper-
ated upon in the same manner, was put upon the same
after treatment. The result was the entire disappearance
of the prolongations of the growth in the face, and the
patient is now perfectly well. The other cases were
similar, but not so pronounced.
Dr. Van Gieson asked if in the case operated upon
in 1876, where the tumor protruded so extensively into
the mouth, if Dr. Lincoln was able to remove, the whole
of the mass through the mouth without dividing it
Dr. Lincoln answered that the entire tumor was re-
moved through the mouth.
The President remarked that he was so favorably
impressed with this operation that he should not try any
other without first attempting to use the wire, and fur-
ther, that no small degree of credit was due to Dr. Lin-
coln for demonstrating this comparatively simple and yet
radical operation.
FIBRO-CVST OP THE UTERUS.
Dr. T. Mitchell Prudden presented a specimen for
which he was indebted to the courtesy of Dr. C. C. Stock-
ard, of Columbus, Miss. The case has already been re-
ported. (See The Medical Record, August 16, 1884.)
Dr. Prudden had submitted the growth to microscop-
ical examination ; found it . to be composed of smooth
muscular and fibrous tissue, presenting very much the ap-
pearance seen in the ordinary fibromyomata of the uterus.
There was no distinct cellular lining of the cavity of the
tumor. He presented the specimen because of its size
and because it was interesting as showing one of the
modes of formation of cysts, namely, softening, and per-
haps dilatation of the original solid tumor by the accumu-
lation of fluid and disintegration of tissue. The entire
weight of the mass, as reported by Dr. Stockard, was one
hundred and thirty-five pounds.
Dr. Ferguson remarked that he had just come from
a post-mortem examination in which he removed a tumor
weighing more than the one presented. It was, however,
an ovarian tumor.
Dr. Castle referred to the case of a patient who died
in Bellevue Hospital, where, owing to the failure of tak-
ing proper precautions, the woman by some of her move-
ments caused the tumor to fall out of bed and it dragged
the patient with it.
Dr. Wilcox asked with regard to the frequency of the
occurrence of uterine fibro-cysts in the negress.
Dr. Prudden said that large tumors like this were
rare, but that small tumors were not at all infrequent
Dr. Castle remarked that it had been said to be tiw
rule rather than the exception to find fibrous tumors of
the uterus in the negress.
intestinal obstruction — uterine fibroids.
Dr. C. W. Knight presented a specimen with the fi^
lowing history : A. B , colored, unmarried, thirty-fi«
years of age, has always been constipated, and has hw
frequent attacks of severe " colic " (?) ; has never bad
October 25, 1884.]
THE MEDICAL RECORD.
471
occasion to call a doctor for these or for other illness.
Bowels have not moved for nearly three weeks. Five
(jays ago began to take purgatives, and has used them
since in great variety, without eflfect Stomach became
swollen, and three days ago vomiting began. Called a
physician, who gave a cathartic No constitutional dis-
turbance was noticed, although there was intense thirst
Vomiting became more frequent ; the vomited matter
was fluid and had a greenish color. During the last
twelve hours of life " several quarts " were vomited, the
jMomen became enormously distended, and respiration
was greatly impeded. Death took place suddenly as the
patient was attempting to rise from bed. The patient
had been walking about her room nearly all day, making
DO complaint of pain, but suffering great discomfort from
the vomiting and the distention of the abdomen. Enemata
of various kinds were resorted to, but they brought away
only a few scybalous masses. On opening the abdomen
the small intestines, intensely congested and distended,
were exposed. The colon was found nearly empty.
About five inches from the caecum the ileum was found
constricted by a band of tissue running between two
Qterine fibroids. The loop of intestine was five to. six
inches in length, was almost black, and was distended
with gas ; it was easily emptied and pushed back through
the constricting band. There was no ulceration, but the
points of constriction were indicated by deep furrows in
the wall of the intestine. The uterine fibroids, mural
and sub-peritoneal, four or five in number, vary in size
from that of a hickory-nut to that of a small orange.
They and the caecum and the first five or six inches of
the ileum were matted together by old peritonitis. There
was no ulceration of the intestine, and recent peritonitis
was limited to the region of the strangulation.
The Society then went into executive session.
THE NEW YORK ACADEMY OF MEDICINE.
Stated Meeting y October i$, 1884.
FoRDYCE Barker, M.D., LL.D., President, in the
Chair.
Dr. Harry Marion Sims presented a
BRONZE BUST OF THE LATE J. MARION SIMS, M.D., LL.D.,
copied from a marble bust made by Dubois, the celebraf-
ted French sculptor. It is a most life-like figure.
The President, in behalf of the Academy, accepted
the gift with appropriate remarks.
Dr. Wm. T. White offered a resolution tendering
the thanks of the Academy to the donor for his beautiful
and highly acceptable gift.
Dr. John Scott, of San Francisco, was introduced to
the Academy and invited to a seat upon the platform.
Dr. Wm. H. Draper then delivered a
MEMOIR OF the LATE WILLARD PARKER, M.D., LL.D.,
in which he paid a worthy tribute to the distinguished
citizen, the skilful surgeon, and the upright man whose
"face was always set before the light."
THE THERAPEUTICAL EFFECTS OF THE INTERNAL ADMINIS-
TRATION OF HOT WATER IN THE TREATMENT OF NERV-
OUS DISEASES.
Dr. a. L. Ranney read a paper with the above title,
in which he maintained that the benefits following the
internal use of hot water were due almost entirely to heat,
and gave the following rules for its administration :
1. An ordinary goblet contains about ten ounces, and
the quantity may be from one to one and a half goblet
2. The water may be flavored with lemon, etc. ; fifteen
minutes may be consumed in sipping a gobletful ; wooden
cups prevent it from cooling quickly ; and it must be
aken hot and not warm — from no® to 150° F.
3. It must be taken one hour and a half before each
Deal, with absolute punctuality, and at bed-time.
4. Increase the temperature of the water as fast as the
patients can bear it.
5. The administration of hot water must be continued
for at least six months to get its full effects.
6. The dose should be determined largely by the
specific gravity and general character of the urine. The
object is to bring the specific gravity of the urine to
the standard of health.
7. The use of cold fluids in the form of beverages
must be absolutely prohibited.
8. Constricted diet is often necessary to the full effects
of the treatment in some form of nervous derangements.
The effects of the treatment were set forth as follows :
I, the first effect is the production of a sense of warmth
in the stomach, attended by eructation of gas not infre-
quently ; 2, the skin soon shows the effect of the heat ;
3, the kidneys exhibit marked effects, and very soon the
quantity of urine is increased. On the other hand, in dia^
betes the quantity of urine is diminished ; 4, the acces-
sory organs of digestion, the pancreas, and the liver are
stimulated, and flatulence and constipation seem to be
relieved.
The author of the paper then referred briefly to the
histories of several cases of different diseases which he
had treated by the internal administration of hot water,
perhaps combined with other remedial agents.
Among these were locomotor ataxia, neurasthenia,
gastralgia, local anaemia of the brain with transient
aphasia, etc.
The theory of its action which the author of the paper
advanced was that the nerves of the stomach, possibly
the solar plexus, were directly influenced by the heat in-
troduced into the empty organ. He believed that ice-
water did more harm than tobacco and alcohol.
Dr. Ranney reached the following conclusions : (i)
The plan of treatment is harmless; (2) its effects are
comparatively uniform when given for a suflicient length
of time ; (3) it seems to exert a curative influence in
many chronic diseases ; (4) it appears that the curative
influence of hot water is not transient ; (5) it may be em-
ployed as an adjunct without detriment to the influence
produced by other therapeutical agents; (6) it has a
marked influence on the vascular disturbances of the
nervous system ; (7) in diabetes and some kidney affec-
tions he had seen it exert a marked influence for good,
and the specific gravity of the urine had been his guide
in estimating the effects produced ; (8) as a laxative it
has a slow but decided action ; (9) the skin is stimulated
and the cutaneous circulation rendered more uniforai.
The author of the paper also recommended the use of
hot water in sea-sickness.
Dr. £. C. Sequin had had but little experience in the
use of hot water, and had never employed it in the treat-
ment of purely organic disease of the nervoUs system.
He had been struck with several points in the paper
which seemed to him to be open for discussion, and per-
haps for some degree of question. First, as to the quality
of the agent. It seemed to him that a temperature of
II o** to 150° F. would hardly justify classifying hot water
as a really heating agent, the internal temperature of the
human body being about 100° F.
In the second place, as to the cases brought forward
by the author of the paper, a large proportion of them
seemed to be cases of neurasthenia, so-called cerebral
hyperaemia, anaemia, etc. Many of them constituted one
of the most doubtful classes in our classification of disease.
Most of these disorders, certainly many of those com«>
monly called cerebral hyperaemia and cerebral anaemia,
were nothing more than cases of mal-assimilation in which
the digestive orgiins were at fault, and in these cases Dr.
Ranney had employed a combined treatment ; combining
hot water with strict regulation of the diet, and in some
instances restriction to a purely meat diet.
Dr. Seguin suggested a question, namely : Was it not
possible that the beneficial effect produced in Dr.
Ranney's cases was due to water and not to hot water ?
472
THE MEDICAL RECORD.
[October 25,
Many patients had a lack of desire for water — what Dr.
McEiroy, of Zanesville, Ohio, had called hydroadypsia,
and many of the symptoms of spinal irritation, so -called
cerebral hyperasmia, neurasthenia, etc, could be largely
relieved by the internal administration of ordinary water.
Hot water might do good as water in aiding assimilation,
but it might be a question whether or not the benefit
resulting was due to anything more than the water.
With respect to the use of hot water in organic nervous
disease, he had had no experience.
Concerning the theory advanced by the author of the
paper, namely, that the water produces its beneficial
effect through reflex action, Dr. Seguin thought there
might be some foundation for it ; but at the same time, if
a share of the good effect was to be attributed to the
liquid, the share which could be attributed to the effect
produced by the heat was not very great. He doubted
if the degree of heat was sufficient to produce more than
temporary hyperaemia of the mucous membrane of the
stomach.
He offered a word in defence of cold water, and saw
no objection to the use of ice-water upon the same prin-
ciple with which he questioned the degree of heat. He
did not believe that ice- water, ice-cream, etc., were
exceedingly cold when they reached the stomach, for they
received a large amount of heat in their passage through
the mouth and oesophagus.
In point of fact, he had obtained just the same results
by the use of ordinary water as those which Dr. Ranney
had obtained by the use of hot water, and he gave it with
the meals.
Dr. R. W. Amidon had had no experience in the use
of hot water in purely nervous diseases, but in the treat-
ment of nervous phenomena such as attended certain
cases of dyspepsia, ansemia, particularly associated with
the rheumatic or gouty diathesis, he had employed it to
some extent. He regarded the derivative action of hot
water as extremely doubtful. Moreover, Dr. Ranney
had said that no beneficial effects were to be expected
until six months had elapsed, but according to his experi-
ence no counter-initant or derivative acted as slowly as
this.
He believed that water acted mainly on account of its
diluent qualities, and especially so when the vascular sys-
tem was depleted, as it was in many if not most of the
class of cases in which beneficial effects had been ob-
tained by its use. That it might act as a tonic, produc-
ing its effects slowly, might be explained on the ground
of gradual improvement of the powers of assimilation in
accordance with well-established chemico-physiological
laws.
Dr. L. Putzel had had no experience in the use of
hot water, but thought that the experience advanced by
the author of the paper proved too much ; for it had
been stated that hot water was efficacious in cerebral
hyperaemia and cerebral anaemia, and if it produced any
effect, which was altogether unproven, it could not be
beneficial in opposite conditions.
He thought some stress should be laid upon the point
made by Dr. Amidon, namely, that therapeutic agents of
this kind act quickly. Hot water should act best at first,
if Dr. Ranney' s theory was correct. Dr. Putzel was un-
able to see how any agent which acted in this manner
could possibly have any effect upon such organic disease
of the nervous system as locomotor ataxia, and he should
be very much inclined to regard the improvement which
Dr. Ranney had reported in these cases as due to the law
of coincidence.
Dr. W. R. Birdsall believed that there was con-
siderable efficacy in the use of hot water, as well as cold
water. He was not prepared to deny the agency of heat
in the use of hot water, and believed that it was one of
the principal agents in producing its therapeutical effects.
What he had wished to hear from the author of the paper
was statistics of a clear character, but unfortunately in
all of the cases reported quite a complicated plan of
treatment had been adopted, consisting in a combination
of agents, nearly all of which had been found more or
less beneficial in the treatment of the dbeases under con-
sideration. Certainly no use could be made of those
cases.
With regard to the use of hot water in the treatment
of functional disturbances of the nervous system, there
were always so many complicating influences that it
would be a long time before we could separate the thera-
peutical action from the mere diluent action of the water.
Still he believed that heat played an important part in
producing irritation of the mucous membrane.
Dr. C. L. Dana had used hot water in the tr«itment
of chronic functional nervous diseases, chiefly in hys-
terical women with S3m[iptoms of gastric disturbance, and
had been disappointed in the results. Perhaps the fail.
ure to obtain benefit was due to the lack of care in its
administration, so minutely urged by the reader of the
paper.
Many years ago Dr. Wilkes had demonstrated that the
best results had been obtained by the use of agents
which did not act upon the nervous system specifically,
and therefore it was altogether probable that the line of
treatment laid down by the author of the paper was
likely to prove extremely useful.
Dr. J. L. Corning had used hot water in the treat-
ment of digestive disturbances concomitant with func-
tional diseases of the nervous system, such as neuras-
thenia, etc., and had obtained good results. He had no
theory to offer with regard to the action of the agent,
but could not agree with Dr. Ranney that the good re-
suits were deferred for six months, for he had seen benefit
follow within six weeks or two months.
Dr. John Scott, of San Francisco, first visited the
Academy in 1866, when he had the pleasure of listening
to a paper and discussion participated in by our honored
president. His next visit to the Academy was at this
meeting, and he had been querying in his own mind as
to how it was the president maintained his perpetual
youth. On confidential inquiry, however, he had learned
to his intense satisfaction that it had been maintained
largely through the agency of hot water. He was not
aware when he came to the meeting that the paper was
to have any special political significance, but it might be
said to have taken such a turn, and as to what its im-
mediate or remote effect would be upon the result of the
political canvass was not easy to say ; perhaps the paper
might be regarded as a political speech in favor of St.
John. He had queried also as to what was to become
of all of the doctors and the druggists, should the plan of
treatment advocated so ably by the author of the paper
be carried into full effect.
During the last thirty years he had used hot water for
a variety of affections, but chiefly for checking emesis,
especially that which occurs after the administration of
ether. He had also employed it in the treatment of a
large variety of affections, changed somewhat in color
to be sure, and more especially in the form known as
milk, and he believed that he had obtained equally good
results as those which had been presented by Dr.
Ranney.
Dr. T. H. Burchard asked the author of the paper,
first, if he had seen any serious or permanent injury done
to the digestive apparatus by the long-continued use of
hot water, and, second, whether he had noticed that the
hot-water treatment had developed a predisposition to
intestinal and gastric hemorrhages. He had had oppor-
tunity to see a large number of patients who had been
following this plan^of treatment quite faithfully, and in
quite a proportion of them he had encountered the per-
manent digestive disorders alluded to, and also the
tendency to the occurrence of internal hemorrhage.
Dr. Ranney, closing the discussion, said he had not
seen any cases, either of internal hemorrhage or per-
manent impairment of the digestive oi^ns, alluded to by
Dr. Burchard. He had seen people who had been re-
October 25, 1884.J
THE MEDICAL RECORD.
473
duced in flesh rapidly by the use of hot water with
restricted diet, but this was purposely done, and when
the treatment had been discontinued they immediately
began to gain in weight.
He thought Dr. Seguin's criticism with reference to
the degree of heat was not valid when the water was
taken as he had directed — taken in teaspoon ful doses as
hot as the patient could swallow, less than 110° F. never
being used. Dr. Seguin's theory that ice-water would
lose heat in its transmission to the stomach, when applied
to the use of hot water would increase the heat, and
therefore increase the efficacy of the agent.
The effects produced by the agent were as immediate
as they could be ; sometimes it took six weeks to get
marked effects, and sometimes it took six months to get
the best effects* Certainly he did not mean to say it
lequired six months to get any effects from the use of hot
water.
The double action of the water — that is, the beneficial
effects produced in cerebral hyperaemia and also in cere-
bral anaemia, could be very easily explained on the
ground that the tendency of the agent was to restore the
vascular apparatus to the normal condition, and there-
fore it might prove beneficial in either abnormal con-
(Stion.
So far as his theory concerning the action of the agent
was concerned, it might be totally incorrect. He simply
advanced it as one which was plausible, and as the one
which seemed to him best to explain the action of the
agent
Of course he had no clear statistics to publish. He
had simply mentioned a few results, had brought forward
a few cases in which he had tried the agent after well-
recognized methods of treatment had proven ineffectual.
Complete statistics could be obtained only after a more
continued employment of the hot water in distinct classes
of cases.
HYDROCHLORATK OF COCAINE AS A LOCAL ANiESTHETIC
TO THE CORNEA.
Dr. C. R. Agnew directed the attention of the Acad-
emy to the local use of this agent, and demonstrated its
anaesthetic action by applying a two per cent, watery so-
lution to the scleral conjunctiva of two persons. Since
the publication of the interesting letter of Dr. H. D.
Noyes, which appeared in The Medical Record for
October 11, 1884, he had employed it in fifteen or six-
teen cases, and with results which had been, both to ob-
servers and to himself, most satisfactory and astonishing.
At the present time he felt that nothing had been given
to surgery of greater importance since the introduction
of ether. It was yet to be demonstrated whether the
agent when dropped into a wound would produce local
anaesthesia. He distinctly disavowed any attempt to
claim priority in its use in this city, but wished merely to
demonstrate its marvellous effects to the Academy.
Dr. Burchard had seen a case of felon in which the
finger was immersed in a solution of cocaine, and local
anaesthesia was produced so that the patient suffered no
pain when the finger was opened with the knife.
Dr. Birdsall spoke of the benumbing effects produced
upon mucous membranes by erythroxylon coca.
The President referred to the use of the fluid ex-
tract of coca for strengthening the vocal cords and im-
proving the voice.
The Academy then adjourned.
(£^owtBpon&jmcii.
A Society for Psychical Research. — An attempt
is being made in Boston to organize a society for psychi-
cal research ; 1.^., for the study of mind-reading, spiritual-
ism, mesmerism, etc. It may not be generally known
that a similar society exists in this city, under the modest
title of ** The Academy of Anthropology."
MiDWivES in Buffalo, N. Y. — Two-thirds of the ob-
stetrical cases reported in Buffalo, N. Y., are said by Dr.
Pryor to be attended by midwives.
A PLEA FOR THE COUNTRY PRACTITIONER.
To THB Editor or Thb Mkdical Rscokd.
Sir : In your editorial on •* The Importance of Holiday
Seasons for Physicians," you state that "the city physician
is subjected to causes of ill-health from which his country
confrire is comparatively exempt;'* that "the latter
breathes purer air and has invigorating rides over hill and
plain/' etc. Having had about ten years' experience in
such invigorating work) I think I can speak from experi-
ence. There are no harder worked physicians on earth
than the country doctor, with a large practice, and none
that needs vacations more. His long rides expose him to
every kind of weather, and there is hardly a storm but
what he is caught out in it. The roads in country dis-
tricts where there are no pikes get almost impassable in
rainy wmters, and we generally have it very wet every
alternate winter here in Central Ohio. I have known
the roads to break up and remain so from October until
May, not frozen so you could drive a wheeled vehicle a
dozen days during the winter — mud often to the horse's
knees from fence to fence. The consequence is that we
are obliged to ride horseback, a very laborious way,
especially if indulged in for five or six months, almost
night and day. The fact is, that a great many country
doctors find long rides so intensely invigorating that they
have to quit, or go to the city in order to get that rest so
much needed by the hard-worked practitioner.
It costs but little more to live in the city than the
country when we take into consideration the amount that
the country doctor pays for his medicine, and the number
of horses it requires to ride over a big scope of country.
He can't get along with less than two, and to do justice
to the horses he needs four more often.
The competition in this part of the country is just as
great as in a city. " The country is full of doctors ; "
every little town has ft-om one to five or six, and they are
not all blockheads [either, but wide-awake, shrewd men,
who understand their business. Country practice is
more difficult than city for many reasons. The country
physician is known by all, and his every movement is
watched and scrutinized and criticised. When he makes
a mistake, or a supposed mistake, it is heralded every-
where, and " off comes his head " often. If the city doc-
tor loses a case, it is not known a square off, and it doesn't
hurt him. A city doctor can get along with less knowU
edge, for he is always acquainted with men eminent in
their specialties, and he can consult them. In the coun-
try the doctor has to practise all the branches of medi-
cine in order to be successfiil, consequently he has to
study hard, as well as work hard, to succeed.
The country doctor's social advantages are not to be
compared to the city physician's. The latter can have
anything in the city suited to his tastes, while in the
country it is long, wearisome journeys and irregular
sleep and irregular meals. I ask what can be more
wearing ? If anyone thinks the country doctor has the
best end of it, he is very much mistaken. They are the
backbone of the profession, and have not gone to the
country for lack of knowledge, but on account of an idea
that they can start with less money, which is often a mis-
take. S. C. DuMM, M.D.
Columbus, O.
"DEAD TEETH IN THE JAWS."
To THB Editor of Thb Mbdical Rbcosd.
Sir : The report of the cases of otologia occurring in the
aural service of Samuel Sexton, M.D., on page 374, cur-
rent volume, entitled " Pain in the Ears due to Irritation
in the Jaws,*' while it may serve to direct the attention
of physicians to make a closer examination of the teeth
in sill cases of pain in the ears, yet fails to establish the
fact that retention of dead (pulpless) teeth in the jaws is
a prolific source of aural troubles. A careful examina-
474
THE MEDIGAL RECORD.
[October 25, 1884,
tion of that report fails to disclose an alarming number
of dead (pulpless) teeth. Case I. reports : "Lower first
and second molars on both sides mere shells." No proof
that the pulps were dead. The surgeon who advised
extraction of the four (temporary) molars destroyed the
masticatory apparatus of the child for at least three years,
and in all probability caused the first permanent molars
to tip forward, so that the crowns of each will be almost
useless during life for mastication ; and in addition to the
above produced an irregularity of the bicuspids (yet to
make their appearance) which will probably render it
necessary that one on each side should be extracted in
order to afford space for the remaining teeth. Case II.
" Both upper wisdom-teeth in a carious state. Both
lower wisdom-teeth just (cut ? ) erupted." The absurdity
of the proposition that the wearing of the vulcanite plate
increased the irritation in the left ear is too palpable to
need comment. Case III. No proof of dead (pulpless)
teeth. Case IV. No proof of pulpless teeth. The pain
in the ears in the preceding cases was undoubtedly due
to exposed or nearly exposed pulps, which any dental
surgeon could have relieved, and at the same time saved
the teeth alive. Case V. No proof of pulpless teeth.
The advice was good. Case VI. No proof of pulpless
teeth. From the report it seems that an unnecessary
number of teeth were extracted because they were cari-
ous ! Case VII. No proof of pulpless teeth. Removal
of the salivary calculus probably all that was necessary.
Case VIII. No proof of pulpless teeth. The erupting
wisdom-tooth probable cause of pain in the ear.
The comments of the surgeon in charge are exceedingly
entertaining. He first advises the extraction of a vast
number of carious (not dead) teeth, and then complains
that the wearing of plates (celluloid, vulcanite, etc.) is
" an evil of vast proportions." I agree with him in the
proposition that a vast deal of ill-advised dentistry is done
every day, but this evil is due as much to the ignorance
of the surgeon and physician as to the lack of judgment
and skill on the part of the dentist. It is no uncommon
experience of dental surgeons to find otherwise well-in-
formed medical men deplorably ignorant when speaking
of dental anatomy and the diseases of the teeth.
The editorial comments on the report above reviewed
are not particularly well-timed. The idea that because
an alveolar abscess may be found discharging into the
mouth a drop or two of pus every day should be thought
a sufficient reason for the extraction of the tooth is not
tenable, as it is well known that any alveolar abscess —
arising from death of the pulp— can be cured by any
competent dental surgeon. I agree most heartily with
the editor when he says, " It would seem . . . that
perhaps the time is nigh at hand when medical men
should be themselves better informed concerning diseases
of the mouth and jaws." It is high time. No intelli-
gent dentist could be such an ass as is implied in the
paragraph, that he would continue *' * treating ' dead
teeth long after their presence in the jaws has given rise
to alveolar abscesses and neuralgias more or less pain-
ful." The necessity for "treating" a dead (pulpless)
tooth is not well established until the formation of an
alveolar abscess. It is presumed that no argument is
called for to sustain the proposition that alveolar ab-
scesses should be cured ; that nearly exposed pulps in
teeth should have a suitable capping interposed between
the pulp and the filling to prevent thermal shock ; " that
all dental surgeons should receive proper and sufficient
medical teaching to enable them to prescribe intelli-
gently and to diagnose correctly ; " but in the light of
present advanced dental knowledge and practice, to have
the profession of dental surgery, whose history contains a
list of names not less known in the world of science than
those of any other honorable profession — Owen, Czermak,
James, Mayital, Wells, Harris, Garrettson, Wedl, Bell,
and hosts of others whose names are indissolubly con-
nected with the science and practice of dentistry — al-
luded to as ** individuals whose limited knowledge of
medicine," etc., by the editor of an enlightened, progres-
sive, and professedly liberal medical journal, is rather
straining at the gnat to swallow a camel. This present
"individual" protests against such editorials as undigni.
fied, unjust, and uncalled for. Respectfully yours,
A. W. Harlan, M.D., D.D.S.,
Prof, Dental Surgery
Coll, Physicians and Surgeons of Chicago,
70 Dbarborn Strkkt, Chicago.
THE FEEDING OF INFANTS WITH COWS'
MILK.
To TUB Editok or Thb Mbdical Rbcskd.
Sir : The Medical Record of September 13th con-
tains an article by Dr. John Binnie upon artificial feed-
ing of infants by means of cows* milk. I am an earnest
advocate of this article as a substitute for mother's milk,
and agree in the main with the suggestions advanced in
the author's paper. But I am of the opinion that too
much stress is laid upon the necessity of employing milk
from one and the same cow. If the article is good, I
maintain that its effect upon the infant is in nowise dele-
terious, whether it be procured from one or many cow?.
The great desideratum is that it be as pure as possible
It is my experience that change, always keeping in view
the purity of the milk, produces no harmful results. To
exemplify : A few years ago I had under daily observa-
tion an infant six months old, travelling with its parents
through the various large cities and countries of Central
Europe. I lay special stress upon citieSy because milk
is supposed to be more inferior there than in the country.
A month was consumed in the journey, this latter being
interrupted by rests of one to seven days' duration.
Upon arrival at these places the best milk that could he
procured was ordered, and notwithstanding this constant
change of milk obtained from different cows of the same
nationality, and even the immediate substitution of that
of another State, the infant enjoyed most perfect health.
I coincide with Dr. Binnie in respect to the causes
which produce harmful effects, with the exception of the
one cited above. Change is the most insignificant of
the causes of failure.
The predominating cause of evil results from bottle-
feeding is the want of cleanliness. Not only should the
utensils be perfectly clean, but they should be of the
simplest possible character. All feeding-bottles with
long rubber attachments should be condemned. ^Vhile
these lighten the labor of the attendant, they are a con-
stant menace to the child's health inasmuch as they
become a focus of disorders, the walls of the tubes afford-
ing a depot for the particles of milk ; and notwithstanding
they may be rinsed, brushed out, and allowed to remain
in water, they will in a short time be found coated, this
coating fermenting the milk passing through them. The
simple nipples, then, are the safest. In employing these
several should be kept on hand, that those not in use
might stand always in cold clean water. When they are
found to be coated, they should be discarded. With
respect to the bottles, it is better to have also several of
these, those not in use being filled with water, They
should frequently be cleansed with soda and hot water.
Feeding should be limited to every two hours in the
very young child. Later, the time may be extended to
every third hour. In the interval, If the infant cries, I
advise a little pure or slightly sweetened water. During
the early months the proportion of milk should be three
parts to one of warm water, the former uncooked. The
amount of nourishment must be gauged to the little one's
capabilities to retain it. The flask should be removed
from the child's mouth immediately after it is emptied,
in order that air may not be sucked into the stomach.
During the process of feeding the nipple must be main-
tained full for the same reason. I have found that a
teaspoonful of lime-water added to each bottle of milk is
indicated when, there is much vomiting after feeding, or
October 25, 1884.]
THE MEDICAL RECORD.
475
when the bowels are " bad." When there is constipation,
a teaspoonful of mag. sulph. mixed with the milk is called
for. In preparing this it is better to add the milk to it
slowly in a vessel other than the bottle until the powder
is entirely dissolved, when it is poured into the flask. If
it is not so treated tlie nipple is often clogged up.
At no age under two years do I permit table food to
be eaten. I confine the feeding to the bottle, crackers,
and bread with very little butter. I have seen children
thus fed pass over the entire period without experiencing
a day's sickness, excepting the eruption of the teeth and
vaccination. I have never known them to suffer even with
colia
I am opposed to all species of artificial food as a sub-
stitute for cows' milk, believing that the latter is the
nearest approach^to mother's milk.
In conclusion, I would say that when the mother is
from any cause unable or unwilling to nurse her infant,
I unhesitatingly elect bottle-feeding, giving it preference
to the wet-nurse, believing as I do that the child will
thrive as well, and will run fewer risks than if the latter
method be adopted. A child fed as I have indicated has
every chance of living, and will develop as well as one
fed upon its mother's milk or one wet-nursed. That it
demands more care and calls for more attention there is
no question. Bottle-feeding should be intrusted to careful
hands only, and should be supervised by the medical
attendant. Etisnns C. Vidal, M.D,
SHALL ARMY SURGEONS PRACTISE OUTSIDE
THEIR POSTS?
To THB Editor or lbs Mbz>ical Rbcord. .
Sir : In my ^last letter, regarding the practice of army
surgeons among civilians, I stated that Dr. Stanton rep-
resented the matter in an unfair light, and his late argu-
ments do not alter my views. It seems difficult to
onderstand why an army surgeon should not have a per-
fect right to practise his profession among civilians, if
they choose to employ him, and if it does not interfere
with the duties of a medical officer.
The point advanced by Dr. Stanton, that the law offi-
cers of the Government are not allowed to give legal ad-
vice to the public, is not well taken. It would seriouslv
interfere with the proper administration of justice if
judges and prosecuting attorneys were allowed to engage
in private practice, but no ill effects can arise by giving
army surgeons the privilege of extending their services
to civilians. A man who enters the military or civil
service of the Government does by no means surrender
the rights and privileges of a citizen, and no reason or
justice could possibly be found in any law, regulation,
or order, which would prevent a physician in the employ
of the Government from using his knowledge and skill,
during his leisure hours, not only for the benefit of his
fellow-men, but also for the purpose of increasing his
income.
In other branches of the public service, either muni-
cipal. State or federal, the attaches engage in outside
work, and it is quite common to see Government clerks
augment their income by performing clerical work for
private parties during their leisure time. If Dr. Stan-
ton's arguments hold good, why is it that it never oc-
curred to our lawyers, or other professional or business
men, that it is improper for Representatives and Senators
to give legal advice, or to continue the practice of their
profession, or attend to other business, while they occupy
seats [in Congress and are paid a fixed salary ? Why
docs not Dr. Stanton object to the outside practice of
physicians and surgeons of municipal or other govern-
ment hospitals, medical officers of boards of health,
police surgeons and harbor physicians, not to mention
the medical officers of the navy, the surgeons of the
Marine Hospital service, pension surgeons, and many
others ? Most of them draw fixed salaries, " in part
paid for by the very physicians they compete with," and
many of these positions are as permanent as those held
by army surgeons, and are the means of bringing the
holders a large private practice, which medical officers
of the army can never hope to gain.
As Dr. Stanton says, what will apply to one branch of
the public service must apply to all others. According
to his views it would be sound logic to prevent all pub-
lic office-holders from engaging in private pursuits during
their leisure hours. To allow them to occupy their spare
time for any laudable and honorable purpose, with a view
of adding a few dollars to their fixed salaries, would open
a way for " unfair and unjust competition " with others,
who have not " an assured and regular income outside of
their practice," trade, or profession.
I still claim that much of the outside work of army
surgeons is done with a view of increasing their knowl-
edge, and I have found, as a general rule, that citizens
often apply to army surgeons for medical advice, for
which they never expect to pay, because they seem to
be impressed with Dr. Stanton's views, "that it is not
proper for them (the surgeons) to receive fees for so
doing." Much of the work of military surgeons among
civilians is a work of charity, and citizens in need of
medical aid never apply in vain to army medical officers
for assistance. The argument that it would be ungra-
cious to prohibit a medical officer from extending relief
to civilians is by no means " umitigated bosh," and I re-
call more than one case, which happened not only on
frontier posts, but also in large cities, with no " dearth of
local physicians," where such restrictions would have
been followed by most serious results.
But it is also true that at a few military posts some of
the better class of people, living in the vicinity, consult
the army surgeon, and, like all decent people, pay for the
services rendered. The incomes of army surgeons are
by no means brilliant, and since most of them have fam-
ilies to support and children to educate, it appears only
praiseworthy if they try to increase their income by en-
gaging in private practice.
Medical officers of the army are not very liable, as a
general rule, to come in active competition with local
physicians. At the majority of posts their official duties
occupy most of their time, and even if such is not the
case, they suffer from the disadvantage that they are al-
most strangers in the vicinity of their stations. Army
surgeons are usually changed every few years, and peo-
ple are not in the habit of changing their old and tried
physician, if he is what he should be, a friend, an adviser,
and a man well versed in the art of healing.
I have occupied much of the valuable space of your
paper, but I shall not ask your indulgence in the future,
and if additional replies should be required, I beg to
transfer the matter to abler hands.
Very respectfully, Caduceus.
Chloroform a Dangerous Remedy for Tape-
worm.— Dr. J. W. Carhart, of Tampasas, Tex., writes
that on August loth he administered the following pre-
scription for tape-worm, as recommended by Dr. J. G.
Brooks :
3. Chloroform,
Ext. filic mas. fl && 3 ij.
Emul. ol. ricini ^i^^U
M. Sig. — One dose after twenty-four hours' fast.
The patient, a lady, very soon after taking the dose,
passed through the excitement stage of anaesthesia, then
suffered from nausea and vomiting. She did not get
over the bad symptoms until next day. No tape-worm
was discharged, though the patient had been passing
fragments for some time. Dr. Carhart has had good re-
sults with Tanret'e pelletierine, and is done with chloro-
form.
476
THE MEDICAL RECORD.
[October 25^ 1884.
^vmvi and ^^wg ^evos.
Official List of Changes in the Stations and Duties of Officers
serving in the Medical Department^ United States Army,
from October 12 to October 18, 1884.
NoRRis, Basil, Lieutenant - Colonel and Surgeon.
Relieved from duty as Attendant Surgeon, Washington,
D. C, and ordered for duty as Medical Director Divi-
sion of the Pacific and Department of California, reliev-
ing Surgeon £. I. Baily. Colonel Baily, on being re-
lieved, will assume the duties of Attendant Surgeon at
San Francisco, Cal.
Spencer, William C, Major and Surgeon. From
Department of Dakota to Department of the East
GoDDARD, Charles £., Major and Surgeon. To be
relieved from duty at Jefferson Barracks, Mo., and to re-
port for duty in Department of Dakota.
McClellan, Ely, Major and Surgeon. From De-
partment of the East to duty at Cavalry Depot, Jefferson
Barracks, Mo. S. O. 242, A. G. O., October 15, 1884.
McKee, James C, Major and Surgeon. Granted
leave of absence for one month, with permission to apply
at Division Headquarters for one month's extension.
S. O. 149, par. I, Department of Colorado, October 3,
1884.
Wolverton, W. D., Major and Surgeon. Granted
one month's leave of absence, to take effect .when his
services can be spared by his Post Commander. S. O.
211, par. 4, Department of the East, October 16, 1884.
Havard, Valery, Captain and Assistant Surgeon.
Assigned to temporary duty at Fort Schuyler, New York
Harbor, N. Y. S. O. 211, par. 2, Department of the
East, October 16, 1884.
Porter, J. Y., Captain and Assistant Surgeon.
Granted leave of absence for one month, on surgeon's
certificate of disability, with permission to leave tlie limits
of the department. S. O. 138, par. 3, Headquarters De-
partment of Texas, October 9, 1884. Confirms tele-
graphic order of same date.
Official List of Chaises in the Medical Corps of the U. S.
Navyy during the week ending October iZ, 1884.
Brush, Geo. R., Surgeon. To temporary duty at
the Naval Laboratory. October 11, 1884.
BuRBANK, Chas. H., Medical Inspector. Detached
from the Brooklyn, and placed on waiting orders. Octo-
ber 15, 1884.
Clark, John H., Surgeon. Detached from the
Lackawanna, and detailed as Fleet Surgeon of the Pa-
cific Station. October 1 7, 1884.
CoofCE, George H., Surgeon. To the Lackawanna.
October 17, 1884.
Edgar, John M., Passed Assistant Surgeon. To the
receiving ship Franklin. October 11, 1884.
Hudson, A., Medical Inspector. Detached from the
Lancaster, and placed on waiting orders. October 14,
1884.
HuGG, Joseph, Surgeon. Placed on waiting orders.
October 13, 1884.
L0V.ERING, P. A., Passed Assistant Surgeon. De-
tached from the Lackawanna, and placed on waiting or-
ders. October 17, 1884.
Marsteller, E. H., Passed Assistant Surgeon. De-
tached from the Monongahela, and ordered to the
Lackawanna. October 17, 1884.
Martin, William, Assistant Surgeon. Detached
from the Passaic, and placed on waiting orders. Octo-
ber 14, 1884.
Martin, H. M., Passed Assistant Surgeon. Detached
from the Brooklyn, and placed on waiting orders.
ppCcdical StjeniB*
Contagious Diseases — Weekly Statement.— Re-
port of cases and deaths from contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
die week ending October 18, 1884 :
Week Ending
Cotes,
October 11, 1884
October 18, 1884
Deaths*
October 11, 1884
October 18, 1884
ii
I
Electricity as an Agent in Promoting the Ab-
sorption OF Pleuritic Effusion. — Dr. W. T. Baird,
of Albany, Texas, writes us a letter commenting upon
Dr. Guiseppe Manzini's views on the use of electricity
in pleuritic effusions. Dr. Baird thinks that electricity
is not necessarily an irritant, but may act as a powerful
sedative, and it is not therefore contra-indicated in the
inflammatory stage of pleurisy. He argues also that it
is not by electrization and stimulation of the respiratory
muscles that electricity causes absorption, but by its
vaso-motor stimulation and general tonic effects. Gen-
eral as well as local faradization would be a more suc-
cessful method in treating these effusions.
The Motor Power of the Human Body.— Dr.
Marey, of Paris, read a paper on this subject at the In-
ternational Congress of Hygiene, in which he described
the ingenious manner in which he had succeeded in
measuring the motive power of the human body in its
every movement. Planks, with india-rubber coils under-
neath, recorded, by expelling the air they contained, the
exact pressure of the foot. The motions were measured;
and photographs, taken in one-thousandth of a second,
recorded every attitude during a leap, and where and
when the effort was greatest By such studies, M. Marcy
had been able to prove that something was gained in
the power of walking, in quickening the step from forty
to seventy-five steps per minute. But the latter figure
was the extreme limit ; with a greater number of steps
power would only be lost instead of gained.
The Experiences of a Hay-fever Patient.— A
writer in the Times says : ** I have had * hay-fever ' for
nearly twenty years, and I have visited many of the
places set down in the association pamphlet as exempt
The best locality I have so far found is the Adirondack
Mountains. At Keene Valley, X,ake Placid, and a hun-
dred other places within them, there is sure relief. But
one must be sure to go into the mountains away from
the railroad. I have tried the White Mountains for four
years. They are excellent, but not always thoroughly
exempt, for sin overheating of the body will often bring
on a bad attack of sneezing, and in rainy weather one
notices a slight difficulty in breathing. In the Adiron-
dacks there are places so exempt that one can do any-
thing and not know that he ever had *hay fever.' I
have tried many of the places mentioned on Lake Supe-
rior, and have found exemption in them all. Neither
have I suffered in St. Paul or Minneapolis to any no-
ticeable extent, or at Lake Minnetonka. Fire Island,
the Isles of Shoals, and others similarly situated near the
land, are not so good as the primitive mountains. They
relieve the disease wonderfully at all times, but it is only
when the wind blows from the sea that they give perfect
exemption."
The Medical Record
A Weekly yournal of Medicine and Surgery
Vol. a6, No. i8
New York, November i, 1884
Whole No. 730
(^KiQixmX |i.rtijcljea.
CONTRIBUTIONS TO
THE ANATOMY OF THE LEMNISCUS.
WtTH Remarks on Centripetal Conducting Tracts
IN the Brain,
By E. C. SPITZKA, M.D.,
PKonssoK or nsumo-anatomy and physiology in the nkw yokk fost-gkao-
UATB MBDICAL SCHOOL.
(Continued from page 451.)
IV.
V. — Relations of the Lemniscus Proper to the In-
ternal Capsule.
Without entering into a special discussion of that part
of the lemniscus which occupies the olivary territory in
lower levels, and in higher ones becomes fused with that
portion of the interolivary tract which with it constitutes
the main part of the lemniscus, let us proceed to consider
its relations in higher (cephalic) levels, where the greatest
obscurity prevails.
The gross appearances indicate a transition of a part
of the lemniscus, which reaches higher (more cephalic)
levels than the post-optic lobes, into the internal capsule.
To what extent there i§ interruption by thalamic gray
matter is uncertain, but the gross appearances alluded to
appear to correctly match the real relations.
In levels slightly caudad of the one in the figure, where
Mesencephalic Region of Man.
_eniina; 6, field of cptic radiado
it is traversed and perhaps joined (?) by thalamic radiations ; 7, 18,
93, numbers m aqueduct,
tic radiations of Gratiolet, chiefly dc-
10, pas-
throug
Pig. 16. — Transirerse Section through lliatamic and Anterior
pointers on nuclei of third pair ; 3, anterior pair of corpora quadrigemina
nved from extemai geniculate body and optic tract; it is traversed and p ^ , ., , .. ,. .
sageof Gzatiolet's fasciculus into the capsule, in part to temporal lobe : 20, 21, 21, similar passage of pes fibres into and through
the posterior serrations of the lenticular nucleus (21) ; 12, pes : 13, substantia nigra ; i^, tegmental nucleus ; 15, roots of third paur.
It was n^lected to designate the lemniscus field ; comparison with Fi^. 14, L, will aid in its identification : it occupies the triangular
field inchided between the upper lateral angle of the aqueduct gray, intrudes one end between the outer aspect of the tegmental
nncieus and the substantia nigra, and detaches its third comer part toward the field 6 ; the mesai demarcation is not as distinct in
this level as in one of those to be described.
the thalamus is struck in its free portion, a clear triangu-
lar field is seen (6), which is an inverted and magnified
reproduction of the lemniscus triangle ; it is a fasciculus
of the corona radiata. On passing cephalad, a part of
the lemniscus runs into a field occupying the place of 6.
It would appear as if tfie thalamus intruded its substance,
so that to reach its double the lemniscus has to break
through. The more plausible explanation seems to be
that the fasciculus bends round from within outward,
with the convexity cephalo-mesad, leaving the gray streak
latero-caudad, so that what was internal and posterior
(meso-caudal) in the lemniscus, became external and an-
terior (ecto-cephalic) in the capsule, and what was ex-
ternal m the lemniscus became internal in the field re-
placing 6. The curve in field 27 of Fig. 12 indicates
such a relation, while the course of the tract in the speci-
men from which Fig. 11 was drawn, is of similar import,
but indicates also a laminated dispersion through gray
matter.
Forel * could never discover a transition of lemniscus
fibres into the thalamus, a small part he traces to the
corpus mammillare, but the major part {Haupt-iheU) be-
comes lost in a confused medley of finely broken up
gray and white substance in the latitude of Meynerfs
bundle in the dog, while in man the gray substance is
wanting, the lemniscus remains more compact, and as I
have not been able to confirm from a study of specimens
stained in fuchsin,* its fibres appear matted together
like felt- work.* I am unable to come to any conclusion
as to the relation between the post-brachium and the
lemniscus layer alleged by Forel. The direction of his
sections is about the most unfortunate to have selected,
as the majority of tracts are divided obliquely in them.
His employment of transverse sections (Meynert-Stilling's
plane) in the dog, possibly accounts for his finding the
relations of many tracts clearer in that animal than in
man. Our conceptions as to direction and space in anat-
omy are commonly associated with the great body
planes, and to this sim-
ple tradition of topog-
raphy Forel's sections
do great violence,
I think that by describ-
ing the relations of the
lemniscus main portion
{Haupt'tkeil—FoTci) in
three successive levels
of the Meynert-Stilling
plane, I may make my-
self better understood
than by proceeding im-
mediately to consider
the course of the fascic-
ulus as such.
First level: Through
the anteriormost twelfth
of the pons, and the mid-
dle of the post-optic
lobes (post pair, C //,
quadrigemina), the main
lemniscus and the de-
tachment to the post-
optic lobes are alto-
gether, the pedo-lemnis-
cal fasciculus nearly
continuous,* covering
Soemmering's substance dorsally. The mesal two-fifths
of this united area follows the ventral face of Weme-
kinck's commissure, being separated from it by a gray
1 Archiv fiir Psychiatrie, vii., pp
* I am indebted to Dr. Starr f
this stainmg reagent ; its future aiefnlness
think will be made most evident in this particular region. ^ . i-v
s Fibzes can be traced for more than the width of the field outward : other fibre
noticed obliquely divided in the interstices of the intervening bundles cannot b
confounded with them.
* A small detachment of Soemmering*! substance mtervenes.
478
THE MEDICAL RECORD.
[November i, 1884,
intercalation. In my case of secondary degeneration
the outer portion was shrunken and degenerated, only a
small area of the part, a third the half diameter from the
raphe, escaping.'
Second level : Through the anterior pair, and the pedun-
culi cerebri, at the level below the emergence of the third
pair, striking at the same time the external geniculata.
Main lemniscus, separated through substantia j, nigra from
the pedo-lemniscal tract by a large interval. It occupies
a nearly mortar-shaped area, the mortar being supposed
to be inclined dorso-laterad. Its base rests half on the lat-
eral sector of the area of the tegmenta brachium^ the
other half fades away into the dorso-mesal face of the
lateral half of the substancia nigra. The mesal end of
the top of the mortar is represented by the end of the
lemniscus field, the ectal end by fibres which begin to
field through the gray matter between the lemniscus and
pulvinar. Most of these fasciculi may be traced a consider-
able distance toward the field which replaces 6 of Fig.
16 in higher levels. In lower levels where this fielding
off detachment is not marked, the lemniscus resembles
the horns of a Cape buffalo, attached to the field of the
tegmenta brachium^ just as the latter are attached to the
bulbous enlargements of the Cape buffalo's forehead.'
Degeneration in my case occupied the ectal half of the
mortar as well as the process directed toward the sub-
stantia nigra. The part directed to the tegmental nu-
cleus, and which is mixed with fibres of the tegmentum
proper was unaffected.
Third level: The lemniscus area described under two
becomes smaller and smaller as the fielding off continues ;
finally direct £aisciculi can be traced into the internal
capsule. These were degenerated in my case, where
detailed examination showed total destruction of the mid-
dle (main) part of the lemniscus tract The course of
the bundle which the dying out lemniscus sends to the
capsule, is first directly ectad, and into the lower part of
the field continuous with 6 ; it does not join the latter,
but changing in direction dorsad leaves the level of the
section. The field which these lemniscus fibres appear
to occupy in the capsule is situated on the border of the
inward and downward slope of the thalamus, in a level
slightly anterior to that of figure 16 ; to accommodate it,
the triangular field 6, is moved laterad and more dorsad.
A direct continuity to this field is not demonstrable, but
as it appears with the disappearance of the lemniscus
the course of the fibres is in that direction, and no other
adequate source ' can be discovered, it is reasonable to
connect them, provisionally at least As already stated,
fibres can be traced from the lemniscus field to the bor-
ders of this one, and above this level the corresponding
part of the lemniscus can no longer be identified. De-
fibrillation supports this view with all the weight which
may be attributed to its uncertain evidence, and indicates
that the fasciculus in which it runs occupies the course
represented in the tract 27 of Fig. 12. In my case of
secondary degeneration, the latter occupied a field dorsad
of the radiations from the tegmental nucleus to the cap-
sule, and up to date has not been traced further.
The relations of the internal capsule at this point are
very complex, but interesting. The outermost fibres of
the pes are the first of this bundle to enter it, as we pass
caudo-cephalad. In transverse sections a bundle is
seen (18, Fig. 16), which is repeated in a number of
levels. In the lowest it represents Gratiolet's fasciculus/
which unites the occipito-temporal lobe to the cerebellum ;
on the level of the body of Luys, the corresponding bun-
dle connects the body of Luys with the inner articuli of
' 1 The lemnisoo-pedal tract was entirely healthy. On the normal side a bundle in
the plane of the section, ran in the substantia nigra from the lemnisco-pedal re^on
to die outer fifth of the main lemniscus, joining it by intrusion and densdculation.
* This simiU may be made for other systems in the mesencephalon, there are
direc concentric repetitions of a similar arrangement, one of these being the posL
long. £uc. of the t^gmoitum.
* The post-brachium is not extensive enough to account for the formation of this
field, lit *s ForePs siatement suggests, the two be confounded.
* Even in sections the suporficud eraminer is misled into suspecting a rdaiioii
to the optic tract ; hence Stilling the younger may have erred in descnbing such a
connection, as he discovered it by the faulty defibriUadoo method.
the lenticular nucleus.' This latter connection is one of
the most satisfactory demonstrations of the section
method. It is in the field 19, which with the elimination
of the field 6 comes in contact with the zonal stratum of
the thalamus, that the outer part of the main lemniscus
tract appears to run.
I am unable to contribute anything to the knowledge
of that part of the lemniscus which iRechsig traces to the
ansa lenticularis^ the analysis of the material at my dis-
posal not having been completed. It would be a re
markable coincidence if, as is not unlikely, the lemnisco*
pedal tract, after temporary deflection to the pes pedun-
culi, took the same course. Thus would the two divisions
of the stratum intermedium become reunited.
VI. — A Note Regarding the Column of Golu
On reviewing the subject of the foetal and post-foetal
development of nerve-tracts, I found that many of the
corrections since made of Flechsig's representation of
the course of Goll's columns, in his first treatise, where
he leaves them undesignated in lower dorsal levels, and
represents them as a semi-oval area on either side of the
posterior fissure of the cord, could have been made by a
more extensive study of embryonic material. There is
really no difficulty in recognizing this tract, in perfectly
firesh cords. Through the courtesy of Dr. Jean F.
Chauveau, I had the opportunity of examining the cord
of a foetus (forty-one centimetres from vertex to heel),
and found that the tract of GoU is triangular with a
pointed apex, directed toward the point of entry of the
posterior roots ; it failed to reach the dorsal periphery of
the cord, except near the fissure. It exactly reproduced
the extent of secondary degeneration noted by recent
German writers, and the me^ degeneration in a case of
locomotor ataxia in a patient of Dr. McBride's^ in whom
the root zones of the lumbar enlargement and lower dor-
sal regions alone were involved, the secondary change in
the columns of Goll having evidtsntly advanced only up
their lower (caudal) portions. In the foetus above re-
ferred to the right crossed pyramid tract was present in
the lumbar cord in its lower levels, while the left was ab-
sent. Correspondingly the right tract extended farther
forward on the right side in the cervical region, sending
a spur between the two divisions of the anterior part of
the lateral column. Evidently this is in connection with
dextral preference, for there was no compensatory de-
velopment of the uncrossed tract.
Although the columns of Goll were still ^ay in this
foetus, the stratum interolivare was in part distinctly white,
there was a whitish field dorsad of the ideal prolonga-
tion laterally of the substantia nigra, and this field ex-
tended into the internal articuli of the lenticular nucleus.
I am becoming more and more convinced from the con^
tradictory nature of these findings that absolute reliance
cannot be placed upon the apparent continuity of mye-
linic development In this case, carefiil analysis showed
that the white matter in the lenticular nucleus was de-
rived from a belt of white fibres surrounding the body of
Luys. The converse of Flechsig's proposition, that nerve-
tracts which do not develop in chronological accord do
not appertain to the same system, has already been shown
to be erroneous by Forel.
VII. — ^The Relations of the Sensory Tracts and
THE Trigeminus Roots.
The cases of lesion of the pons and oblongata, whOe
indicating that below the exit of the trigeminus nerve the
anaesthesia of the face is on the side of the lesion, which
was the case in a tumor of the pons (caudal half) and
oblongata, last autopsied by myself, are too few, and in-
volve too many other factors to permit of the unreserved
acceptation of Starr's conclusion (/t?r. «V., page 55) : that
a lesion in the cephalic part of the trigeminal area in the
pons will always cause contra-lateral anaesthesia, as stated
1 1 haye fiwnd four lenticular mrtkuii i
fifth cUstiiicdIy marked.
I three, and in ooa ceee t
November i, i884,]
THE MEDICAL RECORD.
479
by him. A lesion might indeed occur in this part of the
pons, involving the trigeminus roots---descending of the
same level, or ascending — previous to their escape from
the brain axis, or their union in the great sensory root,
and naturally would result in anaesthesia of the same side
throogbout if direct descending roots existed.
That there is a decussation for certain of the roots of
the sensory division of the trigeminus, has been a familiar
fact since Meynert*s day. Of this nature is probably the
great raphe root (Fig. 15, 5r), and a beautiful set of
fasciculi,' which decussate in the gray matter of the ponto-
cnual region of the dog, in the immediate continuation
cephalad of Wemekinck's commissure (x of the tegmenta
brachium). These fasciculi run from a field which cor-
responds to 14 of Fig. 10 i(not necessarily connected
with it), decussate in the gray matter to the opposite side,
where in a beautiful sweep they reach the exit level of
the fifth pair. It, with the raphe root, embodies probably
the decussated connection of the trigeminus with the
higher centres which Starr had in mind. If the latter's
theorem is correctly understood by the writer, it implies
that the area of the cephalic part of the pons, homologous
with the root region of the caudal half-— for that lies in
the outer third of the reticular formation— -contains a
centripetal tract derived from the opposite trigeminus
nerve. For this theorem there is thus far no anatomical
support, and not even a hypothetical tract, while, as
stated, the cases cited are too few and indecisive, al-
though the general proposition that somewhere between
the capsule and the nerve-root a decussation must take
place is well based on clinical grounds, and has not been
contradicted since Wernicke first asserted it The raphe
root of Meynert, and the strands discovered by me in the
dog and ape, cannot be traced to the capsule, and it is a
great question when the further course of these bundles
will be determined, as small focal lesions of the involved
districts are among the rarest occurrences in cerebral
pathology.^
It is nowhere explicitly stated by Starr that he con*
sidered the descending (mesencephalic) root of the
trigeminus in this theorem, although he speaks of its
junction with the ascending root as the spot which sepa-
rates the area of homo-lateral and contra-lateral facial
hemianaesthesia. If he considered the root, ordinarily so
called a sensory root, he would — ^as it remains on the
same side throughout, from its origin in the vesiculac
cells — have to except so much of the trigeminal distribu-
tion as is provided for by that nerve-root Forel, and
Wernicke agrees with him, traces this root into the motor
division of the tri^^eminus, so that if his view is accepted,
the above exception need not be made. Wernicke also
traces a decussated origin from the substantia ferruginea
(locus coeruleus), which receives a contribution from the
raphe root, and, after decussation, corresponds to what
I term the raphe root To affect this tract, the lesion
would have to be nearer the lateral ventricular angle
than Starr indicates, inasmuch as the outer third of Sie
reticular field does not include this tract'
Wernicke calls attention to the dilemma that either
the descending decussated root embodies all tactile and
pain tracts of the trigeminus, or that some other undif-
ferentiated part of the area destroyed by the tumor was
in connection with the lower root I believe only the
latter alternative can be seriously considered, and Starr's
^planation is in this direction, though it fails to accom-
modate itself to all the facts of the case, besides having
as yet but a very problematical anatomical basis. He
concludes, namely, that the central tract for the trigemi-
nus runs in the outer part of the tegmentum. It may in
> I observed in 1877 an oval hemorrhage, destroying the raphe above the level
of the raphe root, in a paretic dement, at the same time there was an enormous
leatriciilar faemoniiage and a meningeal extravasation, destroying any value the
case mi^it odierwise have had.
* Wernicke amiounoed the separation of the tri^^eminus sensory and the extremity
■cMory tracts (p. 537, Archiv f. Psyehiatrie, viL) seven years before, and also
stated that sesuory tracts for the latter remained on the same side for a further
He also considers all possible en»lanations and objectioBS to them that
'tfa the symptoms reported, in die admirable
part ; but the only cases which permit of a conclusion, as
far as they go, antagonize this view. Both cases are cited
by Wernicke. First,* hemorrhage in the iifwer part of
the left cms : right facial and extremity hemianaesthesia,
left oculo-motor paralysis, right facial and extremity pa-
ralysis. Second,' pea-sized cyst in inner part of left eras,
enclosing the third nerve of that side and extending to
the lamina perforata posterior : left oculo-motor paralysis ;
right facial, hypoglossal, and extremity paralysis ; right-,
sided diminution of sensibility^ including the face. With
connected *^ serous" softening of the contiguous right
eras, right oculo-motor paralysis supervened later. From
these cases it is to be inferred that the trigeminus and
extremity sensory tract travel in that region of the eras
which is traversed by the oculo-motor nerve — in fact, the
tracts which ran in the inner (and outer) confines of the
tegmental nucleus, corresponding thus to the course of
the decussated fasciculi found by me [in the [dog, to v.
Monakow's Kinden-schleife, and to Wernicke's lemnisco-
pedal bundle. As the anaesthesia in none of these cases
was complete, we must conclude that there may be other
tracts, and these may ran as Starr indicates, but evi-
dence does not point exclusively in that direction.
VIII.— Conclusions and Some General Observa-
tions.
The lemniscus layer is not — as Flechsig claims— di*
visible into a larger tract which degenerates in the de-
scending direction, and a smaller tract which " does not
degenerate for long distances in the descending direc-
tion."
To internal caiMule de- To ansa ^dnncmlaris^ aoootding to Fledi*
generates cephalad. aig, does not degenerattt cq»faalad (f).
Lemnasoapedal
tract {RineUn-
SchUifg of Moii-
akow), degenei^
ates caudad only.
Origin in small part finom ante-
rior part of latenQ column (Ho*
m^n's case), chief origin not
definitely determined, but pos-
sibly frwn posterior columns.
Division in middle of poMb
Piniform decus-
sation to nudet of
GoUandBurdach.
The degeneration of Flechsig*s larger portion, as in
Hom6n's case, is both ascending and descending, and
in that case the impulse to descending degeneration was
not sufficient to carry more than a small part near the
periphery of the anterior third of the lateral column be-
low the olives. On the other '|hand, the more compact
tract — that is, the interolivary portion — does degener-
ate in the descending degeneration for its entire (known)
anatomical extent. This part is not in "immediate juxta-
position'* to the great olives, if by "great olives *' the
ganglionic part is meant ; in the upper quarter of the
1 Weber : Mo
* Rosenthal : Wiener Me
JahrbOcher, 1870^
voL 4<^ p. xai, 1863;
480
THE MEDICAL RECORD.
[November 1, jgg.
oblongata it touches the olivary "halo,** in the middle
olivary levels the inner accessory olive (Fig. 4), while in
the lower levels a large mass of fibres (Fig. 3) inter-
poses ; this latter is the " Vorderstrangsrest,'' or remnant
of the anterior column.
The stratum interolivare (intermedium), while not the
largest, is the most distinct of the lemniscus fasciculi ; it
detaches two divisions, a larger to the main lemniscus, a
smaller constitutes the lemnisco-pedal tract, which latter
is a constant feature in the l^igher mammalia.
Ascending degeneration in the case of a lesion affect-
ing the main part of the lemniscus is partial, as far as it
can be traced (in my case), destroying only the outer part
of the field in the thalamus region.'
The diagram on the preceding page illustrates the re^
lation of these different parts.
Since in Starr's case the lemnisco-pedal division of
the interolivary stratum was absent, and this absence
was connected with absence of the hemispheres, and as
the same (?) tract was degenerated in Monakow's experi-
mental ablation of the cortex, and can be traced by di-
rect anatomical methods (dog), it is to be left an open
question whether the interolivary tract does not include
fibres having centrifiigal fimctions.*
One of the reasons for regarding the interolivary stra-
tum as a muscular-sense tract, is that this is the only
sense which can be allowed to decussate from the poste-
rior nuclei in such fashion as this stratum does, if Brown-
S^quard's dictum continues to bear the interpretation it
did up to the time of Ferrier's experiment. It is, how-
ever, questionable whether it is the sole tract for im-
pressions involved in the mechanism of co-ordination 1
There is a singular unanimity in the description of the
kind of ataxia found with lesions of this tract, when alone
involved it relates to manipulation, and not to equilib-
rium. The latter I still believe to be a function which
utilizes the paths of the posterior cerebellar peduncle
and the vestibular branch of the auditory nerve.
As connected with this question, I would endorse the
exclusion of the restiform column from any participation
in the conveyance of pain and temperature sensibility
made by Starr ; this is almost a self-evident proposition.
In concluding that the direct myelo-cerebellar tract may
set up reflex vegetative acts, the same writer advances a
suggestion in conflict with Flechsig's statement to be re-
ferred to. Visceral sensations are not unconnected with
the unconscious maintenance of the equilibrium, and
hence the distribution of the columns of Clarke does not
appear opposed to the view that they conduct centri-
petal impulses regulating the equilibrium. It would be
singular, if the cerebellum were a visceral reflex centre,
that there should be so little uniformity in its develop-
ment in connection with the uniformity in visceral func-
tions of all the mammalia, and no harmony between the
development of any portion of the cerebellum and the
greater or lesser development of the columns of Clarke
adduced to support this theory. The association of vis-
ceral lesions with cerebellar disease and experimental
lesion of the restiform column is, however, a noteworthy
fact, and one which seems to necessitate some such ex-
planation as the one suggested, so that the direct cere-
bellar tract would have to be regarded in part as centri-
petal (visceral equilibrium impressions) and in part as a
centrifugal tract, unless the visceral reflexes be con-
sidered as travelling in a different channel from the one
carrying the unconscious impressions which determine
them. Flechsig' concludes that the direct myelo-cere-
^ Over a year ago Hitziff announced before the German alienists and neurolo-
fl;ists diat he had observed descending degeneration of the lemniscus in a case of
bsion in the crural region. His promised detailed publication has not yet become
accessible to me.
* There is this difficulty about the explanation, if arrest of development is insti-
tuted eariy enough even centripetal tracts are involved by atrophy of the station to
which they go.
><Plan of the Human Brain, p. 34. I cannot agree with Flechsig in the surmise
expressed in his sequel, that die correspondence of the sue of the olives in the ani-
mal scale harmonizes with that of the dentated nuclei, or that both depend for their
common developmental grade on the lenticular nucleus or cerebellar cortex.
Flechsig himself adds a query to this guess. The fact is that in a scries of ani-
mals, faieginning ¥rith the marsupial camivora (opossum), then passing through
bellar tract conducts in a centripetal direction, and traces
it to the cerebellar cortex ; later, in the same treatise
(p. 42^, he cautions against the adoption of the view that
exclusively centripetad conduction occurs in the direct
myelo-cerebellar tract on account of the connection of
the columns of Clarke with the anterior gray horns. May
this not indicate an independent reflex arch ?
The evidence of passive (non-irritative) lesion of the
cerebellum is to the effect that it is not essential to the
proper conduction of the visceral functions, not more so
than the cerebral hemispheres. The argument contained
in the following : << It is a noticeable fact that these symp-
toms of cerebellar disease (indigestion, vomiting of a p^
culiar kind, obstinate constipation, polyuria, albuminuria)
unlike the ataxia, are not produced by lesions of the
vermiform lobe alane^ but occur when the cerebellar hemi-
spheres are the seat of lesions, such as abscess and soft-
ening from embolism and thrombosis, which neither in-
crease the intracranial pressure nor affect in anyway
directly the floor of the fourth ventricle and the pneumo-
gastic centres there or in the flocculus," ' takes no account
of the fact that Flechsig's method teaches that the direct
cerebellar tract connects with the neighborhood of the
vermiform lobe (Mittelstiick) as contrasted with the lat-
eral parts ; or if it does take this' into account, must as-
sume an irritative influence by transmission from part to
part Without venturing to pronounce adversely to this
theory, I offer the above considerations, leaving it to in-
vestigations I am at present concerned with, to contrib-
ute fiu-ther facts to this interesting question.'
As the posterior columns are small in the porpoise and
inadequate to the formation of the restiform, it is to be
assumed that the direct myelo-cerebellar tract is very
large in this animal This tract is connected with the
columns of Clarke, whose extent, in the cord, corresponds
closely to the extent of those body segments in whidi the
great viscera are collected. In the porpoise, as in all the
cetacea and the phocidae, the visceral cavities are un-
usually large, and the viscera themselves more compli-
cated than in related animal groups. The cells of the
columns of Clarke resemble in shape those of nerve
some rodentia to the placental camivora, the ape and man, there is a paraDd rae
and homology of type b aU these p&rts. In the elephant and porpoise, howwer,
notwithstanamg theu- enormous cerehellum, the olive is of no higher a grade of de-
velopment than in the hippopotamus. (In the elephant the olivary lamma is dhr
bulky.) If any evidence were to be derived from comparative anatomy, it vodd
show that there are two types of olivary development, one marked by a progreanc
complication of the dentictilate part of the olive found m animals with firedy mov^
able digiti, and one in which ttie accessory nudei nearlv equaL or even prq»a-
derate over the main U-shaped, respectivdy dcnute nucleus, which is the case m
the pachydermata and the cetacea, who are in no case endowed with free dij^
motion and co-ordination. But for the ^>parent connection between digital v»
tivity and olivary type, I would hazard the suggestion that the development of ifae
olives suggests a grcsiter affinity, zoologically speaking, between the pachydenuli
and the cetacea than I have hitherto been mcuned to admit (Recent Studies m
Localization, Chicago Journal of Nervous and Mental Diseases, zBjj).
> Starr, loc dt, p. 63.
* Comparative Anatomy is competent, I think, to setde some of the questioos indi-
cated. In the porpoise the relations are most aberrant In the usual sttoatioo
there are no pyramids, nor a decussation either of pyramid or interolivary fibns.
There is but««« of the nuclei of the posterior columns, in anything like ue ordi-
nary development, and an atrophic state of the posterior columns generally in the
uppermost cervical levels. The " Vorderstrang-gnmdbilndel ** of Flficfasig «r
enormous, and consequently— the only exception to the rule in mammals— the aa-
terior (ventral) fissure of the cord is deeper than the posterior in diis regiao.
Connected with this, probably, is the fiur^that the posterior lons;itudittal fiusdoiksi
and the inner division of the reticular field are unusually large, oonstitutii« a
united area which is paralld to the raj^ie. The nucho-doraal mnervatioas prob-
ably pass through this tract. There is a raphe, but unlike that of man, it is tbisMr
ventrad than toward the nerve nudei, where it is double the width of other poiDB»
and sends out the only powerfiil lateral processes it boasts of in the coRcapoadiH
parts of the oblongata. The two olivary nudd approach each other as in die ds-
phant, and do not resemble in type die olivary nudd of th^ camivora, bat ifae
padiydermata (hippopotamus, horse, and elq>lian^. The araform fibces of ik
olivary decussational commissure do not tadce a course so near die latenJ field d
the oblongata as in man, but condensing in powerful strands break into vtaH
seems to represent die restiform column from the middle of the reticular fidd. b
some levds there is no fissure nor raphe between the olives in dieir ventral portioas.
The main accession to! the represenutive of the restiform 'vJ«»"«t* appears t» be
the direct transition of fibres from the posterior column through a fidd anaJocoai
to (/^ 3 Fig. 3) die arched fibre fidd which interpolates itself between die nudea
of RoUndo and Burdach, and. which as its partial fi«edom from degenciadae is
my case shows, embodies fibres independent of the interolivary stratum. Ttac
sqipears still more cephakd to be a bodily transposition of the posterior colo ik
restiform column.
At die junction of the oblongata to the pons there is a .powerfril fibce sjsaeo^
identified by the naked eve, which may indicate a decnssataon of ventFd(p^aad
or intermediate) fibres (?), but in connection with this there is also a devdaoBeal
of a lateral ventral mass, attached to the auditory nerve, which is thus nriot
known to be paraUded in mamma|;aTi anatomy.
The pons, notwithstanding its great apparent surfiice development, is tUD, ikat
is, of slight dorso-ventral extent, and consists, as in ihe dephant, of transverse fibti
and ganglia exdusivdy ; there are, as in the dephant, no kmgitudinal, ».«., pyis*
mid fibres. Between the tegmentum and the pons, there is a sjrsiem of oent-
bundles'imbedded in ganglionic matter, which resemble in disposition the Vamm>
pedal bundle.
November i, 1884.]
THE MEDICAL RECORD.
481
nuclei known to be related to visceral functions. It
woald, therefore, as far as the case of the porpoise stands,
be a confirmation of the view that the columns of Clarke
and the cerebellum which derives fibres from them through
the direct myelo-cerebellar tract, have a relation to visceral
fiiDCtions ; the mother-bed of the direct myelo-cerebellar
tract corresponding in extent to the visceral segments, and
its cells corresponding in shape to those known to have
relations to the viscera. One end of the Purkinjean cell
of the cerebellum, too, is as Meynert has ingeniously
indicated, of a similar structure. If any inference is to be
drawn from cell structure as to function, then the Pur-
kinjean cell is a mediator between a visceral centripetal
tract and a cerebral one, connected with the information
of the motor centres as to the space sense. The case of
the porpoise speaks as loudly for the *' equilibrium " as
for the '* visceral '' theory, inasmuch as the wonderfully
co-ordinated movements of the porpoise are^ chiefly
carried out by the trunk muscles.'
It it evident that within a large area of the medulla
oblongata, one covering its entire field, with the excep-
tion of the pyramid tract, and the apparatus of the nerve
nuclei, we must look for the centripetal tracts which in-
form the Psyche of the contacts with the outer world,
the visceral sensations, and the muscular sense. Many of
the movements dictated by the perfective economical
needs of the body are not directly mediated through the
apparatus of consciousness, indeed many of them are
absolutely removed firom the control of the Psyched That
the translation of the peripheral impression to the cen-
trifugal impulse, in their case, takes place without the
intervention of the cerebrum, is evident The ganglionic
apparatus of the cord, and in higher degree of the ob-
longata, suffice for these objects. It is a fact of signifi-
cance, that of the reflex and automatic actions which are
made to serve these objects, those determined in the
mesencephalon, pons, and oblongata far exceed in com-
plexity and elaboration those of the cord, and in direct
proportion to this complexity and elaboration do they
display an approach to intelligence. It is a dogma of
physiology that all the intricate automatisms of the brain-
aris, be they subservient to respiration, thermic regula-
tion, or nutrition, depend for their origin and develop-
ment on impressions indicating the nature of the organic
need.*
We must here assume as an element in our calculations,
that the area of the oblongata within which we are seek-
ing for the centripetal tracts, includes some which we
may never be able to determine, because their disturb-
ance is not made manifest to consciousness, not dis-
coverable by instruments of precision, and cloaked by
vicarious action of the symmetrical ganglionic apparatus.
While unilateral irritative lesions may enlighten us in
this field, through positive symptoms produced, suhirac-
iion lesions * must be bilateral in most cases to do so.
There are other functions, carried on by centripetal
tracts, which are subservient to needs which constitute a
connecting link between the vegetative and deliberate
purposes : they regulate the bodily equilibrium. Not-
withstanding the niany objections repeatedly urged to the
older view regarding the cerebellum, the proposition for-
mulated by me some years ago, that a skilful and rapid
co-ordination, associated with a good sense of rhythm,
space, and time in connection therewith, was not possible
without an intact and well-developed cerebellum, does
not seem to be invalidated by any authentic case, while
it is confirmed by a large number of observations.
The higher form of sensation, that of conscious per-
s?
^ Tilts animal, provided with dumsy flippers and a rudimentary dorsal fin, is ca-
pable of executing evolutions exceeding anything in the vertebrate domain, not ex-
— idag the blinded bats of Spallanani, for tbey mvolve at once gross force and skill.
~ porpoise executes his remarkable evolutions around his own axis, while rush-
_ Mog with the speed of a steamer, and it is a notorious fact that cohabitation
— aa act reauiring the ordinarv mammalian mechanism — is carried on while the
herd as iumDUas along with undiminished speed. All it done by the axial muscles.
s fortunately too !
* I do not enter here into a discussion of Van der Kolk's beautiful theory of res-
the outcome of a direct rhythmical asphyxia of the oblongata.
I involving elimination of nervous mechanisms.
ception, travels through the area left over after the sub-
traction of the cerebellar tracts. Inasmuch as there is
an intimate dovetailing of lemniscus, reticular, and cere-
bellar tracts in this area, in the lower half, and indeed
nearly in the entire level of the oblongata, accurate and
positive conclusions as to the differentiation of pain
thermic, and tactile tracts in the reticular formation and
lemniscus, can be derived — as far as the study of single
cases is concerned — from such only where the focus of
disease is situated above the level of the fully formed
posterior cerebellar peduncle. Of these forms of sensa-
tion, the highest, or rather the one made subservient to
the most intellectual purposes, is the stratum interolivare,
which conveys the so-called muscular sense brainward,
for the purpose of facilitating skilful employment of the
psycho-motor centres. All studies made so far fail to
give any satisfactory account of the raiscn (P/tre for the
paradoxical phenomenon observed by Brown-S6quard —
that the tract for one sense, which is in part but a refine-
ment of associated peripheral impressions, should not de-
cussate in the cord, but decussate in the oblongata, while
the others should decussate in the cord, and — ^redecussa-
tion being fairly excluded, inasmuch as that assumption
would be still more out of harmony with the facts than
any other — not decussate in the oblongata. There is no
physiological theory, nor mechanical factor of develop-
ment, nor, as yet, are there adequate anatomical paths, to
explain why the ordinary sensory channels should, so soon
after their entry, seek the opposite side of the cord to
travel brainward in. It is for this reason, I believe, that /
so many teachers of cerebral anatomy have contented
themselves with tracing the great tracts from and to the
level of the first cervical nerve-root, until Wernicke for-
mally opened a question — ^and answered it as satisfac-
torily as any one up to the present— which had probably
confiised or puzzled all of his co-laborers.
ON THE NERVOUS ORIGIN OF SOME DISOR-
DERS OF THE ALIMENTARY CANAL.'
By LEONARD WEBER, M.D.,
NSW Y<ntK.
The following observations on the often misunderstood
disturbances of the gastro-intestinal tract of nervous ori-
gin will contain nodiing new to those familiar with the
diseases of the nervous system, but will be of interest to
the practitioner, I believe. As to the theory of these
affections, it must be remembered that Leube, in an arti-
cle entitled ** Dyspepsia Nervosa " {Deutsche Zeitsch. fOr
Klin, Med.\ thought the latter to be peripheral neurosis
of the stomach, affecting the central nervous system by
reflex only. It cannot be denied that such cases may
occur, but they are certainly very rare.
I believe, with Beard, F. Richter, Mobius, Leyden,
Burkart, and others, that nervous dyspepsia, eta, is not
of local origin, but a symptom of general neurosis, par-
ticularly of cerebro-spinal neuras&enia. Organic dis-
eases of the nerve-centres may, also, reflex severely upon
the functions of the stomach, when the pneumogastric
centre or the cervical portion of the cord or the abdom-
inal ganglia of the S3rmpathetic have become the seat of
lesions.
Between twenty and thirty per cent, of patients with
organic nervous disease have gastric or intesdnal dis-
turbances. Periodic vomiting and retching — crises gas-
triques of Charcot — often constitute prominent and early
symptoms of typical tabes, but they have been observed
also in subacute myelitis, disseminated sclerosis, and
progressive paralysis. But similar paroxysms of severe
retching and vomiting, associated with violent ^stric
pain, great tenderness in the epigastrium, and the impos-
sibility to retain food, lasting for two weeks and more,
simulating gastritis or ulcer, and presenting considerable
> Read at the meeting of the New York Neurological Society, October j, 1884.
482
THE MEDICAL RECORD.
[November 1, 1884,
difficulties of dis^osis, have been observed occasionally
independent of anatomical changes in the stomach or cen-
tral nervous system. Leyden, in an article on ** Periodical
Vomiting and Gastralgia," published in the Deutsche
Zeitsch.filr Klin, Med,, iv., 4, p. 605, x88a, reports four
cases, one of them, in a man forty years of a^e, coming
on after protracted mental overwork, and endmg fatally.
I have had two well-marked cases of the kind under my
charge, both concerning young women, in the etiology
of which menstrual disturbances played . an important
part Ice applications, morphine injections, and the
blandest possible diet failed to bring relief. But after
raising a blister over the stomach, putting neither food
nor drink into it, and supporting the patients by rectal
alimentation for some days, improvement and final re-
covery took place. Constipation and diarrhoea, hyper-
sesthesia aild neuralgia of the stomach, are quite frequent
in neurotic females, particularly when they have uterine
trouble. In neurasthenic men, diarrhoea, quite inde-
pendent of catarrh or other local causes, is not very
rare. An interesting and obstinate case of periodical at-
tacks of nervous diarrhoea has been under my observa-
tion for some years. F. S , about forty years of age,
a merchant, the father of healthy children, of strong con-
stitution, excessively nervous, showed the first symptoms
of the disorder eight years ago, while engaged m active
and difficult business. He has been carefully examined
by myself and others, and had the counsel of eminent
specialists. But no one has arrived at an anatomical
diagnosis in his case ; a nervous origin of it is almost
certain, the more so as his father, who is still alive, has
been suffering from the same trouble for many years.
Various modes of treatment have given but temporary
relief, the attacks growing rather more severe and per-
sistent as time goes on, and are frequently complicated
by vomiting and gastralgia. Having found that he can
make himself more comfortable by morphia than by any
other remedy, the patient has of late become somewhat
of a morphine-eater. The rather frequent and more
readily tractable forms of nervous dyspepsia, etc., we
may designate, with R. Burkart, as gastric neurasthenia.
The difficulties and discomforts experienced while di-
gestion goes on, constitute the principal complaint in
these cases. All other intercurrent symptoms depend
upon the exacerbation and remission of the former.
Such other cerebro-spinal symptoms are headache, ver-
tigo, cardiac palpitation, backache, depression of spirits,
disturbed sleep, etc. This array of symptoms gives us
a clinical picture quite different from the symptomatology
of catarrh, carcinoma, or gastric ulcer.
There is often a sensation of fiilness and pressure in the
epigastric region, frequent eructation, occasional vomit-
ings tympanites, and flatulency. Sometimes there is ano-
rexia, and again ravenous appetite ; bowels generally
irregular, alternately loose and constipated.
R. Burkart, in an excellent monograph on '* Neuras-
thenia Gastrica,'' Bonn, 1882, descries a new symptom,
ue,y hjrperaesthesia of the abdominal ganglia of the sym-
pathetic. He has found it in almost all his cases of
neurasthenia gastrica, and mentions three localities for
examining for the tender ganglia : i. Plexus hypogas-
tricus. The patient being in the horizontal position,
pressure is made with two fingers of both hands in the
median line, below the umbilicus and a little above
a line that would connect the spin. oss. ilei, perpen-
dicularly downward against the vertebral column. In
neurasthenia gastrica we shall find in this way an ex-
quisitely tender spot, from which painful sensations will
radiate downward and particularly upward. A feeling of
oppression will sometimes come over the patient while
the pressure lasts. A second place corresponds to the
plexus coeliacus; but pressure over that discloses less
hyperaesthesia, and reflex symptoms are absent. Finally,
the plexus aorticus may also be the seat of hyperaesthesia.
Per contra, he has not found any hyperaesthesia of the
above ganglia in neurasthenia without gastric symptoms.
nor in cases of anatomical disease of the gastric intes-
tinal tract
The disproportion between the objective signs and the
numerous complaints is quite characteristic, and the dis.
comfort is sometimes greater when the stomach is empty
than when it is full. While diet has no ^eat influence,
emotion, worry, and excitement, and mtellectual or
physical overwork have so much the more in precipitat-
ing an attack. The condition of the patient is variable;
there are periods of great distress, followed by partial or
complete well-being.
The morbid influences most potent in producing gastiic
neurasthenia are : acute diseases, intellectual overwork,
great emotion and excitement, hereditary neuroses, and
the various sins of civilized life. The prognosis of this
class of cases is generally favorable. Therapeutically
they need generous quantities of nutritious food, good
air, and particularly mountain air, and ought to follow a
suitable regime in sexual indulgence, and in mental and
physical occupation. Bitter waters and saline purgatives
in general are contra-indicated, according to my experi-
ence. The waters of Saratoga, Carlsbad, and similar
places do harm, and the more so, the stricter the diet that
has been observed while using them. I have seen patients
of that class come back from Carlsbad worse than they
were before they went. Hydrotherapeutics in the shape
of tepid half-baths with cold afliisions, or the wet sheet
with friction of the whole surface of the body, are often of
service, and so is massage, generally and gently applied
Galvanism applied every other morning to head, spine,
or sympathetic, according to the indications of the case,
is frequently of good influence. Of drugs I am in the
habit of prescribing small doses of an acid solution of the
comp. hypophosphites between meab, more than any-
thing else. They are generally well borne by the stom-
ach, and I consider them a good tonic for a neuras-
thenic person.
as Wist Forty-iixth Stxbbt, New Yokx.
MINERAL ASTRINGENTS AND CAUSTICS IN
OPHTHALMIC PRACTICE. »
By EDWARD S. PECK, M.D.,
VISITING 6URGKOM TO CHARITY HOSTITAL, NSW YORK.
The motive of this paper was suggested to me by re-
marks made by a member of this Society, some time ago,
relative to the use of various mineral astringents and
caustics in the treatment of eye diseases. It occurred
to me that it would not be amiss to offer the present views
of their use, with special reference to nitrate of silver, as
a monthly contribution, and to endeavor to differentiate
their position in ophthalmic pharmacology.
Conjunctivitis.
The different forms of conjunctivitis may be classified
as catarrhal, vernal, follicular, granular, blennorrhdic^
croupous, diphtheritic, and phlyctenular,
a. Catarrhal conjunctivitis^ or conjunctivitis simfUx,
— ^The general characters of this affection are increased
hyperaemia of the conjunctiva and increased secretion.
The hyperaemia is often very pronounced ; the secretion
is purely catarrhal, consists of mucus, epithelium, and
fat-cells, is a trifle opaque, viscid, and when it becomes
dry the lid-edges are disposed to stick together.
Every abnormal secretion of the conjunctiva, produced
b^ inflammatory processes, is to be regarded as conta-
gious.
A simple catarrhal conjunctivitis is not always am^
nable to treatment ; it may become chronic ; or it may
produce lymphatic infiltration in the vicinity of the cul-
de-sac ; or it may involve enough of the under-lid to
create an eversion of the lachrymal puncta ; or there
may be an ulcerative blepharitis, or a secondary trau-
> Read before the Nortfawestem Medical and Surgical Socieqr, April z^ in4-
November i, 1884.]
THE MEDICAL RECORD.
483
matic keratitis. Such are some of the naembers of the
vicious circle possible to every acute catarrh of the con-
junctiva.
As regards the use of nitrate of silver in the different
forms of conjunctivitis, Graefe *♦ elaborated the princi-
ples to be carried out in a masterly paper on diphtheria
of the conjunctiva. His work in this direction rehabili-
tated the caustic from the disrepute into which it had
fallen. The empirical use of the silver-nitrate is un-
necessaiy, inasmuch as its indications in different forms
of conjunctivitis are tolerably precise. Some of these in-
dications I desire to note here : •
1. The use of silver-nitrate always presupposes an in-
creased flow of blood to the conjunctiva, with a certain
amount of succulence of tissue and serous exosmosis ;
and the more pronounced the hyperaemia of the mem-
brane with its secondary developments, the more, cateris
paribus^ is the nitrate indicated.
2. Silver-nitrate is not indicated in any form o! con-
junctivitis attended by a fibrinous, easily coagulable se-
cretion, so long as this kind of secretion persists. It
frequently happens that blennorrhoic affections of the
conjunctiva have an initial stadium, in which the secre-
tion is easily coagulated when the superficies of the
membrane is smooth and glistening on account of a
highly injected mucous membrane. To apply the silver-
nitrate on such a membrane would be to impair its integ-
rity, to increase the fibrinous exudation, and possibly
to induce a severe disease of the cornea.
3. Silver-nitrate is contra-indicated in deeper inflam-
matory processes of the eye, as, for instance, in certain
diseases of the cornea.
4; The strength of the nitrate must be in proportion to
the intensity of the inflammatory changes of the conjunc-
tiva ; that is to say, a severer grade of conjunctival in-
flammation demands a stronger solution of the nitrate.
These solutions vary from a half to one and a half per
cent.
5. The strength of the nitrate must be reduced in pro-
portion to the disappearance of the inflammation.
6. An eschar forms after the application of the nitrate,
under which regeneration of the disturbed tissues takes
place. The nitrate should not be reapplied until after
the regeneration of the tissues.
7. The influence of the nitrate upon other tissues should
be prevented ; for this purpose either simple water should
be used to wash away the resulting silver-albuminate, or
with stronger solutions of silver a solution of common
salt should be used.
The details of application need not be given here. It
is sufficient to note that silver-nitrate is the astringent to
be used over all others in catarrhal conjunctivitis.
h. Vernal conjunctivitis, — ^This is an endemic form of
catarrh, showing itself in the spring. It is confined to the
limbus conjunctivae and to the adjacent part of the bul-
bar conjunctiva. As a rule, there is no excess of secre-
tion, and the affection is to be regarded as a chronic
conjunctivitis. The membrane is of a dirty red or a
lustreless pink color ; it lacks the freshness and vitality
peculiar to other forms of conjunctival injection. This
is probably due to a serous infiltration which occurs in
irregular spots under the conjunctiva. The disease is
marked by unusual photophobia.
To the inexperienced practitioner there is a great
temptation to use the silver-nitrate, but it will only in-
crease the symptoms, and thereby possibly endanger the
cornea. In the event of a discharge, a weak solution of
silver-nitrate, as one per cent., could be used with bene-
fit The photophobia must be regarded, however, as con-
tra-indicating the use of silver ; such metals as zinc or lead
would be preferable.
c. Follicular conjunctivitis^ properly named from the
development of superficial, globular, pale-red promi-
nences, which accompany catarrhal inflammatory changes
> Von Graefe : Arch. £ Ophtfaal., vol. L, part i., pp.tz6B-a5o.
in the conjunctiva, and which latter, on subsiding, carry
away with them quite every vestige of follicular growth.
Follicular differs from simple catarrh in this development
of follicles. Like simple catarrh it has a secretion mild
in character, while, unlike it, the follicles may be regarded
as lymph-follicles ; that is to say, their structure is that of
the closed lymph-sacs, while the smaller, smooth, whitish
bodies may be regarded as collections of lymphoid ele-
ments. To carry out the analogy between the follicular
and catarrhal forms, it is to be said that the development
of follicles protracts the course of a conjunctivitis, renders
it more obstinate to absorption processes, and more dis-
posed to a recurrence ; on the contrary, there are not
the inflammatory changes in the deeper tissues of the lid
in follicular conjunctivitis which obtain in granular con-
junctivitis.
Secretion of an acute follicular is more contagious than
of a simple catarrh of the conjunctiva. This is the form
usually found in the different members of a family, in
schools, barracks, etc., though other causes may conspire
to extend the eye disease, chief of which is the bad ven-
tilation of such inhabited rooms. Among the causes of
follicular conjunctivitis is to be reckoned die traumatism
due to a long-continued use of irritating remedies, such as
different mercurial ointments applied within the lids, so
much in vogue in South Germany, atropine, etc. Although
atropine may have been used for weeks without any con-
junctival reaction, suddenly, without any warning, a fol-
licular inflammation of the conjunctiva may be developed,
with marked injection and oedema of the lower lid, which
latter may extend to the lid border, and eventuate in a
blepharitis, or may go over on the integument of the lid
and cheek, amounting to a dermatitis miliaris. One
peculiarity of atropine-conjunctivitis is its long duration
and resistance to treatment; these characteristics are
entirely independent of the length of time atropine has
been already used, whether long or short.
As to the management of cases of follicular conjunc-
tivitis, it is to be observed, that fwhile silver-nitrate is the
astringent of all others to be relied on, it is, however, not
to be used early in the case. Antiphlogistic measures are
first to be resorted to ; such as ice-cloths, of one thick-
ness of a square of old muslin, transferred from raw ice to
the eye; scarifications, if the lid is hyperaemic and
swollen, made parallel to the fold of the lid; while later,
and not until the incisions have healed, the silver-nitrate,
not stronger than one per cent. It goes without sa3ring,
that all such cases must be eliminated of their hygienic-
ally bad relations, placed in new rooms, or, at least, in
freshly fumigated old rooms, as when the treatment is
conducted in the wards of a hospital, the dormitories of
lodging-houses, boarding-schools, etc.
d. Granular conjunctivitis. — ^The general characteris-
tics of this form of conjunctivitis are so well known that
it will be hardly necessary to enter into a detailed ex-
planation of its pathological exhibits; it has vaiious
forms, which are arranged under different names, and
require different plans of treatment according to the
different stadia of the pathological process. The terms
granulations, trachoma, etc., imply technical states and
qualities of the granular and granulating process. An
analogy is often drawn between this and the follicular
form of conjunctivitis ; but the similarity is external and
superficial, and is based upon the fact of the formation of
prominences on one and the same conjunctival tissue.
The follicles in the one variety are purely superficial, and
disappear without leaving a trace of their existence;
while the granulations are formed from the cellular tissue
layer, push the epithelium before them, and leave a cica-
trix where they previously rested. Viewed in this way,
granulations belong to the neoplastic growths, as does a
true granuloma. Further, granular conjunctivitis — ^that
is, granulations — may exist not only on the palpebral, but
also on the bulbar conjunctiva, and may extend even
to the limbus of the cornea ; while it is well known that
no papillae exist in these last two locations.
484
THE MEDICAL' RECORD.
[November i, 1884.
It is not to our purpose to dwell on the different sub-
divisions of granular conjunctivitis, as the acute, the
simple or chronic, and the cicatricial, nor to go further
than to mention some of the possible vicious complica-
tions, as e.g,^ contraction and bending of the tarsus ; dry-
ness of the conjunctiva, pr xerosis ; diseases of the tear-
passages, as stenosis, stricture, and imflammation of the
lachrymal sac, e version of the inferior punctum, and ec-
tropion of the inferior lid ; changes in the lashes, as mal-
position and improper growth ; and lastly, diseases of
the cornea.
The secretion of granular conjunctivitis is contagious ;
the contagion depending on the secretion itself, and not
on the granulations. The secretion of the acute is con-
tagious in a higher degree than that of the -chronic form.
Arlt has stated that there was a legitimate connection
between scrofula, or tuberculosis, and trachoma ; but every
practitioner knows that granular conjunctivitis frequently
develops in robust and perfectly healthy individuals;
also, that impoverished persons contract it as well as
those well fed. Inhabitants of high altitudes are less liable
to its attack and severity than dwellers in low and damp
districts. Finally, granular conjunctivitis attacks individ-
uals of ten to thirty years of age most frequently ; during
the first and after the forty-fifth year an initial attack is
seldom observed. It is a disease of the poor people, and
not of those in good circumstances and in the practice of
decent hygiene.
As to the therapeutics of granular conjunctivitis, the
acute form is best treated, from the indicative inflamma-
tory symptoms, by cold applications, scarifications, and
later by astringents ; while the simple or chronic form is
best treated by astringents. Should corneal affections de-
velop, as the result of persistent, pericorneal injection,
in the form of acute infiltration of the periphery of the
cornea, or as abscesses, the treatment must be limited
to atropine, and every kind of caustic be abandoned. For
the final stage of an acute granular conjunctivitis, after
inflammatory symptoms have been removed by cold, and
the serous infiltration by scarifications, the best caustic
to be employed is nitrate of silver, in solution, one to
one and a half per cent. ; but in the chronic form, the
astringent to be relied upon beyond all others is the sul-
phate of copper, the copper-stick or blue-stone, as it is
popularly known. It is enough merely to mention that
removal to pure, dry air, cleanliness, freedom from dust
and smoke, and, if in a hospital, the limitation of pa-
tients to the more open and better ventilated parts of the
ward, must be insisted upon ; if, too, in a hospital, such
patients ought not to be allowed to converse at the bed-
side of others who have had intra-ocular operations, such
as those convalescing from extraction of cataract, iridecto-
my, or paracentesis ; nor, on the other hand, should they
be allowed too close proximity to open wounds, erysipe-
las, pyaemia, and puerperal fever. The same precautions,
though in a more emphatic sense, should be insisted
upon with hospital patients under treatment for the vari-
ous forms of blennorrh5ic conjunctivitis, such as the
purulent ophthalmias of the adult and newly-born, diph-
theritic conjunctivitis, etc. Though at the risk of being
criticised for a digression, I take great pride in noting
that for the last four years of operative work in the oph-
thalmic wards of Charity Hospital, not a single operation
has been endangered by the presence of trachomatous
patients ; and, as is well known, granular conjunctivitis
abounds in the ophthalmic division of the hospital, some-
times ad nauseam.
Neither the purpose nor the limit of this paper will al-
low anything more than a reference to the cicatricial
stage of granular conjunctivitis ; it is properly a stage of
contraction and distortion of the tarsal ligament and lid,
or a stage of deformity, and for which treatment is
chiefly surgical. The operations for blepharophimosis,
as canthoplasty, cantholysis, etc., the different proced-
ures for the relief of ectropion of the lid, eversion of
the punctum, reposition of the cilia, trichiasis, and dis-
tichiasis, as also for stenosis of the tear-sac, stricture,
etc, can here be merely alluded to. They are operations
naturally relegated to the specialist, some of which be-
long to the nice calculations of cosmetic surgery.
e, BlenncrrhUc conjunctivitis. — It is characterized by
the generation of a well-marked purulent secretion from a
highly vascularized membrane, infiltrated with serum, and
covered with granulations. The secretion is its chief
differentiating factor. There are two varieties of blen-
norrhoea — ^acute and chronic. An acute blennorrhoea
is usually binocular (double-sided). It first shows itself
in reddened and partially swollen lids. The swelling can
involve a part or the whole of the lid — can extend to the
bridge of the nose, and may be of such amount that the
upper lid can be raised with difficulty, and the palpebral
slit be seen scarcely at alL A smoky, thinly fluid, copi-
ous secretion begins early to course from the palpebral
opening, capable of being drawn out in elastic threads.
So strongly injected is the conjunctiva, both palpebral
and bulbar, that frequent apoplexies result ; the injection
and infiltration may extend up to the cornea, even over-
hang it, and limit its diameter; this condition of
strangulation of conjunctival vessels is called ^A^www,
and on eversion of the lids a thick welt of bluish-red
tumor is seen between them. So soon as this glistening,
distended mucous membrane is exposed to the air, the
thin exudation is quickly followed by a new discharge.
A burning heat with severe pain in the eyes and brows
accompany the inability to open the eyelids, while the
crypts between and underneath the false folds of con-
junctiva are choked with a rich exudation of a highly con-
tagious, purulent discharge. Subsidence of infiltration
takes place in a few days ; the secretion diminishes in
quantity, but becomes more consistent, and wells up like
a whitish-yellow cream. After continuing from two to
three weeks the inflammatory symptoms begin to disap-
pear, the lids can be more easily opened, the secretion
becomes more mucous, the injection, infiltration, and
granulations subside graduatim, and in from six to eight
weeks the main elements of this special disease have dis-
appeared. This long-continued pressure on the (ante-
rior) ciliary arteries tends to impair the integrity of the
cornea, and to produce secondary affections of that tis-
sue. There may follow this stasis either superficial
ulcerations at the periphery, or deep pus-d6pdts in any
part of the cornea, with abscess and perforation, iris-pro-
lapse, traumatic iritis, etc.
Chronic blennorrhoea differs in the degree of primary
inflammatory symptoms, the secretion is more riiuco-
purulent in character, and easily dries on the lashes.
More than in the acute form, granulations develop, and
ultimately may lead to shrinkage of tarsus and ectropion.
The chief anatomical changes m blennorrhoea consist of
the thickening of the stroma of the conjunctiva, the dis-
tention of the vessels, and the thickening of their adven-
titia. A simple conjunctival catarrh may eventuate in a
blennorrhoea; a conjunctivitis, not originally catarrhal,
may eventuate in a blennorrhoea ; as, for instance, an
acute granular conjunctivitis, or a croupous or diphthe-
ritic form. In fact, a true diphtheria of the conjunctiva,
while itself rare, usually ultimates in a blennorrhoea.
The most common cause of a blennorrhoic conjuncti-
vitis is the conveyance of a similar secretion from any
mucous membrane, either of the patient or of another
person, and that mucous membrane may be conjunctival,
vaginal, or urethral. This contagion may be conveyed
by actual contact, or by transmission through the air.
Further, the daughter-conjunctivitis will not necessarily
be the same as the mother-conjunctivitis.
The management of blennorrhoea must be conducted
on two lines : i, protection ; 2, therapeusis. It is of
the highest importance that, in case the affection is of one
eye, the other should have a protective bandage ; that in
every case the greatest precaution should be taken
against the possibility of a conveyance of discharge to
the attendants. Towels, sponges, and compresses should
November i, 1884.]
THE MEDICAL RECORD.
485
never be twice U3ed without thorough cleansing and dis-
infection, and applicating cloths should be burned.
Treatment proper should be guided by the phase of the
process, by the character of the mucous membrane and
the secretion, and by the corneal implication, if any be
present. The following general rules should be fol-
lowed: I. If the. mucous membrane be smooth and
shin/} and covered with a thin and transparent or slightly
cloudy exudation, or if there be a thin and fluid secre-
tion of a gray or light yellow color, cold applications
roust be used, while caustics must be avoided. 2. If the
tissues are swollen or chemotic, scarifications must be
made, followed by cold applications. 3. If granulations —
that is, papillary bodies in folds — have developed, if the
lid-swelling has begun to subside, if there be not a thin,
glairy exudation, but, on the contrary, a thick yellow-
homogeneous secretion, then caustics are indicated. 4,
If the cornea be involved in the last picture of granula-
tions and discharge, then caustics are indicated, because
so long as they successfully fulfil their indication the
progress of corneal disease is abated.
There is, perhaps, no conjunctival disease in which the
caustic treatment meets with such eminent success as
attends its adoption in proper time and strength in blen-
norrh6ic conjunctivitis. It is a fundamental principle
that the strength of the caustic must be proportioned to
the intensity and development of the inflammatory pro-
cesses ; at the same time the caustic must be used at the
beginning weaker than the grade of the inflaimmation
would indicate, and may be strengthened little by little
as the mucous membrane shows a tolerance. In this
regard is shown the judgment of the practitioner, to pre-
serve the balance of power, so to speak, on the side of
the disease and not on that of the caustic, as it is always
easier to increase the strength of the latter, if required,
than to combat the injudicious effect of a too powerful
caustic. Among the possible bad effects of too powerful
astringent treatment is the destruction of the corneal epi-
thelium, perhaps already undermined by the blennorrhoic
processes. Solutions should average of the strength of one
to two per cent. Corneal disturbances, as simple or ne-
crotic keratitis, abscess, or keratitis profunda, are to be
treated with atropine, one-half to one per cent ; as cor-
neal involvements are usually sequels of the acute in-
flammatory stage, caustics will have been resorted to, and
their use may be continued, but with care.
In this category belongs the blennorrhoea of the newly-
bom, of which but little need be said, as it is easily recog-
nized by the character of the discharges and its appearance
in two or three days after birth. It is a strange statement,
and to some may be new, that not every case of blennor-
rhoea of the infant is developed from a blennorrhoea of the
vagina of the mother ; but without doubt the majority
of the cases do so develop. 1 have treated many cases
of blennorrhoea, beginning within forty-eight hours of
birth from no traceable cause, in which at no time was
there a discharge greater than what might occur in a
mild catarrhal conjunctivitis, and which came to good
recovery in a few days under mild caustic treatment
and cleanliness. In the blennorrhoea of the newly-born,
as in that of adults, the same question arises as re-
gards the continuance of the caustic treatment during
corneal complication, such as keratitis profunda, abscess,
etc.; it may be emphasized on the part of infantile
blennorrhoea, that such treatment is not only not con-
tra^indicated, but, on the other hand, may be pursued with
advantage. The surgical measures necessary in abscess
of the cornea, as puncture, and removal of a prolapsed
iris, win only be mentioned here.
The forms of conjunctivitis known under the generic
heads of croupous and diphtheritic need not claim our
attention ; they are rare, even in a large special prac-
tice, are not necessarily coincident with croup or diph-
theria of the air-passages, and do not indicate caustics
as an essential element in treatment Caustics, how-
ever, are to be used after the pseudo-membrane has I
been removed, and the process becomes a secondary
blennorrhoea.
The last variety of conjunctivitis to claim our notice
at this time is the
/. Phlyctenular. — It is introduced here by way of
negative argument as to caustics ; that is to say, they
are not to be used in any stage. A brief summary
of its characteristics should be given. One of the
most common of all ophthalmias, and chiefly among
children before their fifteenth year, it is begotten in
scrofula, bad hygiene, or poor living ; it is limited to a
small portion of the bulbar conjunctiva between the cor-
neal periphery and the cul-de-sac ; it is known by its
pimple or bladder-like prominences, which may be single
or multiple ; the phlyctens or swellings may become ab-
scess-like, and may form — to use an anomalous expression
— an elevated ulcer. The disease has a peculiar tendency
to extend itself in the form of phlyctens upon the cor-
nea, even to the centre of its face. Patients with phlyc-
tenular conjunctivitis have such scrofulous exhibits as
the following : eczematous and impetiginous eruptions
in the vicinity of the lids, at the nasal angles, on the up-
per lip, behind the ears, and on the hairy portions of the
body; glandular swellings, other mucous catarrhs, etc.
Phlyctenular conjunctivitis is not contagious, as are the
diseases already described. Frequently no abnormal se-
cretion attends it ; on the other hand, it is to be noted
that the phlyctenular form is a frequent sequel of other
diseases in other parts of the organ — such as blepharitis
in scrofulous subjects, disturbances of the tear-passages,
episcleritis, etc.
The treatment in brief follows these lines : i . Iron
and cod-liver oil ; a proper diet and hygiene to combat
any possible scrofula and the tendency to blood-impov-
erishment, of which this disease is an index. 2. Irrita-
tion by csdomel, and by ointments of the red or yellow
mercurial oxide placed within the lids. 3. The avoid-
ance of all derivatives and depressants. 4. The contin-
uance of topical remedies long after all inflammatory
changes have passed away. For the photophobia, always
present, and which in children is known by the peculiar
manner in which they blink at you from under the bent
arm, the sovereign remedy is ducking the face in cold
water.
Finally, in connection with the treatment of mucous
membranes by the silver-nitrate, it should be noted that
the excessive use of this salt produces a discoloration
called argyrosis^ or a silvering of the papillae of the co-
rium. While this is a frequent result of the internal use
of silver, as for epilepsy, chorea, etc., it is quite rare as
due to topical application. Professor Neumann, of Vi-
enna, once showed the author of this paper a section of
the lower lid in a condition of argyrosis, which in a
bright light gave the beautiful lustre of veins of silver
where the papillae of the corium were discolored by the
silver-nitrate.
• S3 West Fiftibth Street.
Eczema and Trophic Centres. — Dr. F. A. Groat, of
Fremont, O., writes ; " In an article in The Medical
Record of March 15th the question is asked, 'Is conges-
tion of the trophic skin-centres the cause of eczema ? *
Since reading that article I have met with a case of vesic-
ular eczema which seemed to be peculiar, in. that it was
developed only over the superficial muscles of both hands
supplied by the ulnar nerve; making its appearance
with the advent of warm weather, for six consecutive
years, only upon these muscles, and never having been
benefited by treatment, local or internal, alone or in
combination. The man was unusually well developed
physically, with no apparent indication of disease, unless
obesity be pathological, and no local cause for the erup-
tion to be found. If from congestion of the nerve-centre,
would it manifest itself only in muscles supplied by ter-
minal branches of the nerve ?''
486
THE MEDICAL RECORD.
[November i, 1884.
THE LAWS OF DISSECTION.
By henry a. RILEY, Esq.,
NBW YOKX. 2 J
The laws of most of the United States, and of England
as well, provide for the lawful dissection of human bodies
in the interests of medical science. These laws are, most
of them, of recent origin, although the first enactment in
England was passed as early as 1540, in the time of
Henry VIII. It was then declared that the Masters of
the Mystery of Barbers and Surgeons might take each
year four persons executed for felony, for anatomies, and
to make incision of the same dead bodies, or otherwise
to order the same after their dissections at their pleasure,
for their further insight and better knowledge, instruction
insight, learning and experience in the science or faculty
of surgery.
In 1565 Queen Elizabeth allowed the College of
Physicians similar privilege of dissecting annually four
felons. In 1752 George II. permitted the bodies of all
murderers executed in London and Westminster to be
delivered to the surgeons for anatomical purposes. Not-
withstanding these enactments, the supply of bodies for
dissection was not sufficient for the demand, and numer-
ous attempts were made by grave-robbers to meet the
wants of medical students. In 1830, the act known as
the Anatomy Act was passed, and it is in pursuance of
its provisions that the medical profession in Great Brit-
ain now secure material for dissection and instruction.
This act provides for the licensing of persons practising
anatomy, and establishes inspectors of the various schools.
The principal section of the act is as follows : " It shall
be lawful for any executor, or other party having lawful
possession of the body of any deceased person, and not
being an undertaker or other party intrusted with the
body for the purpose only of interment, to permit the
body of such deceased person to undergo anatomical ex-
amination, unless to the knowledge of such executor or
other party such person shall have expressed his desire,
either in writing at any time during his life, or verbally
in the presence of two or more witnesses during the ill-
ness whereof he died, that his body after death might not
undergo such examination, or unless the surviving hus-
band or wife or any known relative of the deceased per-
son shall require the body to be interred without such
examination." This act in its preamble declares that the
legal supply of human bodies for such anatomical ex-
amination is insufficient fully to provide the means of
such knowledge, and its effect, as stated by Justice Ste-
phen in Queen v. Price, L. R., 12 Q. B. Div., 247, has
been " that the bodies of persons dying in public institu-
tions whose relations are unknown are so dissected." The
duty of properly interring the remains after dissection is
placed upon the persons giving the bodies to the physi-
cians.
In New York the first law on the subject was passed
in 1854, and it has been amended by legislative enact-
ments passed in 1879, 1881, and 1883. The law as it
now stands is clear, distinct, and satisfactory in its work-
ing. It is as follows : ** It shall be lawful for the gover-
nors, keepers, wardens, managers, and persons having
lawful control and management of all public hospitals,
prisons, alms-houses, asylums, morgues, and other public
receptacles for deceased persons, to deliver, under the con-
ditions hereinafter mentioned and in proportion to the
number of matriculated students, the bodies of deceased
persons therein, to the professors and trustees in all the
medical colleges of this State authorized by law to confer
the degree of doctor of medicine. And it shall be lawful
for the said professors and teachers to receive such
bodies and use them for the purpose of medical study.
Medical colleges which desire to avail themselves of the
provisions of this act shall notify said governors, keep-
•ers, wardens, and managers of public hospitals, peniten-
tiaries, alms-houses, asylums, morgues, and other public
receptacles for the bodies of deceased persons in the
counties where the colleges are situated, and in counties
adjacent thereto, of such desire, and it shall be obligatory
upon said governors, keepers, wardens, and managers to
notify the proper officer of said medical colleges when-
ever there are dead bodies in their possession that come
under the provision of this act, and ta deliver said bodies
to said colleges on their application. Provided, how-
ever, that such remains shall not have been desired for
interment by any relative or friend of such deceased per-
son within forty-eight hours after death ; provided, sdso,
that the remains of no persons who may be known to
have relatives or friends shall be so delivered or received
without the assent of such relatives or friends ; and pro-
vided that the remains of no person detained for debt,
or as a witness, or on suspicion of crime, or of any
traveller, or of any person who shall have expressed a
desire in his or her last illness that his or her body be in-
terred, shall be delivered or received as aforesaid, but
shall be buried in the usual manner ; and provided, also,
that in case the remains of any person so delivered or
received shall be subsequently claimed by any relative
or friend, they shall be given up to said relative or friend
for interment ; and it shall be the duty of said professors
and teachers to dispose of said remains in accordance
with the instructions of the Board of Health in said locali-
ties where such medical colleges are situated, after the
remains have served the purpose of study aforesaid. And
for any neglect or violation of the provisions of this act
the party so neglecting shall forfeit and pay a penalty of
not less than twenty-five nor more than fifty dollars, to
be sued for and recovered by the health officer of said
cities and places for the benefit of their department"
The great demand for bodies for dissection early out-
ran the supply, as has been stated, and the art of the
resurrectionists began to be developed. In the year
1788, forty-four years before the passage of the British
Anatomy Act, the case of Rex v, Lynn, 2 T. R., 733,
was tried. It was one of the first cases of the kind in
the books, and puzzled the lawyers very much, notwith-
standing the fact that the general subject of rights over
dead bodies had been discussed by the text writers. In
that case Lynn was indicted for a misdemeanor in disin-
terring a body for the purpose of dissection. It was
urged on his behalf that the offence was only cognizable
in the ecclesiastical courts, but the judges of the King's
Bench declared that it was a fit matter for a criminal
court, and said that common decency required the prac-
tice to be stopped, ** being highly indecent and cotiira
bonos mores, at the bare idea alone of which nature re-
volted." As the judges, however, thought that Lynn
might have committed the act through ignorance, he was
only punished by a fine of five marks. In some later
cases the punishment was made severe, and at the pres-
ent rime there would certainly be no leniency shown to
any one who removed a body unlawfully. In Regina
V, Sharpe, i D. & B., 160, it was held to be a misde-
meanor to disinter a body at all without proper authority,
even when the motives for the act were laudable, it ap-
pearing that a son disinterred his mother in order to bury
her in his father's grave in consecrated ground, but he
was able to do this only by the use of a false pretence.
The difficulty which the lawyers had in fixing the grade
of the offence came from an inability to decide diat a
dead body could be property and the subject of theft
Willcox, an old writer upon the laws of the medical pro-
fession, says that the whole question of the lawftilncss
or unlawfulness of taking bodies for dissecrion depends
upon the answer to the quesrions : " Is it a violation of
property? Is it a personal injury to any individual?
Or is it an injury to the public ? Every lawyer who has
mentioned the subject has admitted that there is no
violation of property in respect to the corpse itself, wliich
is necessary to constitute the removal an offence ; and
Blackstone has distinctly stated that the only property
violated is the grass and soil of the land wherein the body
was interred, in respect to which the person may bring
November i, 1884.]
THE MEDICAL RECORD.
487
his action of trespass, but the law has not provided any
punishment as for an offence. It is equally clear that it
is not an injury to any person ; for the shrewd lawyers of
Coke's time determined that the body was no person,
but a lump of clay ; and the only injury which can give
a right of action to that, which amounts to a violation of
any legal right of a relative or master, is such as may be
said to recoil upon him by causing him expense, labor,
or loss of valuable service." The theory of the early
cases, such as that of Lynn, seems to be that the offence
is one against the public, but this opinion is not now
maintained against the abstract question of the use of
bodies for dissection. It is no longer considered that
any offence is committed against the person, against the
public, or against property m dissecting the human body,
provided this be done decently, for scientific or medical
purposes, and in the mode prescribed by law. In the
recent well-known case of Queen v. Price, decided by
Justice Stephen, in Wales, no later than February, 1884,
where it was held that cremation was a legal mode of
disposing of the bodies of the dead, this language is
used : " The law to be collected from these authorities
seems to me to be this : The practice of anatomy is law-
ful and useful, though it may involve an unusual means
of disposing of dead bodies, and though it certainly
shocks the feelings of many persons, but to open a grave
and disinter a dead body without authority is a misde-
meanor, even if it is done for a laudable purpose." It
was claimed in this case that the common law gave the
right of Christian burial to every person, and that con-
sequently cremation was illegal, especially if not directed
by the deceased ; but Justice Stephen held that the ex^
pressions implying a righi of burial were used at a time
when cremation was not conceived of as possible in
England, and consequently no special importance is to
be given to the words touching the lawfulness or other-
wise of cremation. The same argument, if valid against
cremation, would hold good in considering the question
of dissection, for if Christian burial is a right and duty, it
would prechide all use of bodies for anatomical purposes.
Following the English common law, the several States of
this country have united in regarding the violation of tombs
an indictable offence, and the intended purpose of the rob-
bery, if it is dissection, does not mitigate the criminality
of the act. In New York, for instance, removing dead
bodies for the purpose of selling the same, or from mere
wantonness, is punishable both by fine and imprisonment.
When the robbery of Mr. Stewart's grave occurred,
some years since, it was thought by many persons that
the law was powerless to punish the scoundrels if caught,
but there would have been no trouble on this point. It
is not at all likely that their object was dissection ; it
must have been to obtain the reward for the return of
the body which they knew would be offered, and this
would certainly come under the provision of the law for-
bidding the removal of dead bodies for the purpose of
sale. In New Hampshire and Vermont the punishment for
this crime may consist of fines, whipping, and imprisonment.
Actual presence at the time of the body-lifting is not
essential to a conviction ; but a person directing the pro-
ceeding, and near enough to give aid and assistance if
required, can be punished as well as those actually open-
ing the grave (Tate v. State, 6 Black, in).
The considerations thus far produced treat only of the
criminality of grave-robbery ; some civil remedies for the
same offence will be touched on at a future time.
A Foreign View of a New York Practice. — A Ber-
lin medical journal publishes the following: **Dr. Beach(!),
one of the first surgeons of New York (!), is living here at
present. This gentleman has gained by his practice
property to the amount of $5,000,000 (!). We are of
the opinion," adds the editor, " that it is the specialists
who are in the best way to accomplish these material re-
sults." It may be asked if the above paragraph is not
part of a scheme to flood New York with Berlin specialists.
PSEUDO-BULBAR PARALYSIS.
Bilateral Apoplexy of the Lenticular Nuclei,
Simulating Lesion in the Floor of the Fourth
Ventricle.
By S. E. fuller, M.D., and WM. BROWNING, M.D.,
BXOOKLYN, N. Y.
It has not been thought possible as yet to include injury
of the lenticular nuclei among the forms of brain dis-
ease which admit of approximate localization. A limited
number of cases have, however, accumulated which seem
to indicate that an insult to both these nuclei, and per^
haps to only one, may produce a picture of its own.
Since, however, these bodies are, from statistics, a very
frequent seat of apoplexy, and besides entirely latent
foci have been found in them at the autopsy, it is prob-
able that the special symptomatology observed in the
other cases may have been caused, not by the lenticular
injury itself, but by an extension of it or its effects to
adjacent parts. Be that as it may, that injury of these
bodies may produce a very well-marked and peculiar
group of symptoms is shown by the following case. It
occurred in the practice of Dr. Fuller, and was seen in
consultation by Dr. McNaughton. The interest of the
case was fully recognized and pains were taken to ob*
serve all symptoms. The clinical history is furnished by
Dr. Fuller ; the results of the autopsy are by Dr. Browning.
A lady, M. J , aged sixty-one, had suffered three
years previously a left hemiplegia without aphasia. Face»
throat, and neck muscles reported to have been unaf-
fected. Further particulars of the immediate attack un-
known. She recovered from it fully. Toward the end
of convalescence she came under my (Dr. Fuller's) care
complaining of a severe burning sensation in the sole of
the left foot. This was remedied with ergot and bromides.
There were no premonitions to the present attack. It
came on about 4 p.m., July 16, 1884, while in the bath^
room. She is said to have called out to a lady in the
next room, saying she was very dizzy and had pain in her
head, the lady helped her to bed. There seemed to have
been no loss of consciousness on the patient's part
Upon my arrival she was speechless, and remained so.
It was only possible for her to make an expiratory guttural
sound. Having been paralyzed before, she immediately
proceeded to show me that it was not the same by raising
first the right arm and leg and then the left. The lips,
tongue, and muscles of deglutition were paralyzed ; the sa-
liva flowed from whichever angle of the mouth was lower-
most ; the upper portion of the facial nerve was function-
ally intact and the pupils reacted normally. She could
not open her jaws, or only to the slightest extent The
lower jaw could be readily depressed with the finger, but
on attempting to swab out collecting mucus from the oral
cavity and throat — as was often necessary — the jaws
would close and press on whatever had been introduced
into the mouth, despite the strongest desire of the patient
to keep them open. The nurse had to be instructed,
before cleansing the mouth, to wrap a blade in soft
material and place it edgeways, so as to keep the jaws
apart until the little procedure was finished. This symp-
tom persisted during the conscious life of the patient The
tongue was quite motionless. The urine had been exano-
ined some time previously, and found free from albumen.
Immediately subsequent to this attack' there was an
enormously increased flow of urine. In the first three
hours she passed water three times. Though not meas-
ured, it was estimated by the attendants to have been a
quart each time. In this urine there was about twenty
vol. per cent of albumen and once a trace of sugar with
Fehling's test Withm twenty-four hours the quantity of
urine returned to normal. Albumen persisted in it for a
time at least. She snored very loudly after the attack,
though not doing so previously. There was no trouble
from the soft palate when awake, although it hung in a
paralyzed condition.
So long as she remained conscious, 1.^., for the first
488
THE MEDICAL RECORD.
[November i, 1884.
five days, she always gave notice of desire to defecate or
urinate — no incontinence whatever. During the same
period she would often motion for spectacles, paper, and
pencil, indicating that the latter be first moistened in the
mouth. She would then communicate by writing her
questions, and showed the full possession of her mental
faculties. This was farther shown by her remembering
when medicine was due (given per rectum and hy|)0*
dermically), by directing attention when a sample of urine
had been forgotten, and in a variety of other ways, ^.^.,
curiosity as to the nature and cause of her own condition.
Sh* would, however, cry rather easily, the tears then
running silently down over the cheeks. This could
hardly be wondered at, or considered as loss of control
over the feelings.
It is very doubtful if she succeeded in swallowing any-
thing, though she tried hard to do so. She was success-
fully nourished with peptonized milk, etc., per rectum.
• The stemo-cleido and other large neck-muscles did
not appear to be affected. The sense of hearing re-
mained good, and, in fact, no anaesthesia of any part of
the body was discovered.
The pulse, respiration, and temperature showed no dis-
tmbance to within forty-eight hours of death. At this
time, after some extra exertion on her part, she gradually
sank into a stupor. Some twelve hours before the end she
became very much flushed and hot to the touch over the
whole body. This afterward gave place to a kind of
collapse. Death on the morning of July 23d.
Post-mortem in the afternoon, with the assistance of
Drs. Fuller and McNaughton. The autopsy being per-
mitted only on condition that nothing whatever be car-
ried away, it was impossible to make a minute examina*
tion of any of the parts, yet this could not have added
very materially to the exactness of the present case.
Only the brain was removed, including the cord to oppo-
site the second cervical vertebra.
The cerebro-spinal fluid was slightly increased. The
vertebral and carotid arteries with their branches on the
base of the brain presented numerous patches of ather-
oma, but were, at least in all their larger divisions, still
permeable. No farther abnormal appearances on any
portion of the surface of the brain.
The lateral ventricles presented nothing unusual, unless
some slight adhesions between the ependyma of the
ventricular roof and floor. Laterally in the brain-sub-
stance, on the two sides very nearly symmetrical, were two
fresh clots. • These were in the lenticular nuclei, extend-
ing into all three divisions and tapering off posteriorly.
On the right side, in front of and external to the recent
hemorrhage, were the remains of the former one. This
was in the claustrum or between daustrum and external
capsule. It extended from nearly opposite the front end
of the ventricle to about opposite the' front end of the
recent hemorrhage, and was consequently just beneath
the Island of Reil. There was simply an oblong space
remaining, with slightly separated walls enclosing a little
brownish, thick fluid matter. The said walls consisted of
somewhat thickened and discolored tissue without any
smooth interior surface. Such is, according to Charcot,
the usual form and appearance of old extravasations at
this point. This had clearly caused the former left
hemiplegia. Motor fibres are not known to traverse this
tract. The paralysis must, therefore, have been caused
by pressure transmitted from the clot, a view which is
corroborated by her recovery.
As to the recent extravasations, the same general de-
scription will apply to both. Each was in amount equal,
perhaps, to a pigeon's egg. The nerve-tissue was not
only much torn, but, from the size of the clot and its
longitudinal form, also forced apart. The two were
from their appearance of about the same date. It was
not possible in either of them to distinguish any older or
newer portion. They were very dark, in part semi-fluid,
and, so far as color and character of the clot went, at
least one or two days old, perhaps several.
The head of each clot was about opposite the front end
of the thalamus, and diminished backward to nearly op-
posite the posterior end of the same. The main ix)rtion
appeared to be wholly in the lenticular nucleus, while its
posterior prolongation or branches may have encroached
to a limited extent on other structures.
No further foci were found in any part of the brain.
The medulla oblongata, pons, etc., presented no morbid
appearance. Sections through these parts were made
very close together, so that even a pin-head clot could
not have escaped notice. An embolus or thrombus of a
week's standing must have produced visible softening, so
that they also can be excluded.
The recent apoplectic centres were so large and the
tissue about them was so torn as to render them value-
less for the localization of any single symptom. The in-
terest of the case, however, lies in the peculiar combina-
tion of symptoms. These presented a complex believed
to indicate lesion in a part that at the autopsy was found
intact. To recall some of them : the paralysis was bi-
lateral, quite symmetrical as regards both extent and
severity, and occurred on the two sides simultaneously.
There was no loss of consciousness. Immediately there
was a greatly increased flow of urine, and which contained
both albumen and sugar. There was also well-marked
labio-glosso-pharyngeal paralysis. This forms a group
of symptoms the cause of which is generally assigned to
trouble at the base of the fourth ventricle.* Thrombosis
or embolism of a terminal bulbar artery is credited with
almost identical consequences, and apoplexy from one of
the same vessels may not appear very different.
** A limited number of cases presenting varying degrees
of similarity to the present one have been brought to-
gether by Ross in his recent work on *^ Diseases of the
Nervous System." ' From these he concludes that de-
struction of the lenticular nuclei in whole or in part may
produce nearly, if not quite, all the symptoms of lesion
of the medulla oblongata. The cases described or ab-
stracted by him, however, ran a slower course, and were
less typical of acute bulbar trouble. Ross, in one place,
calls this form pseudo-bulbar paralysis — a convenient
term for the present. To explain this grouping of symp-
toms, he points out that the lenticular injury must affect
fibres in their course, probably through the internal cap-
sule, from the psychomotor centres in the brain-cortex to
the nerve-centres in the medulla. He notes that con-
sciousness may not be lost at the occurrence of this acci-
dent, but does not in any of his cases mention disturbance
in the urinary secretion. Wernicke mentions the occur-
rence of bulbar symptoms in cerebral disease. He even
cites a case of so-called pseudo-bulbar paralysis, where,
however, the pathological condition varied materially
from that under consideration. In the present case the
two hemorrhages must have occurred at the same time.
Although not into a part vitally so important as the
medulla, yet from their size and after-effects they proved
fatal.
Experimental destruction of one or both these nuclei
has not established any facts available in localization.
Ferrier, together with many neurologists, simply believes
that hemiplegia may result from such injury when unilat-
eral. But these cases, while not disproving, certainly do
not confirm this.
As to the possibility of distinguishing between these two
(the lenticular and the bulbar)forms, some points may be
noticed. In the present case there were no convulsions ;
no ]>aralysis below the throat ; nothing unusual in pulse or
respiration ; evidently no trouble with the sense of hear-
ing, but increased reflex excitability of the nmscles oi
1 In Brain for July, 1884, T. D. Mann describes what he calls a case cfpuntpo-
plcctk bulbar paralysis, liie symptoms ver)' closely resembled those in our own
case. He writes : " llierc is not much difficulty in localizing a lesion such as this.
The symptoms at once point to the posterior part of the rhomboid sinus." Aa sa-
topsy would show whether such complacent confidence in his power of localixaooo
were warranted.
* Vol. ii.. pp. 696-8 of first edition, continued in the second editioo. Farther
two cases of depou in lenticular nuclei— one unilateral— «re given by Ross, in
Brain for July, 1883.
November i, 1884.]
THE MEDICAL RECORD.
489
the jaw. In bulbar lesions the corresponding reflexes are,
on the contrary, lowered, while the other symptoms, here
absent, occur with more or less frequency.
Such and similar points of discrimination would, how-
ever, in view of the very limited number of known cases
from which to draw conclusions, hardly warrant con-
fidence in an attempt at differential diagnosis.
HYDROCHLORATE OF COCAINE AS A LOCAL
AN/ESTHETIC IN GYNECOLOGY.
By W. M. polk, M.D.,
NSW YORK.
As a matter of some interest, just at this time, I give the
results obtained with hydrochlorate of cocaine in two
cases of trachelorrhaphy done this afternoon (October 29,
1884).
Case I. Double laceration of the cervix uteri, ex-
tending on both sides to cervico-vaginal junction, — The
vagina was first washed with a warm water douche, then
the cervix, the patulous cervical canal, and the vaginal
walls adjoining the cervix were carefully washed with
Castile soap, this in turn was washed off, and the surface
carefully dried. Next a four per cent, solution was
painted over the cervix, in the canal, and over the ad-
jacent vaginal wall with a cameVs-hair brush. This was
repeated twice, at intervals of two to three minutes, mak-
ing three applications of the drug. Within three minutes
of the last application the operation was begun.
It required the removal of extensive pieces of cicatricial
tissue from each angle, making it an elaborate operation
of its kind. The time consumed was about forty minutes,
the patient made no complaint and suffered no pain till
the last ten minutes of the procedure, then she spoke of
her discomfort as being a sense of soreness rather than
acute pain.
Thinking that the case might be one of those in which
the normal sensitiveness of the region was not great,
consequently one that might have borne the operation
without the use of any anaesthetic, local or general, I
chose a second.
Case II. — The woman was one having less self-con-
trol than the first, and with a good deal of normal sensi-
tiveness about the uterus and vagina. The preparation
of the region and the application of the anaesthetic was
the same as in Case I.
i^o pain was felt till the lapse of about twenty minutes,
then it was so acute as to require an application of the
solution of cocaine, making in her the fourth. In three
minutes the operation was continued and soon completed
without further pain. This last application was made
directly to the cut surfaces, first freeing them from blood.
The patient, who three years ago had had the same
operation performed under ether, was asked which method
she preferred, that with ether or this last without ; she
promptly replied, this last.
In the first case the effect of the drug seemed to be,
that it not only blunted sensibility, but it appeared to
retard the first appearance of blood upon the cut surface.
These cases I offer as a contribution to the solution of
the question now so prominently before the profession —
the place to be held by hydrochlorate of cocaine as a local
anaesthetic. With a view of testing its value in obstetric
practice a series of observations are being made in the
Emergency Hospital, the solution being applied to the
cervix and upper part of the vagina during the severe
pains of the first stage of labor. The result I beg leave
to communicate to you when the number of cases are
large enough to make the report valuable.
,v
PODERMOCLYSis is the name given to the process
o{ \Tu\^ci\T\g saline solutions subcutaneously. It has
been eni ployed in Naples in the algid stage of cholera,
and witl?^^ some success.
Hernia of the Lung. — Dr. Mariani reports in the
Revista de Medicina y Cirurgia Prdcticas the case of
a man, forty-five years of age, of good general health, in
whom nothing abnormal was discoverable when he was
resting quietly. But when he was exercising actively or
coughmg, a globular swelling appeared in the right su-
pra-clavicular region, varying in size with each respira-
tory movement. During an attack of violent coughing
it would grow to such a size as to pass entirely across
the front part of the neck, attaining a volume equal to
that of the head. Upon the cessation of the provoking
cause, the neck would return to its normal dimensions.
This phenomenon was first noticed when the patient was
fourteen years of age. The diagnosis was made by Dr.
Bellida of a conical hernia of the lung.
Dilatation of the Stomach in Children. — In an
article with this title in the Archives Gdnhrales de Mede-
cine of August and September, 1884, Dr. J. Comby asserts
that the affection is one of by no means rare occurrence
in young children, and he cites in proof of his assertion
upward of fifty cases seen by him in dispensary practice..
Dilatation of the stomach, he says, is constantly associated
with rachitis, and this is not a chance occurrence, but the
relation between the two conditions is one of cause and
effect. The digestive troubles precede and prepare the
way for rickets, but are themselves the result of improper
alimentation. The physical signs of gastric ectasis are a
prominent belly, tympanism, and the succussion sound.
The functional troubles accompanying this condition are
manifold. There may be dyspepsia, convulsions, in-
somnia, urticaria, eczema, bronchitis, etc., any one alone
or several occurring together. The prognosis is serious,
because the dilatation may persist up to the period of
adolescence or even into adult life. The sole cause of
this affection is the improper feeding of infants ; the little
patients are brought up on the bottle, given solid food
prematurely, or weaned at an early period. But the dis-
ease may also occur in infants at the breast, who are
nursed too much or too frequently. The prophylaxis
consists in nursing at the breast and in restricting the
periods of suckling within reasonable limits. Weaning
should not be begun too soon, and should be accom-
panied very gradually. When dilatation exists the diet
should be strictly confined to milk for infants and dry
food for children of a more advanced age. Sometimes
washing out of the stomach is necessary.
Aural Thermometry. — Dr. Flitner {St, Petersburger
Dissertation) has instituted a series of measurements of
the temperature of the meatus auditorius, both in health
and in acute and chronic ear affections. The measure-
ments were taken by means of a specially adapted ther-
mometer. The average temperature of the meatus was
found to be in health 98.4° F., the averages for the axilla
and rectum being at the same time about 99° F. The
author's general conclusions are : i. Daily measurements
of the temperature in the course of inflammations of the
ear show that the temperature ofthe latter stands in a
constant regular connection with the general tempera-
ture of the body. Therefore, in ear affections, the local
measurements not only may be. substituted for, but even
must be preferred to measurements of the temperature in
the rectum and axilla. 2. The same may be asserted in
regard to ear affections complicated with pneumonia,
erysipelas, and other diseases. 3. In cases of ear affec-
tions complicated with morbid processes in the cranial
cavitj', or even on the surface of the skull (caries, phle-
bitis of the sinuses, er}'sipelas), the temperature in the
meatus sometimes stands higher than in the rectum.
Hence the measurements in the ear canal give us a
clearer indication as to the course of morbid process in
the head than the rectal measurements, and are prefer-
able to the latter beyond any comparison.
490
THE MEDICAL RECORD.
[November i, 1884.
The Medical Record:
A Weekly yournal of Medicine and Surgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD & Co.. Nos. 56 and 58 Ufayette Place.
New Yorky November i, 1884.
CURIOSITIES OF MEDICAL ADVERTISING.
•' Nay we see the weakness and credulity of men is such, as they
will often prefer a mountebank or witch before a learned physician."
—Lord Bacon.
We have been furnished with some instructive facts re-
garding the extent and character of the quack advertise-
ments which form so picturesque a feature in the daily
papers of our country. We refer now only to the per-
sonal advertisements of learned gentlemen who an-
nounce "advice free/' " no cure no pay," *' twenty years*
Prussian hospital experience," and similar appeals to the
business instinct and personal confidence of the com-
munity. The American press furnishes a rich field for
the study of this kind of literature, a study which is by
no means without profit, since advertising columns, after
all, reflect the wants of the people. Give us the medical
advertisements of a nation and we can get no inconsid-
erable insight into its character.
One of the first things which strikes the mind in peru-
sing the modest announcements of professional skill set
forth in the daily press is the aptness and vigor of the
literary style. Here for example is a whole story in
three words: "Dr. A. W. X., pile specialist, Indian-
apolis ; " again, " Dr. Tool, removes worms with agree-
able remedies, Philadelphia." With more circumlocu-
tion a Dr. N. B. announces, " after years of prac-
tice" that "married ladies, although apparently healthy
and not blessed with offspring, can receive a medicine
that is pleasant, safe, and certain to crown their hopes.
Let no false modesty prevent your calling." Per con-
tra, another announcement informs the lady readers of
the precious press with a suggestive brevity that " our
pennyroyal pills are as good as gold."
It is not always in simple language, however, that the
specialists of the secular and religious papers present
their claims. Assurances of skill and experience, guar-
antees of success, sympathetic appeals to sufferers from,
alas ! " Our National Weakness " (which we had always
thought was tea) all these are put forth with gorgeous
rhetorical embellishments. We might here express the
wonder how it is that the East Indian missionary, who
« supplies a simple vegetable formula" for cancer, con-
sumption, and erring but noble young men, continues to
hold out so long ; and why it is that " twenty years' ex-
perience in a Prussian hospital " is the necessary qualifi-
cation for the treatment (by mail) of amour blesse.
We desire to do no violence to the feelings of our West-
ern colleagues, but the hard fact exists that the medical
advertiser flourishes with an ever-increasing exuberance
as we go toward the setting sun. He also develops an
originality of expression and fertility of adjective which is
hardly known in the South or East.
From Jackson, Michigan, there comes a two column
ejaculation of the merits of a local doctor beginning:
"Earthquake! Earthquake! Earthquake!" ... "I
will treat on the weekly instalment plan. ... I can
treat the mother, I can treat the father, I can treat the
daughter! ... I will make you a Good Reliable
Family Physician ! " for twenty-five cents a week.
There is a place in Idaho known as Boise City. Two
columns or thereabouts of its local paper are devoted to
the advertisements of cock-sure specialists, and private
dispensaries, where the erring young and the prematurely
old are guaranteed a cure. If it is true that Boise City
is but a sample of other Western towns we can only con-
clude that the amount of '* manhood " lost or mislaid in
the territories is appalling.
It appears to be the custom of these advertising spe-
cialists to make their homes in the great cities and then
placard the columns of provincial newspapers with their
advertisements. San Francisco, St. Louis, Denver, Chica-
go, New York, Philadelphia, and Boston are all more or
less supplied with these creatures, San Francisco heading
the list.
Another custom which is growing rapidly in the West
is that of establishing private dispensaries for the cure
of all forms of ailment. The Oxygen Cure Company
and the Galenic Institute of Minnesota, the Li-po-tai
Chinese Sanitarium of San Francisco, the Medical
and Surgical Infirmaries in Nebraska, Wisconsin, and
Colorado are specimens of this form of enterprise. A
somewhat cursory examination among the papers of a
dozen Western cities shows that all are supplied with
from one to five advertising " private dispensaries.**
Omaha is blessed with three, and San Francisco with
five.
Men and women apply to advertising quacks, first,
because they ignorantly believe in their pretensions j.^j'
second, because they have sotne disease which they do
not wish to disclose to their family physician or a respect-
able medical man ; and lastly, quacks are a final resort
of chronic invalidism or fatal disease. The quacks them-
selves advertise to treat and cure those diseases into
whose therapeutics the element of imagination largely ;
enters. '* Chronic nervous diseases," sexual disorders,
syphilis, all these furnish a fruitful field for presumptuous
ignorance to work upon. Among over fifty quack ad-
vertisements nearly forty appeal to the classes above
mentioned. For the rest, it seems that piles and fistulas,
cancer and consumption, varicocele, rheumatism, and
gout are paying specialties. In a certain section of the
West a Dr. C, "after twenty years' practice in Utah,"
" will visit Southern settlements, treating club-foot, hare-
lip, etc." From which it appears that Utah has advan-
tages for the training of orthopoedic specialists not here-
tofore generally known.
There is some tendency to make homoeopathy a basis
of trade. A doctor in Austin, Texas, announces himself
as a homoeopath, and adds, with a slight degree of ortho-
graphical inadequacy, that he makes " difficult and chronic
November i, 1884.]
THE MEDICAL RECORD.
49^
diseases a specialty.'' He is less liberal than a certain
"s|>ecialist of New York City," temporarily residing
among the Mormons, whose methods of treatment are
stated with an absolute absence of bias, to be " Homoeo-
pathic, eclectic, electricity, and magnetism ; cures guaran-
teed by maiV which, we would add, is by far the safest
way to guarantee them.
It must not be inferred that the East or South is en-
tirely free from the obnoxious advertisements of the kind
we are describing. New York, while it has not many of
the typical advertising specialists, is particularly rich in
<* magnetic healers," 'Vitalizing rubbers," and doctresses
who "take confinements at the house." Throughout
New England the practice is gaining of a doctor pub-
lishing his card, often with some slight recommendation,
such as "graduate of ," "four years* city experience,"
etc., appended. By this means good physicians some-
times get in bad company. Thus the card of a Hartford
physician comes out sandwiched between that of a clair-
voyant and a chronic disease specialist. Certain parts
of New England are victimized by itinerant quacks, who
enter a town, buy up the local editor, and fleece the
hypochondriacs and incurables annually.
We cannot close without referring to an advertisement
which recently appeared in the Philadelphia Ledger.
The capacity shown therein for exact and clear-cut defi-
nition of the author's wants and talents is quite unique.
A physician, graduate of Jefferson Medical College (Class
of?), '* whose religious character is above reproach wants
a cash salary ... in a wealthy sickly family. War-
rants to treat successfully dropsy, consumption, cancer,"
etc. A cash salary in a wealthy sickly family is a great
desideratum, and it is unfortunate that society is so ar-
ranged that wealthy families as a rule refuse to be sickly ;
while sickly families as a rule are bound to be poor.
It would be a mistake to infer from the facts and com-
ments given above, that the practice of advertising in the
secular press is at all common among the profession in
this country. On the contrary, we have been surprised
and pleased to find that among the seventy thousand
V doctors in this country where advertising is a national
institution, so few comparatively indulge in it. That the
practice is sortiewhat increasing, however, cannot be
denied. And we fear that the license given by a wrong
interpretation of good ethical rules, to distribute profes-
sional and " practice limited " cards ad libitum is doing
something to increase this tendency.
THE MEDICAL VALUE OF THE COFFEE ALKALOID
AND ITS ALLIES.
There is one element of uncertainty in medical practice
which doctors ought to eliminate^ and that is the use of
impure drugs. No one has done greater service to the
profession in this line than Dr. £. R. Squibb, and it has
again to thank him for calling in question the utility of
certain preparations which have of late years been flood-
ing the market, viz., those of coca and guarana. Dr.
Squibb states emphatically that no good, fresh, carefully
prepared specimens of coca are obtainable. He also
says that the specimens of guarana, which is not a pure
article but a South American secret mixture, are also
untrustworthy, unequal, and expensive. He has, there-
fore, decided to abandon the preparation of these articles
and to substitute fluid extracts of tea and of green coffee
in their place.
It is known that the active principles caffeine, theinei
and guaranine are chemically and physiologically identical^
From certain tests Dr. Squibb concludes that, in thq
power of keeping ofif drowsiness and producing a sensQ
of restfulness, the following were the equivalents :
Three grains of artificial caffeine =180 grains of coca^
or 45 grains of cocaine ; three grains of artificial caffeine
= 70 grains of tea, containing 2 grains of theine ; three
grains of artificial caffeine = 60 grains of guarana, coa-*
taining 2.6 grains of guaranine ; three grains of artificial
caflfeine = 160 grains of coflfee, containing 1.95 grain
of caffeine.
According to this the cocaine alkaloid is the strongest^
next comes the coffee alkaloid, then that of the tea and
of guarana. The differences between the last three,
however, are slight and might easily be accounted for,,
without having to assume any physiological difference in
the alkaloids.
The conclusion arrived at by Dr. Squibb is that we-
can dispense entirely with coca and guarana in medicine,
and can use instead officinal preparations of tea and
coffee or the alkaloid caffeine. Fluid extracts are pre-
ferred, because in this way the dosage can be more ac-
curately adjusted.
Dr. Squibb* s views and conclusions merit the atten-
tion of the profession, but they are open to criticism in
two directions. In offering the tea and coffee extracts
as substitutes for coca, guarana, and in a measure, caf-
feine, he based his inferences as to equivalence mainly
upon a series of experiments upon a single symptom,
drowsiness, in a single, individual. Furthermore, it is to
be inferred that cocaine and caffeine are identical alka-^
loids. This is not the case. The chemical formulae for
the two are different, and physiological experiments, sa
far as they have been carried, also show some differences
in action.
The claim that tea and coffee extracts will do all that
coca and guarana will is a plausible one, and it is impor-^
tant that it should be definitely established or refuted. We
trust that further careful experiment will be made. Mean*
while we remind our readers of the very truthful words of
Rossbach : " The medicinal use of caffeine is very
limited."
A NEW BISMUTH-TEST FOR SUGAR.
The Trommer test for sugar is, as all urologists are^
aware, inexact and difficult in many cases on account of
various substances which react with the solution, as cre-
atinine and uric acid, and also because creatinine and
other substances retain the cupric oxide in solution. In
order to avoid these difficulties it has been attempted ta
replace the solution by the reduction of subnitrate of
bismuth in the presence of an alkaline liquid. To this,
end Almen has used a solution of 2 grms. of subnitrate of
bismuth, 4 grms. of tartrate of potassium and sodium, and
100 grms. of a solution of caustic potash ; and with this
he has succeeded in detecting o. i of sugar in 100 grms. of
the liquid.
After a good deal of experimentation on this subject,
Nylander, in a recent paper in the Zeiischrift fUr phys^
492
THE MEDICAL RECORD.
[November i, 1884.
iologische Chemiey advises a solution containing 2 grms. of
subnitrate of bismuth, 4 grms. of the tartrate of potassium
and sodium, and 100 grms. of caustic alkaline lessive j
the undissolved bismuth salt is separated by filtra-
tion, and in order to better determine the effect of the
quantity of the caustic alkali, he dissolved in the alkaline
liquid 3, 6, 7, 1 2, and 1 7 per cent, of supposed anhydrous
caustic soda. He found that the solution containing about
8 per cent, of the caustic alkali was much the most deli-
cate, and that it should be used i part for 10 of the liquid
to be analyzed ; also that with this he could easily detect
0.04 per cent, of sugar in the urine. Even with 0.025
per cent, tlie reaction was not doubtful.
It has been objected to the bismuth solution that it gives
a black precipitate, but Nylander shows that this may be
avoided by using not more than 8 per cent, of the alkali
solution, the precipitate being caused by an excess of it.
It does, however, cause a precipitation of phosphates.
In examining one hundred specimens of urine fourteen
were found, by the bismuth test, to contain sugar. These
fourteen were then examined by the Trommer and Worm-
MOller methods; these showed sugar in twelve speci-
mens, the result in the other two being doubtful, but the
yeast test showed that these also contained sugar. The
presence of albumen in a specimen of urine interferes with
the reaction of the bismuth solution, but only when it
exceeds o. 5 per cent. The presence of sugar is shown by
a black or grayish tint. With this test, therefore, as with
others, it is necessary first to free the urine from albumen.
A great advantage of this solution is that it keeps well.
BRAIN-PRESSURE. IN PUBLIC SCHOOLS.
Only a short time ago certain English sanitarians were
claiming that the decreased death»rate in Great Britain
was largely due to the improvement in the modes of rear-
ing and educating children. Now comes an elaborate
report made by Dr. Crichton Brown, in which it is con-
tended that the system of school education in England,
is doing great mental and physical damage to the rising
generations. He claims that in some London schools
nearly one-half (46 per cent.) the children suffer from
iiabitual headache, that 54 per cent, suffer from neuralgia
or toothache, 40 per. cent, from insomnia, and that short-
sightedness gradually increases from 2^ per cent, in
Standard I. to 9 per cent, in Standard VI.
Dr. Brown shows that while in late years the mortality
from hydrocephalus under five years of age has been
steadily falling, owing to improved sanitary conditions,
the mortality between five to twenty years has been stead-
ily increasing. He claims that the cause of this increased
mortality is the brain-excitement and fatigue associated
with the processes of education. The increase in the
number of suicides, especially of those under sixteen
years of age, and the increase of insanity are referred to
as having some connection with the educational methods.
The main point which is made against the British sys-
tem of elementary education is, that it attempts to enforce
the same amount and kind of instruction upon children
who differ in the greatest degree as to mental develop-
ment and physical strength. The grade system, as car-
ried on, is a kind of Procrustean bed, to which youthful
tninds must be made to accommodate themselves. Ex-
aminations, studying after school and at home, are all
sources of immense injury and evil, according to Dr;
Brown.
The report, of which the foregoing are the main feature?,
13 accompanied with a counter-report by one of the offi-
cers of the Government, Mr. Fitch. This latter gentle-
man vigorously and ably criticises Dr. Brown's facts, con*
elusions, and methods.
The London medical press naturally supports the med-
ical view of the case, as presented by the distinguished
Superintendent of the West Riding Lunatic Asylum.
From this side of the Atlantic it appears as if Dr.
Brown had made a very strong plea, but had been rather
carried away by the dominance of preconceived convio-
tions. This indeed is not the first time that he has ex-
hibited his capacity for emplojdng tempestuous argumen-
tation and unscientific method. It seems incredible that
in the present case he has not made some mistakes.
The code exacted by the English school system is lighter
than that of France, Germany, Belgium, and, we believe,
America. Yet we are told that half of the English school
children have continual headaches, insomnia, and neu-
ralgia! Is it brain-pressure that does all this? Then
English children must be phenomenally stupid, since
there is certainly no such condition in other countries.
The fact is, Dr. Brown has dealt with only half the
truth. He should have said more about the homes and
food of the school children. Feed them, clothe them,
and house them better, and the talk about over-pressure
will be very much less.
Not that we deny the existence, to a considerable ex-
tent, of the evils depicted. They are known in this coun-
try as well as England, and the " Procrustean bed system
of teaching" has been condemned for years. But reme-
dies are expensive. The plan suggested of having med-
ical inspectors for the schools is a good one, so far as it
goes. It has been tried in France, and in some parts of
this country, and has, we believe, worked satisfactorily.
AMERICAN MODE OF USING IODIDE OF POTASSIUM.
For over fifteen years, says Dr. E. C. Seguin, in the Ar-
chives of Medicine^ the practice of giving very large doses
of potassium iodide in certain cases has been in use in
a small circle of New York physicians. By large doses is
meant such as make up a total of two and a half to ten
grammes, in twenty-four hours. The cases where these
doses are indicated are those of chronic or subacute ul-
cerative syphilides or of nervous syphilis ; in rapidly ex-
tending syphilitic ulcer; in extremely acute syphilitic
cranial pain ; in syphilitic coma or stupor ; in certain
cases of syphilitic hemispasm, monospasm, or hemiplegia-
The mode of administration is to give the saturated solu-
tion of potassium iodide largely diluted in plain or feebly
alkaline water. It is usually given after meals, and prob-
ably, as a rule, acts better in this way. Dr. Seguin
advises administering it before meals ; and un-
doubtedly sometimes this method is better. It is one
which used to be strongly recommended by older
teachers, on theoretical grounds. It is sometimes found,
we would add, that the iodide can be best taken in one
large dose at night ; or, if the potassium salt causes
irritability, the iodide of sodium may be substituted.
November i, 1884.]
THE MEDICAL RECORD.
49a
It should not be forgotten that in a few cases the
patients cannot take these large doses, and also that a
very prolonged use of them is sure eventually to produce
an atonic state of the gastro-intestinal musculature.
Dr. Seguin has quoted a long list of authorities on
sj-philis, general medicine, and therai)eutics, in order to
show that the plan of heroic dosage here referred to
receives slight or no adequate notice in text-books. It
is only in the works of Loomis, Bartholow, and of Van
Buren and Keyes, Bumstead and Taylor in this country,
and of Buzzard abroad, that any recognition of it is
found.
The writer also shows that the method originated with
the late Dr. Van Buren, of this city, and became grad-
ually adopted as the result of practical experience by a
number of New York physicians. It has been taught by
Dr. Wm. H. Draper, by Dr. K W. Taylor, and also by
Dr. Wm. A. Hammond, for many years. It is essentially
an American, and more essentially a New York, idea.
It is very proper that attention has been called to what
is undoubtedly a remarkably efficient therapeutic meas-
ure, and that due credit has been given to American
medicine for originating it.
Cocaine Hydrochlorate as a Local ANiEsxHETic
IN Gynecology. — Professor Polk, of this city, as will be
seen by a communication in the present issue, has used
hydrochlorate of cocaine successfully in two operations
upon the cervix uteri. The results in these cases look
toward an extensive usefulness of the new anassthetic
not only in gynecology but in many of the minor surgical
operations.
The Profits of the International Health Ex-
hibition.— The Health Exhibition which was lately
closed in London shows a profit of ^30,000.
Dr. Joseph White, of Canajoharie, N. Y., died on
October 27th, in the eighty-fourth year of his age. He
was one of the oldest physicians, and was the oldest
Mason in the State.
The International Collective Investigation. —
The first inquiry which the Committee propose to insti-
tute is in regard to rachitis, its frequency, and the phy-
sical condition of the district in which it is found.
The Price of Cocaine Hydrochlorate. — The
first preparations of cocaine hydrochlorate used in this
city were procured at an expense of 60 cents a grain,
or $12 an ounce for a four per cent, solution. It will
probably be soon about forty cents a grain. Its price,
from present indications, cannot become much less,
as only 0.0 1 to 0.02 per cent, of cocaine can be ex-
tracted from the erythroxylon coca, depending on the
quality of the leaves. The salt used in Albany at Dr.
Merrill's college clinic cost $4.20 per ounce, or 87^ cents
a grain. On the other hand, it may not be generally
known that Merck, whose laboratory prepared the first
used in this city, has an agency in New York, which re-
ceives by cable early word of the exportation of special
drags, and that a considerable quantity is now under way
to New York. At the principal druggists here the demand
Mortality
percent.
has far exceeded the supply. It is to be hoped that the
new importation will bring the drug within easy reach of
all. It had been used on the continent in throat clinics
several months before its introduction into ophthalmic
practice by Dr. Koller, which was at the annual Oph-
thalmological Congress in Heidelberg, September 15th.
We learn from a professional friend, living in our vicinity,
that he had used it in a case of paraesthesia of the larynx
of an exceedingly nervous lady some weeks before the
publication of Dr. Noyes' letter in The Medical
Record.
Another War over Listerism and Ovariotomy.
— A lively discussion is threatened between Mr. Lawson
Tait and Mr. Knowsley Thornton upon the question of
the value of Listerism in ovariotomy. Mr. Thornton has
published a letter {American Journal of Obstetrics)^ in
which he tries to show that his own records of Listerian
ovariotomies are better than those of either Bantock or
Tait, who do not use Listerism. The following tables
are interesting :
Cases. Died.
Thornton, non-antiseptic hospital ovariot-
omies 33 S .15.15
Bantoclc, non-antiseptic hospital , ovariot-
omies 36 8 22.2a
Thornton, "Listerian'' hospital ovariot-
omies 129 15 ii*62
Bantock, *^ Listerian " hospital ovarioto-
mies 113 16 14.15
Tait's " strictly Listerian," on his state-
ment so 3 6
Non-antiseptic 176 24 13.95
It is known that Mr. Tait, when still a rising ovariot-
omist, was hardly treated with fairness by the London
gentlemen whom he now in his triumph too rancorously
assails.
The Decline of Antipvresis. — At the meeting of
the German Society of Naturalists and Physicians in
September last. Professor Ebstein, of Gottingen, read a
paper upon the treatment of typhoid fever, based on the
treatment of 235 cases in the past seven and a half
years. The mortality was 5.5 per cent., or excluding
cases where treatment had not been applied, 2.5 per
cent. Professor Ebstein denied the value of the abor*
tive calomel treatment. He had used careful dietetic
and symptomatic treatment. Baths and antipyretic
medicines were only to be used when the high prolonged
temperature was evidently causing bad symptoms. The
routine use of these measures was not advised. Pro-
fessor Ebstein' s views were supported by most of the
speakers in the discussion which followed.
The Recognition of Hard Preliminary Work.—
Apropos of this matter, which we discussed in our editorial
columns recently, is a letter from a correspondent of the
College and Clinical Record^ who says : ** Men who have
worked their way through a good medical school, and
passed the ordeal of spiking the masked battery they
were compelled to charge at the end of their collegiate
course, feel that they have learned something substantial,
and that their diplomas are the certificates to this effect
made by illustrious men. Every honest worker feels
this ; and even though he know enough to know how
little he knows, yet he feels that his diploma is worth
more than that of a man who graduated at the ' College
of Physicians and Surgeons of Brown's Cross Roads,
Western Arizona.' It is true, a good diploma does not
494
THE MEDICAL RECORD.
[November i, igg^
/ make a good doctor, but it immensely increases the
chances in this direction, and diplomas do have a varying
commercial value ! " A self-protection, the writer adds,
trill drive all graduates of first-class colleges to the
plan of indicating their alma mater after the letters
M.D.
The correspondent from whom we quote is right, so
far as he goes. As is natural witli young graduates, he
attaches a rather exclusive importance to the value of
his alma mater, and forgets that other things than two or
three years at a medical college are required to make a
doctor. The degree of A.B. or A.M., the year or more
in a hospital, the post-graduate study abroad or at home,
may, any one of them, more than compensate for didac-
tic disadvantages.
The Use of Cocaine Hydrochlorate by Dr. E.
S. Peck, of New York. — Dr. Peck writes : " Of the three
uses of the drug — one physiological, two clinical — at my
hands, only one deserves special mention at this time,
while all corroborate its anaesthetic properties. A laborer
received a clean wound of the lower lid, cutting through
the conjunctiva, tarsal margin, and integument. A
stitch in the conjunctiva and two in the integument of
the lid were taken after six instillations of a four per
cent, solution, covering twenty-five minutes. Patient
experienced no pain either from the forceps or needles,
and stated that the sensation was as if something had
been pressed against the parts involved."
The Shady Side of Medical Education Abroad. —
The New York Medical Journal discusses in a forcible
and suggestive manner certain of the dangers to which
students who go abroad to study for medical instruction
are subjected. ** We have no hesitation in asserting," says
Ih^ Journal^ ^' that many a medical student who would
have made a steady and honorable member of his profes-
sion, had he entered upon his duties at once on leaving
college or hospital, has been spoiled by his residence
abroad, where he has broadened his professional knowl-
edge but suffered an irreparable loss of moral tone, in
delicacy of feeling, and in tenderness toward sufifering.
This is no cant — it is simply an every-day experience.
It is unnecessary to urge the trite remark that an edu-
cated physician is something more than an encyclopaedia
of facts or an infallible diagnostician, that he is or should
be an honorable gentleman, and that, too, not for utili-
tarian reasons, but because it is in him. . . . The
* free and easy ' moral atmosphere of the great con-
tinental capitals, notably Vienna, the light regard in
which woman is held, the perfect subjection in which
patients are kept, and the cold-blooded way in which
those patients are treated — all of these are dangerous ele-
ments in foreign medical education. . . . Again,
methods of examination and treating patients are learned
which it would be positive professional suicide for a man
to practise at home." There is more in this same line
given by our esteemed contemporary, who does not at
all deny at the same time that great benefit may be ob-
tained by foreign study. We commend the remarks to
those of our readers who contemplate studying abroad
or sending their sons there. It is true that the profession
has now more need of honorable gentlemen than of
*^ soulless scientists " in its ranks.
The Paris Academie de Medicine has talked cholera
all summer and has got no further on the matter than
when it started. Upon great occasions this learned body
seems always to turn itself into a Cave of the Winds.
Dr. Mills succeeds Dr. Osier as Professor of Physi.
ology in the McGill Medical College, Montreal
Poisoning from Mother Winslow*s Soothing Syr\jp,
— Dr. A. B. Hirsh reported to the Philadelphia County
Medical Society the case of a boy, aged twenty momhs,
who was poisoned by "Mother Winslow's Soothing
Syrup." He was given four doses of less than half a tea-
spoonful in fourteen hours. Vigorous anti-narcotic treat-
ment alone saved the child. Many physicians, we believe,
are familiar with similar cases.
American Academy of Medicine. — At the annual
meeting of the American Academy of Medicine, held this
week in Baltimore, the following officers were elected :
President— A\\>^ri L. Gihon, United States Navy ; Vice-
Fresidenis^^. Stansbury Sutton, of Pittsburg, Pa.;
James A. Steward, of Baltimore, Md.; William Elmer, of
Bridgeton, N. J., and James Cheston Morris, of Phila-
delphia, Pa. ; Secretary and Treasurer — Richard J.
Dunglison, of Philadelphia, Pa., and Charles Mclntyre,
Jr., of Easton, Pa., Assistant,
Dr. Oliver Wendell Holmes, of Boston, and Major
George M. Sternberg, M.D., of the U. S. Army, were
elected honorary members. The following resolution
was unanimously adopted :
" That the American Academy of Medicine recognizes
in the recent munificent gift of William H. Vanderbilt to
the College of Physicians and Surgeons of New York, a
most important and valuable service to the science of
medicine in America ; that in this spirit the Academy
tenders to Mr. Vanderbilt its obligations, with the assur-
ance that in no better way could the higher education of
our profession and the benefit of humanity be promoted."
%tmzyxi& atid Notices.
The Alpine Winter Cure. With Notes on Davos
Platz, Wiesen, St. Moritz, and the Maloja. By A. T.
Tucker Wise, M.D., L.R.C.P., M.R.C.S. London:
Baillidre, Tindall & Cox. 1884.
Dr. Wi^e has made a special study of certain mountain
health-stations, and, writing without bias or exaggeration
of any kind, what he says may be accepted as true with- ,
out hesitancy. The remarkable curative and health-
giving properties of the Alpine climate are abundantly 1
shown in this unpretentious little volume. I
Practical Manual of Obstetrics. By E. Verrier,
M.D., Lecturer on Obstetrics in the Faculty of Medi-
cine of Paris. Fourth Edition, with the Four Ob-
stetric Tables of Professor Pajot ; One Hundred and
Five Illustrations. First American Edition, with Re-
vision and Annotations by Edward L. Partridge,
M.D., Professor of Obstetrics in the New York Posl-
Graduate Medical School. Wood's Library of Med-
ical Authors. New York : W. Wood & Co. 1B84.
This is a brief risumi of practical obstetrics, more par-
ticularly from the French point of view. It has been in
a measure Americanized by the incorporation of more or
less important notes supplied by Dr. Partridge. In its
new shape it will be found serviceable by students and
those practitioners who lack time for the study of certain
details, which are necessarily found in the more pre-
tentious and elaborate treatises.
November i, 1884.]
THE MEDICAL RECORD.
495
Students' Manual of ELEcrRo-THERAPEurics. By
R. W. Amidon, A.M., M.D. New York : G. P. Put-
nam's Sons. 1 884*
This modest little volume can in no way replace, nor
does it pretend to, the more elaborate treatises on medi-
<:al electricity already extant. But as an introduction to
practical electro-therapeutics this book has its raison
atre. Its chief merit consists in the fact that it is quite
concise, and, as far as it goes, thoroughly scientific Static
electricity is not dignified by so much as a mere mention
by the author.
Malaria and Malarial Diseases. By George M.
Sternberg, M.D., F.R.M.S., Major and Surgeon
U. S.f Army, etc. Wood's Library of Medical Authors.
New York : W. Wood & Co. 1884.
The author has wisely prepared a work which will
be very welcome to the general practitioner, as giv-
ing, not the dogmatic views of a single person, but the
combined experience of observers in various countries,
ibcluding, of course, our own. It is obvious to all candid
minds that there are many puzzling problems connected
with the subject of malaria. Dr. Sternberg does not pre-
tend to have solved them. On the other hand, we cer-
tainly know considerably more about malarial diseases
to-day than we did ten or even five years ago. The
author's treatise is in the main an able and candid re-
view of the actual state of our knowledge, considered in
the light of the most recent researches published at
home and abroad, supplemented by the additional infor-
mation derived from the author's personal studies.
Manual of Physiology. By Gerald F. Yeo, M.D.,
F.R.C.S., Professor of Physiology in Kings College,
London, etc. Philadelphia : P. Blakiston. 1884.
This is an elementary treatise designed for the use of
students. It is clearly written, and, while not too bulky
a volume, it yet contains all the facts necessary to a com-
prehension of the principles of physiology. The style is
much simpler than that of Foster's well-known treatise,
and there is far less display of abstruse science. Yeo's.
physiology does not commend itself to advanced stu-
dents, but the beginner will find in it all that he needs
for the acquisition of clear ideas concerning the first
principles of a rather complicated science.*
The Human Element in Sex. Being a Medical In-
quiry into the Relation of Sexual Physiology to Chris-
tian Morality. By Dr. Elizabeth Blackwell. Sec-
ond Edition. London : J. & A. Churchill. 1884.
This little work, though a trifle diffuse in style, and
perhaps a little narrow in some of its positions, is on the
whole a sound, sensible, and useful contribution to the
subject of physiology and morals.
iljepartB of ^ocijeties.
MEDICAL SOCIETY OF THE COUNTY OF
NEW YORK.
Annual Meeiingj October 27, 1884.
S. Oakley Vander Poel, M.D., LL.D., President, in
the Chair.
the report of the board of censors,
together with the report of the counsel of the So-
ciety, E. C. Ripley, Esq., was read by Dr. J. W.
Howe, Secretary, and showed that during the last year
the work oi prosecuting illegal practitioners had been
carried on vigorously and successfully. The Eclectic
Medical College of the City of New York had been pro-
ceeded against for illegal transactions with reference to
granting diplomas, and the prospect was clear for con-
victing the authorities of the institution of having issued
bogus diplomas, and therefore the annulling of the charter
of the college.
the report of the committee on ethics
showed that charges made by one member against an-
other had occurred in only one instance, and in this the
plaintiff had declined to press them.
The committee spoke against the indulgence to which
physicians, to a considerable extent, favored themselves
with, by recommending copyrighted medicines, mineral
waters, etc.
the report of the committee on hygiene
was read by Dr. R. Van Santvoord, Secretary, and con-
sisted of two parts : First,
ventilation of the sewers,
by Dr. E. H. Janes. " Among the reports presented by
the Committee on Hygiene at the last annual meeting was
one reflecting somewhat severely on the method of ven-
tilating public sewers in this city. This subject, regarded
by your committee as an important one, has received con-
siderable attention, and while the method of ventilation
now in use may be open to criticism, and in some locali-
ties decidedly objectionable, the present committee is
not yet prepared to fully sustain the report of its prede-
cessor, nor to suggest any other plan that would be
equally practicable and as readily controlled by the public
authorities.
**The principal object of sewer ventilation is to protect
the atmosphere of our dwellings from what is commonly
called * sewer gas,' or, what it is more properly, sewer air,
with which is mingled more or less of the products of or-
ganic decomposition. Its necessity arises from various
causes to which sewers are exposed. Variations in tem-
perature, the amount of sewage, efficiency of flushing,
rate of flow, and condition of the outlet, all influence the
development of deleterious gases, as they retard or hasten
the process of decomposition, and thus bear an important
relation to the necessity for ventilation. A sewer with a
uniform water supply and a steady, uninterrupted flow
will require less means for ventilation than one which is
tide-locked twice every twenty-four hours, and thus sub-
jected to periodical contraction and expansion of its air
capacity. When a sewer becomes tide-locked, not only
is the discharge for the time being arrested, but the con-
tents accumulate by reason of fresh contributions of sew-
age and tidal influx ; and if this occurs during a heavy
rain the case is aggravated, the accumulations of sewage,
tide, and storm-water increase, and the air in the sewer is
forced back, being more and more compressed, perhaps
to half its original volume. In this condition we have
within the sewer the presence of an additional atmosphere
which no house-trap can withstand. The method of
relieving this pressure adopted in our city, in the city
of London, and indeed in all the cities of England, is to
perforate the manhole-covers that the imprisoned air may
escape along the middle of the roadway, and thus ming-
ling with the atmosphere, the gaseous products of decom-
position are readily difl'used, the organic particles oxidized
and rendered harmless. As the tide recedes the sewer
is relieved of its engorgement, the manhole shafts become
inlets for fresh air, and thus the air in the sewer is re-
newed as the accumulated sewage is washed by the
receding tide.
" During the period of low water, and also in sewers
that do not become tide-locked, the manhole shafts act
alternately as upcast and downcast shafts, according to
variations of temperature which' occur at every discharge
of hot water from the house-drain, causing an upward
current at one manhole and a downward one at the
next. In proportion as the air in the sewer is thus kept
in motion, and the flow of sewage is uninterrupted, will
decomposition be retarded or prevented, a result secured
only by constant motion as opposed to stagnation. It
does not appear that the air from such a sewer discharged
through the manhole-covers along the roadway of a
street lying in the direction of the prevailing winds, can
be to any extent injurious to occupants of houses on such
a street. With stagnant sewers along narrow, crooked
496
THE MEDICAL RECORD.
[November i, 1884.
streets lined on either side with high buildings, the case
is different, and often aggravated by the discharge of waste
steam into the sewer, a practice' which cannot be too
severely condemned.
"It appears to your committee that while the dangers
arising from ventilating sewers into the roadway have
probably been somewhat exaggerated, still a better
method would be desirable, could one equally practicable
be devised and adopted. It has been suggested that
sewer ventilation would be best and most safely effected
by carrj^ng a four- or six-inch pipe from each house-drain
at a point between the trap and the sewer up the wall of
the house so as to terminate above the roof. Were houses
along a street of a uniform height, and the material and
joints of the ventilating pipe impermeable to sewer air,
such a method would be an improvement on the one now
in use, but its adoption would involve the interference
of the authorities with the rights of private property own-
ers, which our citizens are not yet ready to grant. A far
more effective method would be to ventilate through the
house-drains and soil-pipes, the warmth of which would
. maintain a constant upward current, while the perforated
manhole-covers would serve as inlets for fresh air. But
as this method would require absolute perfection in our
plumbing arrangements, a condition which does not ob-
tain in our city, your committee cannot think of recom-
mending it."
The second part was prepared by Dr. Richard H.
Derby, and consisted of
NOTES ON CONTAGIOUS OPHTHALMIA IN SOME OF THE
ASYLUMS OF NEW YORK CFTY.
After giving an outline of the clinical features of this
disease, making special reference to its contagious char-
acter, the writer directed attention to the existence of
the malady among the children cared for in the larger
asylums of this city.
In the asylum for boys he found that about twenty-
nine per cent, had contagious ophthalmia; in the asylum
for girls, nineteen per cent. In nearly all these cases*
the disease^ was in the first stage. On inspecting the
dormitories^and wash-rooms it was found that each child
had its own bed, separate towel, and that water for wash-
ing was supplied from small jets, at intervals of one foot,
along a horizontal pipe above the sink ; no basins were
used. In the boys' asylum the bath-tub was sufficiently
large to allow eight to bathe at the same time.
In another of the largest institutions, 28.5 per cent, of
the seniors ; thirty-six per cent, of the juvenile depart-
ment in the boys' division had contagious ophthalmia ;
in the girls' division thirty per cent, of the seniors were
afflicted with the same affection. Total number of chil-
dren, 1,586.
After giving similar statistics from another institution,
Dr. Derby continued that the conimunicability of the
affection was strikingly illustrated by the fact that when
a group of children presented themselves in succession,
they were those who habitually occupied adjacent seats
in the class-room.
The purpose of these investigations will have been ef-
fected if the writer succeeded in drawing attention to
the fact that in the asylums of this city a disease fraught
with danger to the eyes of all assembled there exists to
an alarming extent
The whole number of children examined was 3,025,
whose eyes were believed in the main to be healthy, and
25.12 per cent., or one out of every four, had communi-
cable eye disease. To meet an evil so great, should not
a commission be appointed by our State Board of Health,
for the purpose of making a thorough investigation of
the condition of the eyes of all inmates of our asylums
and reformatory schools ? Should we not see,^rj/, that
it be an absolute rule in these institutions that no child
be received until his or her eyes have been examined by
competent men ? Second^ that from time to time the eyes
of all inmates of these institutions should be examined.
and if cases of contagious ophthalmia are found they
should be isolated and receive proper treatment ?
For assistance in making these investigations he was
indebted to Dr. W. S. Dennett, of this city.
On motion by Dr. C. R. Agnew, the present Com-
mittee on Hygiene was continued as a special committee
to report further on the subject of Dr. Derby's contribu-
tion.
OFFICERS FOR THE ENSUING YEAR.
President^ Dr. Daniel Lewis; Vtce-Presideni^ Dr.
Laurence Johnson ; Secretary^ Dr. Wesley M. Carpen-
ter ; Assistant Secretary^ Dr. Charles H. Avery ; Treats
urer^ Dr. Orlando B. Douglas ; Censors^ Drs. Joseph W.
Howe, Frederick R. S. Drake, Francis M. Weld, Henry
T. Peirce, William Oliver Moore.
THE COMMITTEE ON PRIZE ESSAYS.
Dr. C. C. Lee, Chairman, reported that only one es
say had been submitted, and that in the unanimous
opinion of the committee it was not sufficiently meri-
torious to be entitled to the prize.
THE OFFICE OF CORONER.
Dr. R. Tauszicy offered a resolution asking the So-
ciety to indorse the nomination of Dr. Messemer for
Coroner. It was laid upon the table.
PROPOSED AMENDMENT TO THE BY-LAWS.
Dr. a. Jacobi offered the following amendment to the
by-laws. That the Comitia Minora be directed to recom-
mend no applicant for admission to membership unless
he be a graduate from a medical college in good stand-
ing, or a licentiate of a regular — ^unsectanan — Stale or
County Medical Society of this or any other State ; or if
his certificate be of sectarian character, unless the appli-
cant declare in writing his or her abnegation of sec-
tarian principles and practice. Laid over under the rule
until the next annual meeting.
An amendment to the by-laws was adopted providing
that the stated meeting heretofore held in the month of
June be omitted.
On motion by Dr. Piffard, the subject of
ARREARS IN DUES
was referred to the Comitia Minora^ to be reported upon
at the next meeting of the Society with reference to the
best method of dealing with delinquents.
APPLICANTS for MEMBERSHIP GRADUATES OF HOMCEO-
PATHIC MEDICAL COLLEGES.
The Comitia Minora^ to which the applications of two
candidates for admission to membership have been re-
ferred back, because they were graduates of homoeopathic
medical colleges, reported again, and recommended that
certificates of membership be granted to these applicants.
The Secretary read letters from the candidates, in
which each stated that he had resigned from all homoeo-
pathic medical societies, did not and would not practise
medicine with sectarian designation, were in no way
connected with homoeopathic medical journals, and were
willing to be governed professionally by the by-laws and
regulations of the Medical Society of the County of
New York.
Dr. £. Eliot, by proxy, offered the following motion :
That a diploma from a homoeopathic medical college
alone must not be considered as a claim for admission to
membership in this Society.
The motion was laid upon the table, and the recom-
mendation of the Comitia was adopted.
The President announced the deaths of Dr. John
G. Adams, Dr. Joel Foster, Dr. David F. Fetter, and
Dr. Allen S. Church.
The Society then adjourned to ^meet on the fourth
Monday in November.
November i, 1884.]
THE MEDICAL RECORD.
497
THE NEW YORK NEUROLOGICAL SOCIETY.
Stated Meeting, October 7, 1884.
W. J. Morton, M.D., President, in the Chair.
on THE nervous ORIGIN OF SOME DISORDERS OF THE
ALIMENTARY CANAL.
Dr. L. Weber read a 'paper on the above subject (see
p. 481)-
Dr. E. C. Sequin, in opening the discussion, said that
the disorders alluded to in the paper just read were far
from uncommon. It must often prove quite difficult,
hoi^ever, to reach a positive diagnosis. The abdominal
symptoms were by no means so characteristic and well-
defined that a clear case could readily be made out. It
was to be remembered that dyspepsia, pure and simple,
was frequently accompanied by a variety of morbid
nervous manifestations. In this countr}' especially, where
we had both many dyspeptics and numerous neurotics, a
differential diagnosis would not always be possible. In
this connection he also alluded to the fact that the ordi-
nary American diet and cookery predisposed to gastro-
intestinal fermentation. He thought that repeated physi-
cal examinations at different penods, even of the same
day, might aid in putting a diagnosis on a firmer basis.
It was important in all cases to separate subjective sen-
sations from true objective symptoms. The discovery of
the tender pressure-points was new to him. He failed to
see how hyperaesthesia of the deep-seated abdominal nerve-
plexuses could be discovered through palpation. As re-
garded treatment, he was of opinion that it should be in
the first place tentative. From his own experience he
was inclined to place more value upon a general tonic
regime than upon direct and local medication.
Dr. Leszynsky inquired whether Dr. Weber s patients
were also sufferers from migraine, and on being answered
in the affirmative as regarded two women, he said that
Clifford AUbutt, in the recently delivered Gulstonian Lec-
tures, had laid stress on the frequent association of these
evils.
Dr. Dana stated that he had failed to find evidence of
hyperaesthesia of abdominal ganglia, especially of the
gastric plexus, in cases of this kind. In his patients, who
were generally quite thin. Dr. Seguin's objections touch-
ing the possibility of deciding as to the presence of this
symptom by palpation, had not been found to hold good
He had been able to explore the abdomen in its deeper
parts very thoroughly in his cases. He pointed out that
fermentative dyspepsia might accompany, as an inde-
pendent affection, various neurotic disturbances, and cited
a case forcibly illustrating such a condition. In the treat-
ment of neurotics suffering with pronounced gastric dis-
turbances he had found mountain air beneficisd.
Dr. Putnam- Jacobi thought that one important diag-
nostic point had been overlooked, namely, the relation
of the onset of the paroxysm of pain to the time of eating.
In purely nervous dyspepsia, say of reflex ovarian or
uterine origin, the symptoms of gastric distress were at
their maximum during the hours of fasting, and relief
might be procured by the ingestion of food In fermenta-
tive dyspepsia, on the other hand, the introduction of
food into the stomach would only aggravate existing
syniptoms. Moreover, pain occurred from one-half to
two hours after a mesiL Besides this, the acid eructa-
tions, the coated tongue, the bad taste in the mouth at
morning, should make differential diagnosis compara-
tively easy. In nervous dyspepsia the tongue was re-
markably clean. During, or even before a paroxysm of
pam, nausea was not observed.
Two marked cases of neurotic dyspepsia had fallen
under her observation some time ago. The first con-
cerned a lady, sixty years of age, who soon after having
come under the influence of London's fog^y weather, de-
veloped two neuroses. The first was spiritualism, and
the second violent paroxysmal gastralgia. Six eminent
London physicians decided that she was afflicted with
cancer. But Italian sunshine quickly cured her. The
second case was that of a man who, after the loss of a
loved child, became much depressed in spirits, and was
afflicted with gastralgic attacks. For months he grew
progressively worse, losing flesh all the time. He was
eventually completely cured by arsenic. Another case
had been cured by the faradic current. She thought that
it was more difficult to distinguish moderate de^ees of
glandular atrophy of the stomach from neurotic disorders
than to separate the latter from fermentative dyspepsia.
Dr. H. D. Chapin believed that the nervous manifes-
tations were often secondary to acid fermentative pro-
cesses, set up by the excessive consumption of starchy
foods.
Dr. E. C. Wendt remarked that it was quite evident
from the drift of the present discussion, as well as from
similar debates in foreign societies, that ^e entire subject
was still involved in considerable obscurity. One thing
was certain, however, namely, that the profession in all
civilized countries was beginning to reinstate the nervous
system, in its relation to disease-development, into a for-
merly occupied position of pre-eminence. Not many years
ago the pathological school had been so exclusively domi-
nant that functional disorders had been almost relegated
to the limbo of the mythical. Within the past few years,
however, a great change had set in, and at present there
seemed to be, if anything, a danger of falling into the
other extreme. Certain it was that to-day there either
was much less gastro-intestinal catarrh, or else it was
more frequently overlooked than formerly; while on
the other hand nervous dyspepsia must either be of much
more frequent occurrence, or else be erroneously assumed
to exist in true structural disease of the alimentary canal.
Clifford AUbutt had, in the recently delivered Gulstonian
Lectures, drawn some vivid pictures of this class of
cases, and the whole subject had been but lately dis-
cussed at the third German Congress of Internal Medi-
cine. At that meeting Leube had reiterated his former
well-known views on nervous dyspepsia. But he had
been opposed by several competent observers, prominent
among whom was Ewald. The latter took the ground
that real disease of the stomach might start the entire
train of nervous symptoms so often seen in neurotics.
Trousseau's veriige stomacale^ dyspeptic migraine, and
Rosenbach's cases of vagus neurosis were some of the
rarer manifestations belonging to this category. Ewald
further asserted that Leube's well-known Verdauungs-
versuch had no great practical value, for he had in
many instances found food-particles in the water used
for washing out th<5 stomach seven hours after a simple
meal. So also he had found the gastric fluid in positive
structural disease, such as cancer and chronic catarrh,
to give normal chemical reactions. Dr. Wendt thought
it was quite evident from all this that we still lacked
decidedly characteristic or pathognomonic symptoms of
this class of disorders. It should never be forgotten that
dyspepsia was not a disease in itself, but might be a
symptom of very many vastly dissimilar affections. To
the presence or absence of painful pressure-points, sup-
posed by Burckart to be characteristic of nervous dys-
pepsia, he had not, from his own experience, learned to
attach any significance. He also thought that the term
gastric neurasthenia, suggested by Burckart, was not a
happy selection. Such cases should be classified rather
under the general heading of " nervous disorders of the
alimentary canal." One point he wished, however, to
emphasize, namely, that nervous dyspepsia did not kill.
He had seen such patients apparently brought to the very
door of death, but in the end they had invariably recov-
ered. One case he remembered in particular, that
was almost the exact counterpart of the first case
mentioned by Dr. Jacobi. Here too, eminent phy-
sicians had been misled, probabl^r by the cachectic
appearance of the patient, to magnosticate gastric
cancer. But the lady in question fully recovered,
and at present, six years after she had been given
498
THE MEDICAL RECORD.
[November i, 1884.
up, she was better, stronger, and weighed more than
at any other period of her life that she could recol-
lect Finally, as regarded treatment, he thought that
general and hygienic measures were more calculated to
benefit sufferers of this class than drugs. Absolute rest
was at times imperative. Of drugs he thought arsenic
was the best for the intervals, and morphine subcutane-
ously or in suppositories for paroxysmal pain.
Dr. Morton alluded to the ready supervention of
diarrhoea through emotional disturbances in neuras-
thenics. Animals under excitement often showed simi-
lar symptoms, but he did not wish to infer for this reason
that they too were afflicted with neuroses.
Dr. Tked, of Kansas City, raised the query whether
we were not painting old facts in new colors. He believed
that all the troubles mentioned in the paper and the dis-
cussion could be included under the old designation of
atonic dyspepsia. His explanation of the origin of these
disturbances was as follows : Nervous influence that
should be sent to the stomach became diverted into other
channels, and as a consequence the gastric glands failed
to perform their function. Besides this, nerve stimula-
tion might happen in the stomach, be thence transmitted
to the central nerve-organs, and once more reflected
back upon the stomach. Ingestion might in this way
lead to watery secretion and thus result in copious
evacuations. But the neurotic taint might manifest its
existence through other organs besides the stomach.
Cardiac palpitation might occur. The latter might even
co-exist with gastric distress and yet the consummation of
digestion be neither retarded nor in any other way dis-
turbed.
The great point to know was, where did all the nerve-
force come from ? How did it originate in the body ?
In his opinion it ultimately depended entirely upon
oxidation or some similar chemical change constantly
taking place in organized beings. He thought that the
various cells of the body might be likened to minute
electric batteries that were perpetually active. Through
their agency force was liberated which primarily assumed
the form of heat. In this way currents were normally
sent to the brain and again started out from the enceph-
alon to other parts.
Of course, if the paths of conduction became altered
failure of force-transmission must result This gave rise
to morbid symptoms which we must endeavor to inter-
pret He also compared the relations of the cerebro-
spinal with the sympathetic nervous system to the two
wires of a battery. One thing was certain, namely, that
new matter or new force had no existence in the human
body. The same physical laws that governed the outer
world also held good for our bodies. It was essential,
therefore, to know well the rules and laws of the trans-
mission and radiation of force in the outer world before
we could hope to understand the actual condition of
nerve-action within us.
Dr. Weber, in closing the discussion, said that he
agreed with Dr. Seguin in the importance which he at-
tached to a thorough examination of cases of dyspepsia
of whatever nature, particularly as to the presence of
dilatation, but believed that dilatation was not only liable
to occur when patients indulged in too liberal quantities
of farinaceous food and sweets, but also by the vicious
habit which many people, young and old, had of putting
much more food into Uieir stomachs at a given meal than
the organ ought to receive at one time. Like Dr. Dana,
he had not been able thus far to verify Dr. Burckart's ex-
periences as to the tenderness of one or more of the
abdominal sympathetic ganglia in certain cases of gastric
neurasthenia.
The good results which Dr. Putnam-Jacobi and others
had seen from small doses of arsenic in the management of
these disorders he was ready to accept as an illustration
of rational therapeutics. He had himself seen excellent
results from drop-doses of Fowler's solution, taken on
an empty stomach, in the early morning retching and
vomiting of habitual topers. He believed that Dr.
Wendt was right when he said that Dr. Burckart's desig-
nation of *^ neurasthenia gastrica" was not happily chosen,
and that the general name of '^ nervous disorders" would
be better.
PSEUDO-BULBAR PARALYSIS.
Dr. William Browning, of Brooklyn, read a paper
illustrating the above condition (see p. 487).
Dr. £. C. Seguin related a case of bulbar disease
which, if not quite germane to the present subject, was
intrinsically so interesting as to merit the notice of the
Society.
Male, forty-four years of age, seen January 31, 1876, in
consultation with Dr. M. J. Moses. Denies syphilis or
recent sore throat Well up to January ist, when he
had epileptiform attacks limited to the limbs of the
left side ; in one attack the tongue was bitten. No recur-
rence of attacks. Subsequently severe right supraorbital
neuralgia cured by arsenic. On January 29th sudden in-
ability to swallow solids developed in four or five hours.
Examination shows a spasm (?) two inches below pharynx.
The voice is nasal and articulation is imperfect. Patient
is conscious of the labor of speaking.
In view of the rapid development of the symptoms, I
expressed the opinion that the case was not one of true
bulbar paralysis of the progressive form, but an acute
paralysis due perhaps to an ignored diphtheria, and that
the prognosis was not quite hopeless.
On February 7th, nine days after the appearance of
dysphagia. Dr. Moses sent the patient bade to me with
the following letter :
«* My Dear Doctor : I asked Mr. S to call upon
you and deliver this note, which for obvious reasons I
send sealed. I am afraid he shows more progressive
symptoms than when' you last saw him, and that the
prognosis made now would not be quite as favorable. I
think it will be necessary to put you in possession of all
that has happened since last Monday when you first saw
him.
"On Monday evening he lost the power of swallowing
fluids, and I passed a stomach-tube, but it produced such
irritation that he almost suffocated from spasm of the
glottis when the tube was in his stomach. I passed the
tube several times, but each time was forced to withdraw
it to avoid a catastrophe. I finally hit upon an idea
which I congratulate myself and the patient upon. Hav-
ing learned from previous examination that the middle
and lower muscles of constriction were not as much in-
volved, I made my patient lie down and permit the
mouthfiil of fluid to flow down below the edge of the
velum, and then to swallow. This efibrt raised the larynx
and propelled the fluid within the grasp of the lower con-
strictors. By this device (lp^8 down at each mouthfol,
with the head thrown far back) Mr. S was able to
take sufficient nourishment, milk, eggs, and beef-tea,
and his medicine, viz., quinine, iron, and strychnia in so-
lution, during yesterday and Wednesday.
" On Tuesday, by violent eflfort, he was enabled to swal-
low sitting up, but at the same time I noticed marked
loss of power in the muscles of the cheeks and lips, and
an aggravation of his nasal speech. I noticed also,
steadily progressing, an irritation of the pneumogastrics,
evinced by violent, prolonged, and characteristic cough.
The irritation is almost constant, touching the throat
with an electrode or the eflfort of swallowing bringing on
a most violent paroxysm. I have faradized the muscles
of the pharynx with a gently increased current, and gal-
vanized the spinal accessory and glosso-pharyngeal with
from four to six cells of Kidder's eighteen-cell bat-
tery. At first each was well borne, but yesterday a very
mild current from either battery provoked vomiting, and
on passing a current Irom six cells over the pneomo-
gastric, I provoked a prolonged and almost exhaustive
cough. I am afraid the disease is progressive and due to
central lesion. I send him to you for another examina-
November i, 1884.]
THE MEDICAL RECORD.
499
tion, that you may compare his present condition with
the result of your examination last Monday, and see if
some new points may not have arisen to point to you a
separation of the two theories then presenting, viz. : labio-
glosso-pharyngeal, or diphtheritic paralysis. . . . '
Examination : speech not as good ; whistling is pos-
sible but feeble ; can't fill cheeks with air ; much saliva-
tion ; orbiculus oris weaker, but can still make O. The
tongue moves well in all directions. Voice not as loud as
at last note. Much cough (more morning and night).
Throat very irritable. No facial palsy (apart from orbic
and buccinator paresis). Voice very nasal and articu-
lation is impaired. In speech and by reflex action soft
pahite acts well. Fails to swallow a morsel of bread,
and the laryngoscopic mirror shows it lying behind the
glottis a little to the left. Rima glottidis red; vocal
cords not seen ; no anaesthesia of face or hands ; no
hemiplegia.
It should be added that two years ago patient had
neuralgia of the left side of the face and paralysis of the
left vocal cord. Again denies syphilis. I adhered to my
dia^osis of acute non-progressive bulbar paralysis, and
advised continuing the iron and strychnia and using
weak galvanism to back of neck And outside of throat.
My notes are not complete, but I can state that the
patient recovered somewhat slowly but completely in a
few weeks.
Dr. Morton alluded to two cases of hysterical simula-
tion of bulbar disease that had been on the point of
being reported as instances of progressive bulbar paraly-
sis, when both recovered completely.
Dr. Seguin said that the converse mistake had once
happened to him. It was a case which, owing to the
absence, at the first visit, of labial symptoms and the
predoniinance of palatal disturbance, was held to be not
a genuine instance of progressive bulbar disease. At the
second visit, however, difficulty of swallowing and other
signs left no doubt as to the true nature of the affection.
NORTHWESTERN MEDICAL AND SURGICAL
SOCIETY OF NEW YORK.
Stated Meeting, April 18, 1884.
E, C. Harwood, M.D., President, in the Chair.
Dr. Edward S. Peck read a paper (see p. 482) on
MINERAL ASTRINGENTS AND CAUSTICS IN OPHTHALMIC
PRACTICE.
Dr. Baruch objected to the use of the word caustic
as implied in the paper, as it was not its usual significa-
tion. Caustics and astringents present this great diflference,
that the former are destructive, and the latter produce
their effect without destruction of tissue. In the groups of
conjunctivitis alluded to, silver-nitrate should be regarded
as an astringent. Silver-nitrate is not a caustic in liquid
form ; it is not destructive except by violent application.
It acts rather as a modifier of the action of disease.
Dr. Page uses tepid water in painful forms of con-
junctival inflammation ; has been led to believe cold
water injurious, and has never used silver-nitiate. He
cited a case of recurrent phlyctenular conjunctivitis,
which was brought on by overwork at school, and was"
successfully treated by general treatment with calomel
applied locally to the eyes.«|
Dr. Knapp agreed with the paper in its differentiation
as to the selection of caustics, especially the sulphate of
copper stick in chronic granular conjunctivitis ; but the
longer he practises in such diseases the more restricted is
his use of caustics. So long as a conjunctivitis is acute,
he abstains from powerful remedies ; he uses cold com-
presses day and night. When the disease is in danger of
becoming chronic, then he uses caustics and astringents.
In the ophthalmia of scrofulous individuals, he has ordered
the head to be dipped in pails of cold water, and with
very good results. The peculiar form of vernal conjunc-
tivitis brought out in the paper he believed to be endemic
in character ; no treatment seemed to be of avail He
prefers mild alkaline washes ; astringents seem to do no
good.
Dr. Bosworth used silver-nitrate only on the mucous
patch in throat cases. He has abandoned all solutions
of the salt in treatment of throat diseases. Cold water is
always an irritant to columnar epithelium.
Dr. Wood thought the hygienic surroundings of patients
suffering firom granular conjunctivitis were frequently at
fault ; upon the correction of these depended the suc-
cess of treatment of such cases. In the ophthalmia of
the newly-born, whether simple or gonorrhoeal, mild treat-
ment met all requirements. Constant washing out with
hot water, and dropping mild alum water into the eye
three or four times a day, constituted his treatment in
such cases.
Dr. McLaury had used hot* water with best effect in
similar cases of purulent ophthalmia of infants.
Dr. Jacobus believed the pain which was felt on the
application of cold water to a mucous membrane was
caused by a swelling and rupture of the epithelium. If
salt in the proportion of about one drachm to one pint
of water be used, it becomes similar to the physical fluids.
In gonorrhoeal ophthalmia he uses hot water for cleansing
and vaseline to keep the lids apart.
Dr. Agnew premised his remarks by saying that thirty
years ago caustics and antiphlogistics were much used in
ocular affections. Now he does not use silver-nitrate in
any form, either in private or public practice, and copper
but a very few times in the course of a year. He relies
upon general treatment more and more each year. He
believed topical applications had been carried to excess.
The cold douche was just the tonic needed in some
chronic forms of conjunctiva] disease. Keeping the parts
clean was an important point always to be had in mind.
Hot water was now used where formerly cold had been
employed. He believed that the highest attention should
be paid to tissue-building.
Dr. Jarvis thought the amount of silver-nitrate em-
ployed should determine whether its effect was or was
not caustic It acts mechanically by producing an al-
buminate, thus securing protection to the subjacent parts ;
this action is chemically astringent When firequently
employed it produces destruction of tissue, and should be
regarded as caustia
Dr. Fruitnight corroborated the statement made by
the author of the paper as to the etiology of cases of
purulent ophthalmia of the newly-born not being neces-
sarily gonorrhoeal ; he had seen a number of such cases
where the mother was positively free from the disease.
He uses in such cases very hot water with alkalies, usu-
ally borax, with best effect
Dr. Knapp further sUted that Ernst Henry Weber,
physiologist of Leipzig, first introduced the use of cold
water in treatment about forty years ago. It was the im-
bibition of water by the epithelial cells which caused pain
during the use of cold water.
The President stated that he uses ice-bags as com-
presses to the eyelids, and has also used cold as well as
hot water as a styptic in ophthalmic practice.
In reply to a question. Dr. Knapp said it was his prac-
tice to use ice-bags to the closed eyelids, but hot water
for cleansing mucous membranes.
In closing the discussion Dr. Peck said that by the
word caustic was implied a destructive agent, and by
astringent the usual pharmacological acceptance of that
class of agents. As the lines of discussion had turned
upon the use of cold and hot water in ophthalmic treat-
ment, he offered the statement that the final effect of hot
fomentations and ice-cold lotions was the same. He
suggested that an application of cold can only be con-
tinued as such by a thin layer of muslin or linen, taken
from raw ice, transferred to the closed eye, and changed
so soon as it acquired a temperature near to that of
500
THE MEDICAL RECORD.
[November i, 1884.
the body ; a hot lomentation or compress must be of sev-
eral thicknesses of fabric, as a fresh laundried hand-
kerchief, wrung out of hot water, covered with dry flan-
nel, and renewed so soon as it became reduced to near
the animal temperature. The term cold compress is an
anomaly. He uses cold cloths in this way to combat
acute forms of conjunctivitis; he also uses hot water
saturated with boracic acid as an irrigant in ophthalmias
attended with discharge. It is a well-attested clinical fact
that patients like hot applications better than cold.
OUR LONDON LETTER.
(From our Special Correspondent)
THE MEDICAL COUNCIL'S AUTUMN SESSION — CONJOINT
EXAMINATION SCHEMES — ^THE COLLEGE OF SURGEONS
AND THE WILSON BEQUEST — NEW DRAINAGE SCHEME
FOR LONDON — ^THE PUBLISHING SEASON — NEW WORKS
AND NEW EDITIONS — ^THE ENTRIES AT THE MEDICAL
SCHOOLS — OVER-PRESSURE IN BOARD SCHOOLS.
London, October x8, 1884.
The General Medical Council met October 7th. As
might have been expected from such an essentially con-
servative body, Sir Henry Acland has been re-elected
President for a third term of five years. I cannot chron-
icle any important proceedings on the part of the Council.
Medical education and examinations were discussed, but
it is of little consequence what conclusions the Council
arrive at as they have no power to enforce their own
recommendations. A considerable amount of time was
spent in discussing Sir Henry Pitman^s motion, sanction-
ing the proposed conjoint scheme on the part of the
College of Physicians and the College of Surgeons.
This has been mooted many times but has never come
to anything. The object is to do away with partially
qualified practitioners. At present, although the College
of Surgeons examine in medicine and obstetrics as well as
in surgery, it is only legally a qualification to practise
surgery. Similarly the license of the Apothecaries' Hall
is only legally a title to practise medicine and midwifery.
There are still a good many men in practice who possess
only one of these diplomas.
The license of the College of Physicians is a qualifica-
tion entitling its possessor to practise all three branches.
It is now proposed (not for the first time) that the Col-
lege of Physicians should relinquish their right to qualify
in surgery, and only give diplomas in connection with
the College of Surgeons. In the discussion on this sub-
ject at the meeting of the Medical Council on the 8th
inst., Dr. Quain opposed this scheme strongly, and refer-
ring to the Surrical College said : " That amiable fox
living in Lincoln's Inn Fields, which never had a tail,
went to the College of Physicians and said, How beau-
tiful I am without a tail ! do drop your tail and be like
me.'* Sir Henry Pitman's motion was, however, carried,
although the weak points in it had been pretty plainly
pointed out by Dr. Quain in a lengthy speech. The in-
stituting a complete diploma, qualifying in all branches
of practice, and one which is accepted for all Govern-
ment appointments, is one of the best things the College
in Pall Mall ever did for the profession, and it is to be
hoped it will think twice before relinquishing its right.
It has, too, paid the College pretty well.
The best thing for the College of Surgeons would be
to get their diploma recognized as a complete qualifica-
tion likewise. They ought to be able to do something
now, for it is estimated that the Erasmus Wilson bequest
will amount to nearly two hundred thousand pounds, in-
stead of one hundred and eighty thousand, as at first
expected. One suggestion is that they should endeavor
to obtain a charter transforming the college into a uni-
versity, empowered to grant degrees in medicine and
«urgery, and located in splendid new buildings erected
on one of the sites still vacant on the Thames Embank-
ment.
Speaking of the Thames reminds me of the new drain-
age scheme of the Metropolitan Board of Works. Your
readers will be astonished to learn that, after spending
millions of pounds upon the drainage of London, a
radical change should be necessary and desirable.
What is proposed in the new scheme is virtually to con-
struct an enormous conduit (which would, I suppose, be
at least ten miles long) to convey the sewage down to
the seacoast in Essex. When it reached the coast it
would be necessarily (from the gradients of the conduit)
far below sea-level, and to pump it into the sea at ebb-
tide machinery would have to be erected still more
enormous and costly than that now in use at Crossness
and Barking. It goes without saying that this proposal
does not receive unqualified or even unanimous approval
from sanitary authorities. Economists have protested
for years against the fearful waste involved in pouring all
the sewage into the river, to say nothing of the pollution
of the stream itself. The latter would be removed by
the new plan, but the former would still go on. The
crux is the enormous bulk of sewage with which we have
to deal Still something might be tried. Meanwhile
the scheme just described is all that the collective wis-
dom of the Board of Works has been able to devise. It
remains to be seen whether it will be carried into effect
The approach of winter is, as usual, accompanied by
increased activity on the part of medical publishers.
Taking students' manuals only, quite a number of new
books and new editions are either announced or have
recently appeared, and of other works there is quite the
usual supply.
A work which will be looked for with considerable in-
terest is a volume of clinical lectures by Mr. Richard
Quain, F.R.S., which is announced as being in the press.
(This gentleman must not be confounded with his emi-
nent namesake, Dr. Richard Quain, the editor of the
** Dictionary of Medicine " which bears his name.) This
venerable professor so seldom appears in print and has
been so long retired from active practice, that his coming
volume will be received with unusual interest.
Mr. Watson Cheyne announces another book on "The
Antiseptic Method in Surgery." This (the second work
by him on this subject) will doubtless contain some of
the results of the researches in the Biological laboratory
of the Health Exhibition.
New editions have appeared simultaneously of Erich-
sen's and Bryant's works on surgery. The former has
been considered as the leading text-book for many years
past now, although its diffuse and wordy style and its
bulk have been great drawbacks to its use by average
students. In successive editions it has swelled and
swelled until in size it threatens to rival if not outstrip
the " System of Surgery," of which a new and (by a re-
arrangement of type) smaller edition only appeared last
year. The latter work, though, is likely to find a formid-
able rival in ** The International Cyclopaedia of Surgery."
A fifth edition of Playfair's *< Midwifery" is announced.
Since its first publication, only eight years ago, it has rap-
idly become the favorite text-book, to the practical exclu-
sion of all others. Lusk's treatise has displaced it some-
what for the higher examinations, but for all others it is
still widely read. A large measure of its popularity is
due to the clear and easy style in which it is written.
Few text-books for students have very much to boast of
in this respect. The best one is, perhaps, the well-known
"Manual of Surgery," from the pen of Mr. Timothy
Holmes, the editor of the " System." Dr. Robert Barnes
is also an able penman, and his work on "Obstetric
Medicine and Surgery," written jointly by himself and
his son, is certain, when completed, to find a large circle
of readers.
Readers of works on medicine are less favored. The
two standard books are "Roberts" and '* Bristowe," and
of both of these new editions have been issued during the
November i, 1884.]
THE MEDICAL RECORD.
501
past eighteen months. The former is doubtless a useful
compilation for examination purposes, but not an inter-
esting work to read otherwise. Bristowe is perhaps a
little more lively writer, but even he makes us long for a
return of the literary grace which adorned the pages of
Dr. Graves and Sir Thomas Watson. Both of these
works, too, sound a very uncertain note in the matter of
treatment Numerous drugs are mentioned under the
various diseases, but the directions as to their administra-
tion are very vague. We are now promised a new text-
book of medicine in the form of a posthumous work by
the late Dr. Hilton Fagge. It is to be in two volumes, and
from Dr. Fagge's well-known learning and industry is
likely to present a faithful reflection of the present state of
medical knowledge, and more especially of the teaching
at "Guy's."
The number of *'full entries" at the medical schools
for the winter session is between five and six hundred.
By '' full entries " is meant the number of students en-
tered for the full course of four years at the hospitals.
From this period of time eighteen months is remitted in
the case of those who have served a pupilage of that
dm-ation with a general practitioner. This applies only
to candidates for the ordinary diplomas. The Universi-
ties require the whole period of four years to be passed
in hospital study, and the College of Surgeons exacts a
curriculum of six years for its Fellowship from those who
wish to take it from their hospital at once. Graduates in
Arts are allowed a year off this.
The discussion on over-pressure in board schools, which
was initiated by the publication of Dr. Crichton Browne's
report on the subject, is still ^oing on. It appears that
after inviting Dr. Browne to inspect and report on cer-
tain schools, accompanied by Mr, Fiichy one of the Govern-
ment Inspectors^ the Education Department, not finding
the report to their taste^ first tried to suppress il and then
endeavored to upset Dr. Browne's conclusions, and set
Mr. Fitch to abuse him. Dr. Crichton Browne has
opened fire on his assailants in the columns of The
Times^ and seems to be getting the better of them. The
whole subject will probably be well ventilated when Par-
liament meets. Meanwhile, among the medical profes-
sion at any rate, the opinion is pretty general that it has
been clearly proved that over-pressure does exist. The
late-payers have long thought so — but for another reason.
THE DANGER OF OPIUM-SMOKING AS A
THERAPEUTIC MEASURE.
To THB Editor of Thb Mkoical RBcoBOb
Sir : In the issue of The Medical Record for Septem-
ber 2oth, page 317, I notice a short article in reference
to " Opium-Smoking as a Therapeutic Measure." Now,
while we will all agree with Dr. Thudichuro that opium-
smoking may prove a palliative and perhaps remedial
agent in the cases mentioned, we must, I think, believe
tlmt the danger of establishing a habit attending the prac-
tice more than counterbalances its usefulness. That the
prolonged use of opium in any form is apt to engender
the " opium habit,'' we all know, and I believe that of
all the modes of administration tending to such an end,
that of opium-smoking is the most potent. This, I think,
is exemplified in the graduates of the various opium dens
that curse our land to-day. Witness the novice who,
feeling a little indisposed, or it may be for the purpose
of experiment, repairs to one of these nests of degrada-
tion. Now, he does not enter such with the intention of
cultivating a habit, and if the possibility of such a danger
was suggested to him, he would laugh at the idea. Yet,
in nine cases out of ten, when he has finished his first
pipe he has forged the first link in the chain that will
bind him a slave to this powerful drug. Nor does he
stop here ; finding the effect so very pleasant, he re-
turns again and again, until the chain is completed and
he is bound body and soul to a master that knows no
mercy. Now, if there is danger of establishing a habit in
the man who, to allay his indisposition or satisfy his
curiosity, inhales the fumes of opium, how much more
danger is there to him whom suffering induces and his
physician adnses to resort to it ? Why, a hundred times
more, I think, and it seems to me that the practice of
that man has been limited who can look upon the dan-
ger as being comparatively nil. Perhaps some may say,
" We would not sdlow our patients to go beyond a certain
limit of safety." Ah, but how are you to know just where
to place this '< limit of safety ? " The line of demarca^
tion is certainly not well defined, and when once beyond
it all the advice or moral suasion in the world will not in-
duce the poor victim to desist in his degrading habit.
Degrading, I say, because, contrary to the opinion of
Dr. Thudichum, I believe that the "stories told of the vic-
tims of opium-smoking" are not sufficiently colored.
They lack the dark and dismal coloring that truly de^
scribes the wretched condition to which these poor un-
fortunates descend. Degrading, because it robs man of
all his finer instincts ; robs him of his intellect, and makes
of him an object of universal commiseration.
I am well aware that there is nothing new or startling
in the foregoing, but as the subject is one which cannot
be too often referred to, and as many men, especially the
younger members of the profession, are prone to act upon
every suggestion brought to their notice, I venture to
offer it as a protest against the practice of " opium-smok-
ing as a therapeutic measure," and I trust it may not be
altogether unheeded.
J. H. Carman, M.D.
South Ahboy, N. J., September 33, 1884.
INTRAVESICAL INJECTIONS OF NITRATE OF
SILVER.
To THB £1ditor of TkiB MsDiCAL Rbcobo.
Sir : At the close of an editorial on intravesical injec-
tions published in the issue of The Record for Septem-
ber 6th, occurs the following: "Nitrate of silver has
been much used in this country and is still used in
France; but the less of that material thrown into a
bladder, so much the better for the patient.''
Now, Mr. Editor, will you favor a large number of
practitioners who are constantly using nitrate of silver
injections (even the strongest solutions, in cases of cystitis,
with the greatest benefit) with substantial reasons for the
advice contained in this extract from your article ? Maify
of us, accustomed to this practice, believe the traditional
fear of making nitrate of silver injections into the bladder
to be wholly imaginary, a veritable b^e noire, as nothing
but good results from their use in our hands in properly
selected cases of cystitis, for which troublesome malady
they may be safely applied and are often eminently
curative after every other measure has signally failed.
The apostle of this practice. Professor Richardson, of
New Orleans, one of the most conservative, able, and
truthfiil practitioners in our country, has fiilly demon-
strated in his clinical lectures and private practice, the
best results to be derived firom the employment of strong
intravesical injections of nitrate of silver in cases of
cystitis, and his statements are being rapidly endorsed
by others in the profession.
In the Philadelphia Medical News of November lo,
1883, after a few remarks on the treatment of vesical
catarrh, I took occasion to report a most aggravated
and instructive case of cystitis treated successfiilly by the
Richardson method, and referred to the favorable experi-
ence of others also who had employed it more exten-
sively.
The attention which I then called to the views of
Professor Richardson has induced many who, like myself,
were no doubt prejudiced against the method, to boldly
try it, and subsequent reports, published and by private
letters, are most favorable to the practice, and confirm
all that has been claimed for it.
502
THE MEDICAL RECORD.
[November i, i38^
For instance, Professor William Gardner, Professor of
Gynecology in McGill University, of Montreal, who
noticed my communication to the News^ relates an
experience very flattering to the method and recom-
mended it in his lectures to the class. In gynecological
cases especially, I venture to predict that there is a
great future awaiting a more extended and systematic
employment of the stronger nitrate of silver solutions in
cases of cystitis. By such means, probably, operative
procedures upon the bladder as a dernier ressort in re-
bellious cases of this malady may be obviated.
There are many physicians, in Texas at least, who,
relying on the published statements of Professor Richard-
son, did not hesitate to accept the clinical facts he en-
deavored to impress, and are now daily employing intra-
vesical injections of nitrate of silver in their practice.
We have witnessed no such baneful results as intimated
by you. Indeed, our surprise is that the practice is not
more generally appreciated.
Professor Richardson's pathological views and rational
treatment of cystitis by strong intravesical injections of
nitrate of silver were published in the Medical News and
Abstract for 1879.
It is my opinion that these should be more widely
known and acted upon.
Very respectfully,
Henry K. Leake, M.D,
Dallas, TkXAS.
[We do not see that the success of nitrate of silver in-
jections in properly selected cases of cystitis militates
against our view, that the less of it thrown into the blad-
der the better for the patient ; and we were fully aware
of the successes and teaching of Professor Richardson
when we wrote the article referred to. But there is a
wide difference between " properly selected cases " and
the indiscriminate use of this solution, which was a mat-
ter of every-day practice a few years ago, and is still the
routine practice with some physicians.
From our " properly selected cases " we should cer-
tainly exclude simple acute cystitis. This point must
seem so clear that we will not discuss it But there are
also cases of chronic cystitis which will be less benefited
by injections of solutions of nitrate of silver than by other
treatment We do not consider these injections advisa-
ble in simple chronic cystitis. In chronic cystitis with
vesical catarrh we have obtained excellent results with
the nitrate injections ; and we have also seen cases, and
others are on record, in which the effect of injections of
strong solutions of nitrate of silver were so violent as to
cause very serious apprehension for the safety of the pa-
tient And in our experience, those cases have done
best in which weak solutions were first used, so as to ac-
custom the bladder to the powerful astringent, and then
the strength was increased up to the desired point
There is another objection to the use of very strong
solutions in many cases : they may cause such a degree
of vesical tenesmus that it is absolutely necessary to ad-
minister large doses of morphia to alleviate the pain. In
these cases we cannot regard the use of an irritant, at
least so powerful as a strong solution of nitrate of silver,
as advisable ; and much better results are to be expected
from ' iodoform, which, as Mikulicz has pointed out, is
especially adapted to mucous surfaces ; or from Ktistner's
method with 1.5000 solutions of corrosive sublimate
injected through a funnel-tube. This is especially adapted
to the treatment of chronic cystitis in women. We are very
much inclined to look upon suppurative cystitis as an af-
fection which should be treated as a suppurating cavity
in any other part of the body ; but with the disadvantage
that we have here a cavity into which there is a constant
flow of an irritating fluid — the urine; and that more
favorable results would be obtained by cystotomy and
thorough drainage ; except in women, where the urethra
is short and can be so widely dilated as to admit of drain-
age through it
We do not, therefore, unconditionally condemn nitrate
of silver solutions ; we know that they act most excel-
lently in " properly selected cases ; " and in the sentence
from our editorial, to which our correspondent refers, we
did not necessarily intend to convey the idea that the
less quantity of the silver used the better for the patient,
but that the fewer cases in which strong solutions are
used the better; the cases being, of course, selected.
We cannot, however, agree with our correspondent that
there is a great future for the stronger solutions of this
salt in gynecological cases, but think that the methods of
Kilstner, already referred to, of Struppi, or of Fritsch
and Jackson more rational, and more peculiarly suited to
these cases. We heartily endorse the recommendation
of Professor Richardson to inject a solution of common
salt into the bladder when the silver solution is too irri^
tating; and will add that we believe the salt solution
plays no unimportant part in the result, especially if it be
a strong solution. It is not at all improbable that it de
lays the decomposition of the urine, which is a chief
cause of the unhappy results in so many cases.
To conclude, we have seen, as our correspondent says,
cases cured by the strong solutions of nitrate of silver
when other remedies had failed ; and we have also seen
a strong infusion of tea succeed when the patient was
rapidly going down hill under the use of the silver solu-
tion. And when we say that the silver was aggravating
the symptoms, we mean that the strong injections were
so irritating, and caused such a degree of vesical tenes-
mus, that it was necessary to narcotize the patient in
order to prevent what we believed to be a dangerous de-
gree of shock. If, however, the strong solution does not
cause such phenomena, we believe it to be, in properly
selected cases, an excellent remedy, and we would not
hesitate to use it. — Ed.]
FLORIDA AS A HEALTH RESORT.
To THB Editor or Tub Mbxxcal Rbookd.
Sir : In the April 26th number of The Record appeared
an article on the above subject by a Baltimore physician.
I eagerly scanned subsequent numbers, expecting some
one with facile pen to reply, as the views of the writer
were very different from those heretofore published, and
from those of physicians in active practice in this State,
as well as from facts that can readily be obtained from
persons who have been benefited or cured by this climate.
For there are men and women in every section of the
State — from the Georgia line to the extremity of the pen-
insula, from the eastern coast that is tempered by " that
river of the ocean," the Gulf Stream, to the western
shore that is kissed by the waters of the Gulf itseU — ^who
bless this "land of fruits and flowers,'' who speak in
glowing terms of the climate that has transformed disease
into health, and has changed the hectic flush to the
"peach-bloom hue." Is it strange that one who has
spent night affer night in sleeplessness and pain, racked
with cough and annoyed with expectoration, debilitated
and enfeebled by months of sickness ; and has had all
this changed to nightly sleep, as sweet and refreshing as
an infant's, the cough allayed, the appetite improved, the
health regained — is it strange, I repeat, that such a one
should speak in vindication of the sunny clime that has
thus benefited him ? Can the physician who has seen
these changes occur be expected to seal his lips and
tacitly admit that the climate of Florida is unsuited to
diseases of the respiratory organs ? There is scarcely a
physician in the State who would not deny such a chai]g^
and prove it untrue by patients who are or had been
under his care.
In the article referred to, it is admitted that this cli-
mate is adapted to cases of rheumatism, chronic neuralgia,
syphilis, and gout. We claim that the list of diseases
that will be benefited or cured in this climate can be
November i, 1884.]
THE MEDICAL RECORD.
503
considerably lengthened. And as physicians we not only
claim it, but can prove it by incontestable evidence. A
complete list, or a catalogue of the varieties of diseases,
will not be attempted, but the kinds of diseases that
experience has shown the climate of Florida most adapted
for will be given. They are : Tuberculosis in which the
deposit is incipient or limited, bronchitis, laryngitis, nasal
and pharyngeal catarrh, asthma, nervous complaints, re-
mits of overwork, and chronic uterine troubles resulting
from congestions. Those aged and invalid persons who,
after battling with the storms of life and the rigorous
winters of the North, now need warmth and rest and re-
laxation, enjoy our genial sunshine and rejuvenating at-
mosphere. There is a peculiar soothing, rest-giving
quality of the atmosphere, which especially adapts it to
Aose who are overworked and jaded, or of a nervous
character. Before they have been here many days they
get the refreshing sleep that has been absent so long. No-
where in our whole broad land can such a man or woman
so quickly get relief as here.
Although the annual rainfall is large (as it should be
on this sandy soil), yet the winter months are of the dry
season. And although we have some rain at this time,
there are very few days that the invalid cannot spend a
portion of in the open air.
As to humidity, this city will compare fiEivorably with
other places. It is less here than at other Florida sta-
tions of the Signal Service on the Gulf coast The
courteous and efficient officer at this station. Sergeant
Smith, has placed his records at my disposal. (1 would
state here that he published in the April 4th number of the
Daily Times-Uhion of this city an abstract of the mete-
orological observations at this station, covering a period
of twelve years, which would be of interest to many.)
I copy sufficient for comparison from the last reports
published from all stations :
Monthly Mban Humidity.
December,
1879.
January,
z88o.
February,
188a.
March,
1880.
"St'
Jacksonville, Fla.
Los Angeles, CaL
Detroit, Mich. . .
New York, N. Y.
77.6
67.9
82.1
73.4
77.1
65.0
79.8
73.3
69.4
67.0
75.1
73-0
63.7
72.6
69.6
70.2
63.0
77.4
65.9
61.0
If space permitted I could introduce reports to show
that the changes from warm to cold are not great or fre-
quent. Northers, in the Texas acceptation of the term,
do not occur here. Of course, when there is an ex-
tremely cold winter in the North, like the last, we have
a little colder weather here than the ordinary season.
\t is aboat fifteen miles on an air-line to the Atlantic,
hence the air is never too highly impregnated with salt
or too ** bracing." It would be hard to find a more
equable and pleasant climate, and at the same time have
all] the advantages of congenial companionship and
the higher civilization. During the fall, winter, and
spring months the State is filled with invalids, pleasure-
seekers, and those seeking investment, firom the more
northern, and I might say from every State and Territory,
as well as from Europe. It has many advantages and a
grand future. Improvement is the watch-word of the
day. It is rapidly filling up with the best class of ac-
tual settlers. It is too late for derogatory writers to curb
her onward march or still her reputation as a health re-
sort.
I intended speaking of the great number of deaths of
consumptives that was said to occur at Gainesville. But I
have just received the July 19th number of The Record
containing an article on that point by Dr. Bradner. My
evidence would simply corroborate his.
Yours respectfiilly,
E. M. Nolan, M.D.
jAaUONVXLLSf'jFLA., Julyl34, 1884.
A CASE OF HAY-FEVER IN AN INFANT.
To THB Editor op Tm Mbdical Rkc(»d.
Sir : On the night of September 23, 1884, I was called
to attend Mrs. P , in her confinement. The labor
terminated without anything unusual occurring to the
mother. At the time she was confined she was suffering
from a severe cold. When the child (a male) was born
it gave a cry and stopped breathing. As it became
purple I cut the cord as quickly as possible, and after
rolling it from side to side and using nitrite of amyl it
began to breathe with difficulty, as though something was
in the windpipe. The eyes were inflamed and were
opened only for a moment at a time, and its nose was
discharging. The child was plump and well nourished
and did not seem to have any difficulty in swallowing.
I gave it a drop of whiskey in warm water every ten
minutes, which revived it considerably, but it had to be
watched and I worked for an hour with it. I gave it mi-
nute doses of tartrate of antimony which gave it some re-
lieC Its greatest difficulty was in living between 9 p.m.
and 3 A.M. ; about 4 A.M. it would begin to breathe easier
and would be comparatively easy during the day. I
then gave it a prescription containing fluid extract of
squills compound, paregoric, and chlorate of potassa,
which gave it some relief but matters continued about
the same, being good during the day and nursing well but
having the trouble at night. October 7 th I gave it the
following mixture : .
5. Sodic bromidi 3 j.
Tinct lobellue gtt. x.
Tinct. opii gtt. iv.
Aquae f|^.
M. Sig. — ^Teaspoonful at 8 p.m. and repeat in two
hours if necessary.
That night it slept without any trouble and has been
all right ever since. On the night of the 7th we had a
frost and the day was cold. The case is very interesting
on account of the age of the patient. The mother was
Scotch and the father a Dane. There is no history of
asthma or hay-fever in the family. If it was not hay
asthma what was it? I do not think the medicine
cured the little patient, and the symptoms and termina-
tion of the case are very suggestive.
Very truly yours,
S. B. Spbrry, M.D.
TWO CASES OF TRAUMATIC DIAPHRAG-
MATIC HERNIA.
To ram. Editoh or Tvm Mbhcai. RgooKP.
Sir : The cases reported in your issue of October nth
by Drs. Kortright and Harris suggest the publication of
the following cases, as they present many points of simi-
larity. They came under my observation while an in-
teme in Bellevue Hospital, and have not been before
published.
Case I. — ^A stout laborer, aged forty-three, was ad-
mitted to Ward 30, April 27, 1881. The history given
was that he had been beating carpets upon a roof when
a chimney near toppled and fell, burying him beneath
the debris. He was thrown forward upon his abdomen,
the bricks fisdling upon his back. He said the daeces
''were crushed out of him." When examined at the
hospital he was suffering slightly from shock. Simple
firactures of the tibia and fibula and of the fourth rib left
side were found There were marks of contusion over the
chest and abdomen. Great pain about the sacral region
was complained of, making it impossible for him to sit up»
For two days all went well except that the bowels
were obstinately constipated. Persistent vomiting then
set in, with considerable tympanites, but no pain or ab-
dominal tenderness were found. The pulse became rapid
and feeble, although the temperature remained nonnaL
The case was seen by several members of the visiting
staff and the diagnosis of rupture of the intestine or a
/
504
THE MEDICAL RECORD.
[November i, 1884.
paralysis from contusion suggested. A displacement of
the heart's apex to the right was noticed.
Early May 2d the patient went into collapse and died
quite suddenly. The vomiting had continued at inter-
vals but did not become stercoraceous. The bowels re-
mained obstinately constipated. The patient complained
at times of dyspnoea. The autopsy was made twenty-
four hours after death.
Upon opening the thorax the left chest seemed nearly
filled with coils of intestine which extended upward as
high as the third rib. The heart's apex was displaced up-
ward and to the median line. The viscera of thorax and
abdomen were removed together. A rupture of the left
leaflet of the diaphragm was found nearly four inches
long, nearer its posterior than its anterior border.
Through this opening had passed about four feet of small
intestine and several inches of the transverse colon. The
intestine showed no evidence of strangulation ; it was
not even congested, but like the part remaining in the
abdomen it was distended with gas. The left lung was
compressed into a mass about the size of a foetal head.
The right lung showed slight oedema. The heart was
normal There was no evidence of pericarditis, pleurisy,
or peritonitis. No external evidence of injury to liver,
spleen, or kidneys. Considerable extravasated blood was
found in the substance of the abdominal muscles and be-
neath them. A separation of the symphysis pubis of one
inch was found, also of half an inch at the sacro-ilial
articulation. The ligaments at both joints were ruptured
but there was no fracture.
In this case the chest was never carefully examined ;
the pain which was often complained of was referred to
the fractured rib# The tympanitic percussion, the dis-
placement of the heart and absence of breathing over the
left chest in front, even had they been made out, would
have found their most natural explanation in a pneumo-
thorax also caused by the costal injury.
Case II. occurred in the service of the late Dr. James
R. Wood. The patient, a man about forty years old, was
admitted to the hospital for a compound fracture of the
left elbow, produced, it was reported, by a fall of forty
feet from a building. The patient was in fair condition,
and nothing in his appearance suggested serious internal
injuries. On the following day the elbow was exsected
by Dr. Wildman, the house surgeon. Very little blood
was lost during the operation but the patient never rallied
from it. He sank steadily and died in collapse fourteen
hours after the operation and forty hours after the injury.
On opening the thorax a large mass was found project-
ing into it on the left side, which on examination was
found made up of the stomach, much distended, the pan-
creas, the spleen, and about a foot of the transverse colon.
These viscera about half filled the chest, crowding the
heart to the right and the lung upward and backward.
None of the displaced viscera bore evidence of any spe-
cial violence or of any strangulation. Considerable extra-
vasated blood was found in the substance of the abdom-
inal walls and in the pelvic cavity.
An examination of the diaphragm showed a rupture
three inches long in the muscular substance of the left
leaflet, extending from the margin of the tendinous por-
tion outward to within an inch of its border.
This specimen is now in the Bellevue Hospital Mu-
seum. L. Emmett Holt, M.D.
33 Pajuc Avbnub, New York.
DEATH FROM THE INTRODUCTION OF A
STOMACH-TUBE.
To THK Editor op Tub Medical Rbooro.
Sir: An unmarried woman, aged twenty-seven, with
a history of chronic gastritis, was being treated by Dr.
B , an itinerant doctor, by introducing a stomach-
tube into the stomach and removing the contents — after-
ward washing out the organ. The operation had been
performed twice successfully. At the third attempt he
claimed to have passed the tube into the stomach, when
she fell back and immediately expired. I was present at
the autopsy. The stomach was dilated considerably
and in an advanced stage of chronic inflanmiation. Na-
merous spots of ecchymosis were present The heart
was pale, and there was fatty inflltration« No other
organic changes were noticed. The remainder of the ali-
mentary canal was healthy, as were the liver, spleen, and
kidneys. She probably died from paralysis of the heart
from the shock of the operation. No coroner's inquest
was held. This case may serve as a warning as to what
might happen in any trivial operation upon a patient with
a weak and fatty heart. A. D. Bundy, M.D.
St. Ansgax, Ia., September 30, 1884.
THE AVOWED OBJECT OF THE NEW YORK
STATE MEDICAL ASSOCIATION.
To the Editok op The Hmdical Rbookix
Sir : In your editorial note concerning the New York
State Medical Association, you say : ** The main object
of the Association is to secure to the profession in New
York State representation in the American Medical Asso-
ciation." Did not the latter association, at its meeting
in Washington last June, throw open its representation
to every respectable physician who accepted its code or
paid Ave dollars ? It appears to me that if the sum in
question will secure personal representation, it is hardly
necessary to become a member of the New York State
Medical Association for the purpose stated.
You further say : "The question will, therefore, doubt-
less be raised whether those counties in which medical
societies have not changed their old code, and which are
still entitled to representation, can send a double set'^
The true position of these societies is this : The action
of the State Society has rendered the old code void in
every county society in the State, so far as the power to
discipline is concerned. Those societies, therefore, which
have not formally adopted the new code are practically
without any at all ; they are in fact ruh-coders. To this
complexion have they come at last. Junivs.
Official List €f Changis in th$ Statums ondDuHu cf Offiun
urving in ths Midical Dtpartnunt^ United SiaUs Armjf^
from October 19 to October 25, 1884*
Alden, Charles H., Major and Surgeon. Relieved
from duty at Fort Yates, D. T., and ordered for duty at
Fort Snelling, Minn. S. O. 125, Department of Dakota,
October 20, 1884.
ViCKERY, R. S., Major and Surgeon. In addition to
his other duties will assume charge of the ofl&ce of the
Medical Director during temporary absence of Major J.
C. McKee, Surgeon U.S.' A., Medical Director of the
Department. G. O. 34, Headquarters Department of
California, October 8, 1884.
WiNNE, C. K., Captain and Assistant Surgeon. In
addition to his duties as Post Surgeon at Benicia Bar-
racks, will also attend the sick at Benicia Arsenal Gal.
S. O. 122, Headquarters Dep't of Cal., Oct. 13, 1884,
Strong, Norton, First Lieutenant and Assistant Sur-
geon. Assigned to duty at Fort Union, N. M. S. 0.
198, Department of Missouri, October 4, 1884.
Phillips, John L., First Lieutenant and Assistant
Surgeon. Transferred from Department of the East to
Department of Dakota. S. O. 245, A. G. O., October
18, 1884.
Official List of Changes in the Medical Corps of the U. S.
Navy^ during the week ending October ^^^ 1884.
Bloodgood, Delavan. Promoted to the grade of
Medical Director, August 22, 1884.
Oberly, Aaron S. Promoted to the grade of Medi-
cal Inspector, March 28, 1884.
Wells, Henry M. Promoted to the'grade of Medi-
cal Inspector, August 22, 1884.
The Medical Record
A Weekly yournal of Medicine and Surgery
Vol. 26, No. 19
New York, November 8, 1884
Whole No. 731
©riglual %xXXt\ts.
CIRRHOSIS OF THE PANCREAS.
By CHARLES WARRINGTON KARLE, M.D.,
raOKKSSOR OP OBSTETRICS, COLLKGR OF PHYSICIANS AND 5URGSONS ; AND OP DIS-
BASfS OP CHILDRBN, WOMAN'S MBDICAL COLLHCB, CHICAGO, ILL.
The occurrence of four cases of chronic inflammation of
the pancreas in private practice, within the space of three
jears, has led me to review the literature on the subject
with more than ordinary care.
That diseases of this organ are rare is undoubtedly
true ; but it is also a fact that comparatively little atten-
tion, up to this time, has been given to their investiga-
tion and study.
Bartholow says that so little is definitely known of dis-
eases of the pancreas, that many systematic works omit
the subject entirely. Atkin, in his large work, does not
speak of disease of this organ. Hartshorn, editing Wat-
son, devotes about fifteen lines to the consideration of
this subject. Flint and Wood have only short articles,
and Da Costa has collected the history of but forty-five
cases, upon which he bases the brief remarks made in
his work on diagnosis. One may look through scores of
journals without finding an allusion to diseases of the
pancreas.
For anything like a comprehensive article, we are
obliged to go to Ziemssen, and here we are met by the
statement that the ^reat rarity of these diseases has hin-
dered the more rapid development of our knowledge of
the bearings and pathological changes in the organ.
It will go without saying that in the living or dead
we neglect to examine this organ as we should ; and for
obvious reasons, however rare or frequent diseases of the
pancreas may be, their diagnosis will remain obscure,
and in the hurry of the post-mortem, often necessary, the
gross appearance of the abdominal salivary gland will
not be considered, and in many cases the organ will not
be found.
Case I. — Edward E , aged sixty-five, American,
contractor and builder. Was seen first November, 1880.
Previous to this sickness he had never needed the ser-
vice of a physician, and had always led a very active life.
During the early part of the year he commenced to ema-
ciate, and applying to a neighboring physician was given
some medicine for malaria. He was not relieved, but
.was able to transact business. Throughout the summer
months his appetite had changed greatly, and he had no
desire for meats, but relished milk, mush, etc.
At my first visit I noticed his white anaemic appear-
ance, and obtained the following personal history : His
ancestry were long lived, and he had never had syphilis.
There was nothing abnormal as regards his nervous sys-
tem. His mental faculties were all good, and he only
complained of a roaring in his head and ears. His
lungs were without a trace of disease, but he was short
of breath on account of weakness. The heart performed
its functions perfectly, but there was heard a slight anae-
mic murmur. There was nothing abnormal in any of the
abdominal organs, as far as I was able to examine them,
and neither albumen nor sugar was found in his urine.
His passages from the bowels were black and thin, with
occasionally little lumps of blood and mucus. His
pulse was 100; temperature, normal. The tongue per-
fectly clean, but, with mucous surfaces and integument,
was almost white; indeed, this was his most striking
symptom. He looked jaundiced, but a close exami-
nation showed it to be a whiteness of the tissues. The
only painful spot on his entire body was at the epigas-
trium, and that was not severe and only produced by
pressure. He complained of thirst and was occasionally
nauseated.
I was unable to diagnosticate the case, but believed
that he was suffering from some disease of nutrition ; ex-
actly the organ affected I was not able to determine.
I treated him for a few days with tonics, mineral acids,
strychnia, and a generous diet. There was no improve-
ment, however, and Dr. N. S. Davis saw him with me in
consultation.
We did not attempt to name the disease, but con-
cluded that somewhere in the line of lymphatics or in
some part of the digestive apparatus, there was a very
serious disorder, which in all probability would cause his
death. He died one month af\er I made my first visit,
having, however, passed into the hands of another pro-
fessional gentleman.
In company with this gentleman I made the post-
mortem. There was nothing unusual to be seen in any
of the principal organs ot his body, excepting the very
marked whiteness of all the tissues, and not until I had
removed nearly the entire viscera of the abdomen and
came down upon a white indurated pancreas did I find
the seat of disease.
The gross and microscopical appearance of this or^an
are given by Dr. S. J. Holmes, I^ecturer on Pathological
Histology at Rush Medical College : " Pancreas con-
tracted ; consistency abnormal ; fibrous to the touch ;
color white. Under the microscope the connective tissue
is extensively augmented, and there is obliteration of
certain glandular vesicles, and atrophy of others, induced
by the pressure of the new-formed connective tissue as
it contracted in its maturity. There was slight fatty de-
generation of the parenchyma of the kidney."
Case II. — Mr. S. K. R , aged fifty-seven, American.
This gentleman, who had been connected with the print-
ing and publishing establishments of this city for years,
was first seen, professionally, January, 1882.
He was known among his associates as a most power-
ful and healthy man, though two years ago he com-
menced to fail in strength — yet up to within two months
of his death he continued to transact business.
I learned at my first visit that about twelve years ago
he had an extensive eczema, and has always been a
dyspeptic. He has also been troubled with hemorrhoids,
and even now every passage is attended with very great
pain and some blood escapes. He has lost about sixty
pounds. The color of his skin is very white, almost
yellow, and yet the conjunctiva is perfectly white.
His pulse, respiration, and temperature are perfectly
natural. He complains principally of pain in the rec-
tum, and a slight sickness at his stomach when food is
taken. He has also a feeling of weariness, and a con-
sciousness that he is continually losing flesh. He does
not like meat of any kind, or eggs.
He has been under the care of several physicians, who,
in the main, have promised a cure. It was diagnosticated
by one as a << severe physical and nervous prostration."
During the first months I treated him with pancrea-
tine, pepsin, and the mineral acids, and at a visit made
February 6th he claims that he has gained three pounds.
He is having, however, alternate diarrhoea and constipa-
5o6
THE MEDICAL RECORD.
[November 8, 1884,
tion. His color is no better, but he does not complain
of quite as much pain on the passage of his bowels.
During all this time his pulse and temperature is natural.
The pulse, if anything, is a trifle slow and without
volume.
About this time, in a conversation with him, he asked
me the direct question, and pressed me for an answer, as to
whether I could assure him of a cure. After considerable
hesitancy, and only after repeated solicitations upon his
part, I told him that I was very much afraid that he had
some disease that would ultimately cause his death. That
was the last time I prescribed for him.
June 26th I made him an unprofessional visit. He
was now being treated by rubbing, and was assured that
in the course of a few days he would be greatly improved.
His pulse was 78, temperature only 97^°, appetite
poor. His bowel difficulty was entirely removed, and the
pain which he formerly experienced had ceased. He
ascribes the cure of this particular symptom to a root
syrup with molasses injections. All the pain and soreness
which he now feels is just below the ensiform cartilage.
He is expectorating a large, amount of mucus, and
has at various times vomited something which his attend-
ants described as looking like fat. About two weeks
previous to this visit he vomited a large amount of
coagulated blood, the hemorrhage continuing for some
eight hours, and the quantity escaping was estimated to
have been about two pints ; of course, it was mixed with
saliva and other secretions.
At this visit it appeared to me that he was certainly
failing, and that a mortal result was liable to take place at
any time. He was still hopeful, however, and was en-
couraged by his attendants. He died June 30th.
In the presence of Drs. R. N. Foster, Cashman, Mr. J.
D. Waller, and the writer, Drs. Graham and Haven made
the autopsy. In compliance with the wishes of the friends,
the abdomen only was opened. There was considerable
fat between the integument and the abdominal muscles,
but nothing abnormal as regards the position of any of
the viscera.
The whiteness of the tissues, so marked at the autopsy of
Mr. E , was also present in this case. With this excep-
tion nothing pathological was found until the pancreas
was reached. This organ was hard and slightly enlarged,
and filled with spots plainly seen with the eye. The
bowel was perhaps contracted in its calibre in some
places, but in the rectum, where so much pain was ex-
perienced up to a short time before his death, there was
absolutely no trace of disease.
There was no abrasion in the continuity of the mucous
membrane of the stomach, and the haematemesis, which
was so profuse a few days before his death, was probably
caused by pressure of the enlarged head of the pancreas
on some blood-vessel, or it may have been from minute
capillaries in the mucous membrane of the stomach which
could not be discovered with the eye. The microscopical
•examination was made by Professor Marie J. Mergler,
and resulted as follows : *' The pancreas measured nine
inches in length, two and one-half in breadth at the head,
two at the tail, and was one inch in thickness. The whole
organ was denser than normal, and its surface presented
numerous yellowish-white spots from one-fourth to one-
half inch in diameter. These light portions were con-
siderably denser than the rest of the organ. On micro-
scopic examination there was found increased amount
of connective tissue throughout the organ, especially in
the light-colored portions."
Case III. — Mrs. R , aged ^6, American ; housewife.
Suffered with most terrible nausea and vomiting during
the first three months of pregnancy. Seen in consultation
with Dr. Haven. Died from exhaustion. Microscopical
changes furnished by Professor Mergler, and correspond
in every particular with the others.
Case IV. — Mrs. G. R , aged 25, American ; house-
wife. Passed through her first pregnancy and was safely
<lelivered Made a good recovery. Six weeks after
commenced to cough, which persisted three or four weeks
Then a diarrhoea with great emaciation troubled her four
months. During this time emaciation and whiteness
of tissues were the most prominent symptoms. Died of
exhaustion. The pancreas was hardened, connective
tissue increased, glandular tissue obliterated.
Physiology, — In considering the diseases of an organ
the function of which we at best are not particularly well
informed of, it may be well for us to study its physioW
That the pancreas is a racemose gland, and lies crosswise*
behind the stomach and the left lobe of the liver, and is
supplied with blood-vessels and excretory ducts, is well
known. Some questions are pending as regards its min-
ute structure, but, on the whole, it is not unlike the other
salivary glands. It is fairly settled now that it has a
most important part to perform in the digestion of not
only fats, but all kinds of food. It acts upon starch,
upon albuminoid materials, and also upon the fats. l\s
power of converting starch into sugar is greater than that
of the other salivary glands, and about all that may be said
concerning the saliva may be repeated in regard to the
product of this gland. Its power of digesting albuminoid
compounds, as well as emulsifying neutral fats, has been
fully demonstrated by a large number of physiologists.
While the bile possesses nearly the same power, in all
probability the complete digestion of fat is only perfected
by the combination of the juices of these two organs, the
liver and the pancreas.
Pathology of the pancreas, — " On account of the slight
pathological importance of the pancreas, only the most
important changes which occur in the glandular tissue or
the ducts will be considered." ' And yet four cases have
died in my practice in four years from inflammation of
this organ. The above quotation simply illustrates what
I have already remarked, that the pancreas has not been
studied as other less important organs have.
In addition to what I shall have to say in regard to the
pathological appearances found in my cases, I desire to
recapitulate what Rokitansky presents in regard to the
abnormities and pathological conditions of the pancreas.
In the first place, it may be absent ; sometimes only par-
tially developed, and the thyroid and thymus glands, widi
the pancreas, have been found in one mass ; the gland
may be enlarged simply from ordinary induration. It is
diminished in size sometimes in persons of an advanced
age, and sometimes, too, from chronic inflammation and
adipose infiltration. There may be induration with en-
largement, or extreme softening with relaxation and suc-
culence of the tissue. Inflammations of this organ are
either acute or chronic, and are either primary or second*
ary. When secondary, usually it is metastatic. In the
acute forms of inflammation the gland is found reddened,
congested, and relaxed ; there is acute infiltration of the
interstitial and cellular tissue. In the chronic inflamma-
tion there is hardening of the cellular tissue and obliter-
ation of the glandular structure with sometimes perma-
nent enlargement, followed occasionally with atrophy <rf
the glands. New growths are not particularly firequent.
Tubercle has never been discovered in the pancreas, and
cancer rarely attacks the gland primarily. The pancreas
maybe the seat of an extensive accumulation of fat In-
deed, the whole organ may be converted into one mass of
fatty tissue. Cysts, cartilaginous and osseous growths axe
found very rarely. Cancer when found involving thc^an-
creas is usually a complication of extensive carcinoma-
tous diseases of other organs. The ducts of the pancreas
may be dilated, or compressed, or completely obfiterated
Calcareous deposits in the excretory ducts, giving
rise to obstruction or obliteration, may be found, or there
may be an accumulation of secretion and consequent di-
latation.
Orth differs in some respects in regard to the firequency
of tubercle and primary cancer, but in the main agrees
with the compilation given above. Ziegler presents
> Orth : Diagnosis of Pathological Analomy. p. 333.
November 8, 1884.]
THE MEDICAL RECORD.
507
nothing of importance in his recent work on pathologi-
cal anatomy.
Having now considered the physiology and pathology
of the organ we are in a position to study the general
symptoms of diseases of the pancreas.
The first symptom which I will notice is emaciation,
proceeding to an unusual degree, and where it cannot be
explained in the usual manner. We ought not to forget,
however, that great loss of flesh is liable to take place in
diseases of any of the digestive apparatus, and it will be
only by excluding other diseases, and by carefully watch-
ing the case, that we shall be able to gain any informa-
tion from this source. It is altogether probable that the
function of the pancreas may be taken up and very
largely compensated by the other digestive fluids, and we
do not forget that experiments have been made upon the
lower animals, and young dogs have recovered and lived
after extirpation of this organ ; but this symptom (emaci-
ation) associated with tenderness in the vicinity of the
pancreas, and with no apparent disease of other neigh-
boring organs, should be taken, it appears to me, as a
possible indication of disease.
A second symptom, and one which, it will be remem-
bered, was present in one of my patients, is a flow of
saliva-looking fluid from the mouth. This occurred to a
very considerable degree in the case of Mr. R .
We are well aware that in diseases of the stomach the
eructation or spitting of saliva-looking fluid is a very
prominent symptom, and unless we take into considera-
tion other symptoms, referable to the pancreas, this one
symptom, it appears to me, loses its diagnostic value.
The presence of fat in the stools is* another symptom.
While the passage of fat in stools has been regarded as a
symptom of very great value, it should be remembered
that when a large amount of fat is taken with the food,
the ordinary secretions of the digestive apparatus do not
appear to be able to digest this unusual amount, and a
fatty stool in such a case would be of no diagnostic value.
It appears to me that in the matter of fatty dejections
it could be regarded as a diagnostic symptom only where
we could demonstrate that a too great amount of fat was
being taken , and that the other organs having to do with
the digestion of fat were in a comparatively healthy con-
dition.
One of my patients vomited a large amount of fatty
material. I do not now remember of seeing this recorded
as taking place in any other case of disease of the pan-
creas.
Among other symptoms, we should speak of pain and
tenderness in the epigastrium ; but we should also re-
member that a very great variety of diseases of the abdom-
inal organs in this vicinity, such as diseases of the stom-
ach, liver, lymphatics, aorta, spine, etc, are attended with
pain and tenderness.
In the consideration of individual symptoms, which will
receive attention at another place in this paper, I shall
hardly mention the possible connection of pancreas dis-
ease with diabetes mellitus. This complication does
occur in some cases, but the explanation of the last-
named disease, as we now understand it, would demand
a discussion relating to certain parts of the nervous sys-
tem at greater length than the limits of this paper would
permit. Sugar was not present in any of my cases.
Etiology. — Concerning the cause of pancreas disease,
whether it be anaemia or hypersemia, atrophy or hyper-
trophy, acute or chronic pancreatitis, nothing is definitely
known.
It seems, however, that constitutional syphilis and al-
coholic excesses have much to do with producing these
diseases, and from Cases III. and IV. in my enumera-
tion it would seem that pregnancy may be an exciting
cause. Other causes have been assigned, but they are
mostly problematical.
Trousseau says that the pancreas undergoes the same
changes that the liver does in chronic alcoholism, and
that the pancreas has six times been seen by the same
observer to be affected ; sometimes altered in the same
manner as the salivary glands, which are described as
soft, yellowish, and having their epithelium manifestly
invaded by granulo-adipose degeneration, or shrivelled
or atrophied like the liver of cirrhosis. I have recently
had the opportunity of making an autopsy in a case
where the immediate cause of death was dilatation of the
aorta with valvular disease, but in a person who had a
syphilitic history; indeed, in 1872 and 1873 ^^ was un-
der my immediate care. Among the organs involved
which we found at the post-mortem, in addition to those
having to do with the immediate cause of death, was hy-
perplasia and enlargement of the spleen, fatty infiltration
of the liver, and marked evidence of chronic interstitial
pancreatitis. I mention this case not because it has any
particular connection with pancreas diseases, but as a
case where syphilis was known to have existed, and where
there was found, ten years after, evidence of chronic in-
flammation of the pancreas.
I desire now to pass in review the four or five princi-
pal symptoms which have been supposed to be always
present in disease of the pancreas, and to examine into
other diseases where we frequently find these same symp-
toms, in order to arrive at some definite conclusion as to
the worth of the so-called pathognomonic indications.
Such symptoms as emaciation, the presence of fatty
stools, the profuse flow of saliva, etc., what are they
worth to us in diagnosticating a case of pancreatic dis-
ease?
It must be remembered, at first, that in all diseases of
the digestive apparatus which continue for any length of
time there is more or less emaciation. We find it, too, in
diseases of the stomach, and in chronic diseases of the
intestinal canal. Particularly do we find emaciation in
cancerous diseases of the bowels, where, in addition to
marked cachexia in almost all cases, we find the loss of
flesh is very great ; there are, however, exceptions to this,
and persons have been known to suffer from cancerous
diseases of the intestines, verified by 'an autopsy, and
yet lose but very little flesh. Extreme emaciation of the
body usually takes place in stenosis of the bowels,
whether it be from cancerous disease or other causes.
In the intestinal parasitic disease called anchylosto-
mum duodenale, a malady which we know but little of in
this country, emaciation is spoken of as one of the promi-
nent symptoms. This is a disease where the parasite
lives on the blood which it takes from the tissues, and
not only does it abstract what it needs for its own sus-
tenance, but as it changes its position it leaves wounds
from which there is a constant escape of blood.
We have, then, here a disease with all the symptoms of
chlorosis, with its attendant paleness of the general in-
tegument and of the mucous membranes, with great fa-
tigue, dyspepsia, and palpitation of the heart, which will
require great care to differentiate from other diseases
of bad nutrition. The parasite gradually extracts blood
from the mucous membrane of the alimentary canal, and
in this way produces not only all the symptoms ot
anaemia, but the particular symptoms of emaciation of
which I am now speaking. The fact, however, that this
disease takes place in, or is imported from, tropical cli-
mates, will enable us to exclude it when we are tr3dng to
differentiate pancreas diseases.
Emaciation is also a symptom of a dilated stomach,
a disease, by the way, which it appears to me takes
place with greater frequency than, perhaps, the profes-
sion recognizes. In this difficulty, while the stomach is
very large, witli apparent obesity, yet there are all the
symptoms of poor nutrition. The patient is pale, hollow-
eyed, and is reduced nearly to a skeleton. There is
also with this a real loss of physical strength.
We find emaciation, too, in cirrhosis of the liver at-
tended with anaemia and loss of strength. This symptom
in cirrhosis appears frequently early, and long before
those more prominent symptoms, such as ascites, etc.,
which occur toward the end of the disease. In some
5o8
THE MEDICAL RECORD.
[November 8, 1884.
cases it is only when nutrition has become disordered
and emaciation and loss of strength are noticed that the
patient first realizes that he has some disease.
We find emaciation in splenic diseases with rigors and
a fever, ofttimes of a hectic character, with sweats,
oedema, slight jaundice and diarrhoea, the patients in the
meantime emaciating rapidly.
This is a symptom, too, that we find present in certain
nervous diseases, and along with the other symptoms of a
unilateral progressive atrophy of the face we find emacia-
tion taking place as a symptom. In Basedow's disease it
is a very prominent symptom. In a paper which I pre-
sented to the Illinois State Society some years ago, I
considered at length the symptom and progress of this
disease, and placed on record the histor)' of a case where
the emaciation had taken place to such a degree that a
lady weighing ordinarily one hundred and seventy pounds
became reduced to probably ninety. In such a case,
however, there are so many other symptoms present that
we can at once exclude any probability of pancreas disease.
Emaciation is present in scrofulous and tubercular dis-
eases, and proceeds to a very considerable extent with
the fever and loss of appetite which we find in chronic
pleurisy or empyema.
It is thus seen that if we place great stress upon the
one symptom of emaciation to help us in making up our
diagnosis in pancreas diseases we shall become involved
in great perplexity, for we have already seen that many
diseases, and many of them quite as obscure as those of
the pancreas, are attended with constant and progressive
loss of fiesh.
In regard to the second symptom — that of the flow of
saliva, or a mucous-colored fluid from the mouth — we find
that this, too, is present in a considerable number of dis-
eases, although not to the same extent that we find ema-
ciation.
The attempt that has been made to base a theory that
a sympathetic or vicarious relationship exists between
the pancreas and^ salivary glands has no good foundation,
and the increased secretion of saliva which is present in
a very considerable number of chronic diseases of the
stomach has no connection whatever with any function
of the pancreas, and in those cases where a considerable
amount of saliva is vomited in the morning, in all prob-
ability it has been secreted and swallowed during the night
' * It has appeared to me, however, since I have watched
Cases III. and IV. of cirrhosis of the pancreas in my
practice, that there may be some reasons for expecting
that the great abdominal salivary gland (the pancreas)
^nay be influenced by the same causes which produce
impressions on the salivary glands in the mouth. The
demonstration of this must remain for future study.
In diseases of the nervous system we find an increased
flow of saliva, but we are usually able to find some local
paralysis as the direct cause. In progressive bulbar
paralysis there is sometimes a constant flow of saliva
from the mouth, sometimes watery and sometimes more
like transparent mucus, and yet progressing to such an
extent as to be of great annoyance to the patient. It is
frequently present m facial paralysis and in some forms
of neuralgia.
Coming to consider the presence of fat in the stools
and other excretory products it seems that we really have
in this a. symptom of more importance than any hitherto
mentioned, but it is not always pathological, as it has
been observed in the faeces of healthy persons who are
partaking of a greater amount of fat in food than was
usual, and more than can be digested by the apparatus
having this to accomplish.
It is also found in the stools of children apparently
healthy, and in some cases the white lumps which we
suppose to be undigested casein are largely made up of
fats ; the fatty acids combine with lime in forming them.*
It has been seen in the stools of patients suffering from
., » Professor T. Uflfelmann : Arch. KinderhcUkunde, x88o.
slight jaundice and other evidences of a temporary disease
of the liver. There is probably associated with this, at
least in some cases, a partial occlusion of the pancreatic
ducts, and recovery will usually take place.
Fat is found sometimes in the stools of persons afflict-
ed with chronic jaundice, where there is occlusion of the
ductus choledochus, either alone or associated with
temporary closure of the pancreatic duct If a large
amount of fat made its appearance it would be an indica-
tion that the fat digestive fimctions of both organs, liver
and pancreas, were probably impaired.
Fatty urine has been found either alone or in the same
patient where fatty stools have taken place. Several
cases of this kind are on record, and among the post-
mortem revelations some disease of the pancreas has
been found.
In looking over the literature for cases in which fat
has been found in the urine, I was impressed with the
similarity of the symptoms present in pancreas disease
with fatty urine, and the history of cases described under
the head of chylous urine.
In 1876 Professor Hollister read a paper on the sub-
ject of chylous urine before the Illinois State Society, and
I cannot but notice the analogous symptoms as related
in his paper.
The emaciation, epigastric pain, and loss of fat corre-
spond to a very considerable degree with those same
symptoms so frequently present in diseases of the pan-
creas.' The theory was even then advanced as to the
possibility of some undiscovered connection between the
lacteal or lymphatic system and the urinary passages.
More recently the thought has been advanced as to the
passage of large amounts of fat from adipose tissue of
the body to the blood, and thence through the vessels of
the intestinal mucous membrane being set free. The dis-
covery of the embryo of a round worm in the blood of
those affected with chyluria has happily made its pathol-
ogy certain. I wish I might say as much in regard to
diseases of the pancreas.
The vomiting of fat is a symptom which I do not now
remember to have seen mentioned in any article on dis-
eases of the pancreas to which I have had access. It
was present in the case of Mr. R , and considering the
fact that the head of the pancreas was considerably en-
larged, so much so as in all probability to press against
the duodenum, it is not surprising that a regurgitation
took place.
If blood or bile may be diverted from the intestinal
canal and thrown back into the stomach when pressed
upon by a cancerous or any other indurated mass, it
seems possible to me that the fatty food which has been
partially acted upon by the secretions of the duodenum
in the vicinity of the pancreatic and biliary ducts may be
pressed back into the stomach and vomited as fatty
matter.
In conclusion, I can only say that notwithstanding the
fact that I have seen four cases of cirrhosis of the pan-
creas, and have studied faithfully all the literature at my
command, diseases of that organ will still remain to me
diflicult to diagnosticate.
In my second case, more from the striking similarity in
the general appearance of the two men than from any
one particular symptom, did I venture to suggest pan-
creas disease. More by excluding everything else, it ap-
pears to me, must we base our diagnosis.
In my third case. Dr. Haven is kind enough to give
me credit for speaking of disease of the pancreas as the
possible cause of such a degree of emaciation; and in my
fourth case the diagnosis was made and adhered to, the
autopsy justifying the opinion.
It is not clear that fatty matter was passed from the
bowel in either of my cases ; but it was evident in both
that the fats were not relished, were not well assimilated
if taken, and that the system was destitute of those fatty
constituents upon which blood and tissue must be re-
plenished.
November 8, 1884.]
THE MEDICAL RECORD.
509
Notwithstanding the fact that fat was not passed in my
cases, after excluding those cases where fat is normal or
accidental, I should certainly regard the presence of fat
in the stools as one of the most valuable symptoms in
making our diagnosis.
The value of vomiting fat as a sign of pancreas disease
must be studied in a greater number of cases. I simply
place on record the fact that it was present in my second
case.
Emaciation takes place in so many diseases that unless
we find the majority of the other symptoms of pancreas
disease present^ it cannot be taken as a sign of great im-
portance.
The extreme whiteness of the tissues will be regarded
the most prominent symptom.
TreattnenL — I have nothing to add which is new ; but
with the improvement which took place in the case in
which I gave the pancreatine but a very imperfect trial,
I certainly feel that the use of this remedy should be in-
sisted upon until its value is fully demonstrated — either
pancreatine as we have it in the shops, or in emulsion, or
what would probably be better than either, the freshly
prepared calves' or pigs' pancreas.
These preparations should be given some time after each
meal, and without acids.
These remedies in the marasmus and infantile dyspep-
sias, where there exists an inability to digest fatty and
starchy foods, should, it appears to me, have a more ex-
tended trial than we have hitherto given them.
Conclusions, — First, from the study of diseases of the
pancreas which I have given up to this time, it appears
to me that inflammations of this organ are more frequent
than we have hitherto supposed.
Secondly, chronic inflammation of this gland is charac-
terized by great loss of flesh, extreme whiteness of the
tissues, and generally pain in the region of the affected
organ. The appetite in some cases continues excellent,
and the patient may take food until the hour of death.
The pulse and temperature remain nearly normal. Among
other symptoms which may or may not be present, is the
passage of fat from the bowel or its eructation from the
stomach.
Thirdly, the pathological processes produce the organ
hardened, connective tissue increased, glandular and
secreting structure pressed upon or obliterated.
Queries. — i. Are not a considerable number of cases
commonly diagnosticated as pernicious anaemia, leucocy-
thaemia, chlorosis, etc., due to chronic inflammation of the
pancreas ?
2, Have we here a disease to which the name ** pan-
creatic anaemia " should be given ?
Idiopathic Convulsions of the Tongue. — Dr. O.
Berger relates, in the Neurologisches CeniralbleUt^ the case
of a woman, twenty-eight years of age, who was seized
suddenly, without any prodromata, and in the midst of
perfect health, with a peculiar spasm of the tongue.
She experienced a sensation of tension in the supra-
laryngeal region immediately beneath the chin, and then
the tongue, which seemed to the patient to be enormously
swollen, underwent a number of undulatory movements.
At the end of about ninety seconds the organ was pro-
jected violently forward, striking the dental arch with a
perceptible noise or appearing between the lips. These
convulsions occurred rhythmically, succeeding each other
fifty or sixty times a minute. Speech and deglutition
were impossible during the continuance of the attack,
which, however, caused no other trouble. The author
cites another case of a man, forty-two years of age, who
6ad similar convulsions, not preceded, however, by the
undulatory aura. This patient frequently wounded his
tongue by closing involuntarily his teeth upon it Dr.
Berger referred these spasms to central excitation, cor-
tical or bulbar, of the hypoglossus. A cure was obtained
by galvanism and hypodermic injections of atropine.
YELLOW FEVER AT PANAMA— ITS CAUSE
AND TREATMENT.
By C. H. WILLIAMSON, M.D.,
p. »l. STKAMBS ACAPULCO.
Having had some experience with yellow fever at diflfer-
ent times, and most recently on the Isthmus of Panama,
I am induced to give a few impressions formed in regard
to the cause and treatment of that disease, though the
views presented may prove neither novel nor interesting
to the profession.
Yellow fever is unquestionably a disease of marine
origin, and an essential element in its production is salt-
water^ with the organic vegetable and animal matter con-
tained therein. This is established by the fact that the
disease is never known to originate away from the sea-
coast or where salt-water does not permeate. Ordinary
malarial fevers may arise in any locality where heat,
moisture, vegetation, and telluric influences combine to
produce them, but the specific fever under consideration
never can be produced without the additional element
derived from the sea or its tributaries. Whether this
is evolved from the decomposition of the vegetable or
animal constituents of the salt-water b uncertain, but it
is probable that both contribute a share. Dr. Domingo
Freire, of Rio de Janeiro, who claims to have discovered
the germ of the fever in the " cryptococcus exogenicus,''
says it is of vegetable origin, but does not, I believe, as-
cribe it necessarily to a marine source. I am inclined to
the opinion that the animal matter of the infusoria in
sea water, by its decomposition, plays a more important
part in the causation of the disease than the vegetable.
This is shown by the prevalence of the fever on board
vessels into whose holds sea water has leaked and satu-
rated the timbers, and it is probable that this water in its
percolation has borne with it more of its animal than
vegetable constituents, whose decomposition in the hot
and unventilated apartments, combined with other favor-
ing, deleterious agents, infects the atmosphere and gener-
ates or maintains the disease. This is chiefly the case
with wooden vessels, as those built of iron rarely leak,
have no timbers to saturate, and can be kept dry and
clean ; hence are always more healthy.
Another reason for the belief in the marine animal
origin of the fever is, that in all tropical regions where it
chiefly prevails coral reefs abound, and animal marine life
is most abundant These reefs, when left bare by the
tides and exposed to the intense rays of a tropical sun,
aflbrd abundant material for rapid decomposition, and
are doubtless most active agents in polluting the air.
The town of Aspinwall, on the Isthmus of Panama, is
located on a small island almost surrounded by a coral
ree£ Here yellow fever is endemic, and sporadic cases
occur at all seasons ; but occasionally it becomes epi-
demic, as was notably the case in the spring and summer
of 1880. At that time there was an unusual prevalence
of low tides and the reef was exposed nearly aJl the time
to the sun, emitting an extremely disagreeable odor, and
cases of yellow fever were more numerous in the resi-
dences near and fronting the beach than in other locali-
ties, though they occurred in other parts of the town,
where coral rock, broken from the reef, was taken to fill
up low places and prepare for the foundations of build-
ings. A stop was soon put to this operation, but of late
it has been renewed, and cases of yellow fever continue
to occur. Two vessels that took coral rock as ballast
had this fever break out on their voyages. If the germ
of this disease is evolved, as I think it is, from the polyps
of coral and other decomposing marine animal matter, it
finds a most congenial atmosphere in which to develop
and spread (and it only can do so where the conditions
are favorable) at Aspinwall, where heat, moisture, and
filth of every kind render it one of the most abominable
places on the globe, and where the utter neglect of all
sanitary measures causes wonder that human life can
exist at all.
5IO
THE MEDICAL RECORD.
[November 8, i884*
The germ of the fever, whatever it may be, is readily
conveyed by fomites in the air from an infected place,
and will rapidly show its effects wherever carried, if heat
and all other concomitants are supplied, but in a tem-
perature below 70° it cannot survive, and at once disap-
pears.
That the disease cannot be conveyed by personal con-
tagion is too well established a fact to admit of doubt,
and was fully proved in the terrible epidemic that pre-
vailed at Norfolk, Va,, in 1855.
In regard to the treatment of the fever, as the kidneys
play the most important part in its pathology, special at-
tention should be paid to their function and every effort
made to keep up their secretion as indispensably neces-
sary to a cure. Suppression of urine is the worst symp-
tom, and, however grave all the others may be, if that
one is absent, there is hope of recovery. I have seen
patients get well after having " black vomit," and all the
other most unfavorable symptoms except suppression^
and until that sets in ^he prognosis is favorable ; but after
it appears and continues for over twenty-four or thirty
hours the case may be regarded as hopeless. In those
attacks where from the onset the brain bears the onus of
the disease and maniacal delirium appears early, soon
subsiding into profound coma, death generally speedily
ensues ; but with the exception of these brain and kid-
ney complications, and their proportion is not very large,
the fever usually yields to prompt and proper treatment.
This should be commenced at once with hot mustard
baths of the lower extremities, and the administration of
a brisk cathartic ; the patient then put to bed and cov-
ered with blankets ; given drinks to promote diaphoresis,
and sinapisms applied over the epigastrium and region
of the kidneys. If after free perspiration and puigation
the fever does not subside, a tentative dose of fifteen or
twenty grains of quinine may be given, but should not
be repeated if it fail to reduce the temperature or in-
creases the headache. Should it act otherwise it may
serve to abort the disease, and can be repeated in a
smaller dose in three or four hours. The fever persist-
ing, the use of diuretics and refrigerant diaphoretics
should be vigorously employed, particularly the former,
to promote the urinary secretion. A combination of po-
tass, nitrat., grs. x. ; spts. nit. dulc, 3 j. ; tinct aconit.
rad., gtt. j. ; aquae, 3 ss., every second hour, I have
used with advantage, and found it generally retained by
the stomach. The acetate or chlorate of potass, may be
substituted for the nitrate in this prescription ; or the lat-
ter m3Ly be given with sulphur, sublim. and pulv. carbo-
nis (one as a germicide, the other as an antiseptic), with
good effect. The action of the kidneys may also be pro-
moted by the bitart. potass, as a drink, and the applica-
tion of dry cups, turpentine stupes, and fomentations to
the loins. When gastric irritability sets in, the stomach
should be kept as quiet as possible and nothing given as
long as it is quiet ; but if it will not remain so, of all the
remedies I have found nothing better than milk and
lime-water to allay the nausea and vomiting. When
" black vomit " occurs I have arrested it with ergot and
tinct. ferri chid.
Having thus outlined the general system of treatment
I have found most beneficial, regard for your valuable
space warns me not to go more into detail of the variety
of remedies employed to meet the different indications
in the stages of remission and collapse.
The temperature of the apartment of the patient
should be kept as uniform as possible, and during the
entire period of the attack he should be kept moderately
covered by bed-clothing and never subjected to a sudden
change. His diet should consist of milk, gruel, and
animal broths, given in very small quantities at a time
and frequently repeated, and stimulants employed when
indicated after the subsidence of fever. A return to
solid food during convalescence should be very gradual,
and great caution in this matter is imperatively de-
manded.
THE COCA LEAF AND ITS ALKALOID.
By WILLIAM OLIVER MOORE, M.D.,
PROFESSOR OF BVH AND BAR DISEASES, NEW YORK POST-GRADUATE MEDICAL
SCHOOL AND HOSPITAL.
The importance which has been attached to the alkaloid
of the coca leaf during the past few days in ophthalmic
surgery has led me to bring together a few facts, historic
and otherwise, for the general reader, knowing that
doubtless they would prove of interest.
Cuca, or coca (erythroxylon coca), as called by
the natives (erythroxylum peruvianum), is found wild in
the mountains of Peru and Bolivia, and is also cultivated
on high altitudes. The leaf is the part of the plant in
which the active principle resides. These leaves, which re-
semble those of the tea-plant, are gathered from plants
varying in age from one to upward of forty years. They
are considered ready for plucking when they break on
being bent, and are gathered in March (after the rainy
season, this being the most abundant crop), in July, and
in November. Good samples of the dried leaves are un-
curled, with a deep green upper and a gray-green lower
surface,and have a strong, tea-like odor. Bad specimens
have a brown color and a smell resembling camphor
The flowers of the plant are small and white, and are
succeeded by red berries.
The seeds are sown in December and January; the
cultivation of the plant gives employment to thousands
of the people, and the annual production in Bolivia and
Peru in 1864 was estimated at two million five hundred
thousand dollars in value.
The green leavrs are spread on coarse woollen cloths
and dried in the sun, then packed in bags, which, in
order to preserve the efficacy of the leaves, must be kept
free from dampness. The leaves are worth in Peru
seventy-five cents a pound, and cost here one dollar.
The habit of the natives of the western countries of
South America to chew the coca leaf, has given much in-
terest to this plant ; the dried leaves are chewed mixed
with quicklime, which is said to make its flavor more
sensible to the taste. In the same way the leaf of the
betel-nut is used by the East Indians.
The leaves are called cuca by the Indians, and coca by
the Spaniards. It has been estimated that cuca or coca
is used by eight millions of the human race, consuming
thirty millions of pounds per annum, by chewing the
leaves made into a ball mixed with lime. The leaves
are deprived of their stalks, two or three ounces of them
being used during one day. It is a powerful stimulant
to the nervous system, enabling fatigue to be borne with
less nourishment and greater ease than usual. A case is
reported by Whittingham,* in 1850, of two men being
buried in a mine eleven days before they could be dug
out, during which time they were kept alive by the small
amount of coca they had with them.
So much vaunted is the coca as a stimulant to ner-
vous energy, that the poet Cowley" represents an Indian
chief as addressing Venus, thus :
•• Our Varicocha first this Coca sent,
Endow'd with Leaves of wondrous Nourishment,
Whose Juice succ'd in, and to the Stomach ta'en
I^ng Hunger and long Labor can sustain ;
From which our faint and weary Bodies find
More Succor, more they chear'the drooping Mind,
Than can your Bacchus and your Ccrfs join'd.
The Quitolta with this provision stor'd
Can pass the vast and cloudy Andes o'er."
It was used by the Indians of Peru in ancient times, be-
ing employed as an offering to the sun ; it was also
thought that unless the priest chewed these leaves during
his ceremonies the gods would not be propitiated. It is
still held in veneration, and is thought by the miners to
have an effect in softening veins of ore if chewed and
thrown upon them. As to the eflfect of this habit of
chewing the leaves on the system, much difference of
opinion exists ; on the whole the opinion of Dr. Smith *
1 Thompson's Cyclopaedia of Chemistry. » Cowley's Works, London, ijfo-
* Peru as It is. London, 1839.
November 8, 1884.]
THE MEDICAL RECORD.
511
is in accordance with most of the facts. He says : " When
used in moderate quantity it increases nervous energy,
enlivens the spirits, and enables the Indian to bear cold,
wet, great bodily exertion, and want of food to a surpris-
ing degree with apparent ease and impunity." Sir Robert
Chiistison, in a paper read before the Edinburgh Botanical
Society, April 13, 1876, on this subject, narrates some ex-
periments on his students and himself, showing the harm-
lessness of the drug.
Bouchardat* states that coca has rendered to thera-
peutics value almost equal to the cinchona bark, class-
ing it as a stimulant to the nervous and muscular sys-
tems^ and ranks it as such with tea and coffee. He terms
it also a " substance d'^pargne," or that which prevents
the rapid waste of tissue. The leaf was first introduced
into France by Joseph Bain, a " pharmacien," about
186^ from which he made an elixir and wine. Vin Ma-
riani, of recent introduction into this country, is made
from these leaves ; we have also a fluid extract, etc.
Cocaine, the alkaloid, was discovered by Niemann in
1855 ; its chemical formula is C„H^jNO^ ; its physiological
action is apparently identical with that of theine, caf-
feine, guaranine, and theobromine. Dr. Alex. Bennett*
was perhaps the first to conduct a series of experiments
with this alkaloid, his observations being made on the
lower animals, and he concludes from these that : i.
Cocaine is a powerful poison, inducing a series of symp-
toms aflfecting the nervous, respiratory, circulatory, and
vaso-motor systems, which terminate, if the dose be large
enough, in death. 2. In small doses, cerebral excite-
ment not followed by coma, and partial loss of sensi-
bility. 3. In large doses it produces cerebral excite-
ment, complete paralysis of sensibility, tetanic spasms,
and death. 4. It paralyzes the entire posterior column
of the spinal cord, also the entire system of peripheral
sensory nerves; but the anterior columns of the cord
and the peripheral motor nerves are not paralyzed. 5.
It does not produce muscular paralysis. 6. It usually
produces contraction of the pupils. 7. It produces an
increase in the salivaiy secretion.
These conclusions were arrived at after experiments
conducted on more than one hundred animals of differ-
ent kinds. Dr. Ott, in The Medical Record, 1876,
finds similar physiological effects, except that he noticed
the pupil to dilate; this is in accordance with our present
experience. It is interesting to note that the neutral
principles contained in coffee, tea, and chocolate, bever-
ages so generally in use, are almost identical in chem-
ical composition, and similar in physiological action, to
cocaine ; and this fact may lead us to find in either theine,
caffeine, or theobromine local anaesthetic properties
similar to the alkaloid of the coca plant ; if so, it would
be much cheaper and more readily obtained. Cocaine
is a very deliquescent substance and it is hard to obtain
crystals, yet by patience they may be.
The experiments with the cocaine hydrochlorate, by
applying it to mucous surfaces, as the conjunctiva, has
been known of only about one month, and, as far as I
know, the American surgeons have been among the first
to operate with its use. The first reports of these cases
are in this journal (page 438). Since then many more
have been made, with almost universal success.
In addition to the three cases reported by me in a
former number, I may cite the following that are of in-
terest :
Case I. — Ella M , aged twelve, leucoma adhaerens,
with partial closure of pupil. Operation of iridectomy
(artificial pupil) performed under cocaine. A two
per cent, aqueous solution was used of the hydro-chlo-
rate, dropped into the eye, eight drops during twelve
minutes. At the end of six minutes, four drops having
been used, the conjunctiva and nasal part of the cornea
were insensible ; in ten, the whole cornea was anaesthetic ;
two minutes later the operation began, when it was
J American Journal of the Medical Sciences, vol. Ixxii.
* British Medical Journal, April x8, 1874,
noticed that the edge of the pupil could be seen, showing
the mydriatic effect of the drug. The introduction of
the speculum and section of the cornea were absolutely
painless. Fearing that the iris might be sensitive (as I
had seen in another case), I injected two drops of the
solution through the corneal wound on to the iris sur-
face, when to my delight the iris section proved to be
painless. The operatioi* did well, and was performed
on October 1 7th. The patient was seen to-day, with no
irritation.
Case II. — Mary H , aged eleven ; leucoma,
with anterior synechia. Iridectomy done at my clinic
at the Post-Graduate Medical School, October 17th.
The solution of four per cent, strength was used. In
three minutes after the first two drops were instilled the
conjunctiva and cornea were almost anaesthetic. To
insure success two more drops were used, and at the end
of seven minutes the operation was begun. The intro-
duction of the speculum and section of cornea were not
felt, but when the iris forceps was introduced and the
iris cut the patient showed some evidence of pain. It
was this that led me to use the cocaine solution directly
to the iris tissue, as in the case previously mentioned.
This patient has thus far done as well as customary.
Case III. — One of lachrymal stricture ; James F ,
aged twenty-eight. This being the first case where the skin
played a part in the operation, the experiment was con-
sidered by me doubtful. However, the four per cent, solu-
tion was freely applied above the inner canthus and over
the openings to the tear passages, and in six minutes the
parts were sufficiently numb to allow of the slitting of
the canaliculus without pain. An AnePs syringe, charged
with eight drops of the cocaine solution, was introduced
into the cut canal, and the ffuid forced into the nasal duct
as far as it would go. After waiting four minutes the
No. 8 probe was passed without pain down to the roof of
the mouth ; this was then removed and a lead wire in-
troduced, the patient all the time having no sensation.
In twenty minutes after the injection the lead wire, which
was purposely left, was felt for the first time.
Case IV.— Michael R-
aged thirty-six ; oritis
syphilitica. Complaining of much pain ; not relieved
by atropine ; was treated by instillation of cocaine, two
per cent, solution, with relief of pain in twenty minutes
after its first use. The drops were used, two every
three minutes till eight had been applied. At the end of
half an hour the pupil was noticed to be larger than
when the experiment was begun. Pain returned that
night, but not so severe as before.
Case V. — Mamie B , aged sixteen, West Harley,
N.Y.; operation at New York Eye and Ear Infirmary.
Diagnosis, irritable stump. Thinking that the anaesthetic
effect of cocaine might go deeper by a freer use, I used
in this case some twenty drops, with some benumbing
influence, yet not sufficient to warrant an operation for
removal of the eye, so after waiting twenty rninutes I
removed the eyeball in the "old-fashioned" way.
Case VI. — The following experiments were made
upon my own eye : October i6th, at the Academy of
Medicine, Dr. Agnew put in two drops of a two per cent,
solution (Merk's^ in my left eye, and in ten minutes the
conjunctiva was insensible. Not only that, but in twenty-
five minutes the pupil was dilated, and remained so for
twelve hours; the accommodation was also affected.
This took place in thirty-five minutes after the use of the
drug, Jaeger No. i being seen at thirteen inches only,
when with the unaffected eye my near point was five
inches. In the morning the accommodation was restored.
October i8th a two per cent, solution of cocaine, ex-
tracted from the leaves by Foucar & Co., New York, was
used ; hitherto all the experiments were made with Merk's
preparation. Four drops of this solution were by Dr.
Minor placed in my left eye, it being in a normal condition,
during five minutes. At the end of eight minutes the
conjunctiva was held by fixation forceps and without my
knowledge. The anaesthesia lasted twenty-two minutes ;
512
THE MEDICAL RECORD.
[November 8, 1884.
in twenty-five minutes from the first drop the pupil was
dilated three-fourths its size, and the accommodation
interfered with. This lasted six hours, the pupil remain-
ing dilated ten hours.
Case VI I. — M. B , thirteen years of age; strabis^
mus convergens. Finding in some operations for squint
that the cocaine acted on the conjunctiva well, but that
when the muscle was hooked pain was experienced, it
occurred to me well to inject under the conjunctiva, over
the site of the muscle to be cut, a few drops of the anaes-
thetic fluid ; this was done in this case, six drops being
injected, and the usual six to eight drops being used on
the surface of the eye. This procedure caused the pain
to be entirely abolished. No bad after-effect occurred.
This mydriatic effect of cocaine is well marked and
will make it a valuable contribution to our list, as
ophthalmoscopic examinations can be made, and the in-
convenience of atropine not be felt, the effect on the ac-
commodation in the former being of such short duration.
The chemical formula of atropia is almost identical with
cocaine. The mydriatic effect of the cocaine applied to
the eye in man differs from the effect noticed by Dr.
Bennett in his experiments, where the drug was given
by the stomach in animals, he finding a contracted pupil
the rule. As to the action of the drug in producing
anaesthesia of the surface both of mucous membranes and
the skin, that is a point still to be worked out. Having
already trespassed too long on your time, I will reserve
further experiments with this drug for the future.
OCTOBBR 18, 1884.
THE THERAPKUTIC VALUE OF A SEA VOY-
AGE IN CERTAIN CASES OF CHRONIC
DIARRHOEA.
By J. W. STICKLER, M.S., M.D.,
ORAMGB, N. J.
While crossing the Atlantic, I have had opportunity to
observe that almost every voyager has, during the entire
trip, been more or less troubled with constipation. This
condition has been referred to by others, among whom
I mention C. Pit field Mitchell, M.R.C.S., who states in
his monograph on the ** Pathology and Philosophy of
Sea-sickness," that of twenty-nine recorded cases — a
fraction only of the number actually observed — constipa-
tion was present in twenty-eight ; in the remaining one
early diarrhoea and subsequent constipation.
Indeed this condition is so common that almost every
one anticipating a sea voyage provides himself with a
suitable cathartic. The ship's surgeon told me that the
most common complaint of all the passengers, steerage
and cabin, is constipation, and oftentimes it is of a very
persistent character, not being relieved by salines, but
requiring drugs more active. So far as my observation
goes, it is most obstinate in those who suffer longest from
nausea and vomiting.
Constipation in some instances may be due to the
presence of the hydrated peroxide of iron in the water
used for drinking and cooking. The presence of the iron
is due to the fact .that the water is carried in iron tanks,
in which there is quite a thick deposit of iron rust which
is mixed with the water by the constant motion of the
ship.
In many cases, however, there is but little water used
till after constipation is well established. Some form of
alcoholic stimulant, or one of the natural alkaline waters,
is used to assuage thirst, and crackers, toasted bread,
with perhaps gruel and assorted fruits, to satisfy hun-
ger.
After the sea-fickness and prostration accompanying
it have passed away, both water and solid food are par-
taken of more freely, and the iron therein contained may
act as an astringent upon the gastro-intestinal apparatus.
H. M. Bracken, M.D., L.R.C.S., who has spent much of
his time on the Atlantic Ocean, writes me as follows :
Sailors would ask for ** black draught," the formula for
which is (according to the Brit. Pharm.) :
]$. Infus. sennae 14 parts.
Magnesiae sulph 4 "
Ext. glycyrrhizse i part.
Tinct. sennae 2^ parts.
Tinct. cardamom, co i\ part.
M. Dose I j. to 5 ss.
(The fact that they asked for a cathartic of their own
accord indicated that they must have been troubled
with constipation, which a comparatively few hours at
sea had produced.) Passengers were generally served
with piL colocynth co. (Brit. Pharm.) (Dr. Gregory's
favorite pill), or pil. colocynth co. et hyoscyami (Dr.
Christison's favorite pill).
The percentage of passengers and crew affected at
the beginning of the voyage was usually large. The con-
dition would last some time and be quite troublesome if
no laxative were taken. One dose generally gave relief,
and was often sufficient for a voyage of such duration as
between England and New York, Persons from the
tropics suffering from diarrhoea were generally benefited
by a sea voyage.
The fresh, pure air from the sea, change of diet, change
of habit, etc., brought about the improvement
Very few cases of diarrhoea originated on board. These
were usually the sequelae of other diseases, or the result
of gluttony. When from the latter cause, a good purga-
tive and twenty-four hours of strict diet would relieve.
I have known others, who on land had tried various
kinds of medication for the relief of diarrhoea, but without
success, not being able to remove the malady till they
went to sea.
Such patients, after being forty-eight hours on the
water, either had one small alvine discharge daily, or
every other day. This condition remained till a laxative
or cathartic was taken.
Great benefit was derived when nervousness was asso-
ciated with the intestinal trouble, especially that form
of nervousness which is the result of over-mental work.
Reynolds says : " Patients near the coast should get
to sea. When undertaking a voyage care should be taken
that suitable provision and nursing should be provided ;
but this, though possible for people in good circumstances,
is often impossible for poorer persons. There can be
little doubt that being sent to sea without comforts in an
advanced stage of the disease is an aggravation of their
condition, and that they should be spared this by judi-
cious early travel. It is to be hoped that the time will
come when all ocean passenger steamers will specially
provide for the comfort and care of sick passengers.
Cabins with extra attendance, and good sick cookery,
would be a great boon for the helpless invalid from diar-
rhoea and dysentery."
In addition to the class of patients referred to by
Reynolds, /.^., those reduced to a state of extreme ex-
haustion, there are patients of ample means who are ren-
dered unfit for the daily round of active business life by
a troublesome diarrhoea, which does not readily yield to
drugs, but which in most instances would be greatly
benefited or cured by an ocean voyage.
Copper as a Prophylactic in Cholera. — The P'tit
Moniteur de la M^decine recently issued an extra ednion
which was devoted entirely to a consideration of cholera.
Among many anecdotes there appears the following:
One day during the height of the cholera scare in Pans,
a blind man was playing the Marseillaise on an old
trombone in a courtyard. Joseph Prudhomme, who was
afraid of the disease, called to him from his window to
desist in the name of public health from playing that
contaminating hymn. "My dear," interposed his wife,
" did you not notice that the instrument is copper ? "
November 8, 1884.]
THE MEDICAL RECORD.
513
THE INDUCTION COII.— ITS VARIETIES AND
THE DIFFERENTIAL INDICATIONS FOR
THEIR USE.*
By a. D. ROCKWELL, A.M., M.D.,
NEW YOKK.
When solicited to contribute something to the annual
meeting of this Academy along that line of research in
which I have been interested for so long a time, I hesi-
tated in the selection of a topic. Of material there is
plenty, and of sufficient importance. The whole field of
the physics, physiology, and therapeutics of electricity
lies open before us. The comparative value of its three
subdivisions offers a subject for discussion and the rela-
tion of experiences, while the differential indications for
the use of these various forms — galvanism, faradism,
and franklinism — is of still greater importance and even
less understood.
Vital in interest as are each and all of these themes,
and others that occurred to my mind, they seemed to be
excluded from discussion here, since it has been suggested
that whatever is presented should flavor somewhat of
originality, or at least be not altogether hackneyed ; and
these topics have, one and all, been discussed at various
times in the current medical literature of the day, and
are more or less fully considered in many of the works
devoted to electro- therapeutics. The laudable aspira-
tion of this Academy, then, as attested by the prospectus
lately issued, confirms the aphorism that " originality is a
thing we constantly clamor for," as well as " constantly
quarrel with." Unfortunately, however, pure originality
in thought or methods of expression is the gift of but few.
Old and long-forgotten ideas are being constantly reha-
bilitated and brought forward under the guise of new and
advanced opinions. In this way, much that would other-
wise be lost or fall short of its proper utilization be-
comes, through a more persistent and perhaps clearer
presentation, a practical part of the world's integral store
of knowledge. While, therefore, none of the facts in
physics that I propose here to present are in any sense
new, yet there has been no general appreciation of them,
and but little knowledge, even among those who have
been endeavoring in a blind sort of way to utilize them,
that such facts existed.
As to the few statements that are made along the line
of therapeutics, the most that I can say of them is that
they are the result of much experience and of very many
carefully recorded observations, and if presented with
any measure of clearness ought to be of some little
service to those who are interested in but who have
given little thought to the matter. But to my theme.
There are two kinds of electro-magnetic machines that
are presented to the medical man for therapeutical pur-
poses. The first is termed a separate coil, and the
second a continuous or single coil apparatus. The sepa-
ratejcoil apparatus is the one most commonly used and
the one most generally understood. The separate coil
is the variety described and illustrated in every text-book
of physics, but not in sufficient detail to make clear its
mechanism when used for medical purposes. Craving
the indulgence of those who may be thoroughly informed
on these points, and who may therefore regard as primi-
tive the remarks that follow, let me by the aid of the
accompanying diagram (Fig. i) describe the course and
influence of the electric current in an ordinary separate
coil faradic apparatus.
All induction machines are composed of not less than
two coils. The first or primary coil consists of a large,
well-insulated wire surrounding a bundle of soft iron
wire, which forms a magnetic centre. Over this first or
primary coil is wound a coil composed of several con-
volutions of fine, well-insulated wire for the induced cur-
rent The terminals of the first or primary coils of wire
are united, one end to the battery that operates the coil,
' Read before the annual meeting of the American Academy of ji Medicine, at
Baltimore^ OctotMr aS, 1884.' •
and the other to the part of the automatic rheotomefac-
cording to the following description. As the battery is
the important factor, let us start from it and follow 'the
connections and action of the combinations'lhat produce
the effect :
The positive pole (P) of the battery is connected \with
the governor marked A (Fig. i). The negative pole
N of the battery is connected with the first end of the
primar}' coil, while the last end of the primary coil is
Fig. 1.
connected with the spring support B. The electro-motive
force is conveyed from the battery through the primary
coil to the spring support B (rheotome), thence to the
platina-pointed screw of the governor D, and lastly to
the battery, making the complete circuit.
In the centre of the coil and surrounded by the soft iron
wires is placed a soft iron rod. One end of the rod is
bent at right angles, so that the hammer on the spring is
directly over and can move toward this soft iron rod,
marked C. When the vibrating spring is resting against
the platina-pointed screw D and the battery is connected
with the coil, the current, as it passes over the wire of
this primary coil, renders magnetic both the centre bun-
dle of soft iron wires and the soft iron rod.
The magnetism is of sufficient force to attract the soft
iron hammer on the spring, and draw it down or near to
the magnetized rod C.
This movement of the spring severs the connection
between the spring and the platina-pointed screw D and
opens the circuit. The soft h-on rod, therefore, loses its
magnetism. The spring ceases to be held down, its ten-
sion being sufficient to raise it to a horizontal position,
where it again rests in direct contact with the platina-
pointed screw D. Again the circuit is closed and the
process as described is repeated with inconceivable
rapidity. By the action of the battery current as it is
conveyed over the primary coil, and the influence of the
magnetized bundle of soft iron wires, a current is induced
upon the second coil of fine wire which surrounds the
primar}- coil. This power of induction can be established
to the fifth and sixth coil, and further if the magnetic field
is properly arranged.
In the ordinary form of induction coil just described,
the terminals of the secondary or fine wire coil are firee
and in no manner connected with the primary circuit.
5H
THE MEDICAL RECORD.
[November 8, 1884.
The influence of magnetism produces a current which we
call pure induced.
In the continuous coil apparatus, on the contrary, we
not only receive the inductive influence, but the primary
influence as well, since it is carried over in combination
with the induced currents. Although called a continu-
ous coil, it is really made up of 8%veral distinct coils, and
each successive coil increases in length but decreases
in thickness. These coils are wound over each other,
and are tapped at difTerent portions of their length, but
unlike other forms, they make direct connection with
each other. This accounts for an apparent contradic-
tion of terms that might prove confusing.
These coils are for convenience of illustration rep-
resented by the upper straight lines , =, ^, = (Fig.
2), termed respectively the primary, first, second, and third
note, however, that this current has considerable chemi-
cal power. It will burn iron or steel, giving forth a
bright deflagrating spark, and will readily electro-plate,
an effect not obtainable with any of the induction coils,
either alone or in combination with each other. This
current is apparently very weak, and induces but slight
muscular contractions in the healthy person. In occa-
sional pathological conditions, however, this mild current
acts with unexpected energy^ producing muscular con-
tractions far exceeding in vigor those that are called
forth by the stronger action of the induction coils.
On account of its mild but efficient action the current
from the primary coil is preferable for applications to the
head and the more sensitive portions of the body, and it
will as a rule relieve pains of a true neuralgic character, and
especially when great tenderness exists along the course
of the nerve, far more effectually than
j the current from any of the induction
i coils. It is impossible to account for
I this frequently observed fact, without
i it be ascribed to a combination of the
Fig. a.
induction coils. The letters A, B, C, D, E represent the
different posts of the continuous coil apparatus to which
the conducting cords are attached, while the numerals i,
2, 3, 4, etc., indicate the combinations by which are
obtained ten different qualities of current. The short
line marked i, starting from A, represents the current
from the short, thick, primary coil marked . Second
line (2), current from the primary and first (==) induction
coils combined. Third line (3), current from the primary
and first and second (==, =) induction coils. Fourth
line (4), current from primary, first, second, and third
f=» ^> =) induction coils. Fifth line (5), current
i-om the first induction coil only. Sixth line (6), cur-
rent from the first and second induction coils. Seventh
line (7), current from the first, second, and third induction
coils. Eighth line (8), airrent from the second induction
coiL Ninth line (9), current from the second and third
induction coils combined. Tenth line (10), current firom
the third induction coil only.
Therapeutical considerations. — When we consider the
many combinations chat are possible in the continuous
coil apparatus and the different qualities of current that
result therefrom, its general superiority over the separate
coil is sufficiently evident ; and this superiority becomes
more marked if we examine into the varied physical and
physiological effects produced by these combinations.
Our object of inquiry, however, is not as to the rela-
tive merits of different machines, but as to the compara-
tive value of and the differential indications for the use
of the various combinations of the continuous coil appa-
ratus. This point of inquiry, although less important than
when it relates to the^two forras-of dynamic electricity,
is yet of no little account, and in some respects has been
found to be more difficult of solution.
Notwithstanding the many qualities of current that are
derived from the continuous coil, I have, after much ob-
servation, reduced to three the number of combinations
that seem to be worthy of differential consideration.
Every therapeutic result that can be obtained by any
vof the ten combinations heretofore considered, will in all
probability result from the use of some one of the fol-
lowing :
-;^i. The current from the primary coil as represented
by the line marked i (Fig. 2).
2. The current from the primary and the first and
second induction coils in combination, as represented by
the line marked 3.
3. The current from the primary and the first, second,
and third induction coils in combination, as represented
by the line marked 4.
{TiThe primary coil yields a current of large quantity but
of small tension, owing to the fact that the wire of which
the^coil is composed is short and thick. It is worthy of
battery and the inductive influence.
When dealing with an agent so subtle
and so little understood as electricity, it is difl[icult to ex-
press one's meaning in terms altogether satisfactory,
but that such a combination is active and effective
is evidenced by the readiness with which electrolytic
effects are produced. Asthenopia is a symptom diat
I have known to be greatly relieved and even cured
many times by electricity, but more especially through
the use of the primary coil. The tired, aching eye
is both temporarily rested after each sitting and per-
manently strengthened by continued treatment. There
seems to be little appreciation, either among ophthal-
mologists or general practitioners, of the great relief
that may follow this treatment in the many cases where
the eyes ache severely, if used even for a little time
before breakfast or at twilight, or where neuralgic pains
exist in or near the eye, or where there is annoyance
from muscal volitantes.
As we include in the circuit With the primary the vari-
ous induction coils, the current increases in strengdi
with each coil that is added. With the addition of the
first induction coil a much greater strength is apparent,
but the combination has no marked physical or physio-
logical effects that need detain us. By including also
the second induction coil in the circuit, however (line
marked 3, Fig. 2), we obtain a current of a peculiar and
unique quality. Like the primar}- coil, it will elecu-o-
plate, but unlike it, it will not bum steel or iron. The
peculiarity of this combination of the coils is that the
maximum of power to contract muscular tissue is here
obtained. Each additional coil now that is attached
simply gives a decreasing contractile power. Why the
maximum of current strength is reached in the combina-
tion of the primary with 5ie first and second induction
coils it is difficult to sayj excepting as we ascribe it to
the law of harmony or polarization that is brought about
by properly conditioning the magnetic centre of the
helix, the several coils composing the helix, and the bat-
tery influence acting upon the coils. The current from
this combination is not at all pleasant ; it is keen and
cutting in character, and with its strong contractile prop-
erties It is peculiarly adapted to those cases where pow-
erful impressions are called for. Hence in not a few
cases of paralysis where the response to galvanism is
perfect, but where there is a diminution of farado-mus-
cular contractility, I have found it preferable to any of
the other qualities of current to be derived from the con-
tinuous coil apparatus.
In superficial forms of anaesthesia it is, perhaps, in no
way superior, but in certain persistent and more deeply
seated forms of lost or perverted sensibility it is decid-
edly more efficacious than other combinations. Its
greater contractile power over muscular tissue, both vol-
untary and involuntary, renders it most efficacious in
November 8, 1884.]
THE MEDICAL RECORD.
515
cases of menstrual suppression, and also for atrophied
conditions of the utenis, for which so much has been done
by electrical methods of treatment. In cases of dysmen-
orrhoea, as well as in the various neuralgias, my experi-
ence leads ine to exclude its use. Faradism has been
used, and with success, to destroy the foetus in extra-uter-
ine pregnancy. While I greatly prefer the galvanic cur-
rent, having always used it without the slightest ill effect,
yet if the faradic is employed I should not recommend
the current from the coils now under consideration, but
the one presently to be described ; for with this latter
form we obtain effects equally destructive to the foetal
life and with* less violence to the contractile tissues of
the mother. There are several other differential points
connected with the use of this series which suggest them-
selves, but they are of minor importance.
When we include in the circuit not only the primary
and the first and second, but also the third induction coil
as represented by the line marked 4, effects are obtained
more interesting and satisfactory than from any of the
other combinations.
These effects are pre-eminently tonic and sedative in
character, and give for this quality of current a range of
usefulness wider than can be ascribed to the others. There
are but few, in all probability, who at this day are unfa-
miliar with the term general faradization, and who do not
understand that by it is meant the application of the
faradic current to the entire surface of the body, from
the crown of the head to the soles of the feet. It is in the
operation of general faradization, when we desire to ob-
tain the best constitutional tonic effects that electricity
is capable of giving, that we resort to this combination
of the primary and induction coils. Its action on the
motor and sentient nerves is less severe, and its general
effects far more agreeable. For the relief of that great
army of symptoms that are so familiar and so perplexing
to those who have had much to do with neurasthenic cases,
there is, according to my experience, nothing to be com-
pared with it Even the galvanic current by the method
of central galvanization, so important in its direct effect
upon the central nervous system, falls short of the thera-
peutic results that follow well-directed applications ;of
general faradization. When persistent failure follows
endeavors along this line of electrization, the cause of
failure must be ascribed to hasty and faulty methods of
administration. In no department of therapeutics is it
of more importance to be thorough in detail. He only
will achieve the best results who appreciates this fact,
who is willing to inform himself as to the modus operandi
of the methods, and who will devote in individual cases
a reasonable degree of time and patience in carrying
them out.
An Antipyretic Formula. — The following is recom-
mended by Dr. de Giovanni as a substitute for quinine, in
which the latter is ineffective or injurious in its effects
(Rivista Clinica, No. 8, 1884) : Ergotine (Bonjean), fifteen
grains ; tincture of valerian, half an ounce ; water, three
ounces ; to be taken during the height of the fever or in
the period of remittance. Usually the good effects are
obtained after one or two doses, but the remedy should
be continued for some time after the subsidence of the
fever. In rebellious cases the author substituted with bene-
fit cherry-laurel water, one-half to one drachm, for the
valerian. The best results were obtained in intermittent
fevers, but good effects were seen also in remittents, in
the hectic of incipient phthisis, and even in puerperal
fever.
Bicarbonate of Soda in Iodoform Poisoning. — Dr.
Behring states that bicarbonate of soda is an antidote in
poisoning from iodoform. Since the latter drug is elimi-
nated in the urine as an iodic salt, the author assumes
that it abstracts alkalies from the blood. By supplying
the alkali thus withdrawn from the blood he believes
that the system may acquire a special toleration for iodo-
form.— Rivista C/inica, No. 8, 1884.
poetess of "l^j^&imX J^cietxce.
German Measles. — It appears to be a somewhat
general opinion that RStheln, or, as it is not infrequently
called, German measles, is a disease of such minor im-
portance as to be unworthy of scientific research ; but a
disease, the victims of which succumb as early as the
fourth day, must be of sufficient importance to demand
our attention and the best efforts of our armamentarium.
Dr. W. A. Edwards, during the winter and spring of
1 88 1-2, studied in the Philadelphia Hospital over one
hundred cases of the disease, and the results of his
observations he details in a paper in the October number
of TAe American Journal of the Medical Sciences. As
regards the diagnosis, he says the eruption appearing
on the third day, first in the face, its rapid extension, its
gradual shading off into the surrounding skin, its eleva-
tion, more particularly in the centre of the patch, which
is also the brightest in color, together with the fact that
desquamation first shows itself there, are all points which,
as far as the eruption is concerned, render the diagnosis
plain ; furthermore, the rash almost at once occupied the
whole body, and never presented a crescentic outline.
The extreme drowsiness during the eruptive stage is a
symptom upon which Cheadle lays some stress. It is
Dr. J. M. Keating' s experience that however severe the
attack may be, or how diffused the eruption, the contour
of the face is never lost, and that by looking properly
you can always see the zygomatic arch ; this, he observes,
is always obliterated in cases of either measles or
scarlatina that are severe in character. Sore throat was
always present ; in scarlatina it is directly in proportion to
the type and severity of the disease ; the more laryngeal
characterof the cough in Rotheln is also worthy of note.
The pulse remains low, that is, much lower than a case of
like severity of either measles or scarlatina. The fact
that Rotheln propagates itself, and never gives rise to
either measles or scarlatina, and, moreover, does not
protect from these diseases, is a further diagnostic point
that should claim our attention. Dr. Edwards highly
recommends the application of oleaginous preparations
to the skin during the stages of eruption and desquama-
tion ; in the former stage for the comfort of the patient,
and to allay itching and aid in the reduction of the tem-
perature; in 'the latter, to prevent contagion, as all of
his cases underwent desquamation, and in all probability
the contagion is carried by these fine scales.
lODOFORM-FORMING BODIES IN THE EXPIRED AlR
OF Diabetics. — As is well known, Fetters, Kaulich, and
others have found acetone, revealed by its peculiar odor,
in the expired air, the urine, and the blood of diabetics.
Later investigations have proved its presence in the
urine by chemical i^eactions, but methods for recognizing
it in the expired air were less available. Several new
acetone reactions having been recently discovered, Dr.
Nobel attempted to reach results more accurate than
have been hitherto obtained. The urine of the diabetic
patient contained no acetone on examination, but some
days after an exclusive fish-diet was begun it contained
large quantities. The expired air was thus examined.
It was first conducted into a WolfiPs bottle, filled with
distilled water, and after half an hour a solution of iodine
in iodide of ammonium and liquor ammoniae was added.
By the next day a yellow precipitate was seen at the
' bottom of the flask, which on microscopic examination
showed the iodoform tablets most clearly. On the other
hand; the urine of another diabetic patient, which only
gave a weak acetone reaction, showed only a slight
separation of iodoform. On another occasion the air
was passed through the water for an hour, the latter was
distilled for six hours in a water bath at 146.4^ F., and
the distillate was divided into three equal portions. To
one the above-mentioned test solution was added, and a
copious precipitate of iodoform obtained. To the sec-
516
THE MEDICAL RECORD.
[November 8, 1884.
ond a (ew drops of mercuric chloride were added, and
then enough caustic potash to render it alkaline ; it was
then filtered and ammonium sulphide added ; this caused
a black precipitate of sulphide of mercury ^Gunning's re-
action). The third portion yielded a positive result with
sodium nitro-cyanide and liquid ammonia (the acetone
test of the author). No doubt remained that the iodo-
form-making substance was acetone. Continued dis-
tillation for an hour gave no more acetone, though the
iodoform reaction revealed jj^^jny milligr. On another
occasion the distillation was made at the tempera-
ture of 1 76° F. ; and after twelve hours the neutral
distillate, which gave distinctly the iodoform reaction,
was treated with spongy platinum, and the presence of
acetyl-aldehyde at the beginning of oxidation was proved
by the reduction of ammonia-silver solution, and by the
color-test of the author (sodium nitro-cyanide, caustic
potash, and acetic acid). By further oxidation acetic
acid was formed, which reddened blue litmus-paper held
over it ; by careful neutralization with very dilute caustic
soda, a red color, which was destroyed by dilute sulphuric
acid, was .obtained with ferric perchloride. Thus, be-
side acetone, ethyl-alcohol was found in the air expired
by this patient. Regarding the destiny of alcohol in the
animal organism, according to some it is oxidized for the
most part, and, therefore, must have a nutritive value ;
while, according to others, the greater part of it is ex-
creted, unaltered, by the kidneys, skin, and lungs.
However this may be, it is evident that no conclusioji
can hence be drawn as to its behavior in the bodies of
diabetics, in whom the oxidation-processes are altered
so much owing to irregular tissue-changes. The alcohol
formed in such subjects may possibly be excreted un-
altered for the most part, which would agree with the
above results. — London Medical Record^ August 15, 1884,
Cholkcystotomy. — In The American Journal of the
Medical Sciences for October, 1884, Drs. J. H. Musser and
W. W. Keen publish an article on cholecystotomy, in
which they relate two new cases, with a table of all the
hitherto reported cases, thirty-five in number. The first
case was that of a man, aged thirty-two, who had had
attacks of biliary colic for five years, followed by jaun-
dice, until he was reduced in strength, and had chills and
fever threatening life. Dr. Keen attempted cholecys-
totomy, the incision being made over a region of dulness
believed to be the gall-bladder. This dulness was found
tp be due to an inflammatory mass, which glued together
the gall-bladder, colon, and intestine. No stone could
be detected. The wound was closed, and recovery ulti-
mately followed a course of Hathorn water at Saratoga.
The second case was also that of a man, aged thirty-one,
with acute gastro-intestinal catarrh, followed by jaundice,
enlarged gall-bladder, and symptoms of internal suppura-
tion. The enlargement of the gall-bladder was demon-
strated by the hypodermic needle, but the fluid was not
bile. Dr. Keen performed cholecystotomy, using a large
hollow-handled spatula to drain off the twenty ounces of
fluid contained in the gall-bladder. The gall-bladder was
found to be seven inches in depth, but neither by finger
nor probe could any gall-stone or the orifice of the duct
be found. A biliary fistula was established, and bile was
discharged through it the next day. The patient died a
week later of exhaustion. The post-mortem examination
revealed inflammatory closure of the cystic and common
ducts at the mouth of the gall bladder and at the duo-
denum. Dr. Musser in his medical comments analyzes
at length the causes, symptoms, and diagnosis of biliary
obstruction, under the heads of jaundice, tumor, pain,
and suppuration, especially in relation to gall-stones .and
other foreign bodies and diseases of the ducts. He
points out the means by which a just conclusion may be
reached, and that cholecystotomy should be resorted to
early in the case rather than wait till the blood is disor-
ganized and the liver softened and made functionally
useless. Especially is this true in view of the low mor- j
tality of the operation, there having been (excluding '
Gross' incidental case) only nine deaths in thirty-four
operations, and of the fact that Mr. Tait has done thir-
teen operations, by far a larger number than any other
operator, all of which have been successful. In his sur-
gical comments, Dr. Keen discusses the surgical means
of diagnosis by aspiration, with or without probing through
the canula, and by acupuncture, both of which, when
properly done, he commends. He also strongly urges
an early laparotomy, followed at once by cholecystotomy,
if found advisable, and condemns the attempt to provoke
or to wait for adhesions. Indeed, upon this disregard of
adhesions hinges the whole of our modem progress in
abdominal surgery. He points out that to Bobbs, of
Indiana, and to Sims, both American surgeons, is due
the credit of first performing and practically perfecting
the operation. He advises the formation of a biliaiy
fistula, rather than sewing up the gall-bladder, and dis-
approves, as a rule, a removal of the gall-bladder, as add-
ing a new and usually a needless danger.
Dyspeptic Coma. — Dr. Riess has observed a number
of cases resembling in their principal features the picture
depicted by Kussmaul of diabetic coma. But in no in-
stance was there any glycosuria, the coma occurring with
anaemia, nephritis, and carcinoma of the liver and stom-
ach. In almost every case the chloride of iron test gave
negative results, showing that the trouble was not due to
poisoning with acetones. The author concluded that the
symptoms of diabetic coma, for which he proposes the
name of dyspnoeic coma, may be also excited by a falling
off in the proportionate number of red blood-corpuscles.
Dr. Litten has observed the characteristic chloride of
iron reaction of the urine in twenty-five non-diabetic
patients, and concludes that it may be found exception-
ally with any disease. In only one of these cases did he
observe the dyspnceic coma of Kussmaul. He saw, how-
ever, several cases in which there was the peculiar odor
of the breath and a soporific condition, but without any
of the respiratory disturbances described by Kussmaul.
He thought, nevertheless, that the two conditions were
essentially the same, and were caused by poisoning from
some substance produced in the digestive canal. This is
probably the same substance to which is owing the pe-
culiar odor of the breath and the characteristic reaction
of the urine. This was supposed to be ethyldiacelic
acid, but Frerichs denies the identity of the two sub-
stances.— Allgemeine Medicinische Central'2^iiungy No.
6Z, 1884.
The Physiological Action of Digitalis. — In the
October issue of The American Journal of the Medical
Sciences Dr. Nickles, of Cincinnati, summarizes the
present state of our* knowledge of the physiological
action of digitalis. The doctrines now universally
taught regarding the action and uses of digitalis differ in
a number of important points from those held two decades
ago. Then we were taught that digitalis is essentially
a sedative, affecting strongly the nervous system, thus
causing feeble and slow heart action. Now the latest
authors teach that the nervous system is only secondarily
affected, while the heart is directly influenced, its action
becoming more powerful though slower. Twenty years
ago we were taught that digitalis is a diuretic, directly
acting upon the kidneys, thus producing in many diseases
a greater secretion of urine. To-day we are told that
digitalis does not act upon the kidneys at all, and only
secondarily affects the secretion of urine by causing a
change in the systemic circulation. In one point, there
is universal agreement, that digitalis recklessly used may
produce the most disastrous effects, and that these may
occur quite unexpectedly in consequence of cumulative
action. But not only in regard to the modus operandi
do present authors differ from their predecessors, but
also as to the therapeutic indications. Two decades ago
digitalis was held to be indicated when the heart's action
is too powerful ; now we are informed that it is useful
only when the heart's action is too feeble. Then author
November 8, 1884.]
THE 'MEDICAL RECORD.
517
taught that digitalis will control, and hence favorably
influence, a hypertrophied heart, while present writers
contend that every disease of the heart attended with
excessive action is aggravated. It was held for a century
that digitalis, though not eminently useful, is still often of
great service in dropsy dependent upon organic disease
of the kidneys ; but now we hear that in diseases of the
kidney, attended with diminished diuresis, it is almost
always useless, and always exceedingly dangerous.
Mumps as a Cause of Sudden Deafness. — Disease
of the ear during the progress of acute infectious disor-
ders is a not infrequent occurrence. Especially are
suppurative inflammations of the middle ear common
during the progress of scarlet fever, and non-suppurative
inflammations are a frequent attendant upon the progress
of measles. The nature and treatment of these ear dis-
eases are well understood. But occasionally during the
progress of mumps a sudden and complete loss of hear-
ing occurs which is not so well known, either as to its
nature or its treatment. A paper on the subject from
the pen of Dr. Leartus Connor^ of Detroit, which appears
in the October number of The American Journal of the
Medical Sciences^ gives the following conclusions : i.
Parotitis in some rare cases produces complete deafness ;
2, this deafness is usually attended with all the evidences
of disease of the labyrinth ; 3, these show that it some-
times begins in the cochlea, but more frequently in the
semicircular canals ; 4, owing to the lack of early observa-
tions and treatment it is impossible to say that it is not
transmitted through the middle ear from the parotids to
the labyrinth ; 5, the history of some of the cases would
seem to suggest that such an origin was possible ; 6,
this possibility renders it very important that every case
of deafness during an attack of mumps be at once care-
fully examined, so as to settle the question ; 7, this
possibility offers the only hope for the successful treat-
ment of these cases so as to prevent deafness. Thus, if
there be a middle-ear disease, we might hope that revul-
sive and counter-irritant treatment would arrest the dis-
ease and save the labyrinth ; S, as to treatment of the
labyrinthine disease nothing has thus far been devised
that has produced any satisfactory result.
Grave Nervous Symptoms Occurring in Typhoid
Fever. — Dr. Baas relates the case of a boy eight and a
half years old, who was suffering from typhoid fever. At
the twentieth day, when the fever was at its maximum,
the child passed some bloody stools, and at the same
time fell into a state of complete cerebral torpor. The
patient gave no signs of consciousness, the pupils were
contracted and responded very sluggishly to light, and
there were several convulsive attacks limited to the right
side of the face. The following day there was paralysis
of the right facial nerve and of the arm on the same side.
The fever began tor subside at this time, consciousness
slowly returned, and the paralysis disappeared. But with
the return of consciousness the child was found to be
aphasic and agraphic. He understood what was said to
him, but was unable to find the words to reply. On at-
tempting to write he could only trace some meaningless
figures which he himself recognized as expressing nothing.
For a few days he was unable even to indicate his desires
by appropriate gestures. He could not count, but would
point with his finger to the number which he was not
able to articulate. Five weeks after the beginning of
paralysis he began to speak, articulating first the vowels
and later the consonants. One month later he had en-
tirely recovered. These symptoms seemed referrible to
lesions in the third frontal convolution on the left side,
and in the motor centres of the cortex. The author
believed that they were caused by a capillary apoplexy.
—Archives Gendrales de Midecine^ September, 1884.
The Varieties of Purpura. — The pathogenesis of
purpura is as yet involved in considerable obscurity. In
a recent study of the subject. Dr. Leloir {Annales de
Dermatologie el de Syphiligraphie) recognizes three main
groups of this affection : A, Purpura from modification
of the vessels. — i. From perturbation of the capillary
circulation, whatever its origin, leading to active or pas-
sive hyperaemia, producing hemorrhage by diapedesis or
by vascular rupture. 2. Purpura lUangiecicLsique of
Cornil. 3. Purpura from primary alteration of the vas-
cular walls, and consecutive rupture of these walls. B.
Purpura from modifications of the blood. — i. Too' great
fluidity of the blood (purpura by diapedesis). 2. From
vascular obstructions determined by certain elements
contained in the blood leading to the formation of throm-
boses and embolisms. This purpura might occur from
simple diapedesis ; it is more often hemorrhagic infarction
of the skin, a. From formation of clots in blood-dys-
crasiae. b. From embolism formed by white corpuscles
(leucocythaemia, etc), c. From embolisms formed by
bacteria or micrococci (septic diseases, etc.). d. From
embolisms formed by altered blood-elements. C Pur-
pura nervosa. In practice, however, many cases will
not fall completely into either group ; very often the ori-
gin seems to be complex. Alteration of the blood, trou-
bles of the circulation, vascular lesions, disturbances of
innervation, all causes of cutaneous hemorrhage, may co-
exist in the same subject. In all probability, even dys-
crasic purpura may be in certain cases the origin of sec-
ondary vascular lesions, of secondary endarteritis. And
it is probable that alteration of the bloo,d often modifies
the action of the vaso-motor nervous apparatus, central
or peripheral. In studying a case of purpura, it must
not be forgotten, then, that its pathogenesis may be com-
plex. The relative importance of the different causes
must be sought ; and an attempt must be made to deter-
mine the relations between the determining primary or
predisposing causes and the occasional or secondary
causes.
Iodized Collodion in Erysipelas. — Dr. Humphreys,
of Texas {NcLshville Journal of Medicine and Surgery y
September, 1884), has used for the past five years iodized
collodion as a local application in erysipelas. He has
had uniform success with it, even in quite obstinate cases.
Constitutional treatment is, however, not neglected by
him. The collodion is applieo with a feather or camel' s-
hair brush, as often as desirable (?). Upon evaporation
of the ether there is a feeling of coolness and ease, after
days and nights of suffering. The following formula for
making the iodized collodion is taken from IValzPs FhotO'
graphic Rays of Lights January, 1878.
g. Sulphuric ether | x.
Alcohol, absolute | x.
Gun cotton 3 ij.
Mix, and when dissolved add
Iodine ammonium grs. 80.
Iodide cadmium grs. 40.
Bromide cadmium grs. 40.
Mix, and bottle tightly for use.
As the salts of cadmium may not be readily obtained
in country drug stores, it is highly probable that two
drachms iodide ammonium and two scruples bromide
potassium or ammonium added to the first three articles
would prove as efficient as the formula given above.
Atropine in Acute Otitis Media of Child-
hood.— Dr. Miot has obtained excellent results in ear-
ache of children from atropine. The children to whom
he gave it were very subject to coryza, and the inflamma-
tion would usually pass from the nose to the fauces and
middle ear. But when atropine was given at the very
commencement of the rhinitis the children were spared
the pain of the otitis. For a child he used a solution
of sulphate of atropine, i milligramme to 80 grammes
of water (^ grain to 20 drachms), the dose of which was
a teaspoonful repeated from two to four times a day at
intervals of two or three hours. For adults he prescribed
a dose of double this strength. The treatment was con-
tinued usually for two or three d^c^s.—Journal de Mide-
cine et de Chirvrgie Pratiques y September, 1884.
5i8
THE MEDICAL RECORD.
[November ^, i884»
The Medical Record:
A Weekly Journal of Medicine and Surgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD & Co., Nos. 56 and 58 Ufayette Place.
New York, November 8, 1884.
THE HISTORY AND PROPERTIES OF CO-
CAINE.
Wackenroder and Johnston expressed the belief, as
long ago as 1853, that an active alkaloid existed in the
leaves of erythr65cylon coca. Gadeke first isolated it,
but it was not till i860 that Niemann {Ann, Chem.
Pharm,^ 114, 213) announced its physical properties and
gave it the name of cocain, A little later Losson found
in coca leaves another, apparently inert, volatile base,
which he called hygrin {Ann, Chem, Pharm,^ 133, 351).
This latter chemist states that in the best leaves the
amount of cocaine was at most one-fifth of one per cent.,
and in the poorer kinds as little as one-sixtieth of one per
cent.
Cocaine crystallizes in large four to six-sided colorless
prisms. It has a bitter taste, benumbing the tongue, a
strongly alkaline reaction, and melts at 98® C. It dis-
solves in 704 parts of water at 12® C, easily in alcohol,
and more easily in ether. Its composition, as deter-
mined by Losson, is C„H,jNO^.
Cocaine unites easily with dilute acids to form crys-
tallizable salts, which are soluble in alcohol but not in
ether.
The salts which the industry of chemists have already
prepared are the muriate (C„H,jNO^HCl), the sul-
phate, nitrate, tannate, and oxalate. Besides these there
have been prepared double salts of cocain-platinum chlo-
ride (C„H„NO,HClPtCl,) and of cocain-gold chloride.
By decomposition with strong acids a new base has
been formed out of cocaine, which is called ecgonin.
A test given for watery solutions of muriate of cocaine
is picric acid, which throws down yellowish precipitate.
The alkaloid cocaine has not been used medicinally
to any great extent, but its physiological action has been
studied by a number of observers.
For man the dose runs from one-sixth to two grains.
Its lethal power is slight and its action is not cumulative
(Husemann). Von Anrep found (Archiv. ges, Physiol, ^
21, 38, 1880) that the cocaine could be taken daily for a
long time without producing any notable disturbance,
and he concluded that its action was not cumulative.
Schroff, who in 1862 made the first experiments upon man
with cocaine {Zeiischrifi f, Wien, Aerzte^ 30-34), found
that in large doses it caused vertigo, lassitude, slight deaf-
ness, disturbance of memory, and of co-ordination of
thought.
Other experiments and observations by Froumiiller
{Prag. [^terteljahrsschr.^ [79, 109, 1863), Jarchanoff
(" Cocain and Diabetes, Petersburg, 1872), and Ploss
{Zeiischr, Chir.^ 222, 1863), appear to show that cocaine
is a narcotic, having a primary stimulating action upon
the brain, and being analogous in properties to cannabis
indica. Froumiiller, in fourteen cases, was able to pro-
duce sleep by giving large doses (up to five grains).
Ploss reports the case of a druggist who took about
twenty- two grains of cocaine in a glass of beer. He slept
quietly for some hours, then awoke with powerful ab-
dominal gripings, burning and dryness of the mouth, and
thirst. He vomited any liquid drank. He suffered fi-om
vertigo, feebleness, and aneuria for twenty-four hours.
The heart's action showed no disturbance, and his mind
was not disordered. The case is instructive as showing
that cocaine is probably not a very poisonous drug to
men, and that in large doses its narcotic action is imme-
diate.
Among animals it has been found that frogs are more
susceptible than warm-blooded animals, and that car-
nivora are more sensitive than herbivora.
The fatal dose for a dog is from three to five grains
(Danini : ** Ueber Physiolog. Wirkung und Therap. An-
wendung des Cocains,'* St. Petersburg, 1873). Rabbits
are killed by doses of o. i gramme per kilogramme of
animal, according to Von Anrep.
The physiological effects of cocaine externally and
internally have been studied by the authors already
quoted, and by Nikolsky (" Beitrag. zur Cocain Wirkung
auf den Thier Organismus," St. Petersburg, 1872) ; Isaac
Ott (Moreno y Maiz : " Recherches Chim. et PhysioL
sur I'Erythroxylon Coca du P^rou et la Cocaine," Paris,
1868) ; by Danini (" Ueber Physiol. Wirkung u. ther.
Anwendung des Cocains," Charkow, 1873) ; Bennett
(" Report on Antagonism of Drugs," 1875) ; ^^^ ^Y ^^^
bach ("R. and Nothnagel's Handbook of Therapeu-
tics"). An excellent review of the contributions of
these authors, to which we are indebted, is given in
Husemann and Hilger's "Die Pflanzenstoffe," Berlin,
1883, from which we summarize the knowledge so far
gained of the properties of the drug.
Locally, it produces the effects upon skin and mucous
membrane which have been already described in The
Record, and need not be repeated now. Moreno, in
1868, showed that local injections abolished reflex move-
ments for a time, and Von Anrep, in 1880, showed that
the sensibility of the skin was abolished when hypodermi-
cally injected^ and that of the tongue when touched with
strong solutions. The same author applied a solution
containing one-half "a milligramme to the conjunctiva,
and found that it caused a temporary dilatation of the
pupil, which was increased by adding atropine. Strangely
enough, Anrep did not note that the conjunctiva was in-
sensible, or if so, did not appreciate the practical signifi-
cance of the fact As Nikolsky found that the pupil is
still dilated by cocaine after section of the sympathetic,
it is inferred that the drug does not act upon the iris
through that nerve.
Cocaine given internally in small doses to warm-
blooded animals stimulates the nerve-centres, acting
most plainly upon the higher psycho-motor cells of the
brain, then upon the medulla oblongata and the cord.
It seems especially to affect the action of the semicircu-
November 8, 1884.]
THE MEDICAL RECORD.
519
lar canals, causing vertigo, and in dogs, at least, disturb-
ances of equilibrium and rolling movements. The pupil
is dilated. A lengthening in the time of muscular con-
traction, claimed to exist by Ott, Buchheim, and others,
is denied by Nikolsky and Anrep. Respiration is has-
tened and labored in warm-blooded animals; in fatal
doses the breathing stops before the heart-action. Upon
the heart moderate doses of cocaine in warm-blooded
animals lessen the inhibitory action of the vagus and
increase the rapidity of the beat without impairing its
strength. Moderate doses appear also to raise arterial
pressure, but in medicinal doses the cocaine does not
greatly affect the vaso-motor system. Moderate doses
increase intestinal peristalsis, while large doses lessen it
and seem to produce a venous congestion of the walls.
There is a decrease in the secretion of saliva and of
mucus, while the urine does not seem to be much affected,
except in toxic doses.
So far as the local anaesthetic effect of cocaine is con-
cerned, it seems to have been independently noticed by
several persons, as we have indicated above. The prac-
tical (application of this knowledge, however, is only of
very recent date.
THE TENEMENT-HOUSE CIGAR BILL AND THE FAC-
TORY NUISANCE.
There have been two recent decisions on health ques'
tions which deserve attention. The first of these is the
judgment of the General Term of the New York Supreme
Court, holding that the Tenement-house Cigar bill is
unconstitutional. This law was passed at the last session
of the Legislature and took effect immediately. By its
provisions it prohibited the manufacture of cigars in all
tenement-houses occupied as the home or residence of
more than three families living independently of one an-
other and doing their cooking on the premises. Two
days after the passage of the act, Peter J , who occu-
pied seven rooms on the first floor of a tenement-house
and manufactured cigars in one of them, was arrested for
breaking the law. He was unable to procure bail and
was committed to prison. A writ of habeas corpus was
then sued out in his behalf, but was dismissed, and an
appeal from this decision has been up for review at the
General Term of the Supreme Court, where it was reversed
and the law declared unconstitutional. The grounds for
this decision are that the labor of the poor man is his
only property and as much entitled to protection as any
of its accumulations ; that this law suddenly deprived him
of the free use of this labor, and in effect seized private
property without just compensation. Such a result is
against the Constitution of the State, and any law which
allows it must be unconstitutional. The opinion goes on
further to say that the ostensible object of the bill, viz.,
to secure better health, as declared in the title of the bill, is
a mere pretence, and that the real object is to " suppress
and restrain such manufacture in the cases covered by the
act, for the purpose of preventing successful competition,
injurious to other modes of manufacturing the same article.'*
The judges find reasons for this belief in the very
&ce of the bill, and they certainly make out a strong
case. They say that tenement-houses where the cooking
is not done on the premises are exempted, and that the
most thronged and over-crowded tenements, which are
occupied largely by persons who live from hand to mouth
and by beggary, can manufacture cigars without interfer-
ence. Also the first floor of the tenement-house is ex-
cepted if in addition to the manufacture of cigars there
be a store for their sale, while if health were the object
this floor, being the resort of more persons than the othersr
would certainly be under the provisions of the bill. The
law fails to secure health to any reasonable extent, but
in the words of the judges it accomplishes a very differ-
ent thing : " If the act were general and aimed at all
tenement-houses, and prohibited for sanitary reasons the
manufacture of cigars and tobacco in all such buildings,
or if it prohibited such manufacture in the living-rooms of
all tenants, another case would be presented. But in the
form in which it comes before us it is so unjust in its ine-
qualities, so harsh and oppressive upon the labor of
poverty, so keenly discriminative in favor of the stronger
classes engaged in the same occupation, that it certainly
ought not to have been enacted."
It is said that the large manufacturers were confidently
expecting that the constitutionality of the bill would be
upheld, and have been perfecting machines which would
do away very largely with hand labor. If these machines
should really be set at work the result will be deplorable,
as the workmen would be in the position of having the
opportunity for work given them again but the work all
taken away from them. The decision of the General
Term may be appealed from, and if so the matter cannot
be considered as settled.
The second case referred to was one in the New
Jersey Court of Chancery, where an application was
made by the Board of Health of Lambertville for an in*
junction preventing the proprietor of a tomato-canning
establishment from turning the refuse firom his works into
a creek, it being alleged that the odor of the decaying vege-'
table matter was injurious to the public health. The
case was bitterly contested, and, as is usual in such cases^
the expert evidence presented was, much of it, absolutely
contradictory. It was claimed on behalf of the defendant
that the smells were not harmful, and also that others
were responsible for the unhealthy condition of the town«
The Vice-Chancellor, in deciding the case, held that the
defendant's factory was the primary source of the nuisance,
and that this made him responsible, even though the bad
condition of the sewer and the discharges of filth by other
persons might have contributed to the nuisance ; and a
decree was made forbidding any further deposit of the
decaying vegetable matter.
There are a number of similar cases depending upon
this decision, which is an important one as tending to
strengthen the powers of boards of health.
ACUTE PAINFUL PARAPLEGIA.
Under the name of ''acute painful paraplegia" M«
Dumolard describes an affection which closely simulates
an attack of rheumatism. The pains suffered by the
patients are often intolerable, and the paralytic symp-
toms, which they rarely mention, may pass unperceived^
The affection is then characterized by the following
phenomena : paralytic symptoms feebly manifested, but
with very intense pains ; on this account Dumolard calls
it '' acute painful paraplegia.''
520
THE MEDICAL RECORD. • [November 8, 1884.
This designation, however, is insufficient, as it says
nothing of the seat and nature of the malady. It is
pharacterized, at the beginning, by sharp pains in the
regions of the kidneys and in the lower limbs, soon fol-
lowed by incomplete paralysis of the abdominal members
and of the bladder, with hyperexcitation of the reflex acts
of the lumbar portion of the cord. In some cases the
pains leave the lower limbs and attack the upper part of
the trunk and the upper limbs, thus causing a very pain-
ful though incomplete cervical paralysis. Though last-
ing for a considerable time, the affection seems to tend
always toward a cure ; but its course is not always simple
and regular.
As the disease is somewhat rare, and as nothing is
known of its nature or anatomical situation of the patho-
logical disturbances caused by it, it may be interesting
to give a short rSsumS of the symptoms presented in the
cases reported by Dr. Dumolard. The affection com-
mences, as has already been stated, with acute pains in
the kidneys and lower limbs. Both limbs are affected,
and the pains extend to the feet. At times they are
very severe, and are accompanied by muscular contrac-
tions and cramps of the thighs and legs. They some*
times come on without appreciable cause, while at other
times they are produced by attempts at movement, by a
shock, or even by a slight touch. The reflex power of
the cord is evidently in a state of hyperexcitation. The
patients seem to be fully aware that the pains are not
the sole cause of the loss of the power of motion. The
pains gradually increase, extend to the bladder, and
micturition becomes painful. These cases were at first
diagnosticated by Dumolard as rheumatism, for which he
prescribed salicylate of soda, with the view that the
meninges were affected, but without result. In a vari-
able time, three to six weeks, the condition begins to im-
prove, and the affection seems to pass off spontaneously.
In other cases the pains begin in the shoulder and extend
to the wrist. In these cases the bladder may not be
affected.
We have now briefly analyzed the principal symptoms
of this curious affection. It commences with a lumbar
pain, with a sensation of weight in, and radiation into, the
back. It may be at first very acute and then gradually
diminish in intensity ; at other times it is slight in the
beginning, and becomes more and more violent. It first
commences just below the kidneys, then attacks the
dorsal region and ascends toward the neck. The pains
in the legs do not always follow the course of the sciatic
nerve, nor are they localized in the joints, as in articular
rheumatism, but are seated, as a rule, along the entire
surface of the affected limb. Whatever may be the man-
ner in which the affection commences, the patient soon
becomes completely paralyzed in the painful regions,
while the pains still continue. The reflex power of the
cord is then slightly exaggerated, and the least shock to
the feet, or the least movement of the affected parts, is
sufficient to cause the painful tetanic contractions. Is it
not possible that this exaltation of spinal reflex may ex-
plain, in certain cases, the sort of muscular impotence
which prevents movements on the part of the patient,
rendering him incapable of taking a step, while in the
horizontal position their muscles appear to be very
strong ? Will not this also explain the difficulty of mic-
turition, by supposing that the exaggeration of the re-
flexes causes a contraction of the neck of the bladder ?
The general state in this affection is never grave ; the
pulse rarely goes above 80 ; the skin is moist ; the tongue,
though white, remains moist, and the general aspect of
the patient is indicative only of pain. The bladder is
generally affected, and the patient makes futile attempts
to completely evacuate it. The paralysis of the bladder
and limbs is never complete, however. As a rule, the
pains are confined to the region of the kidneys and to
the lower limbs during the whole time ; they may, how-
ever, as stated before, suddenly leave these regions and
attack the arms and upper part of the body, and give
rise to symptoms of painful and incomplete paralysis of
the cervical region. The pains do not follow the nerve-
trunks, nor are they localized in the vicinity of the
trunks ; the entire surface of the limb is affected. Nor
are there any lancinating pains, such as are seen in cases
of neuralgia.
The cause of the affection is obscure. All of the pa-
tients seen by Dumolard were in middle life and of the
working class. Most of them referred their attack to ex-
posure to cold or wet. It is noticeable that in six cases
out of seven the patients were attacked in February or
March. Furthermore, all of the patients were males.
The treatment is necessarily symptomatic ; energetic re-
vulsants over the region of the cord should be used per-
severingly; the saline purgatives are indicated for the
saburral state of the digestive tract ; bromide of potas-
sium, as a moderator of the spinal reflexes, is also indi-
cated. Chloral and morphine are indispensable for re-
ducing the hyperaesthesia of the limbs and for the
insomnia. It would seem that the electric current would
be useful in the paralyzed condition of the limbs.
An affection almost precisely similar to this in every
respect was described by Bockhammer some years ago,
and an analysis of his paper may be found in the Revue
des Sciences M^dicdles^ vol. viii., p. 183. It appeared
as an epidemic in Spain under the name of the Azannon
disease, from the village where it appeared for the first
time. The description of it given by Bockhammer cor-
responds in almost every detail with that of Dumolard.
Can it be that this is an abnormally mild form of spinal
meningitis ? Or may it not be due to lead-poison ? It is
scarcely probable that it is a manifestation of syphilis.
Certainly its etiology is very obscure, nor is it likely to be
cleared up, seeing that the patients all recover.
THE NEW PENAL CODE AND THE RHINELANDER CASE.
In our issue of September 20th we gave the main facts
regarding the Rhinelander case, which for many reasons
has excited unusual interest in the community. The de-
fendant, Mr. William C. Rhinelander, committed a homi«
cidal assault upon Mr. John Drake, whom he believed
to be alienating the affections of his (Rhinelander^s)
wife. Being brought to trial, the prisoner's relations
claimed that he was insane, while he himself denied this
and contended that he should be brought to^ criminal
trial for his act.
The position thus taken by the prisoner was unique.
But besides this, the trial involved the application for the
first time of the sections in the new Code providing for
November 8, 1884.^
THE MEDICAL RECORD.
521
the trial of persons who put in a plea of insanity as an
excuse for crime. The law says that if any person under
indictment for the crime of murder or attempt at mur-
der shall appear to be insane, the Court of Oyer and
Terminer may, with the concurrence of the presiding
judge, inquire into the sanity of such person, and may
for that purpose appoint a commission to inquire into
the facts of the case and report to the court. Such a
commission was appointed by Recorder Smyth, which,
consisted of Dr. William Detmold, Mr. Patrick Nolan, and
Mr. Edward Paterson. A large an>ount of evidence was
taken. A report was finally made to the Court, in which
two of the commissioners, Dr. Detmold and Mr. Nolan,
stated the opinion that the prisoner was insane, while
Mr. Paterson gave a contrary opinion.
Recorder Smyth has recently, after reviewing the evi-
dence furnished by the commission, reversed its deci-
sion and decided that the defendant is sane. In doing
this he establishes the precedent that a judge may reverse
the decision of the commission he appoints. The case,
besides furnishing a precedent on the above point, is in-
structive in that it shows how valueless expert testimony
may still be, even under the new law. This law, in fact*
though it gives some additional guarantee that the sanity
of a prisoner is submitted to a careful test, does not in
the least improve upon the mode of getting expert
opinion. In the present case the weight of scientific
opinion was almost entirely on the side of Rhinelander's
insanity. In fact, we do not recall a single name among
the experts put up by Rhinelander's counsel which would
carry weight in the profession. As long as lawyers can
set up any doctor, however unqualified as an expert, we
must expect the present state of affairs to continue. It
is as ridiculous to assume that every medical man, even
if he has had a little special experience, is an expert on
insanity as to suppose that every general practitioner is
an ophthalmologist or a dermatologist.
DEAD TEETH IN THE JAWS.
It would be well if the dead (pulpless) teeth filled and
left in the jaws of people were labelled " at the owner's
risk," and all golden " crowns " and " bridge " structures
attached to dead teeth marked " extra hazardous ; " for it
appears that when the pulp of a tooth has been removed
life no longer exists in the dentine, which derives its
nourishment from the pulp, and there is no way of pre-
venting the dead matter left in its canaliculi from under-
going decay for an indefinite period of time. This matter
has been touched on by our correspondent in another
column, and we believe that the attention of the general
practitioner is now being directed to this subject more
than heretofore. It would seem that dentistry has per-
haps been over-zealous in its efforts to retain defective
teeth in the mouth, or to supplant them with apparatus
which often proves to be anything else than harmless to
the patient. In carrying both of these branches of den-
tistry to what the medical mind regards as a dangerous
extrem**, the health of the patient has too often been
lost sight o£ This, after all, naturally enough, was to be
expected so long as medical men relegated the manage-
ment of nearly all diseases of the mouth, such as the re-
moval of dead teeth, the treatment of alveolar* abscesses,
diseases of the antrum of Highraore, and facial neuralgias,
to dentists who possessed very little if any knowledge of
medicine. It is in consequence of this course that the
treatment of jaw diseases has been lost sight of by the
general surgeon, and we fear that the well-intended
efforts of dental schools to impart surgical knowledge to
the mere mechanics who constitute by far the greater
number of their students, will not remedy this neglected
feature in medical education.
Dentists having a predilection for surgery of the jaws
would do well to recognize this ' state of things, and to
bear in mind that a medical education and training are
necessary accomplishments to acquire before the study
and treatment of any region of the body may be success-
fully taken up. In this way only may the aspirant es-
tablish himself in any medical specialty, so as to gain
the confidence of the profession. At the present time it
is believed that not over five per cent, of dental gradu-
ates, not to mention others who practise dentistry, have
taken the ' degree [of M.D., and of these a very small
number have had any training in the practice of medi-
cine.
The practitioner, in the meantime, who neglects to in-
quire into the state of his patient's teeth, may encounter
much difficulty in overcoming diseases, especially those
about the head, which can in any way be affected by
reflex nervous influences from this source ; and when
the question of the removal of a dead tooth which gives
rise to disturbance is considered, it should not be forgot-
ten that local pain may be entirely unobserved by the
patient.
l^eMJB 0f ttije ^atjejek
Dr. David B. Miller, of this city, died on November
I St, of Bright's disease. He was born in 1836, and grad-
uated at the College of Physicians and Surgeons in 1858.
Dr. Paul Grawitz, of Berlin, assistant at the Patho-
logical Institute, under Virchow, has been appointed to
the charge of the Carnegie Laboratory, Bellevue Hospital
Medical College. Dr. Grawitz has made a number of
very scientific pathological researches, and is eminently
qualified by training to fill successfully the position to
which he is chosen. The faculty of the college are show-
ing a desire to make the Carnegie Laboratory an institu-
tion of positive practical and scientific value not only to
their students but to the profession of the city.
Our Medical Centenarian. — Harper's Weekly pub-
lishes an excellent portrait of Dr. Christopher Columbus
Graham, of Louisville, Kentucky, who recently arrived
at the age of one hundred years. His fellow-citizens
celebrated the occasion by tendering him a banquet.
A Doctor's Heroism. — Under this title the London
Spectator gives an account of a Dr. Samuel Rabbeth, of
London, who sucked the diphtheritic membrane out of a
trachea tube to prevent the suffocation of his patient.
He caught the diphtheria himself and died.
Another French Cholera Commission. — Professor
Jules Aronssqhn has been appointed by the French
Government as head of the commission to study the
cholera in Italy.
522
THE MEDICAL RECORD.
[November 8, 1884.
The Latest Estimate of the Deaths from
Cholera is as follows : France, 6,741 ; Corsica (esti-
mated), 100; Algiers (estimated), 200; Italy, 12,283;
Spain, 436. Grand total, 19,760. The above repre-
sents a period of from June 14, 1884, when the first
case occurred at Toulon, to October 15th. There were
probably about 50,000 cases of the disease.
Bequest to Indigent Medical Students. — The
late Countess Bose, of Kassel, has left to the University
of Berlin, 780,000 marks as a fund for the use of indigent
medical students.
Professor Du Bois Reymond Challenged by a
Quack. — Ex gratia Bismarck, Professor Schweininger
has challenged Professor Du Bois Reymond to fight a
duel, Schweininger having taken offence at the remarks
of Reymond on his appointment to a chair in Berlin
University. Professor Reymond declines to fight.
Two Decisions Regarding the Pay of Expert
Witnesses. — Judge White, of Pennsylvania, has decided
that under the law a physician must answer a summons
from a court to appear and testify as an expert without
remuneration.
A directly contrary opinion to Judge White's was re-
cently delivered in the Circuit Court of Chicago. A dis-
pensary patient sued Dr. Hotz and his substitute. Dr.
Lee, for the loss of an eye, claiming $10,000. Another
physician was summoned to testify as to facts in the
case. Being then asked to testify as an expert and give
an opinion, he refused.
"This action of the court," says the Weekly Review ^ **is
of considerable importance, as it shows that a physician
cannot be made liable for any act of his locum tenens
when duly qualified by law, and further that no physician
is obliged when subpoenaed as a witness of fact to ex-
press an opinion as an expert."
The Oldest Living Microcephalic — ^At a recent
sitting of the Berlin Medical Society, Professor Virchow ex-
hibited a girl, aged fourteen, with a slight though normally
developed figure, but with a diminutive head, scarcely as
large as a man's fist. She came from Offenbach, and
was introduced by her mother, a tall, large-boned woman.
Her face is not larger than that of a new-born child, with
a sharply projecting nose and prominent jaws ; her com-
plexion is delicate, and her features resemble those of a
bird of prey. The size of the brain in this diminutive
skull is proportionately small, and the intellectual powers
are not developed beyond those of a six-months child.
The only word, besides some inarticulate sounds, that
the girl can pronounce is mamma. The parents had
had seven children, of whom four were microcephalic,
but only the one exhibited had lived. When she was at
home she sat quietly, and preferred avoiding the society
of other children, generally withdrawing into a corner of
the room. She ate and drank purely mechanically,
Virchow referred to this case as the oldest one living.
At the recent meeting of the French Association for the
Advancement of Science, Dr. Magitot reported* the case
of a microcephalic woman, aged thirty, weight seventy
pounds. She showed more intelligence than Virchow*s
case, and could dress, take care of herself, and speak
several words.
The Board of Health of this city receives this year
an appropriation of $420,282. It wanted $17,000 more.
American Use of the Thermometer in Disease in
1 808.— In Dr. Elisha North's "Treatise on Malignant
Epidemic Spotted Fever, or Cerebrospinal Fever," he
tells us, page 41, that it will always be well to ascertain
the degree of the patient's heat by a thermometer.
Medical Department University of Vermont.—
Dr. W. Oliver Moore has been appointed Professor of
Diseases of Eye and^Ear, in place of Dr. D. B. St. John
Roosa, who has resigned, and Dr. Stephen S. Burt has
accepted the chair of Professor of Physical Diagnosis.
Pacini's " Cholera Germ." — It has been stated that
Professor Pacini, of Naples, announced the discovery of
a cholera-microbe as early as 1855. A claim of priority
over Koch has been put in, to which, however, we at the
time denied validity. Dr. A. Bianchi, of Florence, has
just collected and published Pacini's works upon this
subject, from which it appears, as we anticipated, that
the particular microbe found by the Italian professor
differs entirely from that of Koch. It is a vibrio found
in the intestine, and which by its growth produces irritar
tion.
M. RicoRD ON the Cholera. — At a recent meeting
of the Paris Acad6mie de M6decine the venerable Ricord
made some remarks upon the cholera. He believed that
it was not contagious, and that it originated de novOj and
was not always imported. Ricord' s experience was dur-
ing the epidemic of 1832. His views are in accord with
those of Jules Gu^rin.
Statistics of Cholera in Italy. — Considering the
brevity of its duration, according to La Gazzetta degli
Ospitali {Lancei)y the present epidemic of cholera in
Naples has exceeded in severity all previous invasions,
including the terrible one of 1837. That was the cause
of 13,800 deaths in five months. The first death from
cholera in Naples this year occurred on August 21st.
From that day to midnight, September 30th, I the
cases numbered 10,957, and 5,778 deaths. In the hos-
pitals the recoveries were 1,121, the deaths 787. The
actual population of Naples is 500,000. At Torre An-
nunziata 137 deaths occurred in 234 cases. From the
I St to the 30th of September 294 soldiers of the Naples
garrison were attacked with cholera, 134 of them fatally.
The mean mortality was 42 per cent. In the aristocratic
quarter of Chiaja, during the whole of September, 162
deaths occurred among 252 cases of cholera. Byfar
the greatest number of victims were women.
Death from Cholera of a Distinguished Italian
Physician. — We chronicle with regret the news of the
death of Professor Luigi Somma, of Naples, the founder
and director of the recently established periodical de-
voted to the study of diseases of children, and entitled
Archivio di Patologia Infantile, A victim to cholera,
the scourge which has so devastated the beautiful city in
which he lived and labored, he fell at the post of duty
and of honor, on September 19th last.
Another Doctor's Novel. — A well-known London
physician has just published a novel called '* Gaythome
HalL" It 4s well spoken of. ,
November 8, 1884.]
THE MEDICAL RECORD.
523
Klein's ** Bacillus Dinner.'* — ^The report that Dr.
E. Klein swallowed a dose of cholera bacilli is laughed
at in Berlin circles among the supporters of Koch. It
yras a sensational performance, they assert, and proves
nothing, except that a suitable nidus is necessary for the
bacilli to develop in — which Klein did not have.
Dr. James C. Carson of the Institution for the
Deaf and Dumb in this city has, says the New York
Medical Journal^ been appointed Superintendent of the
State Idiot Asylum at Syracuse.
Two Faculties and One College. — The style of
two medical colleges and one faculty is not new, and
used to be served up at Louisville, Ky., with consider-
able financial success. To have two faculties and one
college, however, is rather novel. Says the Maryland
Medicaf Journal: "The dissensions between the two
factions claiming to be the Baltimore Medical College
have been freely ventilated by the secular press of this
city. The state of the controversy has not changed,
and the claims to the right of title and property of the
college will have to be decided by the courts. Two
Faculties, having separate buildings, are instructing stu-
dents under the charter of the Baltimore Medical Col-
lege. This is a unique controversy, and its results will
be watched with interest. So far as we can judge, the
Monroe faction seems to have the advantage up to the
present time."
The Charity Organization Society and the
Medical Charities. — The Second Annual Report of
the New York Charity Organization Society states that
it now has one hundred and eighty-three charitable
societies co-operating with it. Among these there are
only seven medical charities, viz.: Home for Convales-
cents, House of Rest for Consumptives^ New York
Hospital, New York Infirmary for Women and Children,
Northern Dispensary, Woman's Hospital, Columbian
Institute. It is evident that as yet there is very little
medical *^ charity organization " despite all that has been
said.
The Courage of Physicians. — The British Medical
Journal^ under date of September 1 7th, states that three
professors and five physicians had been attacked with
cholera during the discharge of their duties at Naples.
The Medical and Surgical Reporter gives currency to a
statement that a young Pole, living in Warsaw, has offered
himself in the interest of science to be experimented
upon in reference to the cholera. '^ I am unmarried,'*
he says, " I have no ties of any kind, and no plans for the
future." His offer had better be taken.
The Peculiar Progress of the Italian Cholera
Epidemic. — A Lancet ^ correspondent writes that* there
are certain phenomena peculiar to this outbreak of
cholera in Southern Europe which should form the
theme of careful official inquiry. After the outburst of
the malady in Toulon its direction was much less north-
ward than southward. Again, both in Italy and France
it visited great seaports most heavily, while in Italy this
curious spectacle was witnessed — it selected alternate
seaports for attack. For example, it overleaped the
populous and not over-cleanly Genoa, and alighted
heavily on the less populous and not more insanitary
Spezia. Again, it overleaped the less populous and de-
cidedly insanitary Leghorn, and exploded with fearful
violence in the more populous, though not very much
more insanitary, Naples. What was its principle of se-
lection ? How is it that Messina and Palermo, sea-
ports so severely scourged by it in former visitations, es-
caped so cheaply on this occasion ? And how is it that
the great provincial capitals — Turin, Milan, Venice,
Florence, and Rome herself, all of them the scenes of
virulent outbreaks on previous occasions — ^have hardly
had one case ?
Cholera and Cleanliness in Naples. — A corre-
spondent of The Lancet writes that the mode in which
the cholera attacked the people of Naples has been very
perplexing to the hygienists. For example, the narrow,
ill-ventilated streets intersecting blocks of buildings in
which the population teems like rabbits have been pre-
cisely those in which cholera has numbered least victims ;
while the dwellings which, from their amplitude and sit-
uation, the freely aired thoroughfares dividing them, are
in marked contrast to the preceding, have contributed
the heaviest contingent to the hospital and the cemetery.
Again, the ill-fed, badly clothed, unwashed inmates of
the rookeries have come off very lightly in comparison
with the well-dieted, comfortably clothed, not uncleanly
bourgeoisie. " Partly because by nature," says the cor-
respondent of the Opinione^ whose letters from Naples
have given the best account of the epidemic, " we have
something of the Arab, partly because the facts above
stated reinforce the sentiment of fatalism which is at the
bottom of our southern character, our populace laughs
to scorn all the admonitions of the authorities and devours
figs, capsicums, tomatoes, more or less unripe, does
everything in fact which it has means to indulge in,
though forbidden by the profession. As to soup-kitch-
ens, it will have none of them. * They,* it says, * are for
the sick, and we are quite well.*" All this, however,
should not shake our faith in the efficacy of pure water and
cleanly dwellings.
A Floating Hospital. — Chicago has followed the
example of New York, and last summer established a
floating hospital, upon which twenty-one thousand four
hundred and eighty-nine persons were cared for and
treated.
A Nov^L Introductory. — The custom of giving
formal introductory addresses is growing less popular in
England, owing, it is said, to the too boisterous way in
which they are received by the students. The opening
ceremony in connection with the London Medical
School this year took an unusual form, which possessed
the merits of originality, interest, and usefulness. The
customary presentation of prizes was made, and short ad-
dresses were delivered. On the conclusion of these
formal proceedings, the field at the back of the hospital
became the scene of further operations, and being lime-
lighted, was seen to be transformed into a battle-field
strewn with the dead and dying remnants of a defeated
army. To these entered an ambulance corps, the mem-
bers of which immediately set about the stem business
of caring for the injiured militants ; and realism was still
further obtained by the introduction of a number of
ladies in the red cross uniform.
524
THE MEDICAL RECORD.!
[November 8, i884.
gletrieMJB and Notices*
Hooper's Physician's Vade Mecum : A Manual of the
Principles and Practice of Physic ; with an Outline of
General Pathology, Therapeutics, and Hygiene. Tenth
Edition. Revised by William Augustus Guy, M.B.
Cantab., F.R.S., Fellow of the Royal College of Phy-
sicians ; Late Professor of Forensic Medicine and
Hygiene, King's College, London; Consulting Phy-
sician to King's College Hospital, etc., etc., and John
Harley, M.D. Lond., F.L.S., Fellow of the Royal
College of Physicians; Honorary Fellow of King's
College, and Late Physician to the London Fever
Hospital ; Lecturer on General Anatomy and Physi-
ology at, and Physician to St. Thomas' Hospital. Vol-
ume II. New York : William Wood & Co. 1884.
The second volume of Hooper's Manual appears as the
monthly number of Wood's Library, following immediately
in order the first volume. It contains the greater por-
tion of the practical part of the work, the first volume
having been devoted chiefly to an outline of general
pathology, therapeutics, and hygiene. At the end of the
book there are tables of remedies and formulae, a glos-
sarial index, and a general index. As to the value of
this work, we can only repeat what was said in noticing
the first volume. It is one of the best manuals of prac-
tical medicine in existence, complete enough to serve as
a guide in the treatment of disease, and yet so compact
as to allow of ready reference by the practitioner, to
whom time is of value.
Corpulence and its Treatment on Physiological
Principles. By Dr. Wilhelm Ebstein. Translated
from the Sixth German Edition by Prof. A. H. Keane.
Wiesbaden : J. F. Bergmann. New York : B. West-
ermann &. Co. 1884.
We have already reviewed a so-called " popular" edition
of this book. We have nothing to add concerning it
now, except to recommend it as a most suggestive and
useful monograph. The present edition is complete and
is well printed.
The Principles or Ventilation and Heating and
their Practical Application. By John S. Bil-
lings, M.D., LL.D. Pp. 214. New York : The Sani-
tary Engineer. 1884.
Originally written as a series of papers contributed to
the Sanitary Engineer^ the material composing this
work has been rearranged and amplified into a quite
complete and most readable book. The author has en-
tered into his task with an evident desire to supply to
the medical profession, as well as to the interested in
sanitary matters in general, much-needed information on
a highly important subject, and to do so in a manner
both rational and practical. In this rather difficult un-
dertaking he has succeeded most admirably.' He first
shows the impossibility of accomplishing anything in the
way of ventilation without some knowledge, at least, of
the principles of physics as affecting the relations of
gases ; then explains these principles as briefly and
clearly as could be desired ; and finally details their ap-
plication to private dwellings, churches, theatres, and
hospitals. He maintains, as is self-evident, the intimate
connection between heating and air-supply, and shows
the absurdity of attending only to the one to the neglect
of the other. He then considers the different methods
of heating, as applied to the various kinds of buildings,
always with a view to securing the necessary and proper
purity of the air. The text is elucidated by drawings,
particularly of plans of some of the more recent and im-
proved structures, explaining their merits and defects.
In short, the book is one that every physician should
make himself familiar with. The questions of hygiene,
with a view to preventive medicine, are constantly as-
suming greater importance ; and among them that of sani-
tary warming and ventilation is by no means of secondary
importance, and one with which the medical man mast
familiarize himself. Dr. Billings' book will tell him just
what he wants to know. The author is one of a class of
whom we have unfortunately too few in this country ;
men who are in a position and who have the ability and in-
clination to apply themselves to the scientific studies of
the profession, without having constantly in their minds
the question whether the result can be utilized in their
practice so as to bring in returns in dollars and cents.
This contributes in no small degree to that judicial fair-
nesr> of mind which is requisite in writing to instruct ;
and as a result this book of Dr. Billings is noticeably
free from bias or prejudice, while the clear and forcible
style makes the work interesting as well as instructive.
Considering the value of the book, it was deserving of
better treatment at the hands of the publishers ; the type,
though clear, is small and very trying to the eyes. If
the book had comprised another hundred pages, the in-
crease in price would have been more than compensated
for by the ease in reading.
A Treatise on Physiology and Hygiene for Educa-
tional Institutions and General Readers. By
Joseph C. Huichison, M.D., LL.D., ex-President
of New York Pathological Society, etc. New York|:
Clark & Maynard. 1884.
In the revised edition of this admirable little work, con-
siderable material has been added on the influence of
alcohol and narcotics on health. Both of these are
treated in a common sense manner. Some alterations
are made throughout the text, which help to enhance the
value of the book for beginners.
Manual of Chemistry : A Guide to Lectures and La-
boratory Work for Beginners in Chemistry ; A Text-
book specially Adapted for Students of Pharmacy and
Medicine. By W. Simon, Ph.D., M.D., Professor of
Chemistry and Toxicology in the College of Physicians
and Surgeons, Baltimore, Md. 8vo, pp. 4x1. Phila-
delphia : H. C. Lea's Son & Co. 1884.
This is a book for careful study rather than for the casual
reading, either of the beginner or the advanced student.
The mastery of its various lessons means work from begin-
ning to end It is impossible for any author of a treatise
on chemistry to give his subject the attractiveness of a
novel, and Professor Simon in this instance has certainly
made no such attempt. He does his duty when he pre-
sents his subjects in all their nakedness of fact and stern-
ness of chemical logic. This is done from beginning
to end in an almost painfully terse manner. The work
is divided into seven principal parts, which are naturally
and simply arranged. The discussion of the fundamental
properties of matter prepares the student for a proper
appreciation of general chemical phenomena, next fol-
lows the consideration of the principles of chemistiy, of
the non-metallic and metallic elements, the old classifica-
tion being in the main adhered to ; next comes qualita-
tive analysis, organic chemistry, and physiological chem-
istry. It will thus be seen that the general subject of
the book is quite thoroughly treated, giving the student
a comprehensive view, and preparing him for most
thorough work in his department. It contains many
beautifully colored plates of chemical reactions, which are
in some instances made with the actual substance when
possessing stability of color, and in others most artistic-
ally and beautifully tinted by the talented wife of the au-
thor.
Inula Campana in the Treatment of Leucorrhcea.
— Dr. Charon mentions several substances which he
states exert a beneficial influence in leucorrhoea. Among
these the most eflicacious, he thinks, is elecampane. It
is given in infusion, tincture, extract, or powder of the
root. The best preparation is an infusion of three
drachms of the root in five ounces of boiling water, the
whole to be taken in the morning. — Rivista ClinUOy No.
8, 1884.
November 8, 1884.]
THE MEDICAL RECORD.
525
&avKJ^Bpan&JmcJ^.
"DEAD TEETH IN THE JAWS."
To THE Eorros op Thb Medical Rbcoko.
Sir : It appears that the allusions to " pain in the ears
due to irritation in the jaws," etc., under '* Hospital Re-
ports," and my comments thereon in The Record of
October 4th, have called forth dissenting views in the
two subsequent issues.
Lest silence might be construed as yielding assent to
your correspondents' views, I would beg space to reply
briefly to some of their strictures. Before so doing, how*
ever, it might be well to state that the cases reported by
my senior assistant, Dr. Bartlett, as coming to the ear
clinic, were not intended to specially illustrate dental af-
fections ; but it was believed that such examples of re-
flected dental initation would not be devoid of interest
to the profession. The extraction and filling of the teeth,
where required, it may be said, is intrusted to our own
dentists, who are competent to do such work.
In regard to the exceptions taken to the concluding
paragraph of the report, I cannot think that, from a clin-
ical point of view, the statements were either too sweep-
ing or overdrawn. Thus the retention in the jaws of
teeth which are diseased from death of the pulp or from
caries have become irremediably sensirive to thermal in-
fluences, or have been deprived of adequate periosteal
nourishment through calcareous formations about the
roots, very frequently gives rise to nervous diseases about
the head. I am convinced that these reflected nerve in-
fluences manifest themselves much oftener since dentistry
has come more extensively into practice during the
present generation, and greater efforts are made to retain
defective teeth in the jaws; and, moreover, the very
general introduction of apparatus for retention in the
mouth of substitutes for absent teeth is apparently ac-
complishing much harm also. Nor does the energy dis-
played in increasing this industry not give promise of
speedy reform. I am not sure that the injurious results
aJluded to are always due to the work of less informed
operators, as has been alleged, since it has been my lot
to have frequently seen morbid processes kept up in the
ears for a long time by diseased teeth which dentists of
repute were ** treating," and speedy recovery has followed
the tooth's removal Indeed, while writing this letter a
well-known medical man who practises dentistry in this
dty came to consult me about an inflammation of one
of his ears, which began to trouble him from the time
the upper second molar of that side was "treated" for a
diseased pulp, and he himself is convinced that the
offending tooth lies at the bottom of the difficulty.
The gist of the whole matter, however, seems to lie in
the question, Whether it is safe practice to retain dead
teeth in the jaws. Teeth seem unlike other parts of
the osseous framework, inasmuch as they are developed
from without, so to speak, and are afterward left con-
stantly exposed to atmospheric, chemical, and mechanical
influences liable to set up destructive processes in this
substance. When limited caries results, its progress may
be interfered Vith for a longer or shorter period of time
by stopping the cavity, but when the nutrition of so large
an area of the bone is interfered with, as occurs from
death of the pulp, it would seem that in a large number
of instances irritation cannot be so easily controlled, and
the affected tooth becomes more or less of a foreign
body, since the moment the pulp dies, thus cutting off the
source of nutrition from the dentine^ the part thus nour-
ished must of necessity die also. In fact the tooth, hav-
mg a vascular or nervous supply from both periosteum
and pulp, the impairment of either must affect it.
From a review of this subject we were further led to
believe that in the case of no dead (pulpless) tooth, how-
ever carefully treated and filled, can it ever be success,
fully demonstrated that a slight irritation is not constantl
present, although no appreciable irritation may be ex-
perienced by the patient.
In regard to the treatment of pulpless teeth, the
practice in vogue seems the reverse of procedures
founded on well-established surgical principles, since
stopping the natural outlet for the escape of putrescent
products from portions of the pulp left remaining in the
canal and in the dental canaliculi through the exterior
part of the tooth itself, makes their passage into the tissues
underneath unavoidable. This diversion of the drainage
must be of questionable propriety in many instances, since
the tissues about the roots of dead teeth are liable to be-
come infiltrated with the products of decomposition, the
absorption of which, when slowly formed, is much more
liable to contaminate the system than the discharge of pus
into the mouth from an alveolar abscess. Furthermore,
inflammation of exposed dentine cannot surely be entirely
arrested in any case by filling the pulp-cavity with any
known extraneous material, and especially is handi-
craft wanting to even imperfectly protect the minute
and often tortuous canals leading down to the apical
foramina of the majority of the teeth. The most skilful
operator can, under these circumstances, at best but
hope that his work will not soon be followed by trouble
arising from the escape of deleterious matter into the
tissues about the root, or the development of peri-
cementitis. He is able only to offer a hopeful but un-
certain prognosis in these cases, but the patient may all
the same remain an unconscious sufferer in respect to the
slow but persistent irritation of the surrounding tissue ;
the irritation thus propagated from the dead tissues of the
dentine will sooner or later most likely be transmitted
through the tissue of the cementum to the periosteum.
It is true that through the periosteum alone the dentine
may long derive some nourishment, yet in the meantime
periostitis often exists, so that the patient, without having
actual pain, is always conscious of undue tenderness
about the root of the dead tooth, which may be much
exacerbated by a severe cold or any sudden wrenching of
the tooth, as in biting some hard substance. A person
with a pulpless tooth in his jaw which has been stopped,
cannot even consider himself free from the danger of
reflected irritation and its various consequences, and he
may, moreover, at any moment experience more or less
inflammation about its roots.
That a defective tooth in many instances may remain
in the jaws of a healthy person for an almost indefinite
period without doing appreciable harm, surely does not
warrant the risk being taken in avery large number of
cases, since what may be tolerated quite well in the
strong and robust will set up serious trouble in those who
are run down frc^n any cause, in subjects of catarrhal
affections, and the like ; in these the more an offending
tooth is "treated," the worse in many cases it will be for
the patient. The writer has been much impressed by
witnessing the sufferings endured by weak and nervous
persons during ineffectual attempts to "treat" and
" cure " their pulpless teeth, and he cannot but regard
such practice as questionable. Indeed, his experience
in practice leads him to believe that some diseases can-
not be successfully treated so long as dental irritation is.
maintained.
It is in respect to matters of this kind that a medical
opinion is often much needed. The question of the
usefulness of retained dead teeth in certain cases is of
such importance that persons are willing to assume
more or less risk to health rather than be deprived of a
useful grinder or an ornamental incisor — these are ques-
tions which no discussion can ever settle.
Samuel Sexton, M.D.
X2 West Thirty-fifth Street, New York, October a8, 1884.
An American Physician to Deliver the Gul-
STONiAN Lectures. — Prof. Wm. Osier, of Philadelphia,
will deliver the Gulstonian Lectures at the College of
Physicians, in London, in 1885.
526
THE MEDICAL RECORD.
[November 8, 1884.
PROFESSOR ALFRED L. LOOMIS ON COL-
ORADO CLIMATE.
To THk Editor op Thb Medical Rbcord.
Sir : Of the recent medical publications there is perhaps
none that is receiving more general attention from the pro-
fession than Professor Alfred L. Loomis's ** Practical
Medicine," and there is probably no portion of this work
which will be more eagerly read, or which will carry more
weight, than that which has reference to pulmonary
troubles, and especially to the climatic cure of phthisis.
The wide-spread reputation of the author as a diagnosti-
cian in these troubles, and his well-known experience,
will give, in the mind of the general reader, the weight of
authority to whatever he may say on these points.
That Professor Loomis places great stress on the cle-
ment of climate in the cure of phthisis is seen by his as-
sertion that "each year's experience impresses on me
the conviction that while climate, more than any other
agent, has a controlling influence over phthisical develop-
ments, each case must be carefully analyzed before any
definite directions can be given as to the climate best
suited to it."
To the medical profession of the Rocky Mountain
region this question is of such vital interest that our first
point of investigation, on receiving the "Practical Medi-
cine," was to see what Professor Loomis had to.say about
our climate. Our curiosity was whetted the more be-
cause of our remembrance that, in his treatise on the
"Diseases of the Respiratory Organs, Heart, and Kid-
neys," page 281, he has committed himself to the opin-
ion that " the climate of Colorado is mild and peculiarly
dry, from its elevation ; the atmosphere is highly ex-
hilarating and peculiarly healthful. Here flowers grow
at the height of eight thousand feet ; usually at a much
less height vegetation does not flourish. The rainfall
for one year was about sixteen inches. In some sections
there are but slight variations of temperature throughout
the year. The winter days are those of a northern sum-
mer ^ and the summer is but little warmer than winter T
(The italics are mine.)
What was our surprise, then, to read in his " Practical
Medicine," page 205, that "there is one grave objection
to Colorado as a winter refuge — the enormous monthly
and also diurnal range of temperature must severely try
any invalid. During March, 1880, the thermal range at
Denver was eighty-three degrees, and in December,
1876, it amounted to ninety-three degrees ; a change in a
single month greater than occurs at London in a whole
year, and greater than occurs at New York in a whole
winter."
Certainly there is a wide variance between these two
opinions, and as it is not to be presumed that the
character of the Colorado climate has been changed to
such a degree, in a few years, as these two quotations
would lead one to suppose, the reader can simply con-
clude that Professor Loomis' s personal experience of our
Colorado climate has led him to change his views, and
that he no longer holds that our " winter days are those
of a northern summer."
The writer is, however, somewhat doubtful whether
this would be a correct conclusion, and he thinks it more
probable that Professor Loomis has been misled by others
in his opinion expressed in the "Practical Medicine."
My reason for thinking so is, that in looking over the
files of the New York Herald^ under date of December
29, 1883, in an editorial entitled " Winter Resorts for
Invalids," beginning : " Dr. S. A. Fisk, writing from
Denver, recently published in Science an interesting
paper containing the results of an extensive investiga-
tion of the relative merits of different American sanitaria
in the cure of consumptives," I find the following :
" But there is one apparently grave objection to Colo-
rado as a winter refuge, which Dr. Fisk seems to esti-
mate too lightly. The enormous monthly and also
diurnal range of temperature must severely try any inva-
lid. During March, 1880, the thermal range at Denver
was 83 degrees, and in December, 1876, it amounted to
93 degrees — a change in a single month greater than oc-
curs at London in a whole year, and greater than occurs
at New York in a whole winter."
Further on in the *' Practical Medicine," pages 206
and 207, is the following, viz. : " Recently Davos am
PlatZy in the Swiss Alps, has been most extensively vis-
ited. Williams, Albutt, and other English physicians
give very favorable reports of it. It is 5,200 feet above
the sea, very dry, but not windy, and not changeable.
Davos possesses also the unique climatic characteristic
of freedom from high winds (the records showing that
firom October i, 1880, to March 31, 188 1, there were one
hundred and thirty-four days with * no wind % while its
* sun temperature ' rises even in January, as Dr. Frank-
lin notes, as high as 150^ — conditions which admit of
much invaluable out-door exercise by invalids. Doubt-
less some high winter resort combining these vitalizing
conditions* can be found in the Southwestern Rocky
Mountain region of our own country."
From the editorial already cited I quote the follow-
ing : " Davos possesses also the unique climatic charac-
teristic of freedom from high winds (the records showing
that from October i, 1880, to March 31, 1 881, there
were one hundred and thirty-four days of * no wind \
while its * sun temperature ' rises even in January, as Dr.
Franklin notes, as high as 150°— conditions which admit
of much invaluable our-door exercise by invalids. Doubt-
less some high winter resort combining these vitalizing
conditions can be found, as Dr. Fisk suggests, in the
Southwestern Rocky Mountains."
These quotations seem to me to justify the conclusion
that in speaking of the Colorado climate, Professor
Loomis has drawn from the statements of others rather
than given the results of his own experience.
To be sure, he may have been responsible for the
editorial from which I have quoted, but a comparison of
the two following passages makes me think that this can-
not be.
In the "Practical Medicine," page 206, he says: "The
extraordinarily dry belt of country which runs northward
from San Antonio, Texas, has begun to endanger the
supremacy of Florida as a health resort for the consump-
tive. That this belt offers some climatic advantages for
weak lungs over the mild but rather humid air of Florida
cannot be doubted."
In the editorial cited is the following : "Another writer
in the Philadelphia Medical Times has also recently
called attention to the virtues of our western climate m
the treatment of consumption, and expresses the opinion
that * the extraordinarily dry belt of country' which runs
northward from San Antonio, Texas, has begim to en-
danger the supremacy of Florida as a winter health resort
for the consumptive.' That this belt offers some climatic
advantages for weak lungs over the mild but rather
humid air of Florida cannot be doubted"
I should like to call attention to the fact that Pro-
fessor Loomis speaks of the air of Florida as being
" rather humid," and yet a little earlier, on the same page
of his " Practical Medicine," he publishes the following :
" Minnesota has a dry, cool, exhilarating climate. South-
ern California, Georgia, and South Carolina have a dry,
warm atmosphere."
Now the records of the Signal Service Bureau, U. S.
Army, accessible to anyone, show that the mean relative
humidity, for a series of four years, was from 65° to 69°
of saturation for Minnesota, Southern California, South
Carolina, and Georgia. We give the data, viz.: Augusta,
Ga., 69.2° ; Jacksonville, Fla., 69"* ; St. Paul, Minn.,
67.3°; Los Angeles, Cal., 65.8°; Denver, Col., 45-8'.
These figures, together with the maps published by the
Signal Service Bureau, at the earnest solicitation of the
Colorado State Medical Society, prove conclusively that
if the air of Florida is " rather humidy* that of Southern
California, Georgia, and South Carolina cannot be called
November 8, 1884.]
THE MEDICAL RECORD.
527
"</ry"— certainly not in comparison with the dry air of
the Rocky Mountain region.
In conclusion, the writer wishes to state that the two
instances of the extreme range of temperature, cited by
the editorial writer and also by Professor Loomis, are
correct, and are taken from the records of the Signal
Service ; yet it seems to him that the citation of such un-
usual ranges is calculated to give an erroneous impres-
sion of our climate, for, as a rule, our winter days are
warm and pleasant, so that it is not uncommon for per-
sons to sit with doors and windows open, or to have pic-
nics in the open air, even in the heart of January. The
illustrations cited may do very serious injury to a climate
whose beneficial eflfects " are incontestibly proved by hun-
dreds of cases,'' and they may, especially when given the
weight of Professor Loomis's authority, deter invalids
from coming to a place of which so impartial a writer as
Dr. Edward T. Ely has remarked : " Colorado can easily
rest on its own merits. . . . Despite all objections
which may be raised, the climate is probably, as we have
aheady said, the very best of its kind at present available
for invalids, and destined to grow in popularity as its
merits become more accurately understood."
Samuel Aug. Fisk, M.D.
373 Curtis Stkbjbt, Dkmvex, Col.
BRIEP NOTE ON THE TREATMENT OF
FRACTURE OF THE CLAVICLE.
To THK Editor of Thb Mbdical Record.
Sir: Fracture of the clavicle is one of those ailments
which are not so serious as troublesome, from the diffi-
culty of keeping the fractured ends in apposition. All
the various apparatus for that purpose have failed, and
the consequence of failure is a protuberance on the point
of fracture, persisting through life, unsightly if not incon-
venient
To avoid this result I propose the following plan of
treatment : Turn the arm of the affected side behind the
back, and bring it as far backward as possible in such
manner that the dorsal side of the hand comes to lie on
the opposite buttock. To retain this position it is neces-
sary only to fix a narrow strip of adhesive plaster around
the wrist and thence around the body, or the whole arm
may be fixed on the body by means of a roller bandage
from under the axilla down to the crista ilias.
I have adopted this plan for the last two years, treat-
ing in that way about a dozen cases (with one exception,
aU children), and the result in every case was a speedy
union without deformity. The only drawback is the
difficulty of lying down, and in fact in my first case, a
girl of ten, the patient sat up in a chair day and night for
two ^eeks, but I found after a while that the children
are able to obtain perfect rest sleeping on the sound side.
S. Teller, M.D.
306 West Thirtv-thiru Street, New York.
"THE HEMORRHOID QUACK."
To THE Editor op The Medical Record.
Sir : A propos of the communication which you published
in a recen: issue from Dr. Stevens, of Chillicothe, Mo.,
and in view of the fact that all parts of the country are
infested by a class of illiterate, incompetent, and un-
authorized " doctors " who advertise to " cure piles with-
out pain," etc., I desire to report the following case which
has very recently fallen under my notice. •
General , a retired army officer, has long been a
friend and occasional patient, his general health being
much impaired from chronic cystitis and gastro-intestinsd
catarrh. He b a monomaniac on the subject of quacks
and their remedies, and I suppose he has dosed himself
with about every " safe " and sure cure ever concocted.
The literature of suburban rocks and fences is to him a
gospel, and the testimonials of eminent judges and divines
are revelations.
Several days since I was summoned in haste to see the
General. On arriving I found him in great pain, which
he referred to the rectum, and explained by saying that
he had been operated upon for piles, a few days previ-
ously, by a *' doctor " whose advertisement he had read,
and who had exhibited a number of very flattering testi-
monials from officers of the army and navy. Upon ex-
amination I found a sloughing ulcer upon the site of what
had evidently been an external hemorrhoid. The bowels,
too, he said, were acting very frequently, and seemed to
be beyond voluntary control. Packing the sore with
iodoform, and prescribing three drops of laudanum to be
taken ever}* two hours, with the object to heal the wound,
control the pain, and restrain the bowels, I withdrew.
The wound progressed well, but in spite of opium,
both by the mouth and rectum, frequent semi-involun-
tary alvine evacuations occurred. Three days after I
first saw him he had a sudden and enormous discharge of
clotted and fluid blood mingled with fecal matter. The
odor was horrible. I now gave injections of ergot and
hamamelis, and ordered opmm suppositories to be con-
tinued. For forty-eight hours all went well, when there
was another copious discharge of very offensive matter,
consisting of blood, feces, and pieces of dark-colored
membranous shreds and flakes. The patient was in a
state verging upon collapse, and complained greatly of
pain and pressure in the rectum. The pulse was weak
and intermittent; surface cool and bleached, and coun-
tenance pinched. Vomiting came on, and things began
to look serious. Examining the anus I saw a dark and
putrid substance protruding, and, drawing upon it, suc-
ceeded in extracting about three inches of what proved
to be a portion of the mucous membrane of the rectum.
I was prevented from delivering the entire mass by at-
tachments at the anal margin, and had to detach with
scissors. Learning now that the quack had used some
sort of injection, which I concluded was carbolic acid,
and that he had either injected a number of hemor-
rhoidal tumors, or had ignorantly allowed a quantity of
the solution to enter the bowel, I saw that I had to deal
with a case of inflammatory sloughing of the lining mem-
brane of the rectum. Digital exploration revealed rough-
ness and great tenderness, and ocular inspection with a
speculum showed an extensively denuded surface, con-
gested and bleeding. Seeking to control any further
hemorrhage and evacuative efforts, I now cleared away all
debris, and, through the speculum, packed the bowel
tightly with absorbent cotton soaked in a strong solution
of glycerine and tannin, and afterward inserted a sup-
pository containing two grains of opium. This treat-
ment, I am happy to say, proved effective, and I believe
my indiscreet friend is out of danger.
Well, here is an instance where an intelligent man
places hiniself under the care of an impudent pretender
for a disease which we all treat with the greatest caution,
and always with anxiety; and he almost pays the penalty
with his life. This pile-driver insisted on our friend tak-
ing his usual exercise, and did not even consider it nec-
essary to see him again after the operation. But what
are we to do about it ? The public are free to consult
whom they choose, and the religious press continues to
spread the glad tidings of the miraculous performances
of any and every impostor who w^pay their regular price.
Unfortunately such results as here narrated are not
generally circulated. Very respectfully,
Geo. B. Fowler, M.D.
II West Forty-fifth Street, New York.
THE PREVALENCE OF CONSUMPTION AT
DIFFERENT AGES OF LIFE.
To the Editor of The Medical Recobd.
Sir : It may be of interest, in relation to the communi-
cations of Drs. Holden and Baker, in The Record of
July 1 2th and August 30th, relative to the above subject,
which having been absent I have but just observed, to
528
THE MEDICAL RECORD.
[November 8,^1884.
present some results and conclusions found by myself in
i860. They are embodied in a paper, afterward pub-
lished, read by me before the American Geographical
and Statistical Society. Up to that time these statistics
relative to the mortality from consumption under various
conditions of climate^ age, sex, etc., were the most exten**
sive that had appeared, one table comprising 27,771,728
deaths from all diseases occurring in various parts of the
world between 1804 and i860. In this paper I have
given three tables illustrative of its prevalence at various
ages, the first from Boudin (" Geographic et Statistiques
M6dicales") ; the second, constructed by myself, of 88,-
427 deaths from consumption occurring in various cities
and countries ; and the third, constructed by me from the
Registrar-General's reports of deaths in England from
1848 to 1852, in 1856, and in London in 1857.
The table of M. Boudin relates to the deaths from
consumption in England and Wales in 1847. It shows
that of 53,317 deaths there occurred —
Under the age of 5 years 9 per cent
Between 5 and 10 years 3. i *'
** 10 •• 20 " 7.5
" ao " 30 •• 14-7
•• 30 " 40 " 26.4
40 " 50 •' 12.8
50 •• 60 *• 7.9
60 '* 70 •• 4.6
" 70 •• 80 •' 1.3
80 " 90 •• ai4
Above 90 •• 0^035 *'
The second table shows that of the 88,427 who died
from consumption —
25.5 per cent, died between the ages of 20 and 30 ;
20.S
ia.3
"3
7-7
6.4
1.3
30 •• 40;
*' " 10 " 20;
" 40 " 50;
birth and 10 years of age ;
the ages of 50 and 60 ;
" 60 - 70;
" 70 '* 8a
It has been variously stated by writers (I quote from
my paper) that consumption is developed at an earlier age
among females than among males. The following table
shows this is not true before the tenth year, yet between
that time and the forty-fifth year the various decades fur-
nish a greater percentage of deaths among the females
than the males; but that after the forty-fifth year the per-
centage is greater among the males.
Third table, of 409,862 deaths occurring in England
and in London :
Males. Females.
Under 5 years of age 8.4 per cent 6.9 per cent.
Between 5 and 15 years 6.2 *' 7.8
** 15 '* 25 ** 22.92 •* 26.1 '*
" 25 " 35 '' 22.6 '' 24.9 "
" 35 '* 45 " 16.9 '* 170
;* 45 *' 55 '* 11.9 ^' 9-5
55 " 65 *' 0.7 •* 5.2
65 '» 75 " a.i " 2.2 *'
" 75 ** 85 ** 0.02 ** 0.03 "
To save space, I have not given in the above tables
the full figures, that is, the number of deaths at each
epoch, but have simply calculated the percentages.
Though I recognize the cogency of Dr. Holden*s state-
ment, that, in order to show the age at which death from
consumption is most liable to occur, the proportion of
the deaths to the number of the living should be con-
sidered, and. that Ja large proportion of deaths from it at
ages when there are the greatest number living, does not
show that it is most liable to occur at those ages ; still, the
above tables, I think, are of equal value in showing, with-
out regard to the living, the periods when death from the
disease is most liable to occur.
Yours truly,
H. B. Millard, M.D.
Xew York, October ao, 1884.
A PHYSICIAN»S EXPERIENCE IN HIS OWN
FAMILY IN CHILDBIRTH AND INFANT
FEEDING.
To TKB Editor op Thb Mkdical Rbcokx>.
Sir : Your readers will all recall the discussion of puer-
peral fever in The Record last winter. My wife's term
of gestation ended in March ; she always had been in
delicate health ; there was considerable of the fever in
our city, and fatal in many cases, one young lady dying
with it only a few doors from us a week or two before
my wife's confinement.
. It will not be hard for any one to imagine my condi-
tion of mind as the time passed. Whether I was to fol-
low the advice of our most enlightened teachers on the
subject or not constantly worried me, as doubtless it
does many others in similar cases now.
Finally, however, I followed the advice of our South-
em brother, who advised throwing away the bed-pan and
having the patient sit up several times a day to urinate,
and used no internal wash of any kind, but kept every
thing scrupulously clean around her. My wife did per-
fectly well without any trouble, and I for one am con-
vinced that it is wrong to fully follow the advice of one
of our teachers and keep the patient austerely on her
back for fear of post-partum hemorrhage. To more
fully indicate my feelings I will add that for the month
of March I refused to attend other cases, and turned
away ten, I think, as I for one feel fully convinced that
the fever is very often carried to patients both by the
physician and also by the nurse.
After a few weeks my wife lost her milk and was un-
able to nurse the baby at all. Now I was in another
trouble. From my own, and the experience of others, I
knew that a bottle-fed baby, here in the city, stood a
very poor show for living, and that many that did live
were poor, feeble, emaciated little beings. I read up
almost everything on the subject of infant food, and tried
some of the well-known preparations, in combination
with milk, which I never fully gave up, but they did not
seem to work satisfactorily. I sent the baby in the
country, but it was troubled there more than ever, dur-
ing a wet period in July which we had.
Finally, I got extractum pancreatis and followed the
directions, only I used more than half water, and when
he* was troubled the most and his food seemed to pass
entirely undigested, I used two-thirds water. The baby
began to improve at once, and is now one of the health-
iest babies around here. I kept him in the country — Or-
ange County — where he could have fresh morning's milk,
until near the middle of this month, September. When
bom he weighed a little less than eight pounds ; now he
is one week over six months and weighs almost three
times as much, his flesh is solid, and he looks far better,
and is as large as many babies one year old. I con-
tinued to use the pancreatis, but do not follow the
directions. I take nearly two-thirds milk oflf the ice, add
the pancreatis and soda, then add hot water and feed at
once. At ni^ht I prepare two bottles and put on ice, or
outside the window when cool, although we rarely need but
one, and often do not use any. If needed in the night
I heat on an alcohol stove in a few minutes, and give at
once. The good derived from the pancreatis is all, or
nearly all, done in the stomach.
The strangest part of it is that the baby seems to do
fully as well, and we think better, on the milk we get here
in the city.
My conclusions are that babies can be brought up on
milk easily and well under favorable circumstances.
Pancreatis and soda aid materially, especially if the food
has been passing or rejected in an undigested state.
But I believe it is far more important to dilute the
milk with one-half, and often in young babies with two-
thirds, water. And above all things keep the feet warm
and have the diapers both dry and warm.
Respectfully, G. F.
NfCWAXK, N. J.
November 8, 1884.]
THE MEDICAL RECORD.
529
^ewr %n6tvnmmte.
A NEW MODIFICATION OF BARNES* DI-
LATOR.
By GEORGE COWAN, M.D.,
DANMLLK, KV.
Having had some practical experience recently of the
difficulties not unfrequently met with in introducing and
retaining in situ during their expansion the Barnes' dila-
tors, I have had constructed, for future
use, by Messrs. Tiemann & Co., of
New York, a modification of this ap-
paratus, which, it is hoped, may in some
measure remove the troubles met with
in their use.
In the Barnes* dilator the pocket
into which the probe is inserted for
introducing the bag serves as a serious
obstruction to its easy introduction, be- 1
sides being placed externally and to
one side of the bag — a very unsuitable
point upon which to direct the force
which is to guide and push the dilator
into its place in the canal. Further-
more, the distal extremity is unneces-
sanly blunt or flat.
In the second place, it is a flat oval
on cross-section, while the cervical ca-
nal, when partially dilated, is probably
more nearly cylindrical in form. The
consequence is that neither the waist
nor extremities of the dilator can be
expanded so as to give it the form best
adapted for its retention when the cer-
vix has been slightly dilated.
The modification which I have had
made, and which the accompanying dia-
gram will serve to illustrate, is circular
on transverse section throughout its
length, and has a tapering distal extrem-
ity for its easy introduction into the
cer\'ix uteri. The probe which accom-
panies it is a small brass rod, having a small button-
shaped extremity, and is introduced through the gum
tube to the inside of the bag, and finally lodged in the
centre of the extremity, thus enabling the bag to fold
and adjust itself neatly and closely around the probe
during its passage through the cervix and along the canal,
while the force is applied in the most advantageous po-
sition, />., inside the dilating bag.
I beg to offer these modifications of the. Barnes* dila-
tors to the consideration of the profession as better
adapted, I trust, to successfully imitate nature's inimita-
ble provision for dilating the cervix.
A NEW SCROTAL COMPRESSOR.
By JESSE HAWES, M.D.,
GREELEY, COL.
Let me call the attention of that portion of the profes-
sion who have to deal with inflamed testicles to a device
recently made at my request by Tiemann & Co.
It is composed of two rubber bags, the inner one easily
distensible, one within the other, and united so as to form
an air-tight compartment between the outer and inner
layers. This double bag is open on one side from the
" mouth " nearly to the bottom ; on each side of this
opening or "slit" are cemented pieces supplied with
eyelets ; a small rubber tube perforates the outer layer
and is cemented carefully to it. Other pieces are at-
tached to its upper part to aid in suspending it to a waist-
belt.
The double bag is sufficiently large to receive the
largest swollen testicle. Placing the testicle within the
bag, its mouth completely encircling the cord, the slit is
carefully closed by lacing ; air is then blown from the
mouth, or by a syringe, through the rubber tube into the
air-tight space. The compression is perfectly equal and
can be exerted to any extent desired ; the air is prevented
from escaping by simply bending and tying the tube.
Its advantages are these : Hot water can be conveyed
into the air-tight space, giving us a warm or hot applica-
tion. A cloth moistened (^. ^., with a lead and opium wash)
can be applied about the testicle before placing it in the
compressor. One compressor will fit all sizes of testicle.
There is no need of shaving the scrotum. It is applied
in a moment. When the swelling has decreased the
elasticity of the rubber still continues to exert a moderate
pressure, and the patient himself may in a moment in-
crease the pressure if it is desired. In short, in my ex-
perience, its cleanliness, its perfectly equal compression,
the ease with which it is managed, and the comfort it
gives the patient, seem to fill every requirement that a
compressor should have.
Official List iff Changes in the Stations ondDuiiis cf Officers
serving in the Medical Department ^ United States Army,
from October 26 to November i, 1884.
Alden, C. H., Major and Surgeon. In addition to
his duties at Fort Snelling, Minn., to perform the duty
of attending surgeon at Department Headquarters. S.
O. 127, Headquarters Department of Dakota, October
23, 1884.
Town, F. L., Major and Surgeon. Assigned to tem-
porary duty as Post Surgeon, Fort Clark, Texas. S. O.
145, Department of Texas, October 27, 1884.
Bentley, Edwin, Major and Surgeon. To be re-
lieved from duty at Fort Clark, Texas. S. O. 145, De-
partment of Texas, October 27, 1884.
Wilson, W. J., Captain and Assistant Surgeon. As-
signed to temporary duty at Fort Trumbull, Conn. S. O.
220, Department of the East, October 27, 1884.
CoRBUSiER, W. H., Captain and Assistant Surgeon.
Assigned to duty at Fort Bowie, Arizona Territory. S. O.
99, Department of Arizona, October 22, 1884.
La Garde, L. A., Captain and Assistant Surgeon.
Assigned to duty at Fort Ellis, Montana Territory, re-
lieving First Lieutenant G. E. Bushnell, Assistant Sur-
geon U.S.A., who, upon being relieved, will report for
duty at Fort Snelling, Minn. S. O. 126, Department of
Dakota, October 22, 1884.
Everts, Edward, First Lieutenant and Assistant Sur-
geon. Leave of absence extended one month. S. O.
107, Headquarters Division of the Pacific, October 21,
1884.
McCaw, Walter D., Fir§t Lieutenant and Assistant
Surgeon. Ordered from Fort Craig, New Mexico, to
Fort Wingate, New Mexico, for duty. S. O. 92, Head-
quarters District of New Mexico, October 21, 1884.
530
THE MEDICAL RECORD*
[November Si 1884,
Official List of Changes in the Medical Corps of the U. S.
Navy^ during the week ending November i, 1884.
Beardslev, Grove S., Surgeon. To Washington, D.
C, for examination preliminary to promotion, and as to
qualifications for sea duty. October 31, 1884.
Craig, Thomas C, Passed Assistant Surgeon. To
the Alliance for temporary duty. October 31, 1884.
Gardner, James E., Passed Assistant Surgeon. To
the Naval Hospital, Norfolk, Va. October 28, 1884.
Hall, John H., Passed Assistant Surgeon. From the
Naval Hospital, New York, to the Navy Yard, Mare
Island, Cal. October 29, 1884.
HoRD, William T., Medical Director. To continue
duty as member of the Retiring Board until January i,
1885. October 27, 1884.
LovERiNG, P. A. , Passed Assistant Surgeon. To the
Naval Dispensary, Washington, D. C, for temporary
duty. October 27, 1884.
Turner, Thomas J., Medical Director. To continue
duty as member of the Retiring Board until January i,
1885. October 27, 1884.
Steele, John M., Passed Assistant Surgeon. To the
Naval Hospital, New York. October 29, 1884.
piedical Itjems.
Contagious Diskasbs — ^Wbbkly Statkmbmt. — Re-
port of cases and deaths from contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the week ending November i, 1884 :
Week Ending
Cas€s,
October 25, 1884 .
November i, 1884
Dtaiks,
October 25, 1884 .
November i, 1884
I
I
I
The Ownership of a Medical Curiosity. — The
newspapers report a very curious case in a Virginia court.
A police officer of the city of Petersburg, named William
Shank, was for a considerable time visibly growing weak-
er and thinner, while his appetite continued enormous,
when one day last week he vomited a hideous-looking
lizard about ten inches long and two inches in circum-
ference. The lizard was dead when ejected, and was
thrown away. It was found and presented to Dr. John
B. Hartweli, a homoeopathic physician, who put it in
alcohol to preserve it. Dr. Shank, a brother of the
policeman, heard of this and demanded the specimen
from Dr. Hartweli, who agreed to give it up if payment
was made for the trouble and expense of preserving the
curiosity. Dr. Shank refused to make any such payment,
and brought suit in one of the inferior courts for unlaw-
ful detention, and secured judgment against Dr. Hart-
well. The latter has appealed the case to the Hustings
Court, and the respective claims of the two physicians
will there be determined.
The Question of Isolation in the Infant Hos-
pitals OF Paris. — If one may judge from the numerous
complaints appearing from time to time in the medical
journals of Paris, the management of the hospitals in that
city is far from being satisfactory. Among all the papers
the Frogris Midical is conspicuous for its increasing
eflforts to bring about reforms in this department of the
government. In a recent editorial it takes the Adminis-
tration de r Assistance Publique sharply to task for its
culpable neglect in the matter of isolation in the hos-
pitals for children. It is only within the last five years
that any pretence has been made of keeping children
with diphtheria apart from the other inmates of the hos-
pitals, and in one of these a separate pavilion for diph-
theria patients was only erected in May, 1882. But as
far as other diseases are concerned there is not at the
present day the slightest provision made for isolation.
So glaring is this evil and so well known that, as was
asserted not long ago by Dr. Maunoir, these hospitals
have a reputation among certain portions of the popula-
tion of being where superfluous children can be lawfully
and at *the same time effectually disposed of. In one of
the three services of one of the three hospitals in the year
1881, fifty-two children contracted measles in the wards*
and thirty of these died. By a simple process of addition
the writer calculates that two hundred and fifty children
are sacrificed in the three hospitals every year by measles
alone, and by measles contracted within the hospital walls
He adds that by a low estimate the number of victims
of contagion from all diseases in the infant hospitals of
Paris may be set down at five hundred annually. Such
a state of affairs seems almost incredible, and one would
suppose that the facts in the case could never have been
presented to the authorities. Yet the writer asserts that
it is not through ignorance that the administration sins,
for its attention has been called time and again to these
and other abuses, but without avail. The authorities sit
by supinely and fold their hands while five hundred little
innocents are sacrificed every year to their brutal indif-
ference. We are accustomed in this country to rail
against our public officials and to think that in no other
land are the people's servants so indifferent to the
people's wants. But very few citizens of New York
would care, we imagine, to exchange our Commissioners
of Charities and Correction for the Administration de
TAssistance Publique of Paris.
The Mental States induced by Fright. — The
Wiener Medizinische Wochenschrift^ of July 19, 1884,
contains an abstract of an interesting account of the
earthquake at Ischia, written by Dr. Fazio, an eye-witness
of the scene. The emotions awakened by the catas-
trophe were of the most varied character. During the
fifteen seconds that the shock continued everybody stood
still, seemingly rooted to the ground with terror. Men
were weak in the knees and shook as with ague, feeling
as though they were about to fall, but none of them had
convulsions, delirium, or syncope. But soon this stillness
was broken by loud cries and howls, and everyone
rushed toward the shore. Then women and children fell
into convulsions or appeared to be semi-paralyzed and
speechless. Rudeness and brutality were mingled with
self-sacrifice and heroism of the most exalted character.
Six hours after the catastrophe the stillness of death
reigned over Casamicciola. Men wandered about the
ruins half clad and silent as if risen from the grave;
women were excited and hysterical ; children of eight or
ten years seemed dazed and stupefied, while smaller chil-
dren stood around unconcernedly eating whatever they
could find in the ruins. It is most interesting to see the
different ways in which [individuals were affected by the
shock. The keeper of a refreshment booth who had lost
ever)rthing kept offering his delicacies to those who
passed by, just as though everything had not been swept
away. A surgeon, covered with blood and sorely
wounded by the fallen beams, was concerned only for
his instruments, and inquired after them of everybody
whom he encountered. An hysterical woman, who had
been bed-ridden for months, jumped up and saved her-
self by flight, and remained permanently cured. Many
who were at first brave and full of energy became later
depressed and apathetic, or had convulsions or alternate
fits of laughter and crying. Sometimes a melancholia was
induced which continued for months, and many became
incurably insane. Abortion was very common, and there
November 8, 1S84.]
THE MEDICAL RECORD.
531
were many cases of suddenly arrested menstruation. The
sexual appetite was universally destroyed for many days
after the earthquake, and in many instances there was
also an aversion to food. There were numerous cases of
retention of urine, sometimes lasting for days and de-
manding catheterization. There were several instances
in which the hair was whitened by fright, and even some
boys of ten to fourteen years showed heads sprinkled
with gray. Many of those buried in the ruins exhibited
the greatest indifference to their fate, following listlessly
with their eyes the motions of those busied in their rescue.
A foreign officer whose legs were imprisoned under some
heavy timbers drew out a cigarette and smoked it with
the utmost nonchalance. One man, as soon as he was
palled from the ruins, shook his rescuer by the hand and
presented him with his card. Another, who lay beneath
the debris for twenty hours, immediately looked at his
watch in order to record the exact instant of his deliver-
ance. A lady who had just been extricated from a mass of
rubbish would not budge from the spot until she could as-
certain the fate of her pet dog, which was buried with her.
One woman who heard a man calling for his daughter,
deceived him so cunningly that she was rescued by him
before the trick was discovered. Most of the people,
however, who were imprisoned beneath the ruins were
too indifferent to their fate to attempt any such deception,
and most of them had not the slightest idea of the length
of time during which they were buried. Most of those
who were wounded by the falling buildings underwent
the necessary surgical operations without experiencing
any pain, though some were hyperaesthetic.
What Constitutes Unchastity. — ^A curious point as
to the proper admission of testimony was presented on
the appeal of a case, where the action was for slander in
charging an unmarried woman with unchastity. The
defendent, in answer, alleged that there was such an in-
crease in the size and such a change in the physical
appearance of the plaintiff as to induce him to believe
that she was pregnant. One of the witnesses on his be-
half was a woman who had borne children, and who was
asked if the plaintiff, as to her physical appearance, ap-
peared like women do when they are pregnant This
question was not allowed, and the appeal from the ruling
was the main point to be decided. The court held that
it was proper to ask a witness his opinion whether a
person was drunk, because that fact is better determined
by the direct answer of the witness than by any descrip-
tion of the person's conduct^ and that there was a simi-
larity between such a case and that where the fact of
pregnancy was involved. The court was of the opinion
that '* if the appearance of the plaintiff, from any cause,
was such that women who had had experience would testify
that she appeared like a pregnant woman physically, the
testimony certainly was important to mitigate the damages
to which the defendant might be subjected. And if the
plaintiff insists that the witnesses should have stated the
facts in detail, in order that the jury might judge whether
plaintiff's appearance was like that of a pregnant woman,
it is obvious that no description of enlargement of size
and the like would convey an accurate idea of the plain-
tiffs whole appearance." It was therefore decided that
it was proper to ask the opinion of the witness whether
the appearance of the plaintiff was like that of a pregnant
woman.
Is Cankibalism Necessarily Murder? — A very
interesting case will shortly be brought to trial in Eng-
land, to determine whether cannibalism is necessarily
murder. The facts are these : The yacht Mignonette,
under Captain Dudley, was disabled in a gale between
Madeira and the Cape Colony last July, and the crew,
consisting of the captain, two men, and a boy, took to
the boat. They soon exhausted their small supply of
provisions, and no help was at hand in mid-ocean. Af-
ter a little they caught a turtle, and this sustained life for
some days. When this was eaten, starvation began.
After some days it was proposed that they should cast
lots to see which should die to save the others, but this
plan was rejected. When fifteen days had passed with-
out food, after further debate it was decided that the boy,
who was very weak and. sinking fast, should die, and the
captain, after asking God to pardon what he was about
to do, killed the youth. For three days the survivors
subsisted on the boy's flesh, and then a passing vessel
picked them up and took them into Falmouth. Captain
Dudley did not conceal the facts, but promptly reported
them, not expecting, apparently, that he would be held
criminally liable. The authorities of Falmouth, however,
arrested him on his own sworn statement, and the trial
for murder will soon take place. It will be seen that
these circumstances are quite different from those of the
Greely party, as there only the flesh of the dead soldiers
wfis eaten. The moral question is much the same, how-
ever, and the Dudley case will certainly give rise to great
discussion as to the propriety of eating human flesh under
any circumstances. It should be remembered that in
the case of the Mignonette the killing of the youth, no
doubt, saved the lives of the others, and had not this
been done all would have probably died. This does not
affect the moral aspect of the case if the act was wrong
under any conditions, nor does the further fact that the
boy would soon have died from nsttural causes ; but these
circumstances will inevitably have some effect upon a
jury called upon to determine whether Captain Dudley
shsdl die for his act. The question of insanity will also
assume a prominent position on the trial, for it is cer-
tainly a matter for investigation whether persons exposed
to the weather for fifteen days in an open boat, without
any food, are responsible for their acts. The outcome of
the trial it is not difficult to surmise, for no matter
whether public sentiment abstractly condemns Captain
Dudley's conduct or not, it is not at all likely that any
jury will bring in a verdict of guilty of murder. The
chances are wholly in favor either of a disagreement or
acquittal.
Sublimate Injections in Joint Diseases. — Professor
Vogt has obtained good results in three cases of so-called
gonorrhoeal rheumatism of the knee by intra-articular
injection of corrosive sublimate. He employed a solu-
tion of bichloride of mercury, i^ grain ; chloride of
sodium, 15 grains; distilled water, 12 drachms. Of this
solution 45 to 75 minims were injected into different
parts of the joint. The injections were repeated every
four days, but how long the treatment was continued the
author does not state. At the time when these cases
were reported he stated that the cure could be regarded
as established, massage and passive motions being all that
was necessary to restore the functions of the joint. In
other non-specific bone and joint diseases a somewhat
extensive employment of this mode of treatment leads
the author to believe that "in certain cases much can be
accomplished by intra-articular injections of corrosive
sublimate." — Centralblatt fur Chirurgie^ August 23, 1884.
Does Decapitation Cause Instant Death? — ^We
noticed recently some experiments made by M, Laborde
with the head of Campi, who was executed in Paris for a
murder, which almost seemed to show that life might be
retained for a time in a decapitated head by supplying
the brain artificially with blood. The publication of these
results in the Revue Scientifique has called forth a com-
munication from another writer who witnessed an execu-
tion in Saigon some years ago, a brief account of which
we abstract from the Tribune M^dicale of August 10,
1884. Decapitation in Annam, it seems, is performed
by a single sword stroke on the neck, the criminal kneel-
ing down and being forced to flex the head so as to sep-
arate as widely as possible the vertebrae. Thus it some-
times happens that the cord is severed by a clean cut
without being either contused or concussed. The writer
being desirous to ascertain whether consciousness were
retained in the separated head, attracted the attention
532
THE. MEDICAL RECORD.
[November 81 1884.
of the criminal to himself by speaking in a loud tone to
one of the officials just before the execution took place.
He was successful in this, for the condemned man looked
up and gazed intently at the speaker for a moment. He
then knelt down and received the death-stroke. It so
happened that the head in falling did not roll, but rested
upright on the sand in such a way that the flow of blood
from the veins of the neck was arrested. In an instant
the eyes were opened and fixed themselves upon the
writer, who stood very near. He moved quickly to one
side and the eyes followed him ; then he returned more
slowly to his former position, and the eyes turned again
in that direction. They followed him but for an instant,
however, and were then suddenly turned away, while an
agonized expression overspread the features, the mouth
opened spasmodically, and the face seemed to gasp for
breath. The movement of the jaw overturned the head
and it rolled on the sand and gave no further signs of
life. Could the cerebral circulation have been main-
tained in this case as it was in that of Campi, by connect-
ing the vessels with an opened artery of a dog, the results
might have been startling enough to disturb even the
most phlegmatic experimenter.
The Value of Cinchonidia. — Dr. J. Weichselbaum,
of Savanna, Ga., writes us in reference to the editorial
in The RECORd of July 19th, upon the value of cinchoni-
dia. He states that " in the female ward of the Savan-
nah Hospital, the service of Dr. R. J. Nunn, we have
been using the sulphate of cinchonidia ior some time.
We use the following formula :
5 . Cinchonidia sulph gr. v.
Sodii bicarb gr. v.
M. S. — One dose for adult ;
with the same result that we had with the sulphate of
quinine. We used it in all cases we would have used
the sulphate of quinine. We never had any of the
trouble complained of by Professor J. Marty." Our
correspondent adds that of late he has been using the
alkaloid cinchonia given with soda, and has had equally
good results. The inference from Dr. Weichselbaum's
experience is that quinine is no safer or surer than its
cheaper allies. This is against the experience of the pro-
fession, and invalidates completely Dr. W.'s observations.
A Case of Cancer of the Pancreas — Autopsy.
— Dr. F. W. Epley, of New Richmond, Wis., sends us
the following : " In view of the fact that the literature
upon affections of the pancreas is exceedingly limited ;
that some of our standard works on pathology pass over
the. organ with the simple remark that * the pancreas is
seldom examined for disease,' and give no further direc-
tions in regard to the post-mortem examination of said
organ, and that in the light of more frequent autopsies
consequent upon death from obscure causes we can ap-
proach nearer the truth in these pathological assertions,
I have reached the conclusion that it is the duty of every
medical man to report cases which come under his notice
where obscure or questionable cases have been cleared
up by an autopsy. On May 25, 1884, Sam M
came into my office and told me he wanted me to see if
I could find out * what in h — 1 ailed him.' I give his
own words, for they are not void of significance in this
case. He stated that he had begun to feel badly soon
after walking a long distance through snow-drifts in the
February preceding. He lost his appetite; had some
uneasiness about the epigastrium ; had a nasty taste in
his mouth ; had not slept a wink for weeks, and ' then
these d— d black janders come onto him and he wanted
to die if I couldn't give him something to relieve him.'
He was restless, weak, but constantly moving, and was
even more impatient than his language indicates. He
was a farmer^ well-to-do, always quiet and always indus-
trious. Upon examination I found him only fairly nour-
ished ; evidently losing flesh ; extremely icteric^ and
covered with an eruption simulating bromism, which kept
him constantly scratching. His stools were entirely de-
void of color ^ except that of prepared chalk. This pecu-
liarity was constant. I found, about two inches to the
right of the umbilicus, a small hard tumor, apparently
about the size of a small tea^cup, but more pointed. It
was hard but freely movable. It was not easily to be
seen, but by close attention the abdominal parietes could
be seen to glide over the tumor. I diagnosed malignant
disease, either in liver or structures closely approximat-
ing it, and contrary to my custom gave up the case at
once, communicating the facts to his wife. He went to
other physicians, and finally struck a lead on two homoeo-
pathic doctors, who * cured him till he died ' on Decern-
ber loth, following. Autopsy revealed cancer, scirrhous
form, in head of pancreas, which had drawn up about the
common duct of the liver to such an extent that it was
impossible to separate the duct, or in fact to distinguish
it by the naked eye from the pancreatic tissue. Henct
the jaundice. There was no obstruction in bowels or
stomach, and no other structure was involved to any ex-
tent, except a portion of the lesser omentum. It occurs
to me that the disease mtut have originated in the head
of the pancreas, thereby occluding the common duct and
occasioning the early and persistent jaundice. The tu-
mor near the umbilicus proved to be a distended galU
bladder. The liquid it contained was of a pearly hue and
quite viscid."
Treatment of Skin Diseases at Vienna. — ^A corre^
spondent of the British Medical Journal writes : " In
Professor Kaposi's wards the permanent bath-beds are in
constant use. Bums, ulcers, and obstinate syphilides are
here treated ; in the latter cases, weak solutions of per-
chloride of mercury may be used with advantage ; in the
cases of bums, the patients express themselves as being
most comfortable ; after being in the * bed ' a few mo-
ments all pain is lost, and there is no dread of change
of dressings, for none are used. Not only does the slough
separate and the wound clean, but cicatrization progresses,
it is said, more rapidly in the water than under any other
treatment. Psoriasis is usually treated with pyrogallic
acid, 10 per cent, in traumaticin ; goa powder in the
same combination is also used. In the treatment of
superficial lupus, iodoform in solution, with collodion or
pyrogallic acid as an ointment, is used ; the former b
usually applied after the affected part has been mbbed
with a strong solution of caustic potash. Several cases
of lichen scrofulosomm have been effectually treated with
cod-liver oil internally, and as an external application.
A few weeks ago a young man was admitted into the
wards suffering from what was at first supposed to be
merely a case of severe intertrigo, affecting the perineum
and surrounding parts. The severe general disturbance,
however, led Professor Kaposi to diagnose impetigo her-
petiformis. This disease, of which only about a dozen
cases are on record, is usually found in women, and ap*
pears to be in some way connected with pregnancy and
the puerperal period ; one case, related by Heitzman, oc-
curred about the time of the climateric. Two cases only
are on record where recovery has taken place. The term
herpes pyaemicus, of Auspitz, was upheld, as the disease
is one which is probably pyaemic in origin, while its pro-
gression is marked by the formation of small, closely
aggregated, innumerable bodies, which are pustular from
the commencement. From the first the case was asso-
ciated lyith high and irregular temperatures, and the pa-
tient was treated with antipyretics, simple dressings being
applied. The affection, however, gradually spread upward
over the abdomen, and smaller patches appeared else-
where. The patient gradually sank into a somnolent
condition ; later he was removed into one of the perma-
nent bath-beds, where he appeared more comfortable, and
the open surfaces more healthy ; it was specially noticed
that this change produced, in addition, immediate and
sustained lowering of the temperature. The patient, how-
ever, gradually sank, and on post-mortem examination
general peritonitis with effusion into the peritoneal cavity
was found.''
The Medical Record
A Weekly yournal of Medicine and Surgery
Vol. 26, No. 20
New York, November 15, 1884
Whole No. 732'
(Ihrigitml Ji^trtijcles*
A NEW THERAPEUTIC USE FOR COCAINE.
By F. H. bos worth, M.D.,
NBW YORK.
In using a solution of cocaine in the nasal cavity for its
anaesthetic effect I have observed an action which has,
as far as I know, not been recorded. When the solution
is applied to the mucous membrane it is followed in about
twenty or thirty seconds by a very notable contraction in
the venous sinuses underlying the part which it reaches,
and as the application is continued over the whole mem-
brane covering the lower and middle turbinated bones
these sinuses become so rigidly contracted that all the
blood which they may have contained is absolutely ex-
pelled, and the membrane clings closely to the bony
structures, which then become visible in absolute outline.
This action of the cocaine was so entirely unex-
pected to me in the first case in which I observed it that
I continued my observations in a number of cases, and
in no single case out of over forty observed carefully has
it failed to produce the same result. Every drop of blood
was expelled from the erectile tissue in each case. The
strength used was a two per cent solution, and it was
applied by means of a pledget of cotton wrapped on a
small probe. The effect was usually observed in a few
seconds; entire depletion of the sinuses of the whole
cavity being accomplished in about three minutes, the
production of anaesthesia, as a rule, requiring a longer
^^
The practical value of the use of the cocaine cannot,
I think, be overestimated, for we possess no other remedy
which can be depended upon to produce this result The
morbid conditions in which I observed its action, and in
which it is of especial value, are as follows :
Hypertrophy of the nasal mucous membrane, — ^This is
by far the most frequent cause of a nasal catarrh, and its
rational treatment demands the use of caustics or other
destructive agent The use of any caustic is followed by
an intense turgescence of the venous sinuses of the nose,
which is a source of distress for hours, and even days, after
its use.
I have cauterized the mucous membrane of the nose
in twenty-seven cases since I observed the above-men-
tioned action of cocaine. The application was ren-
dered comparatively painless by the drug, but the tur-
gescence of the membrane came on in a few minutes
after the caustic was used. By gently bathing the swollen
part with the cocaine the turgescence subsided perma-
nently, and the cauterization was accomplished with-
out pain or the subsequent discomfort which so generally
follows its use.
Another and very notable value of this action of the
cocaine is as an aid to diagnosis in these cases of hy-
pertrophy. In an ordinary case of this kind it is not
possible to determine, on ocular inspection, how much
of the swelling of the membrane is due to connective-
tissue hypertrophy and how much is due to turgescence
of the venous sinuses. By applying the cocaine to the
membrane the element of venous turgescence is entirely
eliminated, and the amount of genuine hyperplasia can
easily be recognized.
Acute coryza, — In an ordinary cold in the head the
prominent condition is the venous turgescence. I ap-
plied the cocaine in seven cases of the affection and in
each case the same result was observed. The venous
sinuses were completely emptied, and the nasal passages
remained absolutely clear. The relief in five of these
cases, which I saw subsequently, lasted from twelve to
twenty-four hours. That is, in these cases the nose did
not become " stopped up" again for from twelve to twenty-
four hours, and then the relapse was only partial. The
colds were broken up. For a cold in the head, then,
cocaine, it seems to me, promises to afford us a remed}',
which is not only prompt, but certain, and by prescribing
it either in the form of spray or as a snuff, we can place in
the hands of our patient a ready means of relief for that
most distressing symptom of a cold, the '* stopped-up nose.'
Nasal polypus, — ^The introduction of an instrument
into the nasal passages usually causes a swelling of the
membrane to such an extent as to seriously interfere
with the inspection of the parts. In operating on four
cases of polypus in the past week, this troublesome
feature of the operation was entirely eliminated. The
venous congestion was thoroughly kept down, and so
clear a view into the upper regions of the nose was , ob-
tained that it was made a comparatively easy matter to
recognize and remove even the smallest growths. But
of still further importance was the fact that in no case
was there other than the most trivial bleeding. In re-
moving nasal polypi with the snare the troublesome
bleeding is never from the mucous membrane, but from
the venous sinuses which may be opened. In the four
cases above mentioned, these sinuses were rigidly con-
tracted by the cocaine, and hence the bleeding from the
operations was but a trivial matter. '
Hay fever. — ^The morbid condition of the nasal pas-
sages in an exacerbation of this disease is undoubtedly a
turgescence of the venous sinuses, probably fi-om a paresis of
the vaso-motor nerves which are distributed to the coats of
these vessels. I have had no opportunities of observing
the action of cocaine in an acute exacerbation of hay
fever, but I have applied it in two cases in which the
symptoms were present to a mild extent. Both were
cases of autumnal catarrh, commencing August 26th and
lasting till the first frost. In each of these cases the re-
sult was the same. There was complete relief from all
the symptoms.
The above-mentioned cases may not, perhaps, be con-
clusive as regards this action of the cocaine, but it cer-
tainly goes very far toward establishing its value. I used
it in forty cases, all presenting marked swelling of the
nasal mucous membrane, both from chronic and acute
causes, and in every case the result was the same. There
was an absolute and complete subsidence of the turges-
cence of the membrane and the sinuses were entirely
emptied of their blood.
Among the observed symptoms of the internal admin-
istration of cocaine is the production of tetanic muscular
contraction. The only explanation of its above observed
action is that it produces the same action upon the mus-
cular fibres which are found surrounding the venous
sinuses which form the erectile tissue of the nose. Its
action, it should be mentioned, is confined to the venous
sinuses, for I have never observed that it exerted any
influence upon the capillary circulation of the mucous
membrane of any region. A tetanic contraction of the
muscular fibres which surround the venous sinuses in the
nose could only produce the condition I have observed,
534
THE MEDICAL JIECORD.
[November
n
t5» 1884.
for when the cocaine has had time to .exert its action,
the mucous membrane is seen to cling to the turbinated
bones with a rigid clasp which can only be described as
tetanic.
While, then, we have in the cocaine a local anaes-
thetic of very great value, I think we also have a thera-
peutic agent of inestimable importance, and which we
have every reason to believe will be efficient, i, to con-
trol the exacerbation of hay fever ; 2, to relieve the most
distressing symptoms of an acute coryza and curtail its
duration ; 3, to control the painful and distressing reac-
tion which results from the use of caustics or instruments
in the 'nasal cavity ; 4, to completely empty the venous
sinuses of^the nasal mucous membrane, and thereby
afford a thorough ocular inspection of the cavities ; 5, to
largely eliminate from our minor operations in the nasal
cavities the troublesome hemorrhage which so often oc-
curs, and to control epistaxis from whatever cause.
SOME NOTES ON HYDROCHLORATE OF
COCAINE.
By N. J. HEPBURN, M.D.,
OPHTHALMOLOGIST TO THE DKMILT DISPBNSASY, NKW YORK, KTC.
In the course of some experimental inquiries into the
anaesthetic action of hydrochlorate of cocoaine, I ob-
served some facts which may be of interest at this time.
A two per cent, solution of the salt (Merck's) was
used in each instance, injected under the skin of the arm
by means of a hard-rubber hypodermic syringe with
gilded steel needle.
On October 16, 1884, I injected six minims of the
solution at 7.30 a«m. In one minute and a half there
was partial anaesthesia of the skin and subcutaneous cel-
lular tissue for a space of eight lines in every direction
from the centre of the injection. In four minutes the
anaesthesia was complete over the same area, which was
bounded by a hypeVassthetic line separating the anaes-
thetic portion from that of normal sensation. The in-
jection was repeated every five minutes in adjacent spots
with precisely similar results, until forty-eight minims had
been used.
By this time ^the general physiological effects of the
drug began to manifest themselves so plainly that it
was deemed unadvisable to continue the experiment.
These effects were increased frequency of the pulse,
increase of one-fourth in the number of respirations per
minute, an agreeable feeling of warmth, moderate mydri-
asis, slightly crossed diplopia, and agreeable hallucinations
with closed eyes, which fancies disappeared when the
eyes were opened. The power of locomotion was very
slightly interifered with. These symptoms gradually dis-
appeared, uiitil, two hours after the last injection, nothing
abnormal was noticed.
Two days later another trial of the same nature was
made, when it was found possible to carry the number
of six-minim injections to sixteen before the general dis-
turbance became too marked to continue.
In a third trial, October 2 2d, using eight minims at
each injection, it took sixteen injections also to produce
the same toxic effect On this trial the disturbances
were more marked, and continued at least four hours,
followed by a period of wakefulness lastinr nearly all
night
The most noticeable of the sensations observed at
this last trial were a general impairment of cutaneous
sensibility, a feeling as if walking on cushions, a tendency
to walk on the heels, and a sensation on grasping an ob-
ject as if something spongy were interposed.
367 West Twenty-^hiro Stkeet.
Two Thousand Dolxars for a Body. — ^The daily
papers mention a recent case in one of the Indiana
courts where a medical college was obliged to pay
$2,000 for having robbed a grave to secure the body for
dissection. The name of the college is not given.
TRACHEOTOMY IN CROUP AND DIPH-
THERIA.
By SIMON BARUCH, M.D.,
It is **9L healthy sign of the times" when the discussion
of worn and tnte subjects of practical import occupies
the minds of our profession, and when the search s&a
novelties is for the nonce in abeyance. The subject of
tracheotomy in croup and diphtheria has long been the
theme of anxious and earnest inquiry. Its literature
has grown to unwieldy proportions, as is witnessed by
the fact that the library of the Surgeon-General's office
contains five hundred and eighty-four separate trea-
tises, upon the subject of tradieotomy in croup and
diphtheria, occupying in their enumeration twelve and
one-half columns of the index catalogue. The paper
read recently upon this subject before the Obstet-
rical Section of the Academy, by Dr. Joseph Winters,
presents an able, lucid, earnest, and logical defence d
this life-saving operation. I am sure its careful perusal
will serve to embolden the timid to advise and execute
the operation more early and more frequently, and it will
encourage the bold in pressing its advantages more
persistently. I make this small contribution to the
subject in order to elicit from practitioners in all sections
of our country an expression of opinion. It is to be hoped
that the interest in the subject will not be allowed to
flag, as has so often been the case in its history, but
that the practical tendency of the modem medical mind
will keep it before the profession until its true merits
are definitely ascertained and recognized. It will be the
most important outcome of the present agitation of the
subject, if general practitioners who in remote country
districts and smaller towns frequently do other siurgical
work, can be persuaded that tracheotomy is not a ha^d-
ous operation, and that as a surgical procedure it does
not require extraordinary skill or knowledge.
It is a sad, too sad fact, that precious time is often
lost in the search for a surgeon; and that at other
times the procedure is regarded by parents in the li^t
of a capital operation, w£ch handicaps their child in its
struggle for life. These reasons operate in favor of delay
until the operation becomes one of emergency. It is a
fact to be remembered, that one successful tracheotomy
for croup or diphtheria will do more to neutralize the
groundless apprehension, in the minds of physicians and
la)rmen, than all the statistics marshalled by high
authority. As an iUustration I will mention that two
year ago Dr. Abram Jacobi performed a successful trache-
otomy on a child in Carmansville, a suburb of this city,
and since that time there is rarely an objection made to
the operation. Within the past six months I have done
it three times in that section of the city, and I cite these
cases in order to illustrate the chief aim of this paper
which is to emphasize the necessity for an early opera-
tion. On May 21, 1884, I was asked by Dr. William
Frothingham to see a boy, three years of age, who had
been under treatment for diphtheria for several days and
was rapidly growing worse. The turpentine treatment, so
much lauded in Germany, was advised and adopted, but
without avail. Patient became cyanotic, and tracheotomy
was adopted as a dernier ressort By the light of «
kerosene lamp, and amid the wailing of parents and
friends, the gasping child was placed upon the table.
He was so completely cyanosed that no anaesthetic was
necessary. When the tradiea was reached pulse and respi-
ration ceased. The trachea was quickly opened, the tube
inserted, and in a moment the inrush of air brought on
cough and an expiratory effort The color returned io
the face, and the child revived, taking nourishnoent,
which he had refused for many hours, because of his in-
tense preoccupation with the struggle for breath. It was
too late, however. The child expired in twenty honrs.
To the second case I was called by Dr. Goodrich on
September 10, 1884, A boy, aged seven, was discovered
Noverober 15, 1884.]
THE MEDICAL RECORD.
535
during the night to be ill. When the doctor was called
to him he made a diagnosis of naso-phaiyngeal and
laryngeal diphtheria. I saw him a few hours later, and
confirmed the diagnosis. The breathing was stridulous,
there was episternal and abdominal retraction, btlt no
cyanosis ; laryngeal stenosis was unquestionable. Trache-
otomy was advised and readily assented to by the physi-
cian and the father of the child. Patient was etherized
by Dr. W. T. Alexander ; there was nothing unusual in
the operation except the appearance of a great gush of
venous blood when the trachea was opened, although the
wound was dry. The incision was thus obscured, but
by aid of a finger-nail it was found and somewhat en-
laiged. The tube was rapidly inserted and hemorrhage
stopped promptly. This point will be referred to below.
Patient received -^g gr. bichloride mercury every two
hours, and 10 til. tr. ferri, with i gr. chlor. potass., every
hour, besides nutrients ad libitum. In eleven days he
was sufficiently recovered to warrant the removal of tlie
tube, and he is now in perfect health.
On October 7th» I was asked by Dr. Goodrich to see
another boy, also aged seven, and, like the last patient,
in perfect health before the attack. This child had,
however, been ill five days without treatment. Stridulous
breathing alarmed the parents, who thought the child was
simply suffering from a cold. When Dr. Goodrich was
called he recognized at once the dangerous character of
the malady and advised tracheotomy, to which the parents
readily assented, because they were aware of the success-
ful issue of the above-mentioned case. When I saw this
patient he was not cyanosed, but there was stridulous
respiration, and in all respects the case resembled the
last mentioned, except in the longer continuance of the
disease. The operation ([under ether) was somewhat
embarrassed by die deep situation of the trachea, a very
large thyroid gland, and the presence of large veins
coursing across the line of incision. The gland was
drawn upward by a blunt hook, the larger veins held
aside, one small vessel tied, and the trachea was now
reached without difficulty. When it was opened it was
so filled with diphtheritic deposit that the incision was
bloodless and the knife grated as if passing through the
soft rind of a melon. It is to me a marvel how this child
breathed through so narrow a channel without being
markedly cyanosed. The tube was readily inserted.
Patient revived, countenance became calm and bright,
pulse more quiet and regular. But it was too late ; he
died on the following day firom asthenia.
These three cases show clearly the vast advantage of
an early operation. The last two cases were circum-
stanced precisely alike, being of the same age, and in the
tame social grade, but the one was operated upon very
early, the other very late. Statistics have again and
again demonstrated the value of an early operation;
common-sense is thus aided by experience. It is crim-
inal to wait until cyanosis hangs out the danger signal
Aphonia, stridulous voice, and respiration, the distended
nostrils, the heaving chest, and appealing eye point un-
erringly to the speedy advent of carbonic oxide poisoning.
The patient is dying from asthenia, and threatened
with carbonic oxide poisoning in addition. We are pour-
ing stimulants, nutrients, and tonics into his stomach with
a view to avert or counteract asthenia. So assiduously
is he "supported," that he is often scarcely allowed to
sleep. Of what avail are all our " supporting measures "
when he is slowly approaching strangulation, when the
respiratory passage is encroached upon more and more
every moment, so that he cannot obtain sufficient oxygen
to carry on the machinery of life ? I take it that oxygen
is facile princeps among stimulants ; it is the great life-
saving principle, the grand protecting »gis against
disease and death. All our energies in sanitary medi-
cine.are bent in the direction of increasing the supply
of oxygen to our dwellings, schools, prisons, etc. ; all
our best efforts in the hygienic treatment of many of our
patients are in the direction of increasing the amount of
oxygen in their lungs. Why, then, stand idly by when
in diphtheria our little patient is hour by hour robbed of
the all-important element ? How absurd it is to supply
artificial stimulants while nature's great stimulant and
sustainet is withheld ! The patient prays for air, and we
•give him milk and brandy ; " he asks for bread, and we
give him a stone." It cannot be too earnestly urged
upon the practitioner that it is his duty to watch as
anxiously for, and guard against, the oncoming of the
threatening air famine (carbonic oxide poisoning) as it is
to watch and ^uard against the approach of the food
famine (asthenia). Just as we increase the stimulants,
when the pulse flags, just in the same measure should
we increase the oxygen when the respiration flags. In-
deed it is an accepted axiom of physiology that man can
exist far better with a limited supply of food than with a
limited supply of oxygen. And yet physicians hesitate
when they clearly see the advent of cyanosis and conse-
quent asphyxia in these cases. He who hesitates is lost,
and will sadly regret his indecision.
Especially is it the duty of the attending physician to
operate early on the first indication of abiding laryngeal
stenosis, when he recognizes the fact that tracheotomy
is really not a dangerous operation. From a somewhat
extensive experience I may be permitted to state that
tracheotomy in children is rarely followed by shock or
accompanied by hemorrhage, which latter is readily
stanched by pressure forceps, serres-fine^ or ligatures. It
is an operation which may be performed without diffi-
culty by an ordinarily steady hand and cool head. Hence
it does not, in my opinion, as a surgical procedure, en-
hance the patient's danger, if undertaken early. When I
lived in the South I was often consulted for foreign
bodies in the air-passage. These were sometimes grains
of Indian com, but most commonly they were the seeds
of the watermelon. This fruit is largely cultivated in the
section of South Carolina in which I resided. The
country people regard it as so harmless that children of
very tender age even are permitted to partake of it.
Every farmer has " a patch of melons ; " hence their use
is universal. It is not uncommon, while riding through
a plantation in midsummer, to see a little negro child
sitting or lying near a big watermelon, and with its tiny
hands digging out the juicy mass and stuffing it into its
mouth. The result is tiiat these babes, as well as older
children, white and colored, occasionally " get the seed
into the wrong throat," and are brought to the physician.
The history of such cases of " croup " is usually clear.
Rarely did a summer pass, during my practice of fifteen
years in that section, without one or more cases of this
kind being brought to me by the parents,; or sent by
country practitioners.
With the exception of one case, the removal of the
foreign body was always advised and executed. Under
chloroform I have never found the operation presenting
serious difficulty ; the foreign body usually presents it-
self at the tracheal incision, or is expelled into the
room with the strong expiratory effort which always fol-
lows the latter. The wound is closed and heals within a
week ; there is usually no shock, no fever, and the only
trouble I have encountered is a slight dysphagia on
the third and fourth days. I can recall only one fatal
case of this kind, a negro boy, sixteen years of age, in
which the nature of the foreign body was unknown and
was not found. My fiiend, Dr. T. T. Robertson, of
Winnsboro, S. C., has obtained quite a reputation as an
operator for watermelon and corn-seeds, having done
tracheotomy many times successfully. It cannot be de-
nied that the presence of a tube in the trachea seriously
complicates the case, but the advantage of a new and
perfect air-channel counterbalances this eviL
The manual of the operation differs somewhat in the
hands of different surgeons, and it is well for the novice to
obtain all the information he can on the " points " which
experienced operators give. It is important to strike the
junction of the stemo-hyoid muscles, and avoid cutting
536
THE MEDICAL RECORD.
[November 15, 1884,
into the muscular fibres. If the latter happens, the opera-
tor will find it difficult to reach the trachea, and there
will of necessity be a larger wound surface and more
hemorrhage. To obviate this difficulty I invariably di-
vide the cervical fascia upon the grooved director, and
never attempt to enter between the sternohyoid muscles
from cUfove. Placing thumb and forefinger upon either
extremity of the sternal manubrium, the median line is
easily obtained, the handle of the scalpel readily enters
between the muscles as they lie separately attached to
the sternum. Upward pressure with the handle acts as
a wedge to separate them. The wound should be as dry
as possible ere the trachea is opened, all vessels being
secured When the incision, which should be ample
always, is made into the trachea, the supreme moment
of the operation arrives. There is a struggle and an
ugly gurgling of air and blood, which readily disconcert
the novice. At this moment the surgeon should be calm,
and steadily press on to the goal — the insertion of the
tube. If blood wells up from the wounded trachea or
from unseen veins, the operator should not stop to
stanch the hemorrhage. The tube is the best haemos-
tatic agent, and through its unyielding channel portions
of membrane and blood are more readily expelled or
drawn than through the tracheal wound, held open by
retractors. I am sure that lives have been lost in the
effort to check the hemorrhage here referred to, and by
delaying the introduction of the tube.
The after-treatment should be vigorously pushed by
constitutional measures and local inhalations of moist
air. It is a too common practice to fill the room with
vapor and exclude the air. The patient needs a moder-
ately warm and moist atmosphere, but he needs oxygen
more.
43 EAtT FiFTV-MiNTM SmBT, October 24, 1884.
CEREBRAL LOCALIZATION— THE CENTRES
FOR VISION.
By PHILIP^ ZENNER, A.M., M.D.,
CXMaNNATZ, O.
(Continued fixun p. 460.)
SOUL-BLINDNESS.
When Munk' removed the central part of the visual
area of dogs he produced a condition which he termed
soul-blindness. The animals, though evidently retaining
the sense of vision, no longer recognized familiar objects.
He supposed their brains to have been robbed of that
part in which were stored up the visual images gained
from past experience, and that they were, therefore, in
the condition of new-bom, who see but do not know
what they see.
A few words of explanation are necessary to express
Munk's views more fully.
An image formed on the retina makes an impression
upon the visual area of the brain and is perceived. If,
at the same time, the attention dwells upon this image
it leaves an impression upon the brain which remains,
perhaps permanently. Now if the object is seen again
It is compared with this retained visual image, and thus
recognized as seen before. This retained or memorized
visual image may now be brought up in the mind without
the external presence of the object, it may appear in the
fancy or imagination, or be utilized in thought
These memorized images are probably received and
stored up where the visual impressions themselves are
received, that is in the visual areas. But Munk believes
that they are stored up in the central part of the vis-
ual area, in relation with the central part of the retina,
and that when this central part is removed the memo-
rized images are lost also. He believes those images
are usually stored up in the central part because for
* S«e leoond paper.
memorizing anything the act of attention is always
necessary. Ordinarily attention is only paid to images
which fall upon the central part of the retinae; there-
fore,^ according to Munk, memorized images are only
stored up in the central part of the visual areas.
Mauthner,* on the other hand, believes that Munk's
soul-blindness is altogether due to impaired vision, that
his dogs do not recognize objects because they do not
see distinctly, and that the efifects would be altogether
the same whether the central parts of the retinae or the
central parts of the visual areas were destroyed
The difference between these views should be dis-
tinctly recognized. Mauthner also believes that ^e
retained visual images reside in the cortex, but he be-
lieves that the seat of these images is coextensive with
vision itself, whereas Munk believes that, while the
whole visual area is devoted to vision, some images are
stored up, retained, or memorized in one part of it, some
in other parts, and that such images may therefore be
lost, while the sense of vision is retained.
Were we only concerned with conditions experiment-
ally produced in dogs, I would not have dwelt upon this
matter here, but similar conditions have, of late years,
been observed in man, and the subject has obtained,
apart from its great theoretical interest, a certain practi-
cal value.
SOUL-BLINDNBSS IN MAN.
A few years ago Furstner first reported such case&
Others of a similar character have since been recorded
All of them were cases of general paralysis. The visual
disturbances in every instance followed paralytic attacks
(apoplectic or epileptic in character), and disappeared
again in part or altogether within a few days or weeks.
In some instances the mind was so clouded that the ob-
servations can scarcely be utilized for scientific purposes;
in others the mind was sufficiently clear when the obser-
vations were made to give the latter an undoubted value.*
A few illustrative cases will now be given. In Furst-
ner's first case,' after an epileptiform seizure with loss of
consciousness, a right hemiplegia of several days' duration
was found, also a deviation of the eyes to the left, which
was of two weeks' duration. A few weeks after this
seizure, when the mind was completely clear, it was ob-
served that patient recognized objects with the left eye,
but did not appear to see with the right one. At least
he did not recognize objects with the latter, and objects
brought suddenly before it did not cause any reflex
movements, winking, etc. At the same time the pupils
responded to light and the fundi oculi were normal.
His vision improved, and it was now noted that when
he tried to f;rasp an object in the hand of the physician
he moved his head from side to side, then seizing the arm
of the physician, followed it until he reached the hand.
He could not count objects without touching them.
Often in attempting to touch objects he reached beyood
them. In counting small objects he often overlooked
some, or counted the same one repeatedly. In counting
he would move his head constantly from side to side. At
a later period he could recognize small letters, but if the
letters were combined to form a word he could neither
read the word nor point out the separate letters.
The patient's mind was quite clear and he was re-
peatedly and carefully examined. It was explicitly
stated that there was neither color blindness, contraction
of the field of vision, hemianopia, nor binocular diplopisi
These visual disturbances had almost disappeared
when the patient had other paralytic attacks and died
shortly afterward. A focus of softening was found in
each occipital lobe.
In a number of cases FQrstner observed similar visual
disturbances. They always followed paralytic attacks,
I Gdiirn und Ange, p. 487.
* U has been attempted to utiliie these cases, especially diose of Ffintner, b
certain questions of localization, but diere are various reasons why they do not an-
swer for this purpose, and that aspect will not be considered here, j
i Axduv £ Psychiatrie, viii., p. 265.
November 15, 1884.]
THE MEDICAL RECORD.
537
but usually disappeared in a much shorter time than in
the above case. But these peculiar visual symptoms are
even more marked in some cases reported by Stenger.*
In Stengel's cases both eyes were equally affected.
I will briefly relate the two most interesting ones.
In the first, in whom there was already a degree of
dementia, there occurred paralytic attacks every four or
six weeks, with some elevations of temperature and con-
vulsions, chiefly on the ri^ht side, followed by transient
right hemiplegia. Following each attack there were dis-
turbances of speech, with a condition termed word -deaf-
ness, and the peculiar visual disturbances we are about
to mention. The patient could see a chair which was in
his way, but only avoided it after having once stumbled
over it. Fire brought close to his eye did not frighten
him. He touched it to find out what it was, and only
then avoided it. He could see wine, but seemed not to
know its use until it was brought to his lips.
There appeared to be no contraction of the field of
vision, for objects brought from any side were immediately
perceived. Fundi oculi were normal. The disturbance
both of speech and vision remained for about ten days
when they gradually disappeared, but after each such
attack a number of words and visual images seemed to
be permanently lost. The post-mortem examination re-
vealed the diffiise changes in the brain commonly found
in general paralysis.
In another case, after a paralytic attack the patient rec-
ognized some objects through the sense of vision, while
he did not recognize others. Thus, he recognized his
bed, fire, and bread, but not a needle, shoes, or his
clothes. But (just as in the case of Munk's dogs) he
learned to know a needle by its mere appearance sifter
being taught what it was by means of other senses.
The last case I shall mention is one reported by Zacher,*
in which a paralytic attack left the patient with diflftculties
of speech, and motor and sensory disturbances, and the
same kind of visual symptoms. Though paralytics gen-
erally seize food very greedily, this patient left it un-
touched until put in his mouth. He was very fond of
cigars, but he now took one in his hand and again laid it
aside, apparently not knowing its use. These visual dis-
turbances were present only a few days.
It is by no means easy to determine the exact character
of the visual disturbances in the above-mentioned and
similar cases. The difi[iculty is increased by the fact that
in all of them there was a degree of mental weakness, and
in some well-marked dementia. It is quite probable that
in all of these instances there was some impairment of
vision, and that impaired vision alone can produce some-
what similar disturbances seems to be proven by two
cases of Wilbrand.* In both of these instances the pa-
tients became suddenly unable to recognize objects about
them, their own houses, streets in which they resided, etc.
They could not, therefore, find their way in the streets,
though they continued to see. Both patients were sound
mentelly, and in each a homonymous lateral hemianopia
was subsequently found.
In the above cases, also, blindness or impaired vision
in parts of the retina is very probable. In the first case
of Farstner the manner of seizing an object, the con-
stantly moving the head from side to side in trying to
count, and overlooking some objects while counting
others repeatedly, seem to point with great certainty to
spots of retinal blindness. It is true that the patient was
carefully examined by skilled physicians and that color
blindness, hemianopia, etc., were excluded, but slight dis-
turbances can be overlooked even on careful examina-
tion. This fact is well.illustrated by a case of Wernicke * in
which an eminent ophthalmologist could find nothing ab-
normal, though relative scotomas were afterward detected,
certain parts of the retina being still sensitive to light,
though the acuity of vision in some parts was diminished.
But if it could be determined that in all cases of so-
^Archiv f. Psychiatric, adii., p. 235.
' Udier Hemianopsie, pp. 172, 176.
* Ibid., xiv., p. 488.
* Gehtmkrankhetten, ii., p. 552.
called soul-blindness there is impairment of vision, this
would not necessarily explain the complex of symptoms.
The condition may, nevertheless, be found in them which
Munk claims to be present in his dogs ; that is, in addition
to a degree of retinal blindness, and quite independent of
the latter, a loss of cerebral visual images which in itself
explains the symptoms.
There is, in fact, much which points toward the cor-
rectness of such an explanation. In many of these cases
there were at the same time disturbances of speech, es-
pecially that condition termed word-deafness, where those
peculiar conditions appear to be positively determined
with reference to hearing whereof there is now question
as to the sense of vision ; for, in these instances, without
having lost the sense of hearing the patients do not com-
prehend what they hear.
It is also a singular fact that in almost all cases of
" soul-blindness " the left side of the brain was affected,
which, as we have been taught by other clinical observa-
tions, seems to be the seat of the highest cerebral func-
tions.
The existence of a condition termed word-blindness,
where written and printed words cannot be read, a con-
dition not infrequently found, and also present in^ some
of the above cases, strengthens the belief that certain
visual images may be lost while vision is retained. Yet
it must be acknowledged that what has as yet been con-
tributed is not sufficient to decide this difficult question,
and its solution must be left, like that of some other
questions with which we* have dealt, to future investiga-
tions.
DiagtwsU. — We must now consider the practical as-
pect of our subject, the value of the visual disturbances
of which we have spoken, especially hemianopia, in diag-
nosis.
When carefully sought for hemianopia is not infi-e-
quently found in cerebral disease, especially in those
cases where the disease is ushered in by an apoplectic
attack. Hughlings Jackson ' found hemianopia in
quite a number of cases of hemiplegia, and Gowers"
states that he never fails to find hemianopia in hemiple-
gics when he looks for it at an early period. But in the
latter case this symptom has a local significance. A
sudden hemiplegia is usually caused by a cerebral hemor-
rhage or the plugging of a vessel, conditions which pro-
duce a temporary paralyzing effect upon the entire brain,
or at least upon one hemisphere. Hemianopia produced
at such a time need not indicate any direct involvement
of the visual centres. In the same way a hemorrhage
in the occipital lobe may cause hemiplegia, though this
part oT the brain has no motor functions. It is these dis-
tant effects, produced by sudden lesions, which, when' not
properly estimated, bring confusion into the study of
cerebral localization. The clinical manifestations, hemi-
plegia, aphasia, hemianopia, etc., which are present only
a short time after an apoplectic attack, are usually value-
less in assisting to localize lesions. Only permanent
symptoms have a local significance.
If, now, hemianopia be a permanent symptom, it indi-
cates that there is a lesion of some part of the visual
apparatus, but it gives us no knowledge of its more exact
locality. We have learned that lesions of the optic
tracts, of the occipital lobes, and of the parts connecting
the two, may cause hemianopia, and must now seek for
other means to determine more precisely the seat of
disease.
There are a few special symptoms which may be of
value for this purpose. The first is the condition of the
pupils. Disease of the occipital lobes has no influence
on the contraction of the pupils. When both occipital
lobes are destroyed, and there is complete blindness, the
pupils continue to respond to light. But if the blind-
ness be of peripheral origin, due to degeneration of the
optic nerves or tracts, the pupils cease to respond to
* Ophtfa. Hosp. Reports, viii., p. 330.
• Brit. Med. Journal, November 24, 1877.
538
THE MEDICAL RECORD.
[November 15, 1884,
light Nevertheless, in cases of hemianopia this differ-
ence in reaction of the pupils is of little consequence,
because one-half of the retina is still sensitive, and the
pupil will respond, no matter whether the injury to one-
half of the visual apparatus be central or peripheral. But
Wernicke believes that, even with these unfavorable con-
ditions, with proper care and skill we can gain something
from this symptom. This is to be done through allowing
light to fall upon only one-half of the retina by means of
proper apparatus. Wernicke mentions a case* where
he censures himself for having neglected this means of
arriving at a correct diagnosis. The case was one in
which there was double hemianopia, therefore complete
blindness. The pupils responded to light, and the diag-
nosis was, consequently, disease of both occipital lobes.
The post-mortem revealed disease of only one occipital
lobe. The second hemianopia was caused by the com-
pression of the optic tract of the other side. Wernicke
believed that he could have arrived at a correct diag-
nosis had he tested the pupils by throwing light upon
only one-half of a retina at a time. On account of the
difficulties and perhaps unreliability of such examinations
we may be permitted to believe that they will never be
of much practical value.
The ophthalmoscopic appearance of the optic disks
may also assist us to distinguish peripheral from central
disease. The object of the examination is to determine
whether or not there is any atrophy of the optic nerves.
Peripheral disease is more frequently and more quickly
followed by such atrophy than central disease, so that
the early appearance of discoloration of the disks makes
the existence of peripheral disease probable.*
These symptoms, then, though they have an absolute
worth, are practically of little value. As in cerebral
lesions elsewhere located we must base our diagnosis
upon the history of the case and the whole complex of
symptoms. The mention of two cases will serve for
iUustration.
The first, a man sixty-eight years of age, observing a
defect of vision consulted an ophthalmologist, who found
a left hemianopia. There was no other symptom at this
time, and the patient continued to attend to his business
until two weeks before I saw him, when his wife sent for
the family physician, because there seemed to be some
change in his mental condition, loss of memory, etc.
When I saw him there was complete blindness in the
left half of the field of vision, and the patient saw but very
little in the right half; there was double hemianopia.
There were no changes in the fundus of the eye and the
pupils responded to Ught There were no other localizing
cerefbril symptoms. His only other were mental symp-
toms. He was forgetful of recent occurrences, more emo-
tional than normally, and was occasionally confused as to
locality.
The diagnosis was, degenerative changes in both oc-
cipital lobes, probably due to thrombosis in the pos-
terior cerebral arteries. The disease involved the visual
apparatus of both sides. It was not a double peripheral
lesion, or the pupils would not respond to light It was
not like the above case of Wernicke, in which one lesion
(a tumor) destroyed one occipital lobe and compressed
the opposite optic tract, because everything was opposed
to the presence of an extensive lesion of this character.
The mental symptoms indicated that the cortex was affected.
From the fact that there were so few symptoms, we may
judge that the cortex was directly involved in the lesion,
and not indirectly affected by a large lesion in a distant
part.
All above said only permits us to conclude that one
occipital lobe is the seat of disease. It could not be de-
nied that the hemianopia of one side might still be due to
peripheral lesion. But it is probable that in the latter
instance also the disease is central, not peripheral.
The second case, a man sixty-six years of age, has had
* GehirnkrankheUen, iL, p. 335.
right hemianopia since seven years ago. At that time
he had a sudden seizure without loss of consciousness—
he cannot recall details at this time — after which he was
confined to bed for a month. He thinks that he was not
paralyzed, but inasmuch as he was confined to his bed for
a month at least, a hemiparesis was probably present An
examination by an ophthalmologist, made four months
later, revealed a right hemianopia, which did not reach
quite to the point of fixation. There was slight improve-
ment within the next year ; the field of vision of both
eyes became a little larger.
Some months ago his vision again became suddenly
worse, probably due to an attack of the sacne kind as
the first one. At the present time there is a right hemi-
anopia reaching, apparently, to the point of fixation,
though, on account of the restless condition of the pa-
tient, its exact limits can not be determined with cer-
tainty. The pupils respond to light The ophthalmo-
scopic appearance is normal. There are no other cerebral
symptoms, but the patient says he is able to do far less
mental work than before the last attack.
This patient has valvular disease. The diagnosis is
embolism of the leffc posterior cerebral artery. But the
diagnosis is only a probable one. It is based upon the
probable extent of lesion, the absence of other localizing
symptoms, and the mental impairment
Bernhardt * reported a number of cases a few yean
ago, where, in addition to hemianopia, there were tran-
sient affection of sensation and motion, and occasional
unilateral convulsions on the same side. The clinical
picture in these cases suggested the presence of degener-
ative changes, especially in the surface of the brain, ex-
tending beyond the limit of the occipital lobes. They
remind us of WestphaFs case, where the autopsy revealed
changes limited to the cortex.'
It is needless to speak further of individual cases. The
above instances are sufficient to indicate how a diagnosis
is arrived at, and they illustrate another fact, that the
diagnosis is often problematical.
It may appear to one who has carefully read these
papers that the laborious and diligent application, and
the profound research which have been devoted to this
subject, though they have done much to enrich scientific
knowledge, have added little to our powers of curing dis-
ease and alleviating human suffering. And, at present,
such a view has much to substantiate it, though the case
of Wernicke and Hahn affords a brilliant illustration of
what can already be done in cerebral surgery. But knowl-
edge of cerebral localization is of very recent date. Ad-
vances are constantly being made, and it is only reasonable
to believe that far more exact diagnoses will readily be
made in the future. Therapeutic appliances are also be-
coming better understood and more valuable, and espe-
cially are radical surgical operations performed with a
degree of safety not formerly dreamt of.
With such favorable indications before us we are not
over bold when we venture to state that the knowledge
of cerebral localization will yet be the source of great
practical benefits to mankind, that it will ofttimes enable
the physician to cure those diseases which are of all the
most appalling, for they not only shorten life and entail
great suffering, but also threaten the affiicted with the
loss of reason.
Trichlorated Phenol in Erysipelas.— -At a recent
meeting of the Surgical Society of St Petersburg, Dr.
Papow communicated the results of his experience with
this form of phenol as a local application in erysipelas.
The author reached the conclusion that the drug arrests
the development of, or destroys, the micro-organisms
upon which the disease is supposed to depend. He ad-
vised its application in a ten-per-cent. solution, to be
brushed over the diseased part and the adjacent skin.—
Gazette des Hopitaux,
' Archiv f. Psychiatrie, xiL, p. 780.
> See third paper.
November 15, 18^4*3 — — ^^ -TRE MEDICAL RECORD.
539
HISTORY OF A CASE OF FISTULA IN ANO
ACCOMPANIED WITH INCONTINENCE OF
URINE OF SEVERAL YEARS' STANDING.
By MORRIS H. HENRY, M.A., M.D., LL.D.,
< LATB SURGBON-IN-CHIEF OF TMK NEW YORK STATB EMIGRANT HOSPITALS.
I BELIEVE in the records of clinical contributions that
speak for themselves, written in such a way that they
need little or no commentary to explain their meaning
or add to their interest.
Case. — Mrs. , about thirty years of age, mar-
ried about ten years, in affluent circumstances, has
children, is of full habit and to all outward appearance
perfectly healthy. I was called to her by the advice of
her medical attendant, at her summer home, some dis-
tance from New York, in June, 1883. She had been
under the especial care of a New York physician during
the summer of 1882, who made his home at a hotel in
the immediate vicinity of her then country residence, but
a short distance from New York. His ** specialty" was
diseases of women, and he was selected to attend her on
that account He made what he termed a "careful and
thorough examination, and discovered an inflammation
and ulceration of the os and cervix uteri, which ac-
counted for all her distress and annoyances.'' Her main
suffering, from her own account, was an intensely irri-
table condition of the bladder, constant desire to mic-
turate, and severe pain in the rectum at every foecal
discharge. This had existed for more than ten years.
She remained under the care of the g3aiecologist during
the summer of 188 1 without deriving much benefit. He
was retained as her medical adviser, and was with her
during her confinement, in the spring of 1882, with her
fourth child. She made a good recovery from the birth
of the child, but she still suffered from distress in the
region of the rectum and the unceasing annoyance of
mcontinence of urine.
Such is the history of the case, in brief, afforded me
June 26, 1883, when I was called to attend her. The
local physician did all in his power to relieve her of pain
until my arrival She complained of a severe and in-
tense throbbing pain in the region of the rectum, which
had been steadily increasing during the past four days.
The incontinence of urine had increased — she had, in
fact, no control over the bladder. She had had no pas-
sage fi-om the bowels for three days, and was averse to
making any effort from fear of an increase of pain. The
recent death of her father from fistula in ano and perineal
abscesses added to her mental anxiety and suffering.
On examination I found a circumscribed, deep-seated
inflammation, about three inches in diameter, on the left
side of the rectum, the external border close in and in-
volving the external sphincter of the rectum. There was
a little oozing firom the centre of the inflamed mass. I
made a free incision and relieved her of about four ounces
of pus. With the aid of a Sims speculum and a probe I
discovered two fistulous openings in the rectum, one ex-
tending about two inches upward from the border of the
anus, and the second not quite as far, both communicat-
ing with and terminating in the external abscess. By in-
serting a probe in each track the figure V was described,
with the pointed end in the abscess. In deference to
her wishes, owing to the appearance that morning of
her menses, there was no fiirther surgical interference
that day. The wound was dressed with warm fomenta-
tions and the bowels relieved with mild enema. She
was freed from the acute pain and the incontinence was
lessened.
July 10, 1883, assisted by the local physician, who
administered a little chloroform, I laid open the two
fistulous tracks, cleansed the parts with a solution of
labarraque, and dressed the wound with iodoform and
vaseline. As soon as she had recovered from the effects
of the chloroform — ^about three hours after the operation
—ten grains of quinine and half a drachm of tincture of
hyoscyamus was administered A few hours of refresh-
ing sleep soon followed. For the first time in many
years she was able to retain her water many hours. Th^
irritable condition of the bladder had ceased. The
wound was dressed twice daily in the usual manner to' in-
duce healing from the lower surfaces.
July 17th. — The wound had entirely healed within the
rectum, and a few days later it had done so along its
whole course. There were no more painful or abnormal
sensations about the rectum. The bowels yielded to
gentle enema, and there was no longer any incontinence.
I heard from her a few days ago — October, 1884. She
was perfectly well.
I have now only to add that I believe , this is not an
isolated case. I record it with the hope of attracting at-
tention to diseases of the rectum as a fruitful source of
''diseases of the bladder and uterus" due to reflex
causes. I have no doubt there are many persons suffer-
ing in a similar manner, without identification of the na^
ture of the disease on the part of medical attendants.
I 581 FiTTH AvBNUR, NovembcT, 1884.
NATURAL SULPHUR-WATERS, AND THEIR
THERAPEUTICAL APPLICATION.
By HOWARD PINKNEY, M.D.,
- NEW YORK.
During two summers spent in Europe visiting a few
of the most noted spas, my attention was attracted
to the large proportion of Americans there seeking
relief for various ailments. I inquired of many why
they came so far? also if they had ever tested the
virtues of American springs ? The usual answer was that
"they had come by Ae advice of their physician," and
that, with few exceptions, " they had never visited for treat-
ment any springs at home." I have conversed with
many of our eminent physicians and surgeons, and find
that while they are quite familiar with the properties of
European medicinal waters, they have paid but little
attention to those in this country. Dr. Walton, in his
work on the mineral springs of the United States and
Canada^ describes over one hundred and ninety sulphur
springs in the United States ; and Dr. Glover describes
thirty sulphurous or sulphuretted spas in Europe. In
comparing the analyses of these different sulphurous
springs it will be found that all so-called springs contain
certain ingredients in common, and differ mamly as to
the proportion of these in^edients in each, and the
temperature of the water as it issues from the sources.
In order to satisfy myself as to some of the therapeutic
effects of sulphurous waters, I spent three months at
Sharon Springs. While there I had the good fortune to
watch its effects in the following diseases, viz.: Rheuma-
tism and gout, acute and chronic, eczema, psoriasis, naso-
pharjmged catarrh, catarrhal inflammation of the Eusta-
chian tube causing deafness, and one case of hemiplegia.
In all the cases of rheumatism and gout seen before
commencing the use of the waters, the secretions, viz.:
urine, perspiration, and saliva, were excessively acid.
After taking the baths and drinking the waters for a
week or ten days, I found the secretions much less acid ;
after the fourth week of their use, in many cases little or
no acid showed by the blue litmus paper test. In the
cases of eczema the same result was shown. In one of
two cases of psoriasis the eruption disappeared entirely
after one course of baths. In the other, who only took
the baths, etc., for two weeks, no improvement was per-
ceptible. In the case of hemiplegia, where the baths
and water were used most faithfully, I could detect no
improvement in the paralyzed parts, although the general
health and appetite improved.
As sulphuretted hydrogen gas is so fi-eely generated in
the bowels and expelled by the rectum, I at first thought
that its introduction into the stomach, especially in cases
540 .
THE MEDICAL RECOiJ& *^*--^:TWi^^^^
1884.
of dyspepsia, would be injurious. I therefore advised
that the water should be first heated, in order to throw
off the free sulphuretted hydrogen before being drunk ;
but, as many visitors, wjio, for years, had been in the
habit of coming to Sharon, informed me that, whenever
thev had dyspepsia symptoms— especially acid stomach
— ^tney always found relief by taking a glass of the sul-
phur-water as it came from the spring, I could not doubt
their testimony, and the following questions suggested
themselves : Does sulphur-water prevent fermentation
outside the body? If so, does it have the same effect in
the stomach ? To solve the first question, I made the
following experiment : Taking two glass test-tubes of
equal size, I partly filled one with sulphur-water taken
directly from the spring. In the other I placed an equal
amount of rain-water. To each I added an equal amount
of ferment, composed of molasses and baker's yeast,
corked and labelled each, and set them aside in a warm
place.
On the following day, when I examined them, I found
that the cork in the test-tube containing the rain-water
had been forced out, and that the fluid in the tube was
turbid and covered with a luxuriant growth of yeast
plant. The other tube, containing the ferment and sul-
phur, appeared the same as when I set it aside — the
cork was firmly in the tube, and no growth appeared on
the surface of the liquid. I repeated this experiment
with tank-water, and the water used at the table for
drinking, with like results — the sulphur-water always ar-
resting ferment3.tion. I naturally came to the conclu-
sion thai if sulphur-water prevented fermentation outside
of the body, it might have the same effect in the stom-
ach. Now, if this theory is correct, may not some
similar change take place in the blood of rheumatic
and gouty patients, and account for, in a measure, the
marked improvement in such cases from the use of the
waters?
As I was anxious to make some investigations as to
the effect of sulphur-spray upon inflamed mucous sur-
faces, I had an excellent opportunity of doing so, and
also the effect of breathing and inhaling an atmosphere
highly charged with sulphuretted hydrogen. In connec-
tion with the baths are three inhaling-rooms. In the
first the sulphur-water is converted into a spray bf means
of compressed air, and so arranged that it can be applied
directly to any part of the throat or nose. In the sec-
ond room the water is converted into spray by steam
and completely fills the apartment. In the third room
the water, as it comes from the spring, is mechanically
broken up and the sulphuretted hydrogen set free by a
series of fountains. The air of this room is constantly
charged with an excess of sulphuretted hydrogen and can
be freely and safely inhaled. All the cases of catarrhal
inflammation that I had an opportunity of watching re-
ceived marked benefit from this mode of application.
The beneficial effects I think result from the following
causes : First, the steam spray softens and relaxes the
inflamed mucous surfaces ; second, the compressed air
spray cleanses and stimulates to a healthy action the
surfaces with which it comes in contact; third, the
breathing of air charged with sulphuretted hydrogen gas
has an anodyne and somewhat narcotic effect. Physi-
cians who are in the habit of using the spray frequently
have added to the sulphur some medication, as benzoic
and boracic acids ; some preparations of the pine, as the
extract or oil made from the needles or leaves of the
pine, such as are used so largely in Germany in similar
affections. The object that I have in view in writing the
above is, to stimulate a more thorough research into the
medicinal properties of the almost numberless medicated
springs in the United States, thereby enabling physicians
intelligently to advise their patients in regard to the
various springs, at the same time sparing them the many
inconveniences of sea and continental travel, especially
should they be lame or crippled.
34 East Forty-pixst Stkibt.
ilep0rtB at hospitals.
ST. LUKE'S HOSPITAL, NEW YORK.
Irrigation of Stomach for Chronic Gastritis.
Reported by SAMUEL T. KING, M.D., House Physician.
The almost uniform success that has been obtained
during my term of service by irrigation of the stomach,
or lavage, for chronic gastritis (gastric catarrh), is my
apology for publishing the results of treatment in the fol-
lowing cases.
The method of lavage, as performed at the hospital, is
very simple. The patient is instructed to take no break-
fast. At about 10 A.M. the stomach-tube is introduced
and the stomach is washed out several times by the aid
of siphonage. The apparatus used consists, first, of a
quite flexible rubber tube from one-third to one-half an
inch in diameter, about twenty-eight inches in length, one
end being freely open and the other closed, rounded, and
with one oval aperture on each side ; second, of an ordi-
nary black rubber tube three feet long, attached by
means of a short glass tube to the stomach-tube first
mentioned ; third, a small funnel. The temperature of
the water used varies from 100° to no** F. In two or
three quarts of this water is dissolved a teaspoonful of
borax. The amount of water tolerated is judged by the
subjective sensation of fulness, and it varies considerably
with each case. The stomach is washed out until the
returning fluid becomes quite clear, usually three or four
washings proving sufficient.
After introducing the tube a little beyond the root
of the tongue, the patient is instructed to swallow, and
at the same time the tube is pushed somewhat rapidly
into the stomach. Occasionally at the first introduction
there is considerable difficulty from retching, but by
proper manipulation this may be readily overcome.
After three or four introductions the patient himself will
be able to introduce the tube.
The following are abbreviated reports of all the cases
of chronic gastritis which have been treated by lavage
during the past year.
Case I. {Services of Drs. Beverley Robinson and
Francis P, Kinnicutt.)—Vioh^x\, W , seventeen years
of age, native of the United States, errand boy, was ad-
mitted to the hospital November 9, 1883. Two years
before entrance he first began to have pains in abdomen,
and soon after vomiting began. Had no hdemateroesi&
At time of entrance he was in a truly pitiable condition,
his stomach rejecting nearly everything. He was rapidly
emaciating. Skilled treatment by drugs had failed to
relieve him. Upon entrance, physical examination re-
vealed dilatation of the stomach. Lavage was imme-
diately commenced, and for the first few days the boy
was nourished entirely by nutritive enemata. On No-
vember 2 2d he was placed upon small quantities of pan-
creatized milk by the mouth, given at short intervals ; and
from that time his diet was gradually increased, with the
exception of one interval of a few days, when there was a
return of the vomiting, until he could eat any form of
nitrogenous food, and, finally, any kind of food. During
the treatment by lavage he was given several drugs to
prevent emesis and putrefaction, but apparently without
any especial benefit. Patient had no more vomiting
after December 2 2d. The lavage was reduced to every
other day January 20, 1884, and entirely discontinued at
the end of another month. From January ist until date
of discharge, February 19th, patient gained eighteen
pounds in weight. From that time to tilie present date,
October 22d, there has been no return of gastric symp-
toms.
Case II. {Service of Dr, George G. Wheelock.y-
Louisa H , colored, thirty (?) years of age, a domestic,
was admitted to the hospital March 15, 1884. For a
I month previous to entrance patient had been vomiting
November 15, 1884.]
THE MEDICAL RECORD.
541
after eating and had suffered ep^astric pain and distress.
On entrance there was anorexia and rather persistent
vomitinfc and she gave a distinctly phthisical history.
Physical examination revealed very slight pulmonary
changes. Having obtained no satisfactory results from
medicinal treatment, April 2 2d the patient was ordered
lavage every day and strictly milk diet. The gastric
symptoms were entirely relieved, and on April 30th she
was allowed some nitrogenous food. On May loth, be-
cause of some irregularity in diet, she again began to
vomit, and although two or three trials were afterward
made to confine her to a restricted diet, she was unable
to restrain her appetite for forbidden articles of food, and
was therefore discharged June 3d, materially improved in
her gastric symptoms.
Case III. {Service of Dr. George G. Wheelock.)—
Catharine T ^ forty-six years of age, married, a cook,
was admitted to the hospital April 15, 1884. She has
always been a hearty eater, and occasionally indulges in
malt liquors. Three weeks before entrance she began
to vomit a greenish (bilious ?) material, and for the last
week the vomiting has been persistent Patient has
sour eructations, vomiting of a sour fluid, and tenderness
and sensitiveness over abdomen, especially in epigastric
region. Bowels are constipated. Medicinal treatment
failing to give relief, she was ordered lavage and milk
diet. She was discharged June nth, having entirely re-
covered from her gastric symptoms. May 22d was the
date of the last vomiting.
Cask IV. {Service of Dr. George G. Wheelock.)—
Geraldine E , colored, thirty- two years of age, mar-
ried, a domestic, was admitted to the hospital April 28,
1884. She has had frequent vomiting and headaches.
She often vomits large quantities, and at times particles
of food which she had eaten four or five days previously.
Upon entrance, physical examination revealed marked
dilatation of the stomach. Lavage with the usual precau-
tions was ordered, and patient was discharged cured
May 31st. She was seen during the latter part of the
summer, and at that time there had been no return of her
gastric symptoms.
Case V. {Service of Dr. Francis P, Kinnicutt.)-^
Eugene F- , twenty-two years of age, single, native
of the United States, a tinsmith, was admitted to the hos-
pital June 25, 1884. For the past year he had suffered
from eructations of gas and a sour fluid and constipation,
and had obtained no relief from skilled medical treat-
ment Has lost but little flesh and strength. Under
treatment by lavage, with pancreatized milk as diet, his
^tric symptoms were markedly improved but not en-
tirely relieved.
Case VI. {Service of Dr. A. Brayton Ball )— Matilda
N- , thirty-three years of age, dressmaker, was ad-
mitted to the hospital August 30, 1884. She was suffer-
ing from chronic bronchitis and asthma. She had also
suffered from sour eructations and occasional vomiting
for some time previous to entrance. Her cough ceased
under treatment, but she suffered from alternating diar-
rhoea and constipation and her gastric symptoms per-
sisted in spite of all treatment. September 24th she was
ordered la vase without change in diet, and in the course
of ten days she was entirely relieved from her gastric and
intestinal symptoms, and has had no return at present
writing, October 2 2d.
Salicylic Acid in I-,upus Vulgaris. — In a case of
lupus, in which the disease had already done much
damage to the side of the nose, the cheeks, and the eve-
brows. Dr. Marshall {Algem. Wiener Med. Zeii.) suc-
ceeded in healing the ulcer with salicylic acid. He em-
ployed an ointment containing 3 j. of the acid to 5j. of
vaseline. The cicatrix obtained was flexible and smooth.
Altogether the result of treatment was very gratifying,
and the author warmly recommends the use of the drug
in'similar cases.
Iodoform in Organic Disease of the Heart. —
Professor Testa {Giornale diMed.'e Ter. di Messine) has
reported some observations made by him on the curative
effect of iodoform in organic disease of the heart. He
has studied the subject for several years, and has ob-
served the effect of the drug in a number of cases. The
remedy is not directed against the lesions themselves, but
rather against the effects produced by them. He ^ves
the drug in pill form every two hours, until one grain is
taken during the day. Its most marked effect is to
diminish the number of heart-beats, while it increases
the arterial tension.
Calculus Impacted in the Ureter, and the
Feasibility of Removing it by Surgical Operation, —
Mr. Henry Morris, Surgeon to the Middlesex Hospital,
London, discusses {The American Journal of the Medical
Sciences) the feasibility of removing from the ureter an
impacted calculus, which, if allowed to remain, will
sooner or later surely cause destruction of the kidney, if
not of life. He gives very fully the clinical history,
diagnosis, and prognosis of these cases, and Anally urges
that a calculus impacted in the ureter sufliciently near
the vesical orifice to be felt with the finger can with care
and suitable instruments be extracted through an incision
of the bladder wall without fear of wounding the peri-
toneum, or laying open the cavity of the bladder. He
describes his method of operating as follows : Having
rapidly dilated the urethra, if the patient be a female, or
opened the urethra in the median line immediately in
front of the prostate, if the patient be a male, the neck
of the bladder should be passed by the index finger of
the left hand, and a careful digital examination made of
the bladder walls. If a hard fixed body be felt covered
over by the bladder mucous membrane, at or near the
orifice of one of the ureters, a gum lancet-shaped knife
on a long slender shank should be introduced along the
left index finger, and with it an incision should be made
through the tissue covering the calculus. The knife
should then be carefully withdrawn, and a slender scoop
or curette, introduced along the index finger of the left
hand, still retained within the bladder, should be employed
for gently turning the calculus out of its bed. Mr. Morris
urges that an exploration of the bladder should be made
with the view of performing this operation on the ureter
— I. In hydronephrotic or pyonephrotic enlargement of
the kidney, associated with bladder symptoms, with the
hope of re-establishing the natural drainage through the
ureter. 2. Before nephrectomy is resorted to for hydro-
nephrotic or pyonephrotic tumors, which have been
opened or tapped through the loin without benefit. 3.
Before nephrectomy is resorted to in cases of suspected
renal calculus in which no renal tumor exists, and where,
after digital exploration and puncture of the kidney
through the loin, no stone is found. 4. In cases of
sudden or rapid suppression of urine, or anuria, occur-
ring after symptoms which have given rise to suspicion
of stone in one or other kidney or both kidneys. A kid-
ney which has undergone compensatory hypertrophy
may become blocked by a calculus which has been forced
by the superimposed urine in the lower end of the ureter,
and which cannot pass the vesical orifice of the ureter.
Such a kidney may be, probably is, the only one the
patient has to depend on ; and in this case death must
ensue if the obstruction is not removed. If no stone can
be felt through the bladder, life may yet be saved by giv-
ing a vent to the pent-up urine by lumbar nephrotomy.
A Case of Imperforate Rectum in which Lumbar
Colotomy was Performed. — Dr. John H. Packard
records a case of imperforate rectum in which lumbar
colotomy was performed with an unsuccessful result.
From his experience he is now of the opinion that in
cases in/which the object is to open the bowel with a
542
THE MEDICAL RECORD.
[November 15, 1884.
view not only to immediate relief, but to thp subsequent
establishment of the natural passage and closure of that
artificially made, inguinal colotomy is the better opera-
tion. His preference for the operation in the loin was
based upon a belief in its greater safety, as well as upon
his familiarity with it as practised upon the adult. But
the risk involved in opening the peritoneal cavity, as
well as the somewhat greater difficulty of the operation,
would seem to be outweighed by the advantage of far
readier access to the cul-de-sac forming the terminal part
of the gut, and by the better prospect of thus remedy-
ing the abnormal condition. — The American Journal of
the Medical Sciences,
The Interval Treatment of Bronchitis. — In The
London Practitioner^ September, 1884, Dr. Drummond,
of Rome, urges the importance of treatment in those pa-
tients who have just \)assed through an attack of bron-
chitis, and having no longer any definite complaints are
apt to fancy themselves in perfect health. He says truly
that the leading points to be observed in the manage-
ment of the various forms of bronchial inflammation are,
as a rule, sufficiently manifest and easy of application, so
that when called in to such cases there is little need for
hesitation in the choice of remedies. Such periods of
attack are, of course, especially at the extremes of life,
dmes of the greatest alarm, anxiety, and pressing danger
to the patient, who is apt, however, to think that, when
they have passed away, all is well again, and for this
reason we commonly lose sight of him until another
seizure compels him again to seek our aid. We know,
however, that this is very far from being the case ; that
very often his condition in the interval is very critical ;
that the latent cause, of which the bronchitis is only a
secondary consequence, is still present ; that the interval
is the period when really curative treatment is available,
and is the most important part of the life-history of his
disease. As time goes on, if no attempt is made to deal
with the diseased condition to which the bronchitis is
due, recurrences are more and more frequent ; and if the
patient is still exposed to the exciting cause, especially
in a variable climate, they come to be taken as a mere
matter of course, and serve to mark the winter exactly
like the return of snow and fog. The patient is hardly
ever well, and becomes habituated to a condition of per-
manent disablement ; his power of resistance to weather
changes is diminished, and a barometric sensitiveness to
them is developed In the background, steadily advanc-
ing, hidden lesions lurk ; and increasing emphysema,
heart dilation, lung collapse, interstitial lobular pneu-
monia, dilatation of the bronchi, and other changes pro-
gress, slowly but surely sapping the patient's strength,
shortening the duration and^'diminishing the enjoyment
of life ; so that, although chronic bronchitis is, per se,
attended with comparatively little danger to life, it none
the less originates or aggravates other lesions, with which
its clinical history is interwoven, and often in their nature
more perilous than itself. As regards the nature of the
interval treatment, it must of course vary in different
<:ases, according to the individuality of the patient.
General measures, proper hygiene, and such medicines
as may tend to improve the patient's constitution are all
indicated, and need not be enumerated here.
Treatment of Malignant Pustule by Cruciform
Incisions and Cauterization. — Dr. Barberini writes to
the Rivista Clinica e Terapeutica for September, 1884,
giving an account of two cases of recovery from malig-
nant pustule. The first case was that of a herder, forty
years of age, of fair general health. On the left side of
the lower lip there was a small black spot, the size of a
centime, slightly elevated, and surrounded by an inflamed
area, which he said appeared the day before as a little
vesicle exuding a little water when scratched. The tis-
sues beneath the black spot were v^ry painful upon the
slightest touch, and the lymphatics of the part were
iswollen and cordlike. The patient's temperature was
103® F. Fifteen grains of sulphate of quinine were given
at once, and two elliptical incisions were made through
the inflamed zone at about -K inch distance from the
blackened eschar, the enclosed parts being excised. The
wound was then cauterized with strong carbolic add
(eighty-five percent.). There was but little hemorrhage,
but the patient fell into a state of collapse almost im-
mediately. The case seemed hopeless, but quinine and
broths were prescribed, and after thirty-six hours the pa^
tient began to show signs of consciousness and progressed
slowly to full recovery. The second case was very
similar to the first. The diagnosis of malignant pustule
was undoubted. The elliptical excision and cauteriza-
tion were practised as in the first case, with equally good
results.
The Treatment of Hemorrhoids. — Professor Vei-
neuil recommends cold local applications and mQd
laxatives in the treatment of slight cases of hemorrhoids.
For the more severe cases he employs forced dilatation.
Hemorrhoids are caused, he says, by a strangulation oC
the superior mesenteric veins which traverse the muscular
wall of the rectum. This strangulation gives rise to the
formation of the venous tumors, precisely as varicose
veins are occasioned by constriction from the ring of the
soleus muscle. If now the muscular contracture be
overcome the venous circulation is restored and the
hemorrhoidal tumors disappear. In order to insure suc-
cess the dilatation should not be attempted with the
fingers, but should be accomplished by means of a spec-
ulum. By means of this instrumental dilatation the
author asserts that hemorrhoids may be radically cored
within a week without the use of the knife. — Revue Mk-
dicale^ September 13, 1884.
Recovery from a Punctured Wound of the
Heart. — An old woman, sufifering from suicidal mania,
was observed one evening to become suddenly pale,
falling back upon the bed, with the features convulsed,
the pupils widely dilated, and the head rolling rhyth-
mically from side to side. The pulse was very small,
almost imperceptible, and there was almost complete
paralysis on the left side and paresis on the right. There
was also vomiting. On searching for the cause it was
found that the patient had stabbed herself with a shawl-
pin. The pin had entered the chest at the apex of the
heart, and had passed inward, and a little downward for
a distance of three and one-fourth inches. The instro-
ment was withdrawn, and under the influence of stimu-
lants the heart recovered its normal action. For some
time there was dyspnoea, and the patient experienced
sharp pains in the precordial region, but at the end of
ninety minutes all these symptoms, as well as the par-
alysis, had disappeared. The patient slept tranquilly that
night, and made a perfect recovery. — Gazette des Hdpi-
taux^ No. 100, 1884.
Colotomy. — A retrospect of the operation of colotomy
appears in the October number of The American Journal if
the Medical Sciences from the pen of Dr. Batt, of Phoenix-
ville. Pa. A surgeon who subscribes to the doctrine that
an artifical anus should not be made in the case of im-
perforate anuSy is not justified in doing so on any principle
of morality, since upon him rests an imperative obliga-
tion to employ to the utmost of his ability the means
placed at his command for the relief of human suffering
and the prolongation of human life. When we likewise
consider of what vast importance is the prolongation of
life in a human adult, and how vast may be the concerns
which hang upon such an event, we find the same imper-
ative duty no less binding. To obviate death from
over-distention of the bowels, which is one of the most
painful at)d distressing terminations of life, colotomy
will be justifiable under conditions of the greatest
gravity ; and may be indicated in any obstructive com-
plication of the lower bowel which has passed beyond the
power of local remedies, and in which a judicious trial of
medical treatment has failed to afford relief. Mr.
November 15, 1884.]
THE MEDICAL RECORD.
543
Phillips, of London, tells us that one case of intestinal
obstruction occurs in every one hundred deaths, and
from 139 cases of obstruction which he collected, in
which surgical aid was not given, 133 proved fatal.
The fact that such a terrible fatality as this should
exist, and an operation affording the advantages of
colotomy be unperformed, must ever be a shadow upon
the honor of modern surgery. Statistics are presented
which show most conclusively that the dangers of the
operation are very few, and that the number of recoveries
depends very greatly upon the nature of the affection for
which it is performed. ^
The Prevkntion of Hernia after Laparotomy. —
In a communication addressed to the CentrcUblatt fur
Chirur^iey No. 35, 1884, Dr. Hagen-Torn writes that in a
recent ovariotomy performed by him, the incision passed
accidentally partly through the rectus muscle and partly
in the linea alba. Five months later he saw the patient,
and found that the cicatrix in the muscle was firm, but
that in the linea alba had yielded, giving rise to a hernia.
The text-books usually advise that the incision be made
in the linea alba, but the writer, basing his opinion upon
his experience in this case, believes that the liability to
hernia after laparotomy would be averted were the in-
cision practised entirely in the rectus muscle. He
thinks, also, that healing by first intention would be fa-
vored by reason of the greater thickness of the muscular
tissue.
Stricture of the CEsophagus from Muscular Hy-
pertrophy.— Dr. Ruppert relates in the Gazeta Lekarska^
No. 17, 1884, the case of a young man who suffered from
a gradually increasing stricture of the oesophagus. A di-
agnosis of carcinoma was made, and gastrotomy was ad-
vised. The patient refused to submit to the operation,
;ind died of starvation. At the autopsy it was found that
the stricture was caused entirely by hypertrophied muscu-
lar tissue. The most careful microscopical examination
failed to discover any trace of cancer, the thickened
oesophageal walls consisting of connective tissue and
muscular fibres in a state of fatty degeneration.
Resorcin in Laryngeal Affections. — Dr. J. An-
deer speaks very highly of the value of resorcin in the
treatment of affections of the larynx. He says that this
remedy has not only the advantage of thoroughly disinfect-
ing instruments without rusting them, but it also possesses
the valuable property of producing anaesthesia of the parts
with which it comes in contact. A weak solution acts
as an astringent, a concentrated one as a caustic, with
this peculiarity, however, that it never occasions cica-
trices, but simply promotes the growth of new epithelium.
This renders it specially applicable to the treatment of
ulcerations of the mucous membrane. The author states
that really surprising results are obtained by the use of
resorcin in hyperplasias, in aphonia of long duration,
and in other laryngeal diseases. In tubercular ulcer-
ations it serves to moderate the cough and quiet the
pain. — Revue Mensuelle de Laryngologie^ (TOiologie et
de RhinologUy September, 1884.
Aphasia from I^^digestion. — Several cases of reflex
nervous troubles, caused by digestive disturbances in
children, are related in the Journal de Medecine et de
Chirurgie Pratiques for September, 1884. A little girl,
three years old, lost all power of speech, or even of
making a sound beyond an exclamation of pain when
pinched. This state continued for two hours, but ceased
immediately upon an attack of vomiting, in which a quan-
tity of food and several unbroken cherries were thrown
off. A little boy was seized during the night with an
attack of acute indigestion, and the next morning was
aphasic and in a soporific condition. He slowly recov-
ered the power of articulation toward the end of that day.
In another case a young girl of nine years was suddenly
seized with heat of the head and flushings, alternating
with pallor of the face. Then she became aphasic, but
recovered the power of speech in about an hour after
having vomited undigested the meal taken the evening
previous. Fraenkel has observed a case of hemiplegia
due to indigestion. A |irl, four years of age, was seized
during dinner with vomiting and complete loss of con-
sciousness. The physician thought that the case was
one of alcoholic poisoning, although the mother affirmed
that the child had taken but a very small quantity of
wine. In about half an hour consciousness returned, and
then it was seen that the right upper and lower extremi-
ties were paralyzed, both motion and sensibility being
lost. This disappeared gradually, and the following
morning the child was perfectly well.
Oleate of Chloral Compound in Pruritus. — A
recent writer (St. Louis Medical Journal) has had an
oleate of chloral made, which he claims to have used
with much success in pruritus anus, eczema, and other
affections associated with much itching. The compound
consists of one drachm each of camphor and chloral
and one ounce of oleic acid, thoroughly mixed together.
Camphor and chloral in equal parts, forming a liquid, has
long been known as a vsduable remedy in cases where
local anaesthesia of the cutaneous nerves is desired, and
has been employed in neuralgias and pruritus. The
addition of the oleic acid will undoubtedly increase the
penetrating power of the mixture. It may thus be found
useful in allaying the itching, while other means are em-
ployed to^ecure permanent relief.
Treatment of True Pneumonia by the Cold Bath.
— Two communications have been recently sent to the
Gazette des Hopitaux by Dr. Chauroier, in which he
strongly condemns the old treatment of pneumonia by
drugs, blisters, emetics, and bleeding. The author claims
that statistics prove pneumonia to be more curable with-
out drugs than with them, and that children always
recover from pneumonia when drugs are withheld. He
used the cold-bath treatment in fourteen children, all of
whom recovered. His observations lead him to conclude
that there is no danger from the bath in any stage of the
disease. He gives a bath of ten minutes' duration, at
from 82° to 90°, ^^^ry two or three hours to an adult,
and two or three times a day to a child. Each bath pro-
duces a lowering of the temperature of from two to three
degrees, of the pulse from ten to thirty-two beats, and
of the respiration from six to fourteen per minute. The
bruit de souffle produced by the fever disappears, dyf p-
noea is decreased, and there is less thirst. Tiie auihor
is inclined to think that mortality may be lessened by
the use of the cold bath, although he is ready to admit
that his own observations concerned such cases only as
would doubtless have recovered without treatment
The Etiology of Convulsions in Children. —
Children, as is well known, are far more prone to convul-
sions than grown persons. According to Dr. Kjellberg
(SchmidV s JahrbiUher\ this is due not to any increased
irritability in the motor or sensory tracts or in the reflex
centres, but to the fact that the brain is unable to exer-
cise any controlling influence upon the reflex centres.
Convulsions which occur at the commencement or during
the course of any acute disease through direct central
irritation are symptomatic. Those which are excited
reflexly by irritation of the sensory nerve-endings are
sympathetic. Symptomatic convulsions are due in part
to disturbances in the circulation and in part to changes
in the blood. Among the disturbances in the circulation,
the most common is a rapidly produced cerebral ansemia.
This may be caused by hemorrhage, a rapid wiste of
the animal fluids, or arterial spasm. In other cases it is
due to cerebral compression or anatomical changes in
the brain, such as extravasation of blood, tumors, soften-
ing, etc. Hyperaemia may also cause convulsions in-
directly. When an excess of blood is carried to the
brain the cerebro-spinal fluid in the perivascular spaces
cannot yield, but makes pressure on the smaller capilla-
ries, whereby they are emptied of their blood, and th*^
544
THE MEDICAL RECORD.
[November 15, 1884.
real condition is then' anaemia of the brain. The action
of venous stasis is very similar in depriving the brain of
its necessary supply of arteiial blood There are often
changes in the blood at the same time with these circula-
tory disturbances. An elevated temperature is one of
the most potent of these causes, as by it the irritability of
the nerve-elements is increased. The quality of the
blood ma^ be impaired also by the introduction of
poisons, either those introduced from without or those
formed in the tissues of the body itself. In this category
belongs also the change in the milk of nursing-women
induced by violent emotion. Sympathetic convulsions
may be excited by almost any irritation of the sensory
nerve-endings, in consequence either of increased irrita-
bility of the nerves or of diminished power of the reflex
controlling centres. In regard to the presence of worms
in the intestinal canal, the author admits that this may be
a cause of convulsions, but insists upon the necessity of
a search for other causes, since worms may be present
and yet have nothing to do with the convulsions. He
believes also that dentition may be of etiological impor-
tance, and does not admit as valid the objections of those
who say that this is a physiological process and therefore
incapable of producing morbid symptoms. He does not
doubt the fact of an hereditary predisposition to convul-
sions in certain families, but admits his inability to ex-
plain it.
The Action of Hypnotics on the Cerebral Cir-
culation.— Drs. Bergesio and Musso, having a patient
who had lost a portion of the calvarium, were enabled to
make observations on the circulation in the brain. They
confirmed the view that the brain is anaemic during sleep.
Paraldehyde gave the same result as natural sleep. Mor-
phia and alcohol caused endocranial congestion. The
authors remark that the hypnotic effects of these drugs
do not depend upon the changes they cause in the*blood-
pressure, but upon some more intimate modification,
perhaps of a chemical nature, of the cells of the cerebral
cortex. — London Medical Record, October 15, 1884.
Experimental Diphtheria. — In a series of experi-
ments Cohnheim and Litten, by temporarily shutting o£f
the blood supply, produced in the respective tissues
changes in many respects similar to diphtheria. Necrosis
by coagulation (Weigert) was a constant result. Dr.
Heubner, following up these researches, produced a local
diphtheria, not by the ordinary method of cauterizing the
mucous membrane, but by temporarily interrupting the
blood-current. His experiments were made on the blad-
ders of rabbits, the neck of the bladder being tightly
ligatured with a silk thread for two hours. On the suc-
ceeding days the alterations produced on the vesical
mucous membrane were carefully studied. On the first
day, these alterations consisted in an intense hemorrhagic
oedema of the mucous membrane, the epithelium being
raised and tumid. On the second day, there was a solid
coagulated exudation. On the third day, true diphtheritic
patches were found on the mucous membrane. Still
later was formed a " necrosis from coagulation" of the
epithelium, and of the mucous and submucous tissues.
Microscopically, this deposit, diphtheritic membrane^ was
seen to be morphologically identical with the deposits
observed in diphtheria, following scarlatina, and in
epidemic dysentery. This artificial diphtheria, then, is
produced by the combination of grave inflammation with
necrosis. That in the diphtheritic parts the circulation
of blood existed, even shortly before death, the author
was able to demonstrate by the auto-injection of the ves-
sels, like that which takes place in a very conspicuous
manner in artificial pustular infection, in most evident
degree, by means of the coloration of the bacilli. In
man, local croup may be caused by spasm of the capil-
laries of the mucous membrane, lasting about two hours,
the capillaries then again becoming pervious to the blood.
Such a transitory interruption of the circulation may hap-
pen even from the pressure of a swollen tonsil on the
vessel. The diphtheria artificially produced by the author
was not transmissible by inoculation in healthy animals.
In the second part of his work, Heubner seeks to estab-
lish an artificial synthesis between local diphtheria and
general infection. To this end he first inoculated ani-
mals in whom the mucous membrane was affected by
local diphtheria, with pustular virus, and found an exces-
sive accumulation of bacilli in the affected parts, but only
in the interior of the vessels, and never outside them.
Afterward he inoculated animals, which were made to
contract a local diphtheria, with diphtheritic masses from
a man affected by grave diphtheria ; the animals pre-
sented splenic tumor, hemorrhage of the serous mem-
branes, and died after two or three days with symptoms
of acute general infection. Microscopic examination of
the patches showed in the affected vessels of the mucous
membrane certain bacilli, partly disposed in groups, partly
distributed in diplococci, partly as chains of four links.
The same result was obtained with inoculation of scar-
latinal diphtheria. However, the author aflirms absolutely
that the bacilli found do not represent the diphtheritic
virus. If this were so, ihey must have been found also
in the man in the vessels of the affected mucous mem-
brane. That, however, the author has never succeeded
in finding, although he has examined a long series of sec-
tions of the uvula. And for general infection there is no
need of special diphtheritic microphytes. The author
recalls the researches made to produce sepsis by the
inoculation of the oral liquid of diflerent men, sick and
healthy (Vulpian). The micro-organisms found in the
diphtheritic masses of the oral cavity are consecutive
to the disease and not vice versa. Therefore, as the
author believes, the virus of human diphtheria has not
yet been found to be constituted of an organized material.
Faradization in Obstetric Practice. — Dr. Tipiakoff
describes the results of faradization as used in Professoi*
A. M. Makeeff's obstetric clinic in Moscow {^VraUh,
Nos. 24 and 25, 1884). The conclusions at which the
author arrives are these: i. The electric current is a
powerful as well as a simple and safe means of inducing
uterine contractions ; hence it is indicated for inducing
abortion or premature labor, also in cases of uterine
atony dSiApostpartum hemorrhage. 2. Since the strength
of the uterine contractions bears on the rapidity of dila-
tation of the OS, faradization is indicated wherever a more
rapid dilatation of the os is desirable ; as, for instance, in
cases of hemorrhage depending on placenta prsevia or
accompanying abortion with an irregular course. 3. In
the puerperal period faradization favors a more regular
and complete involution of the womb. 4. In cases of
puerperal endometritis, faradization brings about continu-
ous uniform uterine contractions, and in this way assists
the organ to expel decomposed lochia; that is. it pre-
vents the possibility of self-infection, and soothes the
paroxysmatic pain which causes so great a discomfort to
the patient.
Affections of the Liver in Inherfted Syphius.—
In the Archives Centrales de M^decine Dr. Barth^lcmy
discusses the question of disease of the liver in connec-
tion with inherited syphilis, by the light of thirty-two
cases, which he has collected from Various sources, manj
being from English publications. From a study of these
cases the author has arrived at the following conclusions.
Inherited syphilis, like the acquired form, may give rise
to four kinds of lesion of the liver: i, a congestive form;
2, diffuse interstitial hepatitis ; a cirrhosis rather hyper-
trophic than atrophic ; 3, gummata ; 4, amyloid disease.
Affections of the liver are much more frequent than they
are supposed to be, bearing in mind the number of sut*
jects of inherited syphilis who survive. Judging from the
frequence of affections of the liver, and from the fact that
the cure or death of the patient may depend on whether
specific treatment is adopted or not, the author thinks
that the question of inherited syphilis should be borne in
mind in every case of hepatic disease where the cause is
November 15, 1884.]
THE MEDICAL RECORD.
545
doubtful, or the course unusual, either in respect of the
age of the patient, or in the absence of a history capable
of explaining the malady. For, after alcoholism and
malaria, inherited syphilis is, in the author's opinion, the
most frequent cause of disease of the liver, not only in
early but in later life.
Hache on the Pathology op Cystitis. — Dr. Hache
thinks that lesions of the bladder and irritation applied
directly to its wall and mucous membrane do not con-
stitute a necessary and sufficient cause of cystitis, except
in case of vesical tuberculosis, or of the presence of a
rough and irregularly shaped foreign body. The causes
capable by themselves of constantly determining inflam-
ination of the bladder are very rare. Beyond tubercular
cystitis, and other forms of cystitis due to some general
morbid condition — as, for instance, those of rheumatic,
gouty, and infective nature, which are not of frequent oc-
currence— there cannot be included in the above category
scarcely any save severe accidental or surgical traumatisms
of the bladder, and too sudden and complete evacuation
of this organ after over-distention. Gonorrhoeal urethritis
does not often give rise to cystitis, except under the in-
fluence of some occasional cause or in a predisposed
subject. Most of the predisposing causes act quite
simply by determining a more or less persistent conges-
tion of the bladder ; others have a more or less obscure
mode of action, although their influence is very decided.
Chief among these predisposing causes are the tuber-
cular, rheumatic, and gouty diatheses. These predispos-
ing causes may sometimes become exciting causes by
increase, extension, or repetition of their action, or
through association with that of other causes of the same
group. These latter causes are congestion and slight
inflammation of neighboring organs, especially in the fe-
male; tumors, calculi, and foreign bodies in the blad-
der ; incomplete retention of urine, with or without dis-
tention ; habitual resistance to the needs of micturating,
and all the causes of dysuria and functional over-activity
of the bladder ; stricture and foreign bodies in the ure-
thra, hypertrophy of the prostate, etc. P'inally, the part
of exciting cause is more especially played by sudden
and complete retention, by cold, by catheterism or ex-
ploration of the bladder. The latter cause can act only
on a bladder predisposed by the presence of a tumor or
calculus; the other two causes are more active, and
may even by themselves suffice to excite an attack of
cystitis. Dr. Hache's study of the pathogeny of cystitis
has led him to insist on the importance of congestion
and diathesic influences, especially the tubercular diathe-
sis, and on the relatively limited part played by lesions
of the urethra and prostate. — Revue de Chirurgie.
Hydrate of Therpylene. — This substance, which
has been discovered by M. Boursier, can be extracted
by distillation from the buds of several sorts of pine.
The fluid is saturated with oxygen, and contains a large
proportion of ozone. According to the author (Rev, de
Th%rap. Midico-Chir.^ No. 15, 1884) it possesses very
marked antiseptic and deodorizing properties, and can
be used for dressing wounds and for painting the throat
in diphtheria. The vaporized fluid has a smell of tur-
pentine, and is said to be an efficient agent for the dis-
infection of rooms.
Lithotrity Extraordinary. — Dr. R. Cran, of Upper
Luckimpore, Assam, states that stone is not so rare a
disease in Assam as Dr. Partridge thinks. He relates
the death of a patient, ** after a most peculiar operation,
which I shall describe as showing the advanced state of
surgery to which they have attained. The priest, having
placed the patient on his back, raised well the anterior
wall of the abdomen, placed a stone on one side of it,
and belabored the other with a second stone, desisting
when the calculus was supposed to have been crushed.
The patient died a few days after the operation. This
was told me by the first man I operated on,** — Indian
Medical Journal.
Experiments on the Supra-renal Capsule. — M.
Tizzoni, the Italian pathologist, has performed during
the past year an interesting series of experiments on the
supra-renal body. In order to avoid unnecessary sacri-
fice of life, the author studied the best methods of remov-
ing the supra-renal capsules without damage to the sur-
rounding structures and with the infliction of the least
possible injury to the system at large. After having
made a small incision in the lumbar region at the level
of the adrenal body, the parenchyma of the capsule was
lacerated and its ablation practised, strict antiseptic pre-
cautions being observed. On the right side the neigh-
boring vena cava inferior rendered the operation of extir-
pation difficult. For his experiments Tizzoni generally
made use of rabbits weighing only about a kilogramme
each, because in this circumstance the muscular mass of
the lumbar region was but little developed, and so the
operation was facilitated. When the animals succumbed
as the result of the operative procedure, death was not
due to the nervous accidents signalized bv Brown-
S^quard, but was caused by subcutaneous and intermus-
cular suppuration infiltrating the neighborhood of the
wound. The majority of the animals which exhibited
contracture of one or other of the front or hind limbs
recovered, and it was only rarely that paralysis and
death followed the appearance of the spastic contraction.
The necropsy revealed in such cases the presence of an
exudation about the meninges of the spinal cord and a
softening of the spinal marrow without any demonstrable
direct connection of the lesion of the supra-renal ca]>sule
with that of the nervous centres. Outside these compli
cations — which may be regarded as quite exceptional—
the operation was generdly followed by no grave acci-
dents ; the animal, if the etherization were not too pow-
erful, gave signs of pain only when the adrenal capsule
was seized and lacerated. If this body, instead of being
completely removed, were allowed to remain in the cav-
ity of the abdomen (of course, after laceration of the
capsule), the healing was much more rapidly effected ;
and if, some days later, the animal were killed, not a
trace of the lacerated parenchyma of the supra-renal
capsule could be detected ; complete absorption of
the essential elements apipeared to have taken place.
Then, according to Tizzoni, the supra-renal body is ab-
sorbed without giving rise to any phenomena such as
might be interpreted to be of the nature of blood-poison-
ing, so that the adrenal capsule contains no organic
poison ; and if by treating the organ with various chemi-
cal reagents a poison be obtained, one may affirm that it
is not produced during life, and consequently the poison
must be due to cadaveric decomposition. A certain
time after the extirpation of the capsule there commences
to appear a brownish discoloration of the nose, as if the
animal had been plunged in charcoal powder after having
drank some liquid. Some small blackish linear markings
also may be found scattered here and there over the
mouth and nasal fossae. The mucous membranes of
these regions seem at first to be intact, but at the end of
some days they become dotted with minute spots of the
color of tobacco ; the minute areas become circular as
they enlarge, and by coalescence a bronzed surface of
considerable extent and of a uniform tint is formed, and
reaches its maximum intensity about the sixtieth day
after the operation of removal or laceration of the supra-
renal capsule. A remarkable circumstance is mentioned
by the Italian observer, which is to the effect that the
destruction of one capsule only brings about unilateral
pigmentation of that side of the body on which the
operation was performed. Tizzoni further states that the
various elements of the supra-renal capsule may be recon-
structed. He observed one case, one hundred and forty-
four days after the supra-renal body had been almost total-
ly destroyed, in which this regeneration had taken place.
He does not seek to explain the mode of production
of the bronzing which he observed. — London Lancet^
September 27, 1884.
54^
THE MEDICAL RECORD.
[November 15, 1884.
The Medical Record
A Weekly journal of Medicine and Surgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD & Co., Nos. 56 and 58 Ufayette Place.
New York, November 15, 1884.
THE UNITED STATES COMMISSIONER OF
EDUCATION ON MEDICAL EDUCATION
AND PRACTICE.
The Report of the Commissioner of Education for 1882-
83 contains an unusually elaborate review of the progress
of medical education, written in a critical but at the same
time candid and intelligent spirit. The views expressed
and suggestions made are in harmony with those which
have appeared in the editorial columns of The Medical
Record during the past few years. Coming from a
gentleman like General Eaton, however, who has made
the subject of education a special study for many years,
they have a fresh interest and force.
A review of the condition of medical education dur-
ing and since colonial times is given, and the gradual
evolution of the present system of making doctors de-
scribed. It is shown that although we have now vastly
better means of educating medical students than for-
merly, yet we are at present suffering from the conse-
quences of a long-continued and irrational freedom in
the matter of graduating and licensing medical men.
The old idea, that a physician should be a man of
learning and letters as well as of art, having been dissi-
pated, and all but a few restrications upon education and
licensing having ceased to exist, " the past fifteen years,"
says the report, " shows a very rapid increase in the num-
ber of medical schools and students."
" In plain English," continues General Eaton, " the
time has now come (the profession being so crowded and
the increase of candidates for employment being so
much greater in proportion than the increase of popula-
tion) when the medical student pays to the medical
college money for which he receives no calculable equiva-
lent ; he asks for bread and receives a stone. The
really capable graduate is jostled, crowded, shouted
down, and trampled upon by a horde of unwieldy behe-
moths, who not only intercept most of the work that he
only is able to do satisfactorily, but who supplement their
scant incomes by arts and devices that his nature and
training forbid him to join in. Having overcrowded all
other departments of medical employment, many of these
physicians by the grace of a diploma have lately taken
up the work of opening and conducting medical colleges,
much to the wrath and confusion of the older schools,
who would dearly like to retain their monopoly of over-
supplying the market with medical 'spring chickens.'
The position assumed by these older schools is exqui-
sitely illogical : they do not like to establish effectual en-
trance examinations (which might force some candidates
to defer the study of anatomy and chemistry until they
had mastered the simpler mysteries of reading and
writing) because they Ao not want to limit the number
of doctors by artificial regulations. This phrase, quoted
from a recent address by a widely known and much re-
spected medical teacher and author, teaches us that
artificial regulations mean all rules or usages that may
or can hinder any young white man from paying money
twice over for the privilege of hearing the same course
of lectures during two courses of instruction. The regu-
lations that forbid the faculty from receiving the money
of a white woman or that of a black man, we learn by in-
ference, are not artificial."
The report begins with some comparative statistics
showing the number of schools of medicine, dentistry,
and pharmacy in this country since 1873.
1873- «874.
1875.
1876.
1877. 1 1878.
1879-
1880. 1881.11882.^
Number of in-l , ,
stitutions. . . I 94; 99 106 xoa 106 106 114 xao za6< 134
Number of in- { | I I
structors... 1,148 x,i2X 2,173 i.aox 1,278, x,337| x,495 f,66oj x, 746, 1,946
Number of ' | ■ | I 'I
students ... 8,68x 9,095 j 9,971 xo, 143 x 1,225 ",830 X3,33i 14,006 14,536 15,151
Another valuable table shows the present condition of
these same schools :
I I
'1
Students.
Libranes.
E
«
I
i
: s§iiy,
iSoii
i!£
E ^ = 1 2 8^ -^ ~
Medical and surgical :
Regular
Eclectic
Homoeopathic
Dental
Pharmaceutical
801,314110,523
io| ioqI 907
III i88| 1,309
iSl 276, 820
151 68' 1,592,
85i'3.6i7i40»o57i.o"
80' 312' 1,400 200
64; 437 4i530 29
24 323! 6,084 23
2| 427, 5^695 263
Grand total 1x34,1,946 15, 151' 1,021 5,1 16^57,766 1,526
Property,
income, etc
11
III
'1
; from pn>-
ive fundi.
Ilfl
! Hi
I
Medical and surgical
Regular
Eclectic
Homoeopathic . . .
Dental
Pharmaceutical
Grand total. . . .
o-c
VTA U
<
11
$2,713,800 11321,283 l$i8,209 i$456.6c»
228,600 I 3,000 ! 02.897
310,000 ' » ' 40.50^
87.0001 I 1,568 74.000
180,2001 6,800 372' 381219
$3i5i9.6oo $331,083 $20,149 ;$672,2i6
Quoting this same "medical professor and author"
further in denunciation of the many new and small col-
leges which are springing up all over the country, the
report adds : " Denunciations like the foregoing are of
little value, for they accomplish nothing ; when analyzed
dispassionately they are reduced to complaints that newer
competitors are underselling 'the old and well-known
stands.' Of course the customers at the cheaper shops
will get an article of inferior quality ; that also is a
Maw' of trade." We cannot agree, however, here with
November 15, 1884.]
THE MEDICAL RECORD.
54T
the opinion further expressed that closing up the small
and cheap colleges would do no good. It is only true
that they will not close until there arises a wider de-
mand for the best educated doctors.
An account of the courageous steps taken by a few of
the leading medical colleges in enforcing preliminary
education, and in adopting graded and longer courses, as
illustrated by the University of Pennsylvania Medical
School, Harvard, the Chicago Medical College, and the
Woman's Medical College of this city, is then' given.
The subject of regulating medical education and prac-
tice is one that particularly interests the profession at the
present time. It will receive with respect, therefore, the
unbiassed views of the Commissioner on this subject.
These [may be stated in a few words. The need and
legality of some control is admitted, while as to the mode
the report says : " The State of Illinois seems to have
solved the problem of protecting the public without as-
sailing the right of personal medical judgment."
In conclusion, the Commissioner offers the following
suggestions as to the best method of regulating medical
education, which we submit, for the present, without
comment: ** Every State and Territory, and Congress
for the District of Columbia, should pass a law ordering
every school teaching medicine or surgery in any fashion
whatever to furnish unquestionable bonds or other like
security for the speedy aqquirement of a fund amounting
to'not less than $300,000 ; the laws should direct that
this sum, as fast as any part of it is collected, shall be in-
vested in United States bonds or productive real estate
or interest-bearing loans on real estate security ; the laws
should also prescribe that the corporations so endowed
shall distribute the income derived from such investment
equitably between at least ten professors ; that these pro-
fessors shall teach, didactically or clinically, at least one
hundred hours apiece in each calendar year, the instruc-
tion by 'each professor to be progressive in subject and
character ; that no students shall be admitted to these
courses of medical instruction before passing a satisfac-
tory examination in the elements of language, mathe-
matics, physics, and biology ; that no candidates shall be
finally examined for degrees by a State board till they
have studied three years, during each of which they must
have studied at least one-third of the course of instruc-
tion provided by the ten professors and the thousand
hours of teaching above mentioned, and, in addition, per-
formed such an amount of dissecting, laboratory work,
and hospital attendance as the faculty shall deem neces-
• sary ; two or more schools desiring to unite their forces
under the provisions of the acts should be allowed to do
80, retaining one of the charters and nariies ahready in
existence if they choose, but surrendering the others;
and all charters not thus fortified and regulated within
two years after the passage of the acts should be declared
null and void."
MADNESS AND CRIME.
A YOUNG man named Gilbert W. H , a physician's
SOD, who had been studying, or intending to study medi-
cine at Baltimore, went off on a debauch lasting several
days. During this time he drank considerable liquor
and performed a good many acts of drunken folly.
Finally, he wound up by shooting two women in a house
of ill-fame in Baltimore. He was brought to trial for
murder in the first degree. Able counsel for the defence
put in a plea of insanity. It was shown that when a boy
he was peculiar, moody, solitary in his habits, and
seemed to go through many of his duties in an abstracted,
and automatic manner. He was once brought home
unconscious. Three local physicians, who had known
him personally in the town where he lived, testified to his.
unusual mental state, and one of them thought that he
was a case of melancholia.
Only one expert witness testified for the defence, and
one for the prosecution.
The witness for the State was Dr. Gundry, of Spring,
Grove Asylum. The hypothetical question put to him
by the district attorney tells the story, and was substan-
tially as follows
Assuming that the party went into the house at &
o'clock A.M. ; went out a few minutes after and did not
return till noon. In the meantime he had gone to a.
gunsmith and purchased two revolvers, the gunsmith at
the time not noticing anything particular in his conduct or
appearance. Assuming, also, that he went to a drug,
store and called for an ounce of prussic acid, then went
back to the house, called for wine, threw it over his
clothes and the clothing of his companions ; assuming^
that he went into a second-story front-room up-stairs^.
and met the two women in company with two others ;.
that he asked to be left alone with two of them. The-
others having left him, that he then locked the dooE
and demanded a diamond ring of one of them. She re-
fusing him, that he then went to a bureau drawer, took,
two pistols, went out of the room, returned a fewt
minutes later, made a second demand, and the party
still refusing, that he began firing, killed the two women,,
and fired at a third who came into the room. After itr
was over that he was cool and collected, and said that
he did the act out of foolishness.
Dr. Gundry testified that the prisoner was sane andi
responsible. Dr. Wm. H. Stokes, of Mount Hope Hos-
pital, testified that he was suffering from acute mania,,
not epileptic. The jury brought in a verdict of man-
slaughter, thus admitting a partial responsibility.
The case is instructive, as again showing the directly
opposing views of two equally experienced medical ex-
perts. It also shows that the good sense of twelve men
sometimes brings trials to a measurably correct issue, de-
spite the contradictory illuminations of science, so-called..
There can be no question that H had never
possessed a perfectly normal bram, and that he was of
unsound mind at the time of his act The real question
would be, therefore, as to whether his mental state was,
the result of voluntary indulgence in alcohol and ab-
sinthe, and as to how much he was responsible for his.
condition. The facts brought out by the evidence are
not sufficient, as reported, to allow of any profitable dis-
cussion on this point. In fact, the whole trial seems.
to have been hastily and superficially conducted.
MEDICAL RHYMES.
We are in receipt of a collection of medical rhymes, se-
lected and compiled from a variety of sources, by Dr^
Hugo Erichsen, of Detroit.' It forms a neat volume of
> Chicago : J. H. Chambers & Co. 2884.
:548
THE MEDICAL RECORD.
[November 15, 1884,
220 pages, embellished by a number of illustrations, and
igracefully chaperoned by a rather amusing introduction
from the pen of Dr. Willis P. King, of Sedalia, Mo.
In France and Germany medical poems, both rhymed
and totally unrhythmical, are commonly endemic, occa-
sionally epidemic, and always welcomed and encouraged
by the profession. But in our own country the medical
muse has been rather coy and timid, quite probably for
lack of persistent wooing.
The collection before us is a novelty, and a dangerous
•one too. If not speedily suppressed, we seriously appre-
hend that it will prove the starting-point of a violent out-
break of the medical rhyming disease. There is but one
-safeguard against the actual spread of this threatening
scourge. It is the immediate extermination of the en-
tire edition already published, with the stern determina-
'tion on the part of an anxious profession to deal similarly
•with all succeeding issues. Perhaps the fell pestilence
may thus be nipped in the bud and a national calamity
averted. Let every practitioner, therefore, be he en-
thusiastic tyro, or the incarnation of accumulated expe-
dience and omniscient medical senility ; be he the ever-
, genial and ubiquitous general practitioner, or the modest,
unassuming, hiding-his-light-under-a-bushel specialist ; be
he a staunch partisan of Old-Code legitimacy in punc-
tilious professional advertising, or a radical, revolution-
ary No-Code iconoclast ; be he a sullen, strictly scien-
tific, materia-medical Nihilist, or brought up in the
•catholic faith of optimistic polypharmacy; be he merely
a mild and harmless bacillophobe or a real raving, hope-
less microbomaniac — why, there are many kinds and va-
rieties of doctors ! — ^let them all agree and for the nonce
make a combined attack against this dangerous produc-
tion. If every man of them will heroically grapple with
-but a single copy of the evil book, the threatened visita-
tion may yet fail to attain the climax of a wide-spread
and appalling professional disaster. But in order to suc-
•cessfully wrestle with and eventually overcome the dire
effects of the " Medical Rhymes," it will be necessary to
resort to cunning prophylaxis. To be forewarned is
the best policy. We recommend, therefore, before at-
tempting the perusal of this dangerous and vicious
volume, the taking enough calabar to produce paralysis
of the muscles of laughter. It is in this way, and in this
way only, that fatal tonic and clonic convulsions of the
-diaphragm can be prevented.
It is, of course, out of the question to indicate pre-
-cisely the varied contents of this novel collection of
medical rhymes. So artfully and deceitfully has the com-
ipilation been made, that some earnest piece of tender
poesy and touching sentiment is quite apt to be im-
*mediately followed by so ludicrous and mirth-provoking
a selection that the sudden transition from soul-stirring
pathos to irresistible shocks of loud laughter, is certain
no capsize the regulating vasomotors of the best-balanced
professional constitution.
But in all seriousness, it is a real pleasure to reflect
*that there are doctors in our land who, besides the
ability to look wise and prescribe dinner-pills, have a
•capacity for writing acceptable verse. Of course we all
fknew long ago that our honored Holmes became a greater
^poet only through having been a great practitioner, and
•that ten thousand verdant youths annually aspire to
quickly become the latter, in order that later they may
have ample leisure to become the former.
But what we did not know, and what we feel quite
happy to learn, is that in all kinds of outof-the-way
towns and villages there may be found physicians, the
mean drudgery of whose daily lives has not chilled warm
sympathy with struggling, erring, ungrateful humanity;
and that at least a chosen few can find honest, noble,
manful words for expressing the true joy that lives in
their souls, as well as the bitter anguish and disappoint-
ments that sometimes threaten to crush body and soul
together.
•• Then struggle on, and on,
With all the real you can,
Your motto, • Love to God-
Love to your fellow-man.' "
PROGRESS IN CHOLERA STUDIES.
The newspaper report that Dr. Koch had finally suc-
ceeded in inoculating rabbits with cholera by his comma-
bacilli is not true. Dr. Koch has not yet succeeded in
producing cholera in the lower animals by means of his
cholera-bacilli, or if he has, the report has not been made
public.
On the contrary, the investigations of the British
Cholera Commissioners, Drs. Klein and Gibbs, have so
far, according to the British Medical Journal, tended to
confirm the view that comma-bacilli are to be found in
other diseases than Asiatic cholera. Furthermore, the
gentlemen referred to have so far found that the bacilli are
not present in great numbers in the intestines of those
who die suddenly of cholera. Still more important is the
fact reported that the comma-bacilli of cholera and of
other diseases develop in much the same way, and that
there is nothing specific in the mode of growth of Koch's
bacillus.
Drs. Finkler and Prior, who discovered a comma-
bacillus in cases of cholera nostras, are continuing their
researches in the laboratory of Professor Ceci at Genoa.
It is quite well determined now that their comma-bacillus
does not develop in the same way as Koch's, and that
it is of a slightly different form.
SERO-SUBLIMATE AS A SURGICAL DRESSING.
In an address delivered at the opening of the London
Medical Society on October 20th, Sir Joseph Lister de-
livered a striking address upon the use of corrosive sub-
limate as a surgical dressing. After describing some'
recent unexpected failures with carbolic acid and eucalyp-
tus, owing to the volatility of those drugs and the un-
certainty as to the gauze impregnated with them being
well prepared, he relates a series of experiments which
he had made with corrosive sublimate. The great ob-
jection to the use of this powerful germicide was its
irritant properties. Sir Joseph, therefore, endeavored
to obviate this, and he succeeded in doing so by com-
bining the sublimate with blood-serum. He found, what
indeed was well known already, that corrosive sublimate
forms with albumen an inert coagulum of albuminate of
mercury, and that this coagulum was then soluble again
in an excess of serum. The solution thus formed con-
tains probably a double albuminate of mercury. At any
November 15, 1884.]
THE MEDICAL RECORD,
549'
rate, all the germicidal properties of the sublimate are
preserved, while the solution is at the same time per-
fectly non-irritating, in any strength in which it would be
necessary to use it. Lister has so far used gauze saturated
with a one per cent, solution. Experiments with a two
per cent, solution showed it to be slightly irritating.
He says : " The corrosive sublimate is so intimately
blended with the serum that when it dries no separation
of crystals takes place. Whether we use i to 100, i to
70, 1 to 50, or even i to 30 parts of blood-serum, they are
perfectly amalgamated, and therefore, from a gauze like
that, no corrosive sublimate can fly off. It can be ma-
nipulated as you please, and as applied dry to the skin
it is absolutely unirritating. If, however, such a gauze
is torn, it gives off a dust which irritates the nostrils. It
is therefore better to cut it with scissors. Then, in the
next place, it is unirritating as acted on by the perspira-
tion. If water is made to act on sublimated serum dried,
it does not redissolve it, as serum does, but it renders
the mass opaque, the water being only partly absorbed
into it ; and the water which remains unabsorbed con-
tains exceedingly little of the corrosive sublimate, which
is almost all retained by the albumen. Hence, when
perspiration soaks into such a dressing, though it moistens
it, it does not produce irritation.''
The use of this sero-sublimate somewhat simplifies
antiseptic methods, since it makes the use of a macintosh
unnecessary.
Lister states that the new compound may be prepared
ytry cheaply. It is only necessary to send to a slaugh-
ter-house, have the blood of a horse ' stirred while co-
agulating, and in this way separate the clot. " You
then," he says, " have several gallons of serum/* This
is mixed with the sublimate in the proportions of i to 75,
to I to 150.
Not many cases are reported showing the practical
value of the new compound, though its germicidal
powers are accurately demonstrated.
Perhaps Sir Joseph would have done well if he had
studied the results of the use of corrosive sublimate by
other surgeons more extensively.
In a series of articles recently published by Professor
J. Mikulicz, of Krakau ( Wiener Medicin, Wochenschr.^
Nos. 142, 143, 1884), a number of cases are reported in
which toxic symptoms were produced by the use of irri-
gating solutions (i to 1,000 or i to 2,000). The danger
is not confined to the patients, but extends to nurses
and surgeons ; and Mikulicz adds that in his opinion
sublimate is more dangerous than carbolic acid or iodo-
form.
We look forward, therefore, to the practical outcome
of Sir Joseph's highly important and scientific contribu-
tion with much interest, but with some incredulity.
^ewTB of Viiz ?82ftjejcti.
The Clinical Society of the New York Post-
graduate Medical School is the title of a society re-
cently organized in this city. It is composed of the pro-
fessors, other teachers, and the matriculants of the
school.
Bequest to a Hospital, — By the will of the late
Mrs. L. J. Kowles, the sum of $25,000 is bequeathed
to the City Hospital, Worcester, Mass.
Cholera in Paris. — Our latest medical exchanges
from Paris speak somewhat incredulously, if not face*
tiously, of the possibility of an epidemic of cholera oc-
curring this year in that city. Despite this, the epidemic
is already upon them, and is advancing rapidly. It was
announced in the Journal Officiel that one case of chol-
era had occurred in Paris before November ist. On
November 7th, it was stated that there were several cases
in the city, and that one death had occurred. Five days
later 83 deaths were reported and 119 cases were ad--
mitted to the hospitals. Another despatch says that on
November nth there were 152 fresh cases and 56 deaths,,
and that the total number of cases to date is 252.
As to the origin of the epidemic accounts at present
differ. One report states that the disease has been in
the city since June last, but has till now been kept re-
stricted. This is extremely improbable. M. Brouardel
states that the disease originated among the rag-pickers
of the densely populated Faubourg St. Antoine, who
became infected by imported rags.
It is improbable that Paris will receive a serious visi-
tation of the disease so late in the season.
Death of T>k, Joseph Allison Reed. — Dr. Joseph
Allison Reed, the Superintendent of the Dixmont In-
sane Asylum, died suddenly this week, of kidney disease,
at Pittsburg. Dr. Reed was born at Washington, Penn.,,
December 31, 1823. He studied at Jefferson Medical
College, where he received the degree of Doctor of
Medicine in 1847. In 1857, he was appointed Superin-
tendent of the Western Pennsylvania Hospital for the
Insane. Dr. Reed made the treatment of the insane hi&
especial study. He obtained from the Legislature the
necessary appropriation for a new hospital building, and
under his supervision the edifice at Dixmont was erected..
Dr. Reed was a member of the Allegheny County Medi-
cal Society, the American Association of Medical Super-
intendents of Insane Asylums, and the American Social
Science Association.
No Authority for Prohibiting the Importation or
Rags. — Epidemics arouse an interest in very curious,
things. A while ago, the American hog was the object
of international solicitude and diplomatic entanglements.
Now it is rags. We are informed by the Journal of
Commerce that the Secretary of the Treasury has no
authority to prevent the importation of rags, and that his.
order is illegal ; also that rags never carry contagion any
way, and the Secretary's edict is, therefore, as unwise as-
it is illegal. In this connection we may observe that a.
new and cheap method of disinfecting rags in bulk has
been recently devised and has been pronounced a de-
cided success.
Rupture of the Penis. — Dr. H. A. Veazie reports
in the New Orleans Medical and Surgical Journal^ a
case of true fracture of the penis. The patient gave his
history as follows :^^' I was having connection, and during
the excitement the party with whom I was having inter-
course withdrew suddenly, and as I followed her my
penis struck a bone, and I felt the organ break, with in-
tense pain. I examined it, saw that it was swelling
550
THE. MEDICAL RECORD.
[November 15, 1884.
rapidly and bleeding from the canal. I felt like urinat-
ing, and tried to do so, but could not, and, as I tried, the
penis pained more and became more swollen." He then
showed me his penis and it was bleeding from the meatus,
the organ itself very much swollen. On examination I
found that the penis had been broken through and through,
except the cutaneous covering. The two fragments could
be moved upon each other, and on making traction a
•distinct sulcus could be felt at the scat of the break,
which was about one inch and a half back of the corona.
The urethral spongy body andt he corpora cavernosa were
evidently broken through. He ultimately recovered.
Dr. Veazie states that this is the first case of the kind re-
ported in this country.
[The late Dr. Valentine Mott reported two similar
cases in 1848 to the New York Academy of Medicine
<" Trans. N. Y. Acad. Med.," vol. i., p. 99), and referred
to several others. — Ed.'J
The Elevated Railroad and Injuries to the
Eye. — The elevated railroad has proved quite prolific
in injuries to the eye caused by the fine steel filings
thrown into the air by the use of the brakes, and the
sparks from the locomotives have occasionally also
caused injuries of the same sort. A case of the latter
kind came before the City Court a short time since and
the jury awarded a verdict of $250 to the sufferer. The
judgment was appealed from and the General Term has
just affirmed it. Chief Justice McAdam, in delivering the
opinion, said that the elevated railroads were bound to
use the most approved methods of preventing the escape
of sparks.
A Sanitary Convention.— The West has a penchant
for sanitary conventions. One of these highly useful
meetings will be held at East Saginaw, Mich., on De-
cember 2d and 3d, under the auspices of the State Board
•of Health. * j
Professor von Pettenkofer on the Non-conta-
ciousness of Cholera. — At a medical meeting in Mu-
nich, October 15th, Professor von Pettenkofer said: "I
think that we all have good reason now to break with conta-
gionist views of the spread of cholera — we have sacrificed
milliards owing to this false doctrine. I declare openly
that I now must uphold my localist point of view all the
more firmly, and with all the greater conviction, as no
proof has been brought against it even by Koch's inves-
tigations. An experiment ought now to be made to see
if cholera can really be produced by Koch's comma-
bacillus; hitherto, experiments on animals have been un-
successful. 1 will, with pleasure, undertake to swallow
bacilli cultivated by Koch himself, [fl-ovided that there is
no temporal or local disposition for cholera (that is, that
cholera is not prevailing), as is the case now in Munich.
Wars have been fought and men's lives have been sacri-
ficed for objects of less importance ; the enormous ad-
vantage is here so obvious, that the life of one individual
is nothing in comparison to it. My example, which, I
repeat, I would carry out with the greatest calmness,
will find imitators. Twenty medical men would easily
be found to follow, hundreds would join them afterward,
and we should be able to judge from the result." Petten-
kofer even declared he would see to his individual disposi-
tion for it, by acquiring catarrh of the stomach or intestine.
"I value Koch as a bacteriologist very highly, and ac-
knowledge his services in the fullest degree, but the con-
clusions which he deduces from his investigations I must
directly dispute."
National Conference of State Boards op
Health. — At a preliminary meeting, held in the city of
Washington, D. C, in May, 1884, representatives from
eighteen State Boards of Health being present, the Na-
tional Conference of State Boards of Health was pro-
visionally organized ; and it was decided that its meet-
ings should be held at the same times and places with
those of the American Public Health Association. In
pursuance of this decision, and in response to the call of
the Secretary, Dr. J. N. McCormack, of Kentucky, the
first annual meeting of the Conference was held in St.
Louis, beginning on Monday, October 13, 1884, the
Hon. Erastus Brooks, of New York, in the chair, and
representatives from twenty States and from Canada be-
ing present. Papers upon cholera were read by Dr.
John H. Rauch, by Dr. Charles Smart, and by Dr. C.
W. Chancellor, of Baltimore. An address embodying
the views of the conference as to the prevention of chol-
era was adopted, and was subsequently indorsed by the
American Public Health Association. The Conference
adjourned to meet in Washington, December loth.
A Medical Practice Act Declared Constitu-
tionat., — On November ist, says the New York Medical
Journal^ the Court of Appeals of West Virginia decided
that the medical practice act of that State was constitu-
tional. This is a substantial and practical indorsement
of the good work done by the State's Board of Health.
Doctors who Died of Cholera. — Of one hundred
and thirty-nine physicians engaged in attending cholera
patients in Naples under the White Cross Society,
twenty died.
The Late Dr. Rabbeth. — Sir William Gull suggests
that a gold medal be struck in commemoration of the
self-sacrifice of Dr. Rabbeth, who died of diphtheria con-
tracted by sucking out the tracheotomy-tube of a diph*
theritic patient.
Death from Methylene. — A young man, nineteen
years of age, was given methylene by Mr. William Square,
Surgeon to the East Cornwall Hospital, Plymouth, Eng-
land, in order to have an operation performed After
getting well under the anaesthetic, the patient suddenly
died of paralysis of the heart. The heart was byper-
trophied, but otherwise normal. The proportion of
deaths from methylene is about one in eight thousand.
American Priority in the Discovery of Cocaine
(Erythroxyline). — We are glad to give prominence to
the following letter from Dr. Samuel R. Percy, of this city,
in which he puts in a claim, apparently a just one, of
priority in the discovery of cocaine, or as he called it,
"erythroxyline." He writes : "On November 4, 1857,
I read before the New York Academy of Medicine an
exhaustive paper upon the leaf of the plant erythroxylon
coca^ and stated that I was busy in its chemical investiga-
tion. On December 2, 1857, 1 exhibited to the Academy
of Medicine one scruple of the alkaloid of the^ leaves to
which I gave the name erythroxyline. At the same time
I left with the librarian of the Academy this scruple of
erythroxyline, a quantity of fluid extract and some solid
November 15, 1884.]
THE MEDICAL RECORD.
551
extract, and also a fine sample of the leaves. I read
before the Academy the method of preparing the alkaloid
and a number of physiological experiments upon dogs.
1 then stated that the hydrochlorate of erythroxyline had
a peculiar but not unpleasant benumbing and paralyzing
effect upon the tongue, unlike that produced by aconitia
and not so persistent. The librarian of the Academy has
been unable to find the paper or the alkaloid, but the fact
of such a paper having been read, and such an exhibit
having been shown, is recorded on the books of the
Academy. I still hope to find the paper. Some three
years after this, Niemann, in Germany, discovered the
same alkaloid, and in his announcement called it 'co-
caine.' Immediately upon this announcement I reiter-
ated the priority of my discovery in Dr. Stephen Smith's
Medical Times. 1 also personally saw Mr. George Wood,
of Philadelphia, and he promised that in the next edition
of the United States Dispensatory the subject should be
fairly stated. He forgot it. The name cocaine is not a
correct one, it is almost universally called cocaine, lead-
ing one to suppose that it is a product from the cocoa
berry. With its correct name erythroxyline it cannot be
mistaken. As an American, I claim the name given to
it in America, and hope that every American surgeon,
will do the same.**
The Opening of the Bridgeport Hospital. — The
opening ceremonies of this hospital took place on Tues-
day, November nth. A number of prominent physicians
and surgeons from this city were present. An eloquent
and appropriate address was delivered by Dr. D. R St.
John Roosa. The meeting of the Fairfield County Med-
ical Society preceded the exercises at the inauguration
ojf the hospital. Dr. Wilson, of Bridgeport, demonstrated
the efficiency of the new local anaesthetic, hydrochlorate
of cocaine, by experiments upon the conjunctiva, and by
hypodermic injections prior to the removal of a timior of
the forehead. The tumor was removed by Dr. Weir
without pain. Dr. Weir made an address upon '^ Hos-
pitals and Hospital Surgeons in Germany." Dr. Wile,
Dr. Mund6, and Dr. Cromack also addressed the Society.
Female Internes in Paris Hospftals. — A cable
report states that the medical and surgical societies con-
nected with the Paris hospitals have voted on no occa*
sion to admit women to compete for hospital positions.
How Cholera Originates. — The account given in
The Lancet of the outbreak of cholera at Yport, Nor-
mandy, is most instructive : " On September 25th some of
the crew of a French fishing-boat that had come from
Newfoundland, and was anchored at Cette, one of the
cholera-stricken towns in the south of France, arrived at
Fecamp, a small seaport town in Normandy, not far from
those above named. These men travelled by rail from
Cette, and on their arrival at Fecamp, which is near to
their home, they had to take a sulphur bath, and fresh
clothes were issued to them before they were allowed to
go any farther. Unfortunately, however, their own
clothes, which were supposed to have been thoroughly
disinfected (having gone through the form), were given
back to them. On Octol^r 4th some of the disinfected
clothes were washed in the sea by a female peasant, who
fell suddenly ill, and died in a few hours ; the physician
who attended her at once recognized the malady as being
Asiatic cholera. The victim was sister-in-law to one of
the sailors, who was not affected by the disease, nor, in-
deed, were any of the others who accompanied him from
Cette. The disease spread rapidly, and in the next day
or two ten persons were attacked, of whom seven died,
and the other three recovered."
Notes and Correspondence on the Use of Muri-
ate OF Cocaine. — At a meeting of the Royal Society of
Physicians of Vienna, Dr. KoUer announced his discov-
ery of the use of cocaine in producing anaesthesia of the
conjunctiva. It seems that he began his experiments
upon animals in the laboratory of Professor Strieker. He
then tried it upon the human eye with results already
known. He used a two per cent, solution.
Docent Dr. Konigstein announced that independently
at the same time he had made the same discovery. He
had used a one per cent, solution. Dr. Konigstein states
that it produces enlargement of the palpebral fissure, and
protrusion of the eyeball and dilatation of the pupil. He
thinks, therefore, that it acts upon the sympathetic.
In London, at a meeting of the Ophthalmological So-
ciety, October 9th, Dr. Arthur Benson, of Dublin, Mr.
Marcus Gunn, and Mr. Nettleship described the effects of
cocaine upon the eye.
Dr. J. R. Uhler, of Baltimore, writes to the Maryland
Medical Journal that he has found that a solution of mu-
riate of cocaine applied to the vulva mitigates the pains
of labor.
Dr. E. S. Peck writes in correction 'of a note pub-
lished last week regarding the price of cocaine. It now
costs only thirty-five cents a grain^ or less.
Dr. W. Oliver Moore writes that in eye surgery co-
caine is six times cheaper than ether, as 3 ij. of a two
per cent, solution lasts for twelve operations, and costs
$1.50 ; ether for the same would cost from $9 to $12.
Dr. H. G. Sherman, of Cleveland, O., has success-
fully used cocaine as a local application for tinnitus au-
rium. A patient suffering from chronic otitis media, who
had long been treated by all known methods, came to
him suffering intensely with noises in the ears. A four
per cent, solution of cocaine was instilled into the ear.
Tinnitus and deafness were lessened. A second case
was tried with similar result?.
Whooping-Cough and Resorcin. — A monograph on
the nature and treatment of whooping-cough has re-
cently appeared at Rio de Janeiro from the pen of Dr.
Moncorvo. He accepts in a great measure the con-
sequences of the germ theory as regards pertussis and
looks on the affection as due to the presence of micro-
cocci, which proliferate abundantly upon the mucous
membrane which coats the upper part of the larynx
above the rima glottidis, where the epithelial cells become
infiltrated, and which region appears to be the seat of
election for the proliferation of the micrococci. Resorcin
directly applied to the mucous membrane of the region
indicated has led to diminution in the number of spas-
modic attacks, which lose their intensity, while the total
duration of the disease is shortened. The benefit is said
to be wholly due to the resorcin, because no other means
were employed. The drug was used in the strength of a
one per cent, aqueous solution as a topical application,
by means of a soft brush mounted on a long handle.
The application was made three, four, or five times a
day. — London Lancet^ October 18, 1884.
552
THE 'MEDICAL RECORD,
[November 15, 1884.
^epavte at S^acUtits.
NEW YORK PATHOLOGICAL SOCIETY.
Stated Meetings October 22, 1884.
George F. Shrady, M.D., President, in the Chair.
GENERAL CARCINOSIS.
Dr. John A. Wyeth presented a specimen, accompanied
by the following history, furnished by his house-surgeon
at the Mount Sinai Hospital : Franz S , aged thirty
years, a native of Germany, single, and a machinist, was
admitted September loth. Last May the patient noticed
a swelling at the left side of the umbilicus. It gave him
no pain. It gradually increased in size downward and
forward until it gave him great inconvenience from
its size, weight, and position. During the last four
months the patient has lost eighty pounds in weight, has
had for some time a cough, with some expectoration,
occasionally bloody. Last April the patient had his left
testicle removed at the German Hospital, presumably
for tubercular disease. Of late the pain in the abdomical
tumor has become so severe that it prevents him from
sleeping. There was no history of gonorrhoea, chancre,
or rheumatism ; no oedema. One brother and his moth-
er died of phthisis, a remaining sister has some lung
trouble.
On admission the patient has a large tumor involving
the umbilical, left inguinal, and left lumbar regions,
extending about two inches to the right of the umbilicus
downward almost to the symphysis pubis, and also
around to the back. The tumor is painful on pressure.
Pressure over the region of the left kidney gives rise to
pain also on the under surface of the liver and over the
left upper half of the thorax, especially near the sternum.
There is some bulging at the upper part of the left side
of the chest anteriorly, and the outline of. the clavicle is
entirely obliterated. The left axillary and supra- clavicular
glands are much enlarged. The abdominal tumor has
a nodular feel, and a number of small, nodular bodies
can be felt near it.
Physical examination of the lunss revealed slight dul-
ness and broncho-vesicular breathmg at the right apex
anteriorly; marked dulness, diminished voice and breath-
ing ; crepitant, subcrepitant, and sonorous rales at the
left apex anteriorly. There was resonance between the
splenic dulness and the tumor.
The patient had marked laryngitis, loss of voice, and
spasmodic cough. There had been no haematuria at any
time. He was much emaciated, his appetite was poor,
temperature 100** F., and he complained of constant
pain.
September i6th. — Great pain in the left leg and thigh,
limb cold and mottled, and foot anesthetic. No pulsa-
tion in the femoral artery. The swelling of the left lower
extremity continued to increase, accompanied with pain
along the course of the artery, and on September 2 2d
several large blebs were observed near the ankle. The
general condition of the patient grew worse, and he died
on October 15th, with symptoms of pulmonary oedema.
Autopsy, — On opening the abdomen a large tumor was
found occupying the left inguinal and lumbar regions,
and covered by the adherent mesentery. The abdominal
wall was not involved. The tumor was firmly attached
to the vertebral column, and to it were attached the
descending colon and left kidney. The ureter had been
compressed by the tumor and hydro-nephrosis had re-
sulted. The tumor seemed to arise from glands in the
lower dorsal and lumbar regions, and had surrounded the
aorta and vena cava completely. The vertebral column
and intervertebral cartilages appeared healthy. The
left external iliac artery was flattened and nearly occluded
by the tumor, and there was thrombosis of the iliac vein
extending down into the left femoral. The mesenteric
glands were involved, as also were the glands passing
below Poupart's ligament, with the femoral vessels. The
anterior mediastinum was occupied by a new growth,
which was attached to the sternum, and extended back-
ward about one inch behind the trachea, surrounding it
and the great vessels of the neck. The apex of the left
lung was pushed to the left by the tumor, and the upper
lobe was infiltrated with the new growth. The upper
lobe of the left lung also contained numerous cavities,
and there was marked bronchitis and laryngitis. The
right lung appeared normal. The liver showed numer-
ous broken-down white foci, varying in size from one-
fourth to two inches in diameter. The kidneys were
congested, the spleen and stomach were normal, and the
bladder contained nodules similar to those seen in the
liver. The brain was not examined.
The specimen had been examined by the pathologist
of the hospital, who pronounced the new growth to be can-
cerous, probably originating in the lumbar glands, with
metastasis into the mediastinum and other organs of the
body. The point of interest in the case was thie fact
that the patient was operated upon for removal of a
tumor of the testicle, which was considered to be tuber-
cular in character, and within a few months subsequently
a new growth occurred in the line of the lymphatics upon
the same side of the body, which growth was carcinoma-
tous, and was followed by malignant growths in the lungs,
liver, bladder, and mediastinum. The testicle was re
moved by his colleague, Dr. Gerster, who had presented
it to the Society as a tubercular testis, and on examining
the records of the German Hospital it was found that the
case was recorded there as one of tubercular disease of
the testicle.
The Secretary thought that the group of testicles
which Dr. Gerster presented to the Society had not been
examined microscopically when exhibited, and therefore
it might be possible that the specimen referred to by Dr.
Wyeth was cancerous. [The records show that the tes-
ticles presented by Dr. Gerster had not been examined
microscopically. They were referred to the Committee
on Microscopy. W. M. Carpenter, Secretary.]J
inhalation of a blow-gun dart — tracheotomy-
exploration OF THE TRACHEA AND PRIMARY BRON-
CHI—FAILURE TO REMOVE THE FOREIGN BODY WITH
INSTRUMENTS — SPONTANEOUS REMOVAL SUBSEQUENTLY
— RECOVERY OF THE PATIENT.
Dr. Wyeth presented a specimen which related to
tracheotomy performed in an attempt at removal of a
foreign body from the trachea or bronchi. A. A , of
Wallingford, Conn., ten years of age, on September 7th,
while in the act of blowing a dart gave a forced inspira-
tion and sucked the dart into his trachea. Violent
coughing immediately followed. Respiration became
difficult. The boy turned blue in his face, and his mother
thought he was choking to death. The immediate symp-
toms of suffocation, however, soon disappeared. Between
that date and September loth the boy was carefully exam-
ined by the family physician who concluded that the
foreign body had been carried down through the trachea
and had lodged in the right bronchus.
On September nth the patient was brought to New
York, when Dr. Wyeth examined him and reached the
conclusion that there was a foreign body in the right
bronchus. He also called Dr. Learning and Dr. Elsberg
in consultation, and Dr. Elsberg gave the opinion that
the foreign body was located in the right bronchus, al-
though he was unable to see it. Dr. Learning examined
the patient, and located the foreign body in the second
bifurcation of the right bronchus anteriorly, basing his
diagnosis not only upon the hissing rA.le heard immedi-
ately over that portion of the bronchial tube, but upon
the fact that there was associated with it an area in
which the normal vesicular respiration was entirely ab
sent.
On the following day chloroform was administered,
and l^x, Wyeth performed tracheotomy just above the
November 15, 1884.]
THE MEDICAL RECORD.
553
sternum, introduced his little tinger, passed it toward
the bifurcation, but was unable to touch it He then
turned his finger upward, explored the trachea and lar-
ynx, but was unable to find any foreign body. He then
introduced a pair of angular forceps into the trachea,
passed them downward to the bifurcation, turned the in-
strument into the right bronchus, and began to fish for
the body in the following manner : He opened the in-
strument to the extent of one-fourth of an inch, pro-
jected it one-fourth of an inch, and then withdrew it,
and went on in this manner exploring all four quarters
of the bronchial circumference. He did this throughout
the entire right bronchus, but did not touch anything
which felt like a foreign body.
He then took a piece of ordinary surgeon's wire, at
the suggestion of Dr. Learning, made a loop, carried it
in without difficulty, and fished again in the region which
he had explored with the other instrument, but was un-
able to find any foreign body. He then concluded that
the foreign body was lodged beyond surgical reach, and
further operative interference was discontinued. The
patient rallied firom the chloroform, . and subsequently
did well, only a moderate elevation of temperature ensu-
ing, which soon subsided.
Dr. Wyeth kept the operation wound opened by
stitching two rings of the trachea with fine silk suture to
the integument on each side, and fastening the ends of
the suture behind with adhesive plaster, which left the
opening patent to the fullest extent. He left the wound
open because he thought that perhaps the foreign body
when loosened, if it was loosened, might lodge in the
larynx, and the patient would suffocate before it could be
removed, whereas, if the wound was open, it would
probably lodge there as it came up from the bronchus.
On September 24th, twelve days after the operation,
he called Dr. J. H. Ripley, Dr. A. Jacobi, and Dr.
E. G. Janeway in consultation. Dr. Jacobi was doubtful
as to the presence of any foreign body in the lungs. Dr.
Janeway said that, from the physical signs, he did not
feel like saying there was a foreign body in the lungs, yet
he thought it was safe to treat the patient as if there was
one there. Dr. Ripley believed there was a foreign body
m the lungs, but was of the opinion that it had been
shifted from the right to the left bronchus, because while
there was the same sound, but less intense, heard at the
point where the original rile was discovered, there was
at the same time diminished respiratory murmur all over
the If// lung, which was recognized by all the consulting
physicians at the time the examination was made. Dr.
Ripley thought that the patient had coughed the dart up,
and that with the next inspiration it was returned and
lodged in the primary bronchus on the left side.
The result of the consultation was that the tracheal
wound should be kept open by means of a canulated
silver tracheal tube, and on the next morning Dr. Wyeth
administered chloroform and opened up the wound in the
trachea, which had in good part united. He also deter-
mined, after the wound was opened, to explore the left
bronchus, and to facilitate this procedure he laid the boy
upon the operating-table on his right side, with the head
hanging well over the edge of the table, so that any blood
which might be caused by the finger coming in contact
with the granulation tissue would run out of the wound.
As he pushed his little finger down into the trachea he
prolonged the operation for perhaps half a minute. The
boy's face turned blue, when he removed the finger and
the patient inspired very deeply, and immediately after-
ward coughed and made a violent expiratory effort
While tHe patient was making the expiratory effort Dr.
Wyeth closed the tracheal wound completely with his
thumb, and when it had passed off he immediately intro-
duced his finger a second time, and produced the same
asphjTxia with the same result, and kept his finger upon
the tracheal wound the second time. During this entire
procedure no foreign body was discovered. Dr. Wyeth
then introduced the tracheal tube, was about ready to tie
the little bands behind the n^eck, when the patient began
to have some spasmodic action of the muscles of the
larynx and the respiratory muscles became fixed Sus-
pecting that the tracheal tube had become obstructed he
immediately removed it, found it clear, and just at that,
moment the dart was seen hanging from the right side of
the mouth. He closed the tracheal wound immediately
with adhesive plaster, and the boy made an uninterrupted
recovery.
In reply to a question, Dr. Wyeth expressed the opin-
ion that the foreign bo^y never changed its location un-
til it was finally removed by the violent expiratory ef-
fort.
The President suggested that the usual rule was that
when such bodies became impacted in the trachea or
bronchial tubes they were expelled by the first violent
expiratory effort.
Dr. Wyeth remarked that it is well known that the
trachea and bronchial tubes were tolerant of foreign
bodies, and referred to a case in which the foreign body
remained in the trachea three months without producing
marked symptoms, and was then expectorated.
Dr. H. C. Coe referred to a case in which a young
man inhaled an entire head of timothy grass. As a re-
sult of this it was supposed that he had some chronic
lung trouble, and phthisis had been diagnosticated.
Nearly a year afterward he coughed up the foreign body,
immediately began to regain his flesh and strength, and
ultimately made a complete recovery.
Dr. J. Lewis Smith said that several years ago he
had a case in which a piece of a shell of a hickory-
nut was drawn into the lungs. There was decided dul-
ness on percussion over a circumscribed area, and symp-
toms of fibroid pneumonia developed, but the child
subsequently expectorated the foreign substance and re-
covered completely.
The President thought that in Dr. Wyeth' s case,
where the point of the pin evidently pointed upward, it
was safer to perform tracheotomy, explore the trachea
and bronchi, rather than to wait for spontaneous removal
of the foreign body. He also referred to a case in which
a boy, five or six years of age, inhaled the spiral spring of
an ordinary spring clothes-pin. The accident occurred
while he was close at hand, and at first he thought the
patient would die of suffocation, but he succeeded in
catching the spiral spring with the end of his finger and
removed it. It had lodged in the top of the larynx.
Dr. Furman referred to a case in which a patient,
while under the influence of chloroform for the purpose
of having a tooth extracted, inhaled a fragment of one
of the teeth, and it entered the right bronchus. The pa-
tient suffered two or three weeks from bronchitis, but
finally the foreign body was expelled.
The President remarked that while it might be safe
to allow rounded bodies to remain in the trachea or
bronchi, and await spontaneous removal, it would be, on
the contrary, justifiable to perform tracheotomy where ir-
regular-shaped bodies had entered the respiratory pas-
sage and become fastened.
Dr. Wyeth thought, in view of the number of cases
mentioned in which the foreign body had been removed
from the lower air-passages spontaneously, that it might
be a question whether operative interference should be
resorted to, at least very early.
Dr. W. M. Carpenter, as bearing upon this point, re-
ferred to a paper read by Dr. Leaming before the Sur-
gical Section of the New York Academy of Medicine, in
1879. [O" referring to Medical Record, vol. xv., p.
208, it will be seen that Dr. Leaming reported six cases
of foreign bodies in the air-passages. In three cases the
foreign body was expelled spontaneously ; in two cases
it was removed by operation. In one of the sponta-
neous cases the foreign body was a head of timothy, and
although it was coughed up, the patient died of destruc-
tion of the lung, due to the presence of the head of hay.
In one case the foreign body, a portion of a tooth, re-
554
THE MEDICAL RECORD.
[November 15, 1884.
mained, and produced disease which caused the patient's
death.
In the discussion which ensued there was a difference
of opinion with reference to the early performance of
tracheotomy. W. M. C]
Dr. Carpenter also thought that, in very many cases
at least, the symptoms of immediate suffocation pro-
duced by a foreign body entering the lower air-passages
soon subsided, and therefore that the apparent urgency
for immediate operative interference passed away.
A method of removing foreign bodies from the larynx,
such as coins, etc., not infrequently practised in rural
regions, was to lift the child suddenly by the cars, per-
haps patting him on the back, and holding the head
. downward at the same time.
TUMOR OF THE BREAST.
Dr. W. p. Northrup presented a microscopical sec-
tion of a tumor of the breast, which was removed by Dr.
C. C. Lee at the New York Foundling Asylum. The pa-
tient was forty-five years of age, the mother of ten chil-
dren. Just before the birth of her last child she no-
ticed a lump in the breast, and when the child was seven
weeks old the operation was performed for its removal.
The tumor was situated to the left of the nipple, and
had been painless for the most part, but recently it had
been the seat of occasional lancinating pains. There
were two or three enlarged axillary glands. The nipple
was markedly retracted. The patient had been seen by
five or six surgeons of this city, who made a diagnosis of
malignant growth, and recommended that it be removed.
The tumor was about the size of an ordinary orange,
very firm to the feel, and somewhat lobulated. There
was no ulceration. An incision was made at the outer
side of the tumor, and when the firm mass was reached
there gushed out a large quantity of fetid material which
looked like pus, and Dr. Lee supposed that he had
opened an abscess, and those who were present also
supposed that the cavity opened was that of an abscess.
He accordingly pared off the edges to remove the indu-
ration as far as possible. In this he had no difficulty
with reference to the anterior wall, but the posterior
wall was almost of a cartilaginous induration. He did
not remove the indurated glands of the axilla. The
wound healed almost entirely by first intention, but its
edges were much indurated and reddened ; yet when the
patient left the hospital the induration had somewhat di-
minbhed, and the enlargement of the axillary glands was
very markedly decreased. The prognosis was regarded
as very doubtful, as probably the disease would return.
The tumor microscopically exhibited a multitude of
giant cells, such as seen in ordinary inflammatory tissue.
The specimen had been examined by Dr. Delafield,
whose ultimate report wsls, that one or two weeks before
the birth of the child, and nine weeks before the opera-
tion, there was probably an adenoma ; that subsequently
an abscess developed, and that the adenomatous tissue
was perforated throughout by this granulation tissue,
which had obscured the original type of disease.
It was also possible that the affection was only an ab-
scess, with induration. The probabilities, however, were
that the original tumor was an adenoma, that an abscess
occurred, and that the giant cells were simply a part of
the granulation tissue, and not of special importance.
The President, as bearing upon this case, referred to
one in which, two years ago, he removed a tumor that,
according to the description, presented almost exactly
the same physical appearance. The patient was forty
years of age. There was, however, no retraction of the
nipple, nor was the skin involved. There was slight en-
largement of one of the glands of the axilla. The cyst
which the tumor contained was so tense that when the
knife entered it the fluid contents spurted out to a great
distance and were exceedingly offensive. He removed
the remainder of the growth, and also parts of the en-
arged glands of the axilla. At that time he regarded the
prognosis as very good, but six months subsequently en-
larged glands reappeared in the axilla, rapidly put on a
malignant appearance, and were removed. Six months
afterward, in the line of the lymphatics, the supra-axillary
glands became involved, and he removed a very large
one in the subclavian triangle. Both of these tumors, on
microscopical examination, were found to be malignant
Subsequently there was a reappearance of the growth
higher up along the side of the trachea, and in the glands
by tfie side of the sterno-cleido-mastoid muscle. The
patient is now dying of gradual suffocation and asthe^
ma.
The President regarded the prognosis in Dr. North-
rup's case as exceedmgly bad.
Dr. Wyeth regarded the presence of giant cells |as
special to sarcomatous and tubercular tissue. While it
was not generally conceded, he nevertheless believed it to
be true that sarcoma never exists without the presence
of giant cells.
Dr. Northrup did not regard the arrangement of the
tissue as either tubercular or sarcomatous, and thought
that the giant cells belonged to granulation tissue.
Dr. Wyeth said it had been unusual in his experience
to see such a growth -of giant cells in granulation tissue.
Dr. a. B. Robinson remarked that giant cells were of
common occurrence in granulation tissue, especially the
more chronic forms of inflammation.
The President remarked that clinically these growths
were followed by secondary development of carcinoma,
even though it was a chronic abscess. He should rec-
ommend, under such circumstances, removal of all the
indurated tissue and all the enlarged glands from the
axilla.
Dr. Wyeth thought that all enlarged glands in all
operations for removal of tumors from the breasts should
be removed.
ULCERATIVE ENDOCARDITIS.
Dr. J. Lewis Smith presented a specimen from a case
of endocarditis, attended by hemorrhages, which occurred
in the New York Foundling Asylum during his service
in August last. The following history was prepared by
the house-physician, Dr. H. P. Bissell : Mamie D ,
aged five and a half years, had scarlatina in 1882, measles
in 1883, and since had two attacks of pneumonia. In
June of the present year she contracted pertussis, and on
August 24th she was sent to the hospital.
On August 25th she was first seen by Dr. Smith. At
this time her ajcillary temperature was 104^**; tongue
dry and furred ; some cough, but examination of the
chest negative.
August 26th. — 10 A.M. : Axillary temperature 100°,
slept tolerably well during the night, and had two
alvme evacuations since yesterday. 2 p.m. : Axillaiy
temperature, io2|° ; pulse, 160, after crying. The bowels
are regular; the face pallid and anxious, the patient
fretful when disturbed, and each day attacks of vomiting
occur, and the vomited matter presents the ordinary ap-
pearance. Dr. Smith examined the patient thoroughly.
The action of the heart though rapid was accompanied
by no perceptible abnormal sounds, and the urine, tested
by heat and nitric acid, was found free from albumen.
From the history and appearance of the child, especially
from its pallor, anxious features, and the persistent hack-
ing cough which closely followed the cough of pertussis,
Dr. Smith believed that the case was one of acute miliaiy
'tuberculosis, though the possibility of its being typhoid
fever was considered. Three grains of quinipe were
given every six hours. Between 5 and 7 p.m. she had a
copious evacuation from the bowels of very black blood,
which strengthened the suspicion that the disease might
be typhoid fever.
August 27th. — 10 A.M. : Temperature, axillary, 102° j
pulse, 160 ; has vomited often since yesterday, but no
blood. An enema of hot water was given last night,
since which no bloody stool has occurred. 2 P.M. : Tem-
November 15, 1884.]
THE MEDICAL RECORD,
555
perature, axillary, 104^° ; pulse, 168 ; heart carefully
auscultated, but no abnormal sounds noticed ; its action,
while very frequent, was strong and irritable, 8 p.m. :
Temperature, io2|°; pulse, 144; had^one normal stool
since last record ; has vomited much, for which bismuth
and pepsine have been administered.
August 28th. — Had one dark stool since 'yesterday,
not bloody.
August 30th. — 10 A.M. : Temperature, .104° ; pulse/150 ;
slept at intervals during the ni^ht ; breathing still labored,
and sighing ; she takes nourishment readily and in fair
quantity; physical examination of chest reveals only
the abnormal breathing. 8 p.m. : Temperature, io2|** ;
pulse, 140. About two o'clock this afternoon she had a
passage from bowels, consisting of about three table-
spoonfuls of red blood, and another of the same charac-
ter, but not so copious, a little later. For these she was
ordered an enema of hot water and alum.
August 31st. — 10 A,M. : Patient rested pretty well last
night; temperature, 104^°; pulse, 160. 3.20 p.m. : Tem-
peratiu-e, io2|° ; pulse, 150. 7 a.m. : Temperature,
^^SV I pulse, 150; respiration, 36; tongue coated and
dry ; some tenderness on pressure over abdomen.
September ist. — 10 a,m. : Temperature, 102° ; pulse,
144 ; general condition about the same. 8 p.m. : Tem-
perature, 103°; pulse, 140.
September 2d. — 8 a.m. : Temperature, ioif°. 3 p.m. :
Temperature, 103° ; pulse, 140 ; a good deal of vomiting
to-day ; hands and feet cold.
September 3d. — 7 a.m. : Temperature, 98^° ; frequent
vomiting. 11 a.m. : Temperature, 105 i° ; pulse, 168;
head hot, hands and feet cold. 8 p.m. : Constant vom-
iting. To-day for the first time small extravasations of
blood were observed under the skin, especially over the
abdomen, and a few fine rftles were observed in the right
side of the chest, probably produced by extravasated
blood in the alveoli of right lung ; temperature, io2|° ;
pulse, 150 ; respiration, 44.
September 4th. — 8 a.m. : Patient vomited blood twice
this morning ; temperature, ioif°. 2 p.m. : Temperature,
iooJ°.
September 5th. — 9 A.M. : Temperature, 102°.
September 6th. — Died at 7 a.m.
This patient was examined by several physicians, but
to all of us the disease was obscure. Acute miliary tu-
berculosis, typhoid fever, and purpura hemorrhagica were
considered, but no positive diagnosis was made.
Autopsy^ September 6th, nine hours after death. —
Numerous points of extravasated blood underneath the
integument ; general paleness of all the internal organs.
Brain : Entire right anterior lobe, except that looking to-
ward the median line, covered by extravasated blood,
which filled the intergyral spaces; a similar extravasa-
tion, but less in extent, over the right posterior lobe ; no
points of extravasated blood noticed in substance of the
brain ; small extravasations of blood under the pleura,
and in substance of lungs, no other pulmonary lesions ;
similar extravasations underneath the peritoneum, and in
substance of liver and spleen ; none observed in the
kidneys, which may explain the fact that the urine re-
mained free from blood. The entire gastric, and a con-
siderable part of the intestinal mucous surface, presented
as mottled an appearance as the skin in measles, due
to the extravasation of blood in and underneath it.
The state of the heart was of chief interest. In this
organ we found the primary disease, to which all the
symptoms were referrible, A small quantity of blood
was found in the cavities, but an oblong fibrinous concre-
tion was attached to the mitral valve ; its length three-
fourths of an inch, its breadth one-third of an inch. The
curator, Dr. Northrup, will state the results of his exam-
inations, which establish the diagnosis of an ulcerative
endocarditis.
This child, so far as known, never had rheumatism. It
is only of late years that ulcerative endocarditis has begun
to attract attention, and a number of cases have been re-
ported. During the present year a case occurred in the
Middlesex Hospital, London, and in the discussion it was
proposed to designaLte the disease septic endocarditis.
What may be the relation of micro-organisms to it, I am
not prepared to say, but I believe that micrococci have,
as a rule, been found in abundance upon and under the
surface of the endocardium in those who have perished
from this disease. The contamination of the blood and
the infarctions seem to result entirelyj^from the endocar-
ditis.
Report on the pathological specimen by Dr. W* P*
Northrup, — Heart and liver : From the margin of one
cusp of the mitral valve hangs a pyriform body about
two centimetres in length, half as wid6 at its widest part,
its pedicle having a diameter of about a half centimetre.
On the contiguous portion of the opposite cusp is a nod-
ule of about the same diameter as the pedicle of the
first. Its surface has a rough, villous appearance. An-
other nodule, much smaller, of similar appearance, is sit-
uated on one of the columnae corneae, at the level of the
dependent end of the adjacent polypoid body. About
six other small, some minute, points of similar appearance
are found in the same (the left) ventricle.
Microscopic examination of the polypoid body shows
nearly all of it to be made up of fine granular matter,
composed largely of rod- shaped bacteria, coated on the
surface with recent fibrin and white and red blood-cells.
The peduncle fits upon a cone of new growth from the
valve. The section now under the microscope is a longi-
tudinal cut through the polypoid body, extending also
through the cone-shaped base into the substance of the
valve. In this section the whole process is manifest.
From below upward we find four gradations, (i.)
Granular matter of polypus, made up of rod-shaped
bacteria mostly. (2.) At the margin of the wart-like ex-
crescence a zone of necrosis showing pus, broken-dovm
tissue, etc. (3.) A broader area of swollen cells, either
of connective-tissue cells or new cells, some pus, swollen
and granular fibres. (4.) The deeper tissue of the
valve in nearly normal condition.
The second section is a similar view of the nodule on
the contiguous portion of the companion cusp. The
process here shown is the same, though less advanced.
It shows swollen cells, zone of necrosis, adherent
granular mass skirted by fresh blood-clot. In both cuts
the white cells in the clot increased markedly in propor-
tion to the red, especially next to the granular matter,
and are deposited in strata. The heart muscle and the
liver were examined. The liver is the seat of moderate
fatty infiltration. Neither liver nor heart muscle show
micrococci.
This case seems to me, taking the history and the
lesions, to furnish a typical section of malignant endo-
carditis or acute ulcerative endocarditis. There are no
ulcers showing loss of substance. The lesion in this
case is the nodular outgrowth of connective tissue, form-
ing vegetations on the margin of the valve, the outer
margin becoming ulcerated ; upon this roughened surface
the fibrin accumulated and formed the polypoid body.
The part played by the rod-shaped bacteria I know
nothing of. They are there in myriads.
The Society then went into executive session.
Prophylaxis of Migraine. — Dr. Haig reports in
The Practitioner the case of a young man, thirty years of
age, who suffered torments from frequent attacks of hemi-
crania, which ceased entirely after he adopted a purely
vegetable diet, although they had recurred as frequently
as three times a week before that time. Dr. Haig
thought that possibly the neuralgia was caused by poison-
ing with ptomaines formed in the intestinal canal during
the digestion of meat. After living upon an exclusively
vegetable diet for a considerable time he was able gradu-
ally to return to a bill of fare containing a small quantity
of meat.
556
THE MEDICAL RECORD.
[November 15, 1884.
THE NEW YORK ACADEMY OF MEDICINE.
Stated Meetings November 6, 1884.
FoRDYCE Barker, M.D., LL.D., President, in the
Chair.
the pathojlogy of sensory aphasia — with a speci-
MEN.
Dr. R. W. Amidon read a paper based upon original
observations in one case, with a revieiv of the history of
twenty-three others reported by different authors.
The specimen was accompanied by the following his-
tory : A female patient, sixty-four years of age, married,
had been in perfect health up to nine years ago, when
she began to suffer from flatulent dyspepsia, headache,
and other neurasthenic phenomena. Six weeks before
Dr. Amidon first saw her she was seized with severe
pain on the left side of the head, which continued three
days, when she became flighty and excitable, and vomited.
At the date of his first visit, June, 1883, the right pupil
was larger than the left, the tongue deviated slightly to
the right, the right hand was not as much stronger than
the left as it should have been, and it was somewhat
tremulous. There was no weakness of the right lower
extremity, and no marked disturbance of motility. The
fundus oculi was normal, and acuity of vision was ap-
parently perfect. With regard to speech, it was only in
answering questions that she spoke incorrectly. She
gave inappropriate answers to interrogatories, she could
not count, or say letters, but when she spoke of her own
accord her remarks were connected and intelligible. She
knew all her friends except her husband, but called her
son her father. She could not read and could not be
induced to write. She could hear well, and could sing
correctly. She was subject to periodic attacks of a spas-
modic nature, occurring at intervals of about a month,
characterized by a cry, a drawing up of the right hand,
and drawing of the mouth to the right, followed by
general convulsions, sometimes with involuntary evacua-
tions. P'ebruary 15, 1884, she was seized with a convul-
sion at 7 P.M. which continued until 11 a.m the i6th,
when she became comatose and in this condition died.
Her family stated that during the last twenty-four hours
of life she passed very little urine.
At the autopsy the kidneys were found to be the seat
of advanced interstitial changes.
The right cerebral hemisphere was normal. On the
left side there was an irregular depression, with destruc-
tion of the cortex by softening, involving the inferior
parietal lobule, the angular gyrus, the second occipital
and the first temporal convolutions. There were athero-
matous changes in the vessels supplying these parts, one
of them being entirely occluded.
Dr. Amidon then presented eight diagrams and read
the histories of cases reported by Balzer, d'Heilly, and
Chautemesse, A. B. Ball, Chauflfard, Giraudeau, SeppiUi,
and others.
Of the twenty-four cases, in eight with lesions affecting
the visual and the auditory regions of the left hemisphere
there was both word-blindness and deafness ; in two in
which the area of vision alone was affected there was
word-blindness ; in fourteen with the lesion in the audi-
tory region there was word-deafness.
Dr. Amidon drew the following conclusions : Word-
blindness is an incapacity to understand speech, written
or printed, vision and intelligence being preserved. It
is generally dependent upon a destructive lesion of parts
of the inferior parietal, middle, angular gyrus, and second
occipital convolutions of the left side. Its mechanism
consists of an abolition of the transformation of written
words into visual verbal images.
Seppilli's conclusions were that word-deafness was a
lesion of speech clinically and anatomically distinct from
aphasia. It was often associated with amnesic or motor
aphasia, or with word-blindness. The lesion of word-
deafness consisted in destruction of the first and second
left temporal convolutions. Its mechanism consisted in
abolition of transformation of spoken words into verbal
images. He considered word-deafness of great value in
locating a lesion of the left temporal lobe.
Dr. Frank H. Hamilton then read a paper entitled '
THE ASIATIC CHOLERA AT SUSPENSION BRIDGE, 1854,
AND ITS LESSONS — WHAT WE KNOW OF CHOLERA.
The paper was the fulfilment of a promise made to
the editor of the Buffalo Medical Journal in 1854, to
write a paper, some time, on the Asiatic cholera as it pre-
vailed at Suspension Bridge that year. After directing
attention to the extreme fatality of the epidemic and its
rapid spread among the workmen at Suspension Bridge,
the author ascribed the great mortality to the elevated
temperature, moisture of the ground, and alluvial, re-
cently upturned soil It was at the request of Dr. Rogers
that Dr. Hamilton and two other physicians visited the
patients during this epidemic The following lessons
which he had drawn from it were not presented as new,
but as being entitled to special notice in view of the fact
that we were liable to have cholera imported into this
city at any time. His opinions would be expressed
chiefly upon the question of what is the present state of
knowledge of the nature, the etiology, the mode of prop-
agation, and the treatment of Asiatic cholera.
First, Dr. Hamilton claimed that we had no positive
knowledge of the existence of a specific cholera germ.
In 1854 an Italian |physician described a germ to the
presence of which he ascribed the development of
cholera. Recently Koch had discovered the comma-
bacillus, which he regarded as the true cholera germ, but
after reviewing the facts for and against Koch's views,
and the observations of others who had investigated the
subject, the author stated that in view of the conflicting
testimony with regard to the theory of Koch that the
comma-bacillus was the cause of cholera, we were justified
in the assertion that the claim had not been established.^
Even if it were determined that the comma-bacillus was
always present in cholera and never in otner disease or
in health, it would not be certain that the bacillus and
cholera stood in the relation of cause and effect.
Again, the theory was also defective in that it had not
been shown that the introduction of this germ into the
animal system would produce cholera. The inoculations
by Koch himself, practised upon the lower animals, had
been barren of results.
Again, if it were established that a microbe was the
cause of cholera, the question would remain to be an-
swered, which of the microbes hitherto described, or yet
to be discovered, would prove the efficient agent. But
it might still remain to be proven, should the experi-
mentalists succeed in producing cholera by the introduc-
tion of a fluid containing a germ or germs into the sys-
tem, whether the efl&cient agent were the fluid or the
germ. It might be the fluid containing the microbe
which was the cause of cholera, this fluid having taken
on properties which no microscope could detect. The
author did not wish to be understood as underestimating
the importance of microscopical studies ; much useful in-
formation had been derived from the microscope in the
study of disease ; but so far as the cholera or other epi-
demic infectious diseases were concerned microscopists
had not taught us any important lessons either with
regard to their cause or their prevention. Germicides
kill the microbes when attacked outside of the body, out-
side of their native soil, but within the body these rem-
edies had no effect upon them. Consequently, patients
continued to die of cholera after the discovery of microbes.
Again, it had not been positively proven that the active
agent in the production of the disease resided in the in-
testines ; the symptoms would indicate that it might also
exist in the blood.
The cholera germ, using this term in its general signifi-
cation, might be conveyed firom place to place by the
November 15, 1884.]
THE MEDICAL RECORD,
557
dothing or any other textile fabric, by articles of food or
water, or animate or inanimate substance. It might be
conveyed a considerable distance by the air — ^how far it
would be difficult to say ; probably much would depend
upon the force of the wind and other atmospheric con-
ditions. He had reason to think it could not be thus
conveyed farther than a mile or two. The theory of
Koch, that the germ only found its way into the system
through the mouth and stomach, was corollary to his
theory of causation by the comma-bacillus, and that in-
troduction of the poison through the mouth and into the
stomach might be one of the means of propagation could
be admitted, but that it was the only means the history
of epidemics showed not to be true.
It was not necessary to assume that because the in-
testinal secretions were changed, or the mucous mem-
brane congested, that the virus was originally implanted
in the intestinal canal The blood and the renal secre-
tion also underwent changes quite as marked as those
which took place in the intestinal secretions.
Although the cholera virus were received into the
human system it need not necessarily give rise to
cholera. It seemed probable that every person living in
a cholera atmosphere received more or less of the virus
into the system, but only a small proportion of these
persons took sick and died It was true of all the in-
fectious diseases that the reception of the virus into the
system did not necessarily produce that specific disease.
It was also true, however, that a large proportion of
those exposed to infectious diseases became infected,
whereas only a small proportion of those exposed to
cholera took the disease. A suitable soil was necessary.
Cholera also differed from other infectious maladies m
that one attack did not insure protection against another.
The conditions which protected against cholera were
all those which went to prevent disturbance of the ali-
mentary canal ; also the avoidance of impure air, over-
crowding, bad ventilation, decaying vegetable or animal
matter, stagnant water, a warm and moist condition of
the atmosphere. The most efficient agent for the propa-
gation of the disease seemed to be the vapors rising from
newly exposed soil, and decaying animal and vegetable
matter, together with a warm and moist atmosphere.
That filth was not the only efficient cause of the spread
of the disease was shown by the fact that, during the epi-
demic at Buffalo, those persons living in dirty shanties on
a sandy soil by the lake escaped. But there were in-
stances on record which went to show that a favorable
condition of the soil and atmosphere alone would not
check the spread of the disease, if other local conditions
sufficiently favored its spread.
The profe.ssion had long sought for a specific against
Asiatic cholera, but there were really but very few
specifics against any diseases, and none had yet been
found for infectious diseases. But in the case of scarlet
fever, etc., the disease would run a certain course, and
we could only seek to conduct the case to a favorable
issue, whereas in cholera, if we took it in time we could
often abort it. It was seldom, however, that a patient
was saved to whom remedies were not administered
until after the period of collapse had arrived. The
remedies which had proven most successful were those
which had long been known to be most successful in the
treatment of diarrhoea, cholera morbus, and analogous
affections. The most efficient means prior to the stage
of collapse were opium and rest. Dr. Hamilton pre-
ferred opium in the solid form to morphine. The patient
would be more likely to recover were he removed to a
region not favoring the propagation of cholera, and
usually it would be found that the disease would not be
spread in his new domicile.
It was believed that the cholera was brought to Sus-
pension Bridge by some immigrants, but these people did
not, so far as was known, suffer from the disease either
before their appearance at Suspension Bridge or after
their departure, which went to prove that the rapid
spread and fatality of the affection among the laborers
there was due to the condition of the soil and atmo-
sphere. Again, in only a few instances, and in which
the topographical conditions were favorable, was the
cholera virus carried to and spread in neighboring
localities.
Should cholera appear in this city, would it prove as
fatal as it had done in Naples and the South of France ?
Dr. Hamilton answered in the negative, and for the
reason that our climate is more favorable, our system of
sewerage better, and we had efficient sanitar}' measures
for the prevention of the spread of the disease. He re-
ferred to the success attending the efforts of the Sanitary
Commission in stamping out cholera from Black well's
Island in 1866, and spoke of the efficient work done by
Dr. Yale, then one of the house-staff.
Dr. L. M. Yale said that his own experience with
cholera had been confined to the epidemic on Black-
well's Island referred to by the author of the paper.
The report which he then made included also the ex-
perience of his associates upon the Island.
The epidemic broke out at the workhouse. It had
been preceded by a period of great heat and also the
prevalence of diarrhoeal troubles throughout the Island.
It became necessary, therefore, to put diarrhoeal reme-
dies in various parts of the buildings, so that the patients
could get them without the trouble always of searching
for a physician.
The water-supply for a time was cut off, owing to some
defect in the system of supply, and the bread bad been
sour for a short time.
The first case of Asiatic cholera occurred in the work-
house, although there had before been some cases of spo-
radic cholera in Charity Hospital. By the third day after
the appearance of the first case Dr. Yale had thirty-three
cases — twenty-three of which proved fatal — ^and about
twenty per cent, of the entire number of inmates were
carried off before the disease was checked. The epi-
demic occurred principally on the lowest ground of the
island. More women contracted the disease than men,
and this might be accounted for by the fact that the
men went out to work by day, and their wards were
larger; the women remained in the wards, and the
evacuations stood hi a tub in a room where the inmates
often remained for a considerable time in conversation
with one another.
Again, the patients, being unwilling to go to the
cholera hospital, tried to conceal the fact when they
were seized with diarrhoea. These faulty conditions hav-
ing been corrected, the cholera was rapidly and perma-,
nently stamped out.
Dr. Yale mentioned one circumstance which was not
easily explainable ; namely, that in one pavilion as many
as thirty cases of cholera developed ; whereas in another
pavilion, not thirty feet distant, not a single case oc-
curred, although the conditions, so far as could be ob-
served, were no better in the one than in the other.
Dr. Francis Delafield said he supposed all would
admit that cholera belonged among the infectious dis-
eases, or a class of diseases which did not develop unless
the human body were infected by a specific poison. No
matter how bad the influences under which human beings
lived with regard to soil, food, and hygiene in general,
they might develop many other diseases, but they would
not develop cholera unless there were added to these
other favoring conditions the specific poison that be-
longed to the disease. Whether that specific poison had
always to be imported into new regions to develop the
cholera, or whether it were capable of originating in new
regions, might be a subject of dispute, but experience
seemed to show that its home was India, and that other
regions did not suffer until the poison was imported.
It being admitted that the disease was due to a spe-
cific poison, the question came up, What is that poison ?
Here we have had all varieties of theories, none of which
have proven particularly satisfactory. The latest theory,
558
THE MEDICAL RECORD.
[November 15, 1884.
to which attention had been called this evening, was that,
in accordance with the prevalent doctrine of the times,
most of the infectious diseases are due to the pres-
ence and growth of certain minute organisms. Fashions
of this kind in science and in medicine sometimes prove
good, and sometimes prove bad ; and whether a given
fashion will prove the one way or the other could be
known only after the lapse of some period of time. Dr.
Hamilton had stated very fairly the evidence for and
against this view of the causation of cholera. He had
not stated, however, what Dr. Delafield considered par-
ticularly important to be borne in mind, namely, that
there were only a very few men whose testimony was of
any value in speaking of the presence or absence of
germs in disease, and the reason was the very great diffi-
culty attending the manipulations incident to the proper
performance of the experiments.
Dr. Hamilton had called attention to the very impor-
, tant point of the bearing which the condition of the soil
-and hygiene had upon the development of cholera, and
this might be briefly expressed in this way : Whatever
conditions of air, of temperature, of soil, of food, and of
general hygiene would predispose to the development of
diarrhoea would also predispose to the spread of cholera.
In other words, wherever there was present a predisposi-
tion to diarrhoea and also the specific poison of cholera
we would have cholera developed in its worst form and
to the widest extent. If all these predisposing condi-
dons are absent, then the cholera germ may find its way
to the place and not produce cholera at all.
This seemed to bring us to the means by which we can
prevent the spread of cholera. In the present state of
civilized society, quarantine measures seemed to prove
useless if commercial relations were to be continued with
other countries. What we should do was to seek to
remove all the conditions which favor the development of
•the disease.
Dr. a. L. Loomis said that his personal experience
with cholera had been limited to a few cases which he
.saw in this city in 1866-67, and he had therefore felt,
when requested to discuss the paper, that he was largely
in the position of one who was simply a student of the
literature of the subject.
It seemed that, at the present time, we might justly
divide the infectious diseases into three classes, according
to the nature of their specific causes.
The specific cause in the one class produced its dis-
ease on being transmitted to the well person directly
-from one already infected. There was no evidence that
the exanthematous diseases were transmitted in any
other way than by direct or indirect exposure to the con-
tagion.
The second class was that in which the disease was
due t o exposure to a poison developed outside of the
.human body, as decomposing or^nic matter.
The third class was that in which the poison developed
within the living organism, or one affected with the dis-
ease, and was capable of reproducing the disease only
when it had undergone certain changes after its discharge
^r removal from the infected person. To this ckSs
(belonged typhoid fever, and cholera, as Dr. Loomis be-
lieved from his study of the literature of the subject. The
home of cholera seemed to be Bengal, and epidemics in
x>ther parts of the world could always be traced as having
x>riginated there. He did not believe that cholera was
ever of spontaneous origin. Dr. Loomis then gave
instances which went to show that in every epidemic of
>the disease its origin could be traced to spread of the
contagion through soiled clothing, infected water, etc.
The view that the poison was active only after it had
•undergone certain changes on being removed from the
human organism was favored by the fact that those mak-
ing autopsies, those attending the patients, and micro-
scopical observers of the fresh discharges, seldom con-
tracted the disease. He was of the opinion that the
poison entered the body only through the mucous mem-
brane> but not necessarily by way of the mouth and
stomach.
Sufficiently strict quarantine relations would prevent
the spread of cholera, but the difficulty of establishing
such quarantine had already been mentioned. The
efficacy of the treatment spoken of by the author of the
paper had been of great interest to him.
Dr. John C. Peters showed maps illustrating the
spread of cholera from its home in India, and speaking of
preventing an epidemic in this country by quarantine,
said that so long as Denmark enforced her quarantine
relations she had escaped from cholera, whereas as soon
as those restrictions on one occasion had been removed
the disease poison was imported, and she, with many
other cities of neighboring countries, had many inhabi-
tants perish. Quarantine had also proven efficacious in
Greece.
The Academy then adjourned.
THE INDUCTION COIL AND ITS VARIETIES
—A CORRECTION.
To TKK Editor op Ths Mbmcal Record.
Sir : In my article on the Induction Coil, etc., in the
last issue of The Record, I wrote, that if the subject is
** presented with any measure of clearness, it ought to be
of some little service to those who are interested in, but
have given little thought to, the matter." If, however,
any one, even though he be the veriest expert in physics,
can make head or tail to Fig. 2 of said article, he must
possess a keenness of insight quite phenomenal. The
continuous coil-induction apparatus is used by many
physicians throughout the country, but its physical, physio-
logical, and therapeutical characteristics seem to be little
understood ; and, therefore, in this paper I endeavored
to answer as concisely and clearly as possible the many
questions that have been put to me, both personally and
by letter. Unfortunately, however, through some over-
sight, neither the printed matter nor the cuts were sent
to me for revision, and the result is, an unintelligible de-
scription. A correct understanding of the part devoted
to therapeutical considerations hinges upon this cut. As
soon, therefore, as a new one can be made, and for the
benefit of not a few of your readers who are interested
in this matter, I trust you can find room for its reinser-
tion. A. D. RocicwELL, M.D.
NOWMBBR 8, 1884.
OUR LONDON LETTER.
* (From our Special CorrespondcnL )
SIR JOSEPH LISTER ON CORROSIVE SUBLIMATE AS AN
ANTISEPTIC DRESSING — THE HARVEIAN ORATION — AN-
OTHER DEATH FROM THE SUCKING OF TRACHEOTOMY
TUBES IN CASES OF DIPHTHERIA.
LONDOM, October a j; 1884.
The event of the week has been the delivery of Sir Joseph
Lister's address on Corrosive Sublimate as a Surgical
Dressing. This event took place last Monday at the first
meeting for this session of the Medical Society of Lon-
don. Sir Joseph commenced his address by frankly ac-
knowledging that he had had during the past twelve
months instances of failure with antiseptic dressings and
one fatal case. This induced him to turn his mind seri-
ously to the subject, and he came to the conclusion that
the volatility of many antiseptics is a cause of their inef-
ficiency. They are completely preventive of sepsis when
first applied, but this protective influence gradually les-
sens. Eucalyptus gauze was very troublesome to manu-
facture properly, and required great care both in the
original preparation of it and also to preserve it unim-
paired aifterward. Sir Joseph mentioned incidentally
that, as regards the carbolic dressings, he had'founda week
I
November 15, 1884.]
THE MEDICAL RECORD.
559
the limit of time during which a carbolic acid gauze
dressing might be regarded as effectual.
Salicylic acid was non-volatile; iodoform only very
slowly volatilized. Neither of these had he found to
be powerfully germicide. His attention had therefore
been directed to corrosive sublimate. With regard to
this agent numerous experiments were narrated at length,
as weU as cases in which it had been successfully applied.
Koch's experiments with this substance were referred to.
Koch had found a solution of only one part of corrosive
sublimate in twenty thousand parts of water quite suf-
ficient to absolutely destroy the vitality of the spores of
the bacillus anthracis. One part of sublimate to three
hundred thousand of a solution of extract of meat had
been found by Koch sufficient to " inhibit " the action
of the spores, so long as they remained in it. The " in-
hibitory action," as Lister terms it, was, he said, suffi-
cient in surgery.
The " wood-wool sublimate" used in Germany was,
he remarked, inconveniently bulky, so he had had a
gauze prepared containing one per cent, of sublimate.
This he had found suflftcient, but he had found the pro-
tective (dipped in a solution of one in five hundred) irri-
tate the skin. Numerous experiments were fully described
in his long address, but the result at which Lister has
arrived is the use of a gauze prepared with a solution of
one part of sublimate in one hundred parts of blood serum
from a horse. The original precipitate caused by the
addition of albumen to a solution of corrosive sublimate
is, he finds, soluble in excess of the albuminous serum,
and the resulting solution is efficiently antiseptic. Two
and a half parts of this solution are contained in each part
of the gauze. Gauze thus prepared has not caused irri-
tation. That prepared from a solution of one part of
sublimate to fifty of serum has in some instances done so,
but this has disappeared when the weaker gauze has been
substituted. Lister strongly recommends that during the
first twenty-four hours after an operation this gauze
should be used in abundance in at least sixteen layers.
With the sero-sublimate gauze dressing the ** protective"
is not used, and the outer wrapping of mackintosh is un-
necessary. The instruments used during the operation
cannot of course be previously soaked in the solution as
with carbolic acid.
The annual oration at the College of Physicians has
this year been delivered by Dr. Russell Reynolds. This
oration has lately attracted more attention on account
of the counter-claim set up in Italy for Cisalpino as a
discoverer of the circulation of the blood. This claim
was pretty well overthrown by Dr. George Johnson in
his Harveian oration of last year, and he has since written
a pamphlet on the subject, still more conclusively estab-
lishing Harvey's claim to priority. The present oration
was chiefly interesting from the prominent relief into
which what maybe called "foresight" on the part of
Harvey was thrown by the lecturer. He showed that
Harvey had some knowledge of reflex action, even as
now understood. He also appeared to have some fore-
cast of our present-da^ knowledge of the vaso-motor
system, and had some idea of the action of sexual selec-
tion on the perpetuation of species.
Another instance of a medical man acquiring diph-
theria with fatal results firom sucking a tracheotomy tube
on a diphtheritic patient is reported this week. Dr.
Samuel Rabbeth was the senior resident medical offi-
cer at the Royal Free Hospital, and only graduated at
the University of London in November last, when he
• obtained the scholarship and first gold medal in obstetric
medicine. His death adds yet another to the list of
brilliant careers cut short prematurely. Nearly all the
newspapers are eulojgizing his memory and holding him
up as a hero to be imitated. A hero ' no doubt he was,
for it requires more courage to incur such a risk than to
rush to meet death in scenes of excitement. The ques-
tion, howev.er, occurs whether he ought to be imitated.
Can it— on any theory of ethics — be the duty of a medi-
cal man to lay down his life, or even to incur the grave
risk of catching diphtheria, for the sake of affording a
moribund patient the distant chance of recovery ? Dr.
Rabbeth's case illustrates the melancholy fact that not
only may a valuable life be lost, but, as in this case, be
risked in vain ; for his patient died after all. Surely a
suction-apparatus might be tried by the operator before
applying his mouth to the wound, and, in hospitals, there
is no excuse for such not being at hand.
OUR PARIS LETTER.
(From our Special Correspondent)
ANGINA PECTORIS AND ITS TREATMENT — CHOLERA —
HEALTH OF PARIS — HOSPITALS FOR CONTAGIOUS DIS-
EASES.
Paris, October 24, 2884.
There has always been great confusion, or rather mis-
apprehension, as to the real nature or pathology of that
terrible affection termed " angina pectoris,'* some looking
upon it as a simple neurosis without any actual disease
of the heart. Jenner, in 1799, considered that the dis-
ease in question was caused by ossification of the coro-
nary arteries, whence the division into symptomatic and
idiopathic anginas. Other pathologists attributed the dis-
ease to atheroma, aortitis, affections of the heart, aneu-
rism of the aorta. More recently Professors Germain
S6e and Potain make out that angina pectoris is pro-
duced by the constriction or obliteration of the coronary
arteries which result in cardiac ischaemia. Still more re-
cently, Drs. Lancereaux and Peter, the former looking
upon the disease as neuralgic, while the latter considers
it to be a cardiac neuritis. Dr. Huchard, Physician to
the Hdpital Bichat, in a work recently published by him,
gives his experience of the disease, and seems to favor
the theory advanced by Professors S^ and Potain. Dr.
Huchard, placing the subject in a clinical point of view,
divides the affection into true and false^ or into organic
and functional anginae pectoris. The former is a rare
disease and consists in an organic alteration of the coro-
nary arteries, producing ischaemia of the heart, and which,
sooner or later, almost always proves fatal. The pseudo
or functional angina is much more common, and is met
with as a complication of other affections, such as hys-
teria, neurasthenia, neurosism, exophthalmia, arthritis,
rheumatism, gout, dyspepsia, etc., which angina is con-
sidered perfectly curable.*
As regards the treatment of angina pectoris. Dr.
Huchard has found nothing equal to the nitrite of amyl,
which he says fulfils the two principal indications : the
suppression of pain and the overcoming the syncope
which attend the disease.
Dr. Huchard prefers the nitrite of amyl to anything
else during a fit. It acts with extreme rapidity, in a few
seconds, and mav thus prevent imminent death. Its ac-
tion is explained as follows : It increases the activity of
the intra-myocardiac circulation in the cases in which the
latter is seriously impeded by the spasm or obliteration of
the coronary arteries. Moreover, it acts on the peripheric
arteries by producing dilatation in them, and by thus
diminishing the peripheric resistance it favors and aug-
ments the ener^ of the central organ of circulation. Dr.
Huchard administers the nitrite by inhalation in doses of
three to six drops, which is poured on a handkerchief and
may be repeated two or three times in the twenty-four
.hours. It is considered advisable to begin with the ,
minimum dose, that is, three drops, which may be gradually
increased to ten, twelve, fifteen, and even to twenty
drops at a time. Dr. Huchard considers the nitro-
glycerine and the nitrite of sodium as inferior to the
nitrite of amyl in the treatment of this affection. As
adjuvants or preventives the author attaches great im-
portance to the employment of the iodides of potassium
or sodium, the latter being the more preferable, as it is
1 This form is also produced by the abuse of tobacco* and is explained by the
direct influence of the poison on the heart and its blood-vessels, and also by.its
action on the nerves of the heart and of the stomach.
56o
THE MEDICAL RECORD.
[November 15, 1884.
better tolerated by the patient. Such is the treatment
of the true angina pectoris. In the pseudo forms, the
same inhalations combined with h3rpoderniic injections
of morphia may be usefully employed during the par-
oxysms, and hydrotherapy to prevent recurrences of the
latter. The treatment appropriate to the concomitant
affections must, at the same time, be rigorously at-
tended to.
If the present cholera epidemic in this country, which,
however, is gradually dying out, has been disastrous in
one way, it has proved beneficial in many others. It
has roused the people to a sense of the necessity of thor-
ough sanitation, which I mean to be used in its widest
sense — personal, domiciliary, and public. Everywhere
sanitation is the order of the day, and among other meas-
ures the Parisians are only now beginning to look to
their potable water, and they now admit that the water
they drink may be the vehicle of disease-germs, and par-
ticularly those of cholera and typhoid fever, a fact long
well known to them, but which up till now they have
repudiated, simply because it was not a French idea.
The sages have since discovered that the water of the
Seine is a great deal more contaminated than it was
twenty years ago, even in making allowance for the in-
crease of the population, and projects have been set on
foot in and out of the Academy of Medicine for its thor-
ough purification, and for the adoption of such measures
as may be necessary to prevent its being rendered foul.
Apropos of cholera, Dr. Leroy de M6ricourt read his
report on the numerous papers that were forwarded to
the Paris Academy of Medicine on the nature and treat-
ment of cholera, and among them was the report of the
commission formed by the Soci6t6 de M6decine of Mar-
seilles, which concluded that Koch*s theory was only a
hypothesis without any foundation, and that the comma-
bacillus could not be looked upon as the specific agent
of cholera.
Paris is in a remarkably healthy state at the present
time. It is free from epidemics of any kind, and even
typhoid fever, which is generally so prevalent in spring
and autumn, has been raging with less severity than it
has done for many years previously, the number of deaths
during the last two weeks being fewer than that shown in
any previous weekly report of this year.
The Council of Hygiene and of Salubrity of the Seine
has proposed the creation in Paris of refuge-houses where,
in case of the occurrence of croup or any other con-
tagious malady among children, parents could remove
them at once. They will there be properly cared for
until they have completely recovered, and thus prevent
further contagion among other members of the family.
Official List€f Changes in the Staiiotu arndDuHss ef Offiars
serving in the Medical Department^ United States Army^
from November 2 to November 8, 1884.
Spencer, W. C, Major and Surgeon. Ordered to
Fort Trumbull, Connecticut, for duty as Post Surgeon,
relieving Assisilint Surgeon William J. Wilson, U. S. A.,
who will report at Department Headquarters and await
further orders. S. O. 227, Department of the East,
November 5, 1884.
CoRBissiER, W. H., Captain and Assistant Surgeon.
Ordered to Fort Grant, A. T., for duty as Post Surgeon.
S, O. 102, Department of Arizona, October 30, 1884.
Hopkins, William E., First Lieutenant and Assistant
Surgeon. Ordered to Fort Lowell, A. T., for duty as
Post Surgeon. S. O. 102, Department of Arizona, Octo-
ber 30, 1884.
Egan, Peter R., First Lieutenant and Assistant Sur-
geon. Relieved from duty at Fort Lowell, A. T., and
ordered to Fort Bowie, A. T., for duty as Post Surgeon.
S. O. 102, Department of Arizona, October 30, 1884.
Official List of Changes in the Medical Corps of the U. S.
Navy^ during the week ending November 8, 1884.
Craig, Thomas C, Passed Assistant Surgeon. To
the Alliance for temporary duty. November i, 1884.
Swan, Robert, Passed Assistant Surgeon. Detached
from the Naval Hospital, Norfolk, Va.,.and placed on
sick leave. November 3, 1884.
WiEBER, F. W. F. Appointed Assistant Surgeon.
November 3, 1884.
^jedical Items.
Contagious Diseases — ^Weekly Statement.— Re-
port of cases and deaths from contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the week ending November 8, 1884 :
Week Boding
Cases.
November i, 1884
November 8, 1884
Deaths,
November 1, 1884
November 8, 1884
I
A Fresh-Air Supply for Cities. — A writer in the
Journal de Midecine de Paris advances the curious prop-
osition of furnishing all large cities with an abundance
of fresh country air just as they are now supplied with
gas and water. He draws a vivid picture of the count-
less benefits that would follow* from the general adoption
of such a plan. The sick and the debilitated would re-
gain health and strength, while the capacity of city
dwellers for intellectual and physical labor would be
greatly increased. The method proposed is simple
enough. A large open field is to be chosen in the
country and this is to be surrounded with a high wall and
planted around with balsamic trees so as to filter the air
from dust. Then by means of an immense fan the air is to
be forced through a large conduit and distributed through
smaller pipes to the chambers in the dwellings and other
buildings in the city. In summer the air could be cooled
and in winter warmed before entering the houses. The
imaginative writer calculates that by means of a turbi-
nated wheel three metres in diameter and a twelve-horse-
power engine^ 120,000 cubic metres of air could be de-
livered to the city every hour. Such an atmospheric rus
in urbe would be very charming, and so doubtless would
be the odor of this once pure air after it had traversed
several miles of city soil in company with the sewers and
the gas-pipes.
Temporary Preservation of Post-mortem Spec
MENS. — In the second number of The Asclepictd^ among
the Opuscula Practica, Dr. Richardson describes a
method of temporarily preserving specimens taken from
the dead body. A wide-mouthed bottle, with a large
stopper, which is made to fit evenly by the use of a litUe
glycerin, is filled with a mixture of common coal-gas and
one drachm of ammoniated chloroform. The stopper is
then tied down. Any part which is desired to be pre-
served is placed in a fold of soft muslin and gently pressed
so as to remove superfluous fluid. The next point is to
introduce the part enveloped in the muslin into the bot-
tle without displacing more of the gaseous contents than
necessary. The ammoniated chloroform is supposed ** to
prevent the breaking'up of the water of the tissues," and
the carbon monoxide of the coal-gas preserves the color
of the specimen. — Lancet.
The Medical Record
A Weekly yournal of Medicine and Surgery
Vol. a6, No. 21
New York, November 22, 1884
Whole No. 73S
ilhrigitmX Ji^rtijcIcB.
SOME MORE EXPERIENCES WITH JEQUIRITY.
By CHARLES SOHNLIN, M.D.,
ST. PAUL, MINN.
Not many new remedies produced such an excitement
as the jequirity did, but like every newcomer it had, and
has still, to struggle hard before it gets the recognition
which it merits. The opinions of the authors are still
now divided : some of them praise it as one of the great-
est remedies, others condemn it altogether, and a third
class of authors keep quiet, waiting for what will be
the end of the fight. What we want is the publication
q{ some more clinical observations, sine studio et ira, but
with a more special description of the peculiarities of the
cases.
Let us first look over a little the clinical experiences
of some authors. After a few favorable reports a great
deal of opposition was made by DenefFe, of Ghent.
He says he never got a good result, but he saw in one
case a simple vascular keratitis becoming a pannus cras-
sus, and he had in one case a perforation of the cornea.
He always maintained the inoculation of gonorrhoeic virus,
and does not think the jequirity has any advantages over
it ; on the contrary, he thinks the effect of the jequirity is
transient, while the inoculation of the gonorrhoeic virus
produces a permanent cure.
But about the same time Dr. Peschel, of Turin, pub-
lished first twenty-two and then about eighty full cures
with jequirity, without any failures or any accidents. He
had only to produce the inflammation several times, then
the eye healed up completely. Twice he met a slight
infiltration of the cornea which quickly healed.
In this country the jequirity was first tried by Dr.
Omening, of New York, who published two favorable
cases in The Record, February lo and March 17, 1883.
After this Dr. Feck published five first-class results, and
twelve cases succeeding in a less degree. He never had
a bad accident to the cornea, only some transient des-
quamation. Also Dr. Hotz, of Chicago, Dr. Standish, of
Boston, myself, and others published some very good re-
sults with jequirity. Dr. Landesberg, of Philadelphia,
treated 9 cases, but had in 5 cases no result, in 2 cases
a bad inflammation of the cornea, and in i case a pan-
ophthalmitis.
Some bad results were also published in Spain. Dr.
Osio lost three eyes by panophthalmitis, and had one
case of perforation of the cornea and one case of a large
leucoma. Dr. Chiralt, another Spanish oculist, had only
favorable results.
The Russians like the jequirity : Dr. Adamyk, Dr.
Schmidt (40 cases). Dr. Maklakow (10 cases), and others.
In Algiers Dr. S6dan had, under 16 cases, 3 full cures,
7 cases were improved, 6 remained unchanged, and in
one case he had a bad afiection of the cornea.
In Italy, besides Dr. Peschel, also Dr. Mazza, Dr.
Ponti, 'Dr. Guaita, Dr. Manfredi, and others, had some
first-class results. They could not cure all their patients,
but a great many of them. Dr. Manfredi had some bad
accidents, he lost three eyes, but, as he says himself, by
the use of too strong infusions of jequirity.
On January 28, 1884, there was in the French Society
of Ophthalmology a very instructive discussion about je-
quirity, which is especially interesting because there were
given some more special indications for the use of this
important drug. Coppez had only first-class results,
never a failure, and never an accident. Menacho and
Vallez unite in praising the jequirity. Nicati saw some
good results only when the cornea was covered with
pannus, and never in the beginning of the disease. Some
men, like Galozowski and Dor, never saw a good result,
but Nachet cured ten out of eleven cases. Armaignac
had, in the same patient, on one eye a first-class result,
on the other eye a failure. He produced with the mas-
sage just as intense an inflammation as with the jequirity.
Panas likes the jequirity, but only in some inveterate
cases with pannus. De Wecker thinks it has to be
avoided in aJl the cases where there is the least tendency
to purulent discharge. Gayet and Bordet had thirty-
three failures with children. They treated with jequirity
some children two years of age, who had had, in their
opinion, for two weeks, granulated eyelids. When you
read Bordef s paper, you do not wonder that he obtained
no result, you only wonder that he always continued to
treat other children, after having had some failures with
them, and that from an experience limited to children he
drew conclusions about the general use of jequirity.
Some important indications for the use of jequirity
were given by Von Hippel He found, as Sattler, that
the condition of the conjunctiva is of great importance.
When it was covered with scars, then he never obtained
a typical inflammation ; the cases with papillar hyper-
trophy were also unfavorable. Besides, the condition
of the cornea is of interest. A cornea which is still in
good condition is in greater danger from jequirity than
a cornea covered with pannus, or even an ulcerated
cornea.
In cases of fresh granulations with much hypersemia
of the conjunctiva, Von Hippel never saw a disappear*
ance of the granulations. But when the conjunctiva
was pale and to a large extent covered by some hard,
yellowish, prominent granulations, then he had some
first-class results ; if there was at the same time pannus,
the jequirity had a good effect upon it, but it disappeared
only after two to four months. . Some first-class results
were obtained in cases of expired trachoma, with atrophy
and shrinking of the conjunctiva and a thick pannus.
After all these many observations it seems a l|Kle
strange that Professor Jacobson, of Kcenigsberg, Prussia,
last summer, scared by one case of panophthalmitis he
produced with jequirity, wrote a furious article against
De Wecker and the jequirity humbug, as he expresses
himself. He admonishes the other physicians to be
cautious, '^ as his case did not seem to be the only one
of this kind.'' Also his assistant. Dr. Vossius, had no
good results with jequirity. He used it over fifty time?,
but he cured neither the acute hyperaemic nor the pale
dry granulations. He got a good result only at times in
cases of old trachoma with scanty granulations and
pannus ; still, in these cases he likes better the sulphate
of copper. Besides, he had many accidents ; three times
an acute dacryocystitis, one time gangrene of the eyelids,
fever, delirium, a long-lasting affection of the ear, and
periostitis of the nasal bones. Once the opacity of the
cornea grew worse and glaucoma was contracted ; again,
he had a purulent keratitis and panophthalmitis. No
other author had such bad luck as Dr. Vossius. Dr.
Chauzeix, of Paris, had better success ; he used the
jequirity also in fifty cases, and with good result. On
562
THE MEDICAL RECORD.
[November 22, 1884,
the other side, Dr. Schenkl, of Vienna, had thirty failures
with jequirity.
1, for myself, am very well satisfied with the jequirity
after an experience of over fifty eyes treated with it. But
I selected my cases carefully.
First. — I never used the jequirity in a child's eye;
my youngest patient was a girl of fifteen years, with
granulations and pannus of two years' standing. She
went three times through the jequirity treatment and was
improved a great deal, but not fully cured. When 1 dis-
missed her she had still a few granulations at the fornix
and a slight pannus. The conjunctiva looked white, the
cornea a little cloudy, without veins ; but when I kept
the eyelids open for a while, then the conjunctiva soon
became red and covered with veins, and also on the
cornea appeared a few red lines which disappeared, to-
gether with the injection of the conjunctiva, within a few
hours.
Second, — 1 never tried the cure in a fresh case of gran-
ulations with hyperaemia.
Third. — I never proposed it in a case of dry, yellow-
ish, sago-like granulations, where the only trouble of the
patient is sometimes a burning sensation with some weak-
ness of the sight. 1 treated only two eyes of this kind,
by the special request of the patient, with jequirity, but
the granulations looked, after the treatment, exactly as
before. 1 added a few weeks of daily use of bluestone,
and succeeded in relieving the complaints of the patient,
but the granulations still exist.
Such eyes are in another danger from the integrity of
the cornea. I never had a bad accident, but the only
trouble I had was in a case of five-year-old granulations
with intact cornea ; the patient, a girl of twenty years,
had only on one side a little pannus at the upper border
of the cornea. 1 was badly surprised, at the fourth day
of the treatment, when the inflammation was going down,
to discover in the centre of both corneas a gray infiltra-
tion, which lasted about two weeks and left some slight
opacities.
Fourth, — I would never dare to treat with jequirity a
granulated eyelid during one of the inflammations which
occur so often in this disease. The accumulation of the
two inflammations might be fatal to the cornea.
The most favorable cases for the jequirity treatment
are those of three years' or more standing, where the
granulations have passed the acme of their development
If the eyelid is equally thickened and the granulations
are no more very prominent, but are imbedded in the
substance of the eyelid, and look more like spots than
like buttons, and if the upper half of the cornea is
covered with a narrow reticulum of fresh veins, which ap-
peared when the patient " had caught cold " and existed
for a few weeks without any change, then you have the
most favorable case for the jequirity treatment. Two
weeks after the first instillation of jequirity the pannus
and granulations are gone, the inside of the eyelid is
smooth and equal and has quite a peculiar appearance,
yellowish, pale, and gelatinous, as if transformed into a
substance like one of the granulations. As soon as you
see this appearance you can take the patient for cured.
The thickening of the eyelids never goes away.
Less favorable are those cases where you find the eye-
lids not thickened, but hardened and crooked, excavated
at the inside by curvature of the cartilage, and covered
with scars and some scanty prominent granulations, and
where the cornea is covered with a thin membrane, con-
sisting of pretty well developed connective tissue and a
wide-meshed network of old veins.
While I cured every case of the former kind with one
jequirity inflammation, I had in my cases of this latter kind
always to repeat it, and to add for so long a while treat-
ment with atropia and yellow ointment that I did not
know to which I owed the final result. In these cases
the corneal trouble has by-and-by grown independent of
the granulations ; it is (if there do not exist any irritating
eyelashes) maintained by the irregular form and the scars
of the upper lid, and the chief remedy is the atropia
Bluestone, which gives so good results in cases without
corneal trouble, is quite useless in such cases ; yellow
ointment does good if combined with atropia. 1 did not
see any harm done by the jequirity ; even the whole
process of the cure seemed to be shortened by it, but it
is too hard to judge about that, as the duration of the
trouble is also very different when treated alone with
atropia and yellow ointment.
When the cornea has been affected for a long while in
a more serious way the corneal trouble continues after
the granulations are gone, sometimes in the most favor-
able cases. One patient of mine, whom I treated eighteen
months ago with jequirity with a good result, calls about
every six months at my office with a fresh pannus ; it ap-
pears quite suddenly in a night and disappears, after in-
stillation of atropia, within a few days. When he came
to me he had granulations of ten years' standing, the eye-
lids were thickened and covered at the inside with granu-
lations. The cornea was covered with pannus and
several ulcers and spots. The eyes had been sore the
last four months without interval, and he was nearly
blind. The granulations disappeared within two days
after a treatment of five applications of a two per cent,
infusion. The ulcers of the cornea healed up within four
weeks, and left only some slight spots and an irregular
astigmatism. The lids remained thickened, their inside
became smooth and took the appearance as above de-
scribed. For the watering of the eye I split the tear-
points and introduced the probes a few times, as I
always do after the jequirity treatment. After treatment
in this way he was enabled to do his work as a stonemason,
and till to-day there has been no change in his eyes ex-
cept the above-mentioned slight attacks.
Another trouble which outlasts sometimes the granu-
lations are relapses of iritis. If anybody with granulated
eyelids contracts an iritis with synechias in connection
with his corneal trouble, then, of course, this is not cured
by the jequirity; still the strong diminution of the intra-
ocular pressure, which cannot be produced by any drug
in such a degree as by the jequirity, may have a good in-
fluence upon it.
As for the danger from the jequirity, I am not afraid
of that. If we take the great number of cases treated
with jequirity till now, in comparison with the few eyes
destroyed by it, then we cannot say that it is a'danger-
ous thing. Besides, we must take m consideration that
a good many of the accidents happened in the beginning,
when we were not yet acquainted with the indications
for the use of the new drug. Manfredi allows himself
that he used too strong solutions, others may have had
some unsuitable cases which they would now no more
treat with jequirity. It is hard for me to judge about
that, because I could not find out the details of all those
cases ; but, for instance, Jacobson's case was absolutely
unsuitable for the jequirity treatment. His case was a
middle-aged woman', with evidently expired granulations.
She had the last attack of inflammation fifteen years ago.
Jacobson used the jequirity with the intention to clear
up an opacity of the cornea which existed since the
childhood of the patient, and was nearly free of veins.
The inside of the eyelids were covered with scars, Ja-
cobson does not say that he saw any granulations; be-
sides, she had a blepharophimosis and a partial symble-
pharon posterius. Indeed he diminished, eight days
before the beginning of the cure, the phimosis by cutting
the external corner, but it is nevertheless more than proba-
ble that in this case the cornea was exposed to quite an
extraordinary pressure. I do not think that from Jacob-
son's case any other conclusion can be made but that
the jequirity was used in a case unfitted for it.
The presumption that all the cases ending fatally, in
which no too strong solutions were used, have been in a
similar way unfitted for the jequirity treatment, like the
one of Jacobson, is the only explanation I can give for
their loss. If the jequirity would be a dangerous rem-
November 22, 1884.]
THE MEDICAL RECORD.
563
edy, as the gonorrhoeic virus seems to be for the eye,
then I think I should also have had an accident in my
fifty cases. I used in no case less than three applica-
tions of a two per cent, infusion within nine hours, the
first one at 9 a.m., the second one after noon, and the
third one at 6 p.m. Often I added even a few more on
the second day, when the eye was already inflamed.
But I allow that the necessity of selecting the cases
properly is a great impediment to the general use of the
jequirity by the physicians. This is shown by the experi-
ence of Professor Jacobson, who selected his unfitted case
for a trial with the jequirity just because he mistook it
for a very suitable one. I should be happy if my lines
would help a little in this regard, and I am fully con-
vinced that the jequirity, if confined to the proper cases,
will by and by get proper recognition as a beneficial
remedy.
THE TREATMENT OF DYSPEPSIA BY HOT
WATER.
By THOMAS W. SHEARDOWN, M.D.,
WINONA^ MINN.
In reference to the paper entitled "The Therapeutic
Eflfects of the Internal Administration of Hot Water in the
Treatment of Nervous Diseases," as read by Dr. Ranney
at the meeting of the New York Academy of Medicine,
October i6th, and published in The Record of October
25th, my own personal experience may afford some items
of interest
Let me premise by stating that I have, until one year
ago this last September, always enjoyed the most robust
health, have been something of an athlete, having required
medicinal treatment but once in my life, and that for pneu-
monia when twelve or fourteen years old, from which I
fully recovered in due time. During the last week in
August, 1883, I came near being prostrated firom sun-
stroke ; did not lose consciousness, however, but came
within an ace of it. The week following I commenced
having some trouble with my digestion, vomiting occasion-
ally, this emesis soon becoming more and more frequent
until I voniited a portion of every meal taken. Now, by
vomiting I do not mean just simply spitting up a mouth-
ful, or a small portion of food now and then, but a square
old-fashioned vomit, ejecting a major portion of the con-
tents of the stomach each time. This act of emesis was
preceded by no pain or nausea whatsoever, absolutely
none, nor have I ever experienced any pain or nausea
either bcforey during^ or after the act of vomiting, simply
an uncomfortable feeling which would not subside until
the food was ejected ; then instandy all was serene and
quiet until after the next meal. I could vomit easily,
with no trouble at all, and at any hour of the day or
night. The usual time for ejecting my food (for it be-
came a habit) was from one-half to two and a half hours
after eating. There seemed not to be so much trouble
with my powers of digestion as with absorption and
assimilation, for the act of chymification seemed to be
performed all right The stomach seemed to prepare
the food, but there it would lie in a pulpy mass, the sys-
tem refusmg to take it up, except, of course,'in very limited
quantities. I was not always actually compelled to vomit
after each meal, for I could, by exercising all of my will
power, keep it and carry it over a meal, or even two
meals, but there it would lie, and until I emptied my
stomach I was always uncomfortable — mind, no pain, or
nausea, or heartburn, or anything of the kind ; simply an
uncomfortable feeling that was instantly relieved by empty-
ing the stomach.
This condition of afiEsdrs went on for about three months,
viz., from the first week in September, 1883, until the day
after Thanksgiving. During this time I had tried all, or
nearly all, the modes of treatment and remedies recom-
mended by our best authors. All of the pepsines, pan-
creatines, lactopeptines, saccharalid and otherwise, acids
and alkalies, strychnia, nux vomica, and arsenic, etc..
ad infinitum ; in fact, all of the recognized forms of treat-
ment— of course endeavoring to govern, regulate, and re-
strict my diet. From the pepsines, lactopeptines, and pep-
tones, I derived positively not the slightest benefit nor
from the acid treatment. From alkalies followed by arsenic
I received some temporary benefit, but soon relapsed into
the same old rut of constant and regular emesis. I was
constipated, of course, and was obliged to resort con-
stantly to laxatives, and used the common " seidlitz
powder " more than anything else. Aside from this, my
general health was pretty good. I had a ravenous ap-
petite all the time, invariably arising from the table
hungry ; had no headache, no pulmonary or catarrhal
difficulty ; urine normal in color and quantity, but a
little deficient in weight. Occasionally would see the
black specks of indigestion before my eyes, and at
five or six different times my eyes would lose the power
of accommodation for a short time only. In trying to
read or write, my words would all run together and be
blurred, and I could not make my pen follow the line,
and for a few minutes I could not exercise the power of
speech with control ; I could not say what I wanted to.
I would try to say a certain word or phrase, ask or an-
swer a certain question, and I would say something else
entirely irrelevant. I would know and realize instantly
when I used the wrong words, and would stop and try
again, and after several times trying and using all my
will power in concentration of my mind and thoughts I
could get my words right. These nervous irregularities
only occurred a few times and only for a few minutes,
not over ten or fifteen, at a time ; but tliey were
accompanied by a little, not much, dizziness, a very
weak and faint feeling pervading the whole system —
an indescribable sick feeling not to be localized, but
general. These nervous phenomena and sickness would
pass away immediately after lying down flat on my back.
I think I have outlined the details of the trouble
from which I suffered. Let me repeat one thing to
make the point I am coming to more striking. From the
first week in September until the day after Thanksgiving
— about three months — I vomited every single day, never
less than twice (unless I would force myself to retain nay
food), and frequently four and five times. I am safe in
saying I vomited not less than three hundred and
fifty times in that length of time. I had lost fifty pounds
in weight, and was becoming very nervous, irritable, de-
spondent, and disheartened. Was losing all energy and
becoming very weak. How I got enough nourishment
to sustain life at all is still a mystery to me. I had been
carefully dieting myself, and regulating and restricting
food both in quantity and kind, with no benefit whatever,
and on Thanksgiving Day I made up my mind I would
eat at least one more square meal, let come what would,
so I ate a hearty, old-fashioned turkey dinner, with its ac-
companiment of mince pie, English pudding, etc., top-
ping off with a plentiful supply of egg-nogg. As a
natural consequence, I was very sick, more so than
ever before. Just the day previous I had read Dr.
Cutler's article, in the London Lancet^ on the use of hot
water in dyspepsia, and without much faith made up my
mind to try it. The last thing at night on Thanksgiving
was to empty my stomach again, and the first thing
the next morning I had my maid bring a pint of hot
water, boiling hot, to the bed before I got up. I took a
clean rubber catheter and sucked the hot water through
that, it being so hot I could not touch my lips to it at all,
nor hold the vessel in my bare hands. I drank all of
the water in less than twelve minutes. I laid in bed an
hour and a half, and then got up and ate my breakfast of
porterhouse, baked potatoes, bread and butter, and coffee,
and I kept it down, and with no unpleasant feelings. At
10.30 A.M. I drank twenty ounces of hot water taken from
the fire boiling, and taken through a tube as before, ate
dinner at 12 o'clock and retained it. At 4.30 p.m. I drank
twenty-four ounces of hot water, and at 6 o'clock ate my
regular supper and retained it. I drank sixteen ounces
564
THE MEDICAL RECORD.
[November 22, 1884,
more half an hour before retiring. The next day I
went through the same performance again, taking sixteen
ounces each lime, and likewise every day until Christ-
mas Day. Not once did I miss taking my lyater in six-
teen-ounce doses, nor did I vary five minutes from my
regular time ; nor did I during that time take one
drop of liquid food, milk, tea, coffee, or cold water, or
any hot water, except at the time specified.
After the first draught of hot water not one single
time did I vomit, until Christmas Day, when I foolishly
omitted my hot water, and partook of a Christmas din-
ner from which 1 was sick the remainder of the day and
the day following ; but recourse to hot water soon cor-
rected it. Now, this shows the efficacy of the hot-water
treatment. It stopped the vomiting at once — not slowly
or gradually, but at once. From Christmas until the
middle of last September, about nine months, I used the
hot water, but not as regularly as I should have done. I
would use it a couple of weeks at a time, and it would
stop the vomiting at once, but after ceasing I would oc-
casionally eject my food, but only after some indiscre-
tion in diet. I removed from Tennessee (Knoxville,
where I had lived the last year) to my old home in Min-
nesota, and since I have reached here, my native
State, and where I have lived nearly my entire life, I
have been able to discontinue the hot water entirely, and
remain well, gaining strength every day and fast recover-
ing my normal weight. This change of climate has, of
course, helped to benefit me. Then one great auxiliary
to the hot-water treatment I have found out is an almost
exclusively meat diet^ putting as little of a fermenting
nature into the stomach as possible. It has been said
of this hot- water treatment that it is very slow in its ef-
fects. In my own case it acted at once, from the very
first draught.
The modus operandi of the hot water in my own case,
I must confess, I do not fully understand. I had always
considered my trouble reflex in character, and due to
some irritation to the pneumo-gastric from overheat. For
the past ten months I have used hot water in my prac-
tice in quite a number of cases of dyspepsia, indigestion,
and allied gastric troubles, and with most excellent re-
sults every time when the treatment was persevered in
for any length of time. Ordinarily, I think, the hot
water acts more mechanically than otherwise, by moder-
ately distending the walls of the stomach and washing
them thoroughly, carrying down all debris, thus leaving
the stomach perfectly sweet and clean for the reception
of food. The presence of the water hot would tend to
allay the inflamed mucous surfaces, and also tend to
stimulate the secretion of the gastric juices, cold water
having a diametrically opposite tendency in my humble
estimation. The ingestion of cold water, and, in fact,
any and all fluids, must be absolutely prohibited ; no coffee^
no milky no tea.
After drinking the hot water in the prescribed quan-
tities regularly for two or three days, there will be no
sense of thirst between meals, as it were, the draught of
hot water effectually satisfying all the demands of the
system for liquids. The patient will begin to even relish
the large dose, which at first thought seems so unpalata-
ble. 1 used the hot water all in all for nearly a year,
and never got tired of the taste. There is only one ob-
jection to its use, and that is the amount of time con-
sumed and the bother and trouble in its preparation.
After continued use, should it pall on the taste, flavor
with a few dops of essence of peppermint or cinnamon,
or a few drops of any of the dilute mineral acids make a
pleasant change.
The rules laid down by Dr. Cutler, also by Dr. Ran-
ney, must be rigidly enforced. I can fully endorse them.
Without following closely these directions you cannot
make a success of the " hot-water cure." Let me formu-
late them again, i. Prohibit absolutely all other liquids.
2. Drink the water in as large quantities as will effectually
satisfy all demands of thirst, as hot as can be borne, four
times daily, an hour and a half before each meal and half
an hour before retiring, the object being to have the
stomach as nearly empty as possible when the water is
taken, and to give it time to get out of the stomach be-
fore food is taken, thus avoiding dilution of the food. 3.
Limit your patients to as near an exclusive meat (rare)
diet as possible.
These three rules, if rigidly enforced and followed out,
I fully believe, will effectually control that bugbear of
American physicians — dyspepsia.
November x« 1884.
DEAD TEETH IN THE JAWS.
By R, wood brown, D.D.S., M.D.,
LATE DENTISl- TO THE OUT-OOOK SBKMCB OF THE LONG ISLAND COUJtGF
HOSPITAL.
Under the above title there have appeared in Thk
Record several articles the reading of which has
prompted me to pen this paper. I shall notice the dif-
ferent points irrespective of Uie order in which they ap-
pear, limiting myself more particularly to the editonal of
October 4, 1884.
The statement in the fore part of second section of the
editorial of above date says : " It would not be strange if,
in the course of events," "when all teeth without pulps,
and hence in process of more or less decay, as well as
those which the deposit of tartar, or other cause, had
entirely divested of periosteal nourishment, would be
promptly condemned as unfit to remain in the jaws."
We take the liberty of disagreeing with the editor as
regards the ffrst part of this statement, and we think he
is wrong in the latter part.
Teeth without pulps are not necessarily dead. Dr. J.
Morgan Howe, Medical Record, October 18, 1884,
writes correctly that teeth " are not in an appreciable
degree deprived of periosteal nourishment by the death
of the pulp." When we have a periosteum destroyed wc
almost always find a pulpless tooth, but we do not con-
sider a tooth or root dead unless the entire periosteum
is absorbed ; a tooth may be a living structure long after
the pulp is dead or removed. If we should extract a
tooth in a normal condition, crack it open, and try to re-
move the pulp from its bed with a pair of pliers, we wiD
notice that there is some difficulty in so doing. Why ?
Because the pulp is attached to its parietes by odonto-
blasts, which are connected to the pulp by small bands,
and to the dentine bv fibrillae which enter the dental
tubes. It is thus shown why the dentine is so sensitive
when attacked by caries, also the part it takes in the
nourishment of the member. Now, take the same tooth
and make a section of the root, and we will find, under
the microscope, that the dentine is composed of tubes
one-ten-thousandth of an inch in diameter ; that the
crusta petrosa, or cementum, is made up of lacunae and
canaliculi, but no Haversian canals ; also that the perios
teum is full of blood-vessels. We will also see that the
tubes are connected to the lacunae and canaliculi directly
and by interglobular spaces, and that the latter are in
connection with the periosteum.
Again, if we view a transverse section of dentine, we
will notice that the tubes contain fibrillae or a substance
capable of carrying nourishment. In a dry section, the
contents being contracted, this substance can be seen
more easily. We have now a direct connection between
the dentine and periosteum, and can understand why the
pulp is not necessary to the vitality of the tooth, having,
as it does, ability to draw nourishment from the perios-
teum, thereby maintaining its normal condition. It
should be remembered that membrane covering the pulp
is continued through the apical foramen and becomes the
periosteum upon the roots. If there is a membrane lin-
ing the pulp chamber, we have not been able to find it.
What part the pulp takes as regards tooth structure, after
the tooih is formed, is, we think, not positively known, but
our experience tells us that teeth are just as liable to de-
November 22, 1884.]
THE MEDICAL RECORD.
565
cay with pulps as without them. The damage from caries
is done before the dentine is reached ; the cause of caries
is from without, not from within. If a tooth is perfect
when erupted, it will last a lifetime unless injured by
acids or abrasion. Pulps counteract decay so far as to
throw out lime salts into the dental tubuli, which make a
more perfect barrier to the encroachments of decay ; this
same process goes on after a nerve is capped. The den-
tice after this change is called osteo-dentine ; why, we do
know, as our microscopical investigations have not shown
any characteristics of bone in the so-called osteo-dentine.
This action of the pulp in resisting decay is the only
part it takes in nourishing the tooth, and even here there
is not sufficient pabulum thrown out to resist the encroach-
ment, much less to restore broken down structure. The
only result from the barrier thrown out by the irritated
pulp is a retardation of the progress of decay. The very
fact that a large number of pulpless teeth and roots are
retained in the mouth without periostitis, ulitis, or suppu-
ration, is sufficient testimony that dental pulps are not at
all necessary to the retention of teeth ; also that pulpless
teeth should not ''be condemned as unfit to remain in the
jaws," and that teeth are not necessarily in the process
of more or less decay *' because deprived of nourishment
on account of dead or extirpated pulps.
As to the latter part of the editorial statement — " as
well as those which the deposit of tartar, or other cause,
had entirely divested of periosteal nourishment, would be
promptly condemned as unfit to remain in the jaws."
The main point here is the divestment of the perios-
teum. We do not think a root ought to be removed for
the reason that there is no periosteum ; it does not follow
that the root is offensive and discharging purulent
matter because divested of its membrane. There are two
kinds of decay, hard and soft, the latter emitting a dis-
agreeable odor, the former not doing so. Memory bears
us out in saying that crowns of teeth are more apt to be
the prey of .soft decay than are the roots. The excep-
tions in these cases prove the rule. If a root is entirely
divested of periosteum, the crown gone and no diseased
tissue surrounding it, there should be some hesitation
before condemning and removing from the jaws. Every
root taken from either maxillas weakens the arch and
seriously threatens its usefulness. Again, the presence
of tartar or salivary calculi does not always threaten the
life or usefulness of a tooth, even if the entire periosteum
under the deposit is destroyed. We have seen teeth
covered with tartar to such an extent as to preclude the
probability of any membrane remaining, yet for years
after they have been doing good service.
There are certain conditions which should govern the
extraction of teeth or roots, and they are pre-eminently
pathological. Periostitis, where it is not traumatic, indi-
cates one of two causes, or may both — a diseased pulp or
periosteum. Here it is bad practice to extract, if of
recent origin ; if chronic and the roots crownless, we
advise imuiediate removal. If there is a probability of
the disease abating and there is enough structure to work
upon, then extraction should be a dernier ressort Af-
fected teeth with crowns are more liable to produce in-
flammation and its train of disturbances than are roots
alone, owing to continued irritation by mastication.
Periostitis does not always destroy the periosteum, but,
if mild and chronic, may produce a condition known as
exostosis. This many times is the cause of neuralgia
from pressure upon the nerve. Many patients are dosed
with all the neurotics known, without the thought of
chronic inflammation of the dental organs ; yet, on the
other hand, many a dental arch is sacrihced without caus-
ing relief. Teeth in which the pulp remains after death
very often causes discoloration from hematine which is
absorbed into the dental tubuli.
The editorial remarks in the latter part of the second
section, relative to the danger from putrescent teeth, are
not too strong, but to the point, and certainly they do
not merit discussion ; in fact, they are irrefragable.
The object of this paper is an endeavor upon the part
of the writer to correct what he thinks is an erroneous
idea — the idea that teeth, because diseased, should be con-
demned as unfit for the jaws ; also to show why they
should be allowed to continue their usefulness. It should
not be forgotten that roots preserve the contour of the
dental arch, and are not always foreign bodies when the
pulp is destroyed, even if both pulp and periosteum have
ceased to perform their functions. We know that many
constitutional disturbances are attributable to diseased
dental organs, and, owing to professional inability, many
teeth are lost. This naturally leads us to the third sec-
tion of the editorial mentioned, which speaks of dental
education. It is lamentably true that a large number of
dentists are utterly incapable of treating severe, compli-
cated cases of diseased teeth, but we must not enter the
field of dental education, although it is a subject which
has occupied our mind and pen, and is still occupying
our thoughts.
ElXVBNTII AND MaIN StRKBT, KanSAS CiTY, Mo.
BUCCAL BREATHING.
Its Causes, Serious Consequences, Prevention, and
Cure.*
By GEORGE W. MAJOR, B.A., M.D.,
LATE CLINICAL ASSISTANT IN THK HOSPITAL FtJR UlSBASES OK THE THROAT AMD
CHEST, LONDON, ENC. : INSTRUCTOR IN LARVNGOIjOGV AND DISEASES OP THE
THROAT, M*GILL UNI\'SRSITV, .MONTREAL, CAN.,' FELLOW OK THE AMERICAN
LAXYNGOLUGICAL ASSOCIATION .' I'HYSICIAN TO THE MONTREAL GENERAL OUT-
PATIENT DEPARTMENT.
The habit of breathing through the mouth, instead of
through the nose, is so very prevalent, and its serious
results so little appreciated, that I have been induced to
make it the subject of a few remarks before this Associa-
tion. The first breath of life is taken through the nostrils,
and if this precedent should not prove sufficient to satisfy
us of the natural mode of respiration, let us refer to
Genesis, where we learn that at the creation of man
" He breathed into his nostrils the breath of life." The
instinct of the savage mother leads her to carefully close
the lips of her sleeping infant, lest the cold air might
prove injurious should it enter the lungs by the passage
of the mouth.
The professional trainer insists upon the athlete breath-
ing with closed mouth. The fireman entering a burning
building carefully avoids speaking, or the parting of his
lips. It is recorded that one may breathe mephitic air
for a short time through the nose, if the lips are firmly
sealed. The army surgeon requires the raw recruit to
undergo, in his examination, physical fatigue with closed
lips.
All these decisions have been arrived at as the result
of observation, though no doubt to many of those who
insist that under certain circumstances nasal respiration
should be strictly observed, the true reason for this pre-
caution may be quite obscure, or perhaps entirely un-
known. Nine out of every ten persons will tell you that
the nose is the organ of the sense of smell, quite oblivious
of the more important function of respiration.
This question of oral respiration is one that has not
even at this late day received at the hands of the pro-
fession the study and research it truly merits. If it is the
result of mechanical obstruction of a permanent nisiture, it
is not a habit but zn unfortunate necessity ; but, on the
other hand, temporary nasal swellings often develop a
habit which is unconsciously and innocently pursued
with the most serious results to health and development.
Any one of a number of conditions may singly give rise
to oral respiration, but we generally find more than one
present before man allows himself to be converted into
a mouth-breather.
In the human economy the nose performs several ini-
^ Read before the Canada Medical Asbociatioiii held at Montreali August 26,
1884.
566
THE MEDICAL RECORD.
[November 22, 1884.
portant functions, the chief being that of a respirator. It
purines, moderates the temperature and moistens the
air before it reaches the sensitive larynx and lungs. It
purifies the air by arresting foreign and irritating particles
in their passage through the cavities of the nose. It
moderates the temperature of the air by rendering it as
nearly that of the human body as possible. It moistens
the air by virtue of the secreting power of its lining
membrane and glands.
An example of its first influence may be had in the fact
that in oral respiration dust will lodge in the pharynx and
larynx that under otherwise normal conditions would
scarcely, if at all, gain an entrance to these organs. Of
the second, on going into the cold outer air of winter a
single breath through the mouth will, by its impact, pro-
voke cough and a sensation of coldness, which, if taken
through the nostrils, would be so moderated that on reach-
ing the lower border of the palate it would give to one's
sensation no appreciable difference of temperature, and
could be breathed with comfort and impunity. Of the
third, if from any cause nasal respiration is impeded, say
during the night, we rise with dry, harsh palate, tongue,
and throat, the secretion of the buccal mucus being neither
so constituted nor sufficient to moisten the air and keep
the parts themselves in a healthy state.
The mouth was alone intended for the taking of food
and speech; it is, therefore, not very remarkable that
many and baneful results should follow in the wake of
those who violate the natural laws by putting parts to
uses for which nature never intended them.
Certain physical deformities result from this habit, ag-
gravated in the same proportion as that in which this
hurtful method is practised. Among these may be men-
tioned general debility ; malnutrition, as shown in spare
habit of body and undersize; deformed chest, with
prominent sternum, sunken sides, retraction at the line
of attachment of the diaphragm, and rounded shoulders.
The upper lip is more or less shortened, the mouth
open to a greater or less degree, the upper central inci-
sors generally prominent, with irregular development of
the symphysis of the upper jaw. The alae of the nose
are thin and flattened, and the muscles of the nose and
its neighborhood wasted. These conditions are always
more marked on the side of greatest obstruction. The
face presents a pinched expression. We also find an ex-
pression of stupidity in aggravated cases, with loss of
memory occasionally — these two latter possibly the re-
sult more of intemasal pressure than of mouth-breathing
directly.
Dupuytren many years ago associated pigeon-breast
with large tonsils; but in point of fact any interfer-
ence with nasal respiration, be the cause what it may,
will, if of sufficient gravity, produce this deformity. In
addition to the appearance laid down as indications of
oral respiration, I have observed an abnormal acute-
ness in the development of the upper jaw, whereby the
hard palate is of great vertical depth, with corresponding
narrowing from side to side. The central incisors in
this class of cases are not prominent, but usually show at
the middle line near the margin of the gums a point of
decay.
It is also worthy of passing comment to note the
frequency with which we encounter decay of the upper
teeth. According to my idea this is largely dependent
upon mouth-breathing. I do not think the prevalent
opinion, that the cause lies in the escape of corroding
gases from the stomach, is altogether a correct one. An
offensive breath, in my experience, arising from the stom-
ach, is somewhat infrequent. The odor, if not of de-
cayed teeth, is most probably that of decomposed nasal
or pharyngeal secretions, the tendency to change being
manifest in disordered constitutional conditions, especially
if accompanied by any elevation of temperature. The
injury to the upper teeth may be regarded as the result
of dryness caused by the passage of air between and
around them, facilitating decomposition of any food pres-
ent, and favoring the fonnation of acids capable of reacting
vigorously. The lower teeth are protected by the lip
and tongue, and moistened by the saliva, and are there-
fore free from the evil influences exerted above.
The injury to digestion, as a direct result of impairment
of the power of mastication, at once suggests itself. It is
not during the day only that the subject of oral respira-
tion suffers ; at night the aggravation is intensified. The
position of the body during sleep favoring, as it does, .
increased flow of blood to the head, the result is in-
creased difficulty, as shown by the open mouth, snoring,
and general restlessness, the latter the direct resuh of
deficient oxygenation, assisted no doubt by the fact that
during sleep the voluntary respiratory muscles used dur-
ing the day are no longer available.
I trust I shall not be considered as taking an extreme
view if I should state that after a careful inquiry I have
found that in a large proportion of mouth-breathers in-
voluntary micturition during the night is not unusual
This latter, of course, is attributable to carbonic-acid-gas
poisoning — the sensitive air-passage refusing to take in
the cold, dry, impure air, and as a result, there is deficient
lung expansion and aeration. It is unnecessary here to
enlarge upon the consequences of deficient oxygenation,
they are patent to every one.
The principal causes that lead to mouth-breathing are
the various deviations of the nasal septum ; ecchondrosis
and exostosis of the nasal fossae ; hypertrophy of the tur-
binated bones or of their soft tissues ; dilatation of the
various sinuses, whether of a permanent or temporary
character ; tumors of various kinds, known as polypi ;
oedema of the septum, particularly common at its pos-
terior border ; overgrowth of the erectile tissue of the
posterior temiinaiions of the lower turbinated bones;
adenomata ot the vault of the pharynx, being an hyper-
trophy of Luschka's tonsil ; growths in the same region,
the most common being fibroids and hypertrophy of the
buccal tonsils.
As the habit of mouth-breathing is developed usually
in early childhood, its prevention must largely depend
upon the recognition by those in charge of the forma-
tion of an unnatural and hurtful method of respiration.
In order to do this, mothers and nurses must first know
that the nose is the proper channel by which air enters
and leaves the lungs.
If the practice is merely the result of habit, induced
by some temporary nasal or naso-pharyngeal obstruction,
the simple closure of the mouth after clearing the nostrils
will generally suffice ; or if still more obstinately pursued,
a bandage tied under the chin and over the head will
serve to keep the jaws in contact. If there be, however,
any mechanical impediment, as swelling, hypertrophy, or
growths, they must be treated radically. The age of the
child never should negative surgical procedure, as the
conseqences resulting from neglect of early interference
may be fraught with very serious af^er-injury. In early
infancy I have more than once used the galvano-cauteiy
with the most satisfactory results.
It is manifestly the duty of the profession to teach the
public that the nose is the organ of respiration ; that
it is also the organ of smell they will themselves discover.
It now remains to briefly refer to the treatment essential
for the removal of the obstacle to free nasal respira-
tion. The first cause referred to, and perhaps the most
common, is deviation of the nasal septum. I may say
that in practice it is almost the exception to see a straight
one. Deviation of the septum may be single, double, or
multiple, and this may take place in a vertical, horizontal,
or diagonal line, or present so many irregularities as to
occupy every possible direction.
In many cases, especially of vertical deviation, the
angle at which the cartilaginous septum is bent is so
acute that the nostril in which the convexity presents it-
self is often so perfectly close as to be utterly useless for
any purpose of respiration : the prospective gain on the
opposite side is neutralized either by an hypertrophy of
November 22, 1884.]
THE MEDICAL RECORD.
567
the lower or middle turbinated bone and soft tissue, or
perhaps by a second deviation posteriorly, giving the sep-
tum a sigmoid shape. As regards the side to which the
deviation exists most frequently, statistics of over seventy
cases compiled by myself do not show any very special
selection as to right or left, but to the left, if anything.
No doubt exists in my mind that deviations are the re-
sult of mechanical violence — blows or falls on the nose.
Females, though presenting deviation, do so, for obvious
reasons, very much less frequently than males, and also
show a much less exaggerated type. In prize-fighters, or
those who have engaged much in boxing, the cartilagi-
nous septum is bent into every possible shape, without
very severely affecting nasal respiration or the external
form of the nose. In these cases the cartilage is tele-
scoped downward much on the principle of a mast, but
without radically closing the side passages. It has
seemed to me that a vertical deviation is more likely to
date from an injury received in childhood than from one
later in life, and an analysis of cases strengthens this belief.
In May last I saw a lady, Miss T , aged thirty-
seven, who had been confined to her bed for five months,
suffering from the most excruciating form of headache,
which had refused to yield to a variety of treatment. On
examination nasal obstruction from swelling of the mu-
cous lining was found, deviation of the septum posteriorly,
and more or less tiue hypertrophy of the turbinated
bones. Means, such as nasal inhalations and sprays, af-
forded some relief by reduction of the swelling of the
membrane, and much more decided, if not absolute immu-
nity from pain was had by successive applications of the
galvano-cautery. This result was obtained purely as the
result of diminished pressure. At first the patient was
incapable of even standing alone, but in a few short
weeks had gained strength, and is now perfectly restored
to health.
A second instance. Miss M , aged twenty-eight, who
had for some months been the subject of hallucinations,
and, at times, of violent mania, was referred to me for a
pain felt on the right side of the head behind the ear,
and covering a space of the area of the palm of one's
hand. Nasal obstruction in the right nostril, the result
of deviation, was noted, and when in the course of three
weeks it was somewhat reduced the mental condition had
wonderfully improved, and convalescence is now com-
plete. The pain, which was described as a sense of
pressure, impTOvtd ^ari passu with the reduction of the
nasal stenosis — as in like proportion did the mental
state. Each must draw his own inference from the re-
port of this case.
Under the head of deviation, a rather interesting ab-
normal hyper-development of the vomer, giving rise to
buccal breathing, might find place. Miss D , aged
twenty-two, was sent to me for treatment by my es-
teemed friend. Dr. Arthur A. Browne, of this city. Na-
sal breathing was impossible, and more or less deafness
was also complained of. The anterior nares showed no
cause. On exploring the vault with the index finger a
very peculiar state of affairs was found to exist. It gave
the impression to the touch of a partition running an-
tero-posteriorly, dividing the naso-pharynx into two sep-
arate lateral chambers. This bony extension refused to
be displaced, and seemed continuous with the vomer in
fioat, being joined to the vault above, and to the poste-
rior superior pharyngeal wall behind. On examination
with the rhinoscopic mirror the above description was
verified. It was covered with mucous membrane, which
had undergone catarrhal swelling, obstructing the passage
of air and pressing on the Eustachian orifice laterally.
Under appropriate treatment the engorgement was re-
lieved, and with it all the discomforts for which advice
was originally sought. There is but one other case of
the kind on record, that reported by Dr. John N. Mac-
kenzie, of Baltimore.
The fourth and last case that I shall present to you is
that of a prominent canon who applied more for relief
from vocal disability than for any pain or nasal incon-
venience, fie was a confirmed mouth-breather, proba-
bly from childhood. There was an extreme vertical de-
viation of the cartilaginous septum to the left, entirely
obstructing the nasal passage of that side, while the con-
cavity on the right was occupied by a long myxomatous
tumor. The soft palate clung listlessly to the pharynx,
having long since forgotten its function. The removal
of the growth, which was of considerable size, afforded
some relief, and as hypertrophies were reduced by local
medication and the galvano-cautery, satisfactory prog-
ress was made. Though no attempt has been made as
yet to operate on the deviation directly, manipulation of
it twice or thrice daily by the subject himself, shows
considerable alteration of its outlines. Meantime the
palate has gained some tonicity, and breathing is carried
on by the nose almost entirely. Snoring at night also
has ceased, and the voice, some months ago, was suffi-
ciently recovered to fill a large church at a crowded
service. These disabilities, however trifling they may
appear to the casual observer, may be, as in this gentle-
man's case, sometimes a serious obstacle to preferment.
The health also suffers from the exertion necessary to
make one's self heard from the pulpit ; the naso-pha-
ryngeal cavities ceasing to be resonators, much greater
pressure is necessary to produce voice.
These cases have been briefly referred to for the pur-
pose of showing how various and serious may be the
consequences of internasal pressure, and how speedily
and easily measures aimed in the proper direction may
give assurance of relief and cure.
For the relief of deflection or deviation of the nasal
septum a variety of means have been from time to time
suggested, but it is practically only in cases of the vertical
form that operative interference is either urgently called
for or hkely to be of value. The method (Ingalls',
of Chicago) that most commends itself, both from
its simplicity, as also its successful results, is that in
which the mucous membrane of the deviated side and
the cartilage are carefully divided in a triangular man-
ner, the apex being upward, the cartilage dissected from
the mucous membrane of the opposite side and removed,
the septum being brought into line with pliers, and the
divided mucous membrane held by sutures and a pad of
some soft antiseptic material. The resiliency of the car-
tilage is such that a portion must be removed equal to
the redundancy, in order to acquire a straight line. Of
the many punches introduced but one seems to me to
fulfil all the requirements, and at the same time to be
comparatively free from fault. It is one (Sajous', of
Philadelphia) in which a blade can be fixed at any de-
sired angle, and the septum divided through from side to
side, and straightened by allowing overlapping, or the
excess may be removed and the cut edges placed in line
and held by plugs until healed.
All the operations whereby openings between the nos-
trils were caused are unwarrantable, as forming a space
for the accumulation of dried secretions. It is not un-
usual to find nature performing the operation of removal
of the deviation by setting up ulceration and necrosis of a
portion of cartilage of the size of a sixpence, or even
larger. When this occurs pressure only is relieved, and
no appreciable gain is secured the nose as an air-passage.
Ecchondrosis and exostosis are of not uncommon oc-
currence, and are capable of removal by scalpel, saw, or
pliers, but more nicely by means of the surgical engine
and burr ; no violence is used, pain is trifling, and the
time occupied in performance is very brief.
Hypertrophy of the turbinated bones, if very consid-
erable, is also best reduced by the drill attachment, af-
terward crushing down and washing out the debris. The
hemorrhage is slight compared with that resulting from
the use of gouges and other means of destruction. Hy-
pertrophy of the soft tissues, with or without dilatation of
the venous sinuses, whether partial, general, temporary,
or permanent, has for many years been looked upon
568
THE MEDICAL RECORD.
[November 22, 1884.
therapeutically as a most unsatisfactory complaint. When
chronic, it has generally been termed hypertrophic ca-
tarrh, and when acute, hay-fever, summer catarrh, coryza,
and so forth. The various methods adopted for the
treatment of either the chronic or acute variety have '
been eminently unsatisfactory, more especially was this
the case in the latter.
In the chronic variety caustics were employed, whereby
large areas of tissue were destroyed, and great and pro-
longed pain ensued, or the actual cautery was introduced
through the nostrils and applied so as to form deep
sloughs, depending upon the cicatricial contractions for
a cure. In the acute form the use of various lotions and
pigments served the purpose of cleansing the tissue, with
little or no effect in shortening the duration or prevent-
ing a recurrence of the attack.
Independently of the pain and risks attending the em-
ployment of caustics in the nose, the function of the
organ must be somewhat interfered with if much of its
lining membrane is destroyed, and on the latter ground
alone recourse to these means is somewhat questionable.
The actual cautery as well as the thermo-cautery pre-
sent the not unimportant drawbacks that they must be
heated before being introduced, and unless both patient
and practitioner are uncommonly steady, and the passage
less tortuous than usual, more parts will be brought in
contact with the heated instrument than desired.
In the galvano-cautery, on the contrary, we possess an
appliance that answers all possible requirements. It is
under perfect control ; it does not destroy needlessly ; it
is not heated until in contact ; it is comparatively pain-
less, and if employed with ordinary care it need be fol-
lowed by no evil consequence.
The method of employing it in the chronic variety is
somewhat thus : After introducing the knife as far back
as possible, to turn on the current, drawing the electrode
slowly forward, steadily pressing its cutting edge against the
hypertrophy, thus scoring the tissue. This may be done
several times at each sitting. The good effects that fol-
low are not only the result of the contraction of the
mucous membrane, binding down, as it were, the enlarged
venous sinuses, but also the dividing of a number of mi-
nute superficial vessels bloodlessly at each passage of
the knife, while at the same time but little sacrifice
of tissue is engendered.
In the acute variety the procedure is somewhat different,
and for this reason : in those so-called cases of hay-asthma,
or hay-fever, there exists an unnatural , excitability or hy-
persensitiveness of the nasal mucous membrane, and it
is necessary to first allay that before scoring. This is
best accomplished by passing the flat of the knife as freely
as possible over all the lining membrane within easy
reach, and thus proceeding to incise deeply in a linear
manner as before described. That summer catarrh has
no peculiar relation to either the pollen of hay or of the
rose, or to any other spore or animal exhalation, is now
pretty well acknowledged. If any additional proof be
needed to strengthen this view, it may be found in the
fact that all manner of treatment based upon the spore
theory, heretofore introduced, has ignominiously failed,
and the treatment by galvano-cautery has been as uni-
formly successful.
The beneficial effect of high elevations in this sadly
misunderstood complaint is not that it frees the mem-
brane from contact with irritating substances, but may
safely be attributed to the influence a rare atmosphere
has in unloading the local apoplexy, thus rendering the
membrane less irritable. I have had under observation
a case where a lady, the subject of hay-fever, thrived
amid four hundred acres of timothy, and on returning to
the city was forthwith attacked by her old enemy.
Of the various tumors likely to be met with in the
naso-pharynx as obstructions to nasal respiration, there
maybe mentioned the gelatinous, polypous, and the fibroid
— the former very common, the latter rather rare. The
usual method of removal of the myxomatous variety by
forceps is somewhat objected to popularly, especially if
it has been once undergone. The forceps oftentimes is
the best means, however, of reaching the growths, ex-
cepting perhaps the various snares, properly curved and
armed with a special wire. These snares can be intro-
duced painlessly, and the growth engaged in the loop,
gradually working up its pedicle and running it close
to its attachment. An application of the galvano-cau-
tery now will prevent any likelihood of return. The
fibroid tumor, though capable of removal by the forceps,
can be best cut through at its origin by the galvano-
cautery wire ecraseur, and whatever pedicle remains
may be effectually destroyed by an application of the
electrode. A simple metho4 in the myxomatous variety
is to pass the knife through and sear up the body of Ae
tumor, thus exposing the pedicle to view, and leisurely
proceeding to cut it from its attachment with the same
instrument. This method has also the advantage of
being painless.
One peculiar feature I have observed is the difficulty,
and, I may say, the danger, attending the use of anaes-
thetics in subjects of nasal or naso-pharyngeal tumors,
when nasal breathing is impossible or very difficult.
M. A. C came under notice December, 1882, com-
plaining of suflfocative attacks on retiring for the night
On examination of larynx, congestion was found;
pharynx also involved in the hyperaemia. A posterior
rhinoscopic examination was impossible, owing to spas-
modic action of velum and attacks of difficult breathing.
Anteriorly, nares were found congested ; anterior illumi-
nation showed at posterior orifices a white, glistening
surface, visible through both nasal passages. A probe
passed was opposed by a partially yielding body,
preventing the further passage into the vault. This dtf-
ficulty was reinforced by recurring spasm of the soft
palate packing up the space. Tumor was diagnosed.
All efforts with forceps used posteriorly were rendered
futile by the spasmodic action of the velum and choking
on the part of the patient. Snares were borne heroically,
but all attempts, even with the finger passed behind,
were unavailing in engaging the growth, though fre-
quently repeated. Education of the pharynx was equally
unsuccessful. On June 7, 1883, assisted by my friend
Dr. Roddick, chloroform was administered, and so badly
borne that inversion and drawing out of the tongue,
which had been swollen, were practised, the jaws requir-
ing first to be forced open. Some minutes later, by
passing my finger up behind the palate and directing the
palmar surface backward, I succeeded in forcing the
tumor against the pharyngeal wall, and by steady press-
ure downward tore it from its attachment. Bleeding
was very free. The growth proved to be a fibroid,
and was on its anterior surface bilobular, intimately
adapting itself to the nasal orifice, while posteriorly it
was spherical, giving a cast of the vault.
The galvanic cautery was applied under chloroform
(which was now well borne) to the base of the tumor.
An examination a year afterward developed no re-
currence. The principal difficulty was referred to the
left subclavicular region, and flattening was undoubtedly
present, but no sign of dulness or other organic change
was observed.
A second case, W. M , male, aged seventeen, was re-
ferred to me at the Throat Clinic of the Montreal General
Hospital, by Dr. Roddick. In this case the right nostril
was the seat of attachment. The tumors showed from
the anterior nares, and the auriscope and finger develo]»td
the fact of extension into the pharyngeal space. They
were found to be attached to the middle turbinate. Two
were removed by forceps anteriorly, and the third and
largest one was pried backward as described in the
former instance. Bleeding was free, but easily arrested.
These growths gave rise to difficult breathing and asth-
matic attacks, with occasional bronchitis, for over two
years. The cautery was used a week later to the field
of attachment.
November 22, 1884.]
THE MEDICAL RECORD.
569
CEdema of the septum, diagnosed by rhinoscopy, is
easily overcome by either passing a long needle, made
for the purpose, through all tissue necessary for remov-
al, and afterward passing the cold wire down over and
cutting through ; but still more simply and expeditiously
with the galvano-cautery knife, one or two sittings ac-
complishing the task painlessly and effectually. Over-
growth of the erectile tissue of the lower turbinated bone
sometimes causes an obstruction to breathing, acting
Almost after the fashion of a valve at the posterior ori-
fice of the nasal passage. I have removed a pair as
large as small plums, that were the provoking cause of
one of the most severe attacks of asthma I have ever
seen. For the removal of these bodies the cold wire
straight 6craseur is best and most satisfactory, although
using the curved electrode from behind the velum has
answered well when from deviation of the septum or
other causes a snare could not be passed by the anterior
nares.
Adenomata of the vault may greatly obstruct nasal
breathing, and need instrumental interference. In early
childhood, when they are soft and numerous, they can
generally be easily scraped off with the finger-nail. In
the adult they become more tough, when forceps, snares,
or the hooded galvano-cauter}', become necessary. These
growths are very common, and are very frequently asso-
ciated with hypertrophy of the buccal tonsil. They may
be looked upon as the result of anterior nasal disorders,
and secondary to them. The tonsil of Luschka tends to
atrophy at adult life, unlike the buccal tonsil, so that
we may safely and truthfully say, in so far as the Eusta-
chian tonsil is concerned, that the child will outgrow ity
a statement often — ^unfortunately too often for the well-
being of the child — made use of with regard to the buccal
tonsiL The buccal tonsils, when hypertrophied, offer an
obstruction to nasal respiration often more by their back-
ward pressure on the posterior palatine pillars than by
reason of their bulk. When the enlargement is very
great, both oral and nasal breathing is impeded ; this is
the cas ! especially in the recumbent position.
In 1828 Dupuytren noticed the frequency of chest de-
formity in cases of enlarged tonsillar glands. Chassaig-
nac, in 1843, observed that although increased efifort
of the diaphragm neutralizes to a certain extent the im-
pediment to respiration offered by enlarged tonsils, there
are frequent intervals when the power of this muscle
becomes temporarily exhausted, and 'the oxygenation of
the blood is very incompletely performed.
Both these observers attributed the ill effects of en-
larged tonsils to the fact that they impeded the entrance
of air into the lungs, and not to the real cause, namely,
the prevention of air entering the lungs from the nasal
passage above. The pharynx is sufficiently spacious to
admit of a volume of air much greater, even if seriously
obstructed by enlarged tonsils, than could possibly pass
through the narrow anterior and posterior nasal orifices.
The spacious mid-chambers of the nose were intended
for the purpose of preparing atmospheric air for healthy
lung respiration, and have no influence whatever on the
quafitity capable of being transmitted through the nasal
passages. As to the wisdom of the so-called extirpation
of the tonsils, when they act as mechanical impediments
to respiration, there seems to me to be no doubt The
various fears entertained concerning the influence of their
ablation on general development are purely chimerical.
I do not think I exaggerate in saying that in one hun-
dred and forty-two tonsillotomies performed by myself
the patients or their friends had reason to re^et the
results obtained by its performance. Surgical interfer-
ence is the only means of satisfactorily getting rid of
these abnormal growths, and it has seemed quite safe
in its performance. I have had one hemorrhage, not a
very severe one, more the result of the obstinacy of the
patient than of the operation. The tonsillitome is the
safest, best, and most expeditious means of operation,
and an instrument after Physic's pattern is much to be
preferred. Rest in the recumbent position should be
enjoined for four or more hours afterward. Crushed ice
should be used freely, and an astringent of tannic and
gallic acid applied. Bearing in mind the possibility of
hemorrhage, and taking the precaution for the preven-
tion of it, will surely go far to render the liability to it,
however little, less.
It is generally but not always necessary to remove both
tonsils. A curious fact, call it a coincidence if you will, ob-
served during the last epidemic of diphtheria was, that in
not less than three subjects in whom it had been necessary
that but one tonsil should be removed, no exudation
occurred on the surface of the ablatized tonsil, and but
very little in its vicinity. This was very well marked in
one case, a very severe one, which was seen daily by Dr.
Browne and myself for a period of over three weeks.
The membrane, though uniformly spread over both sides,
avoided entirely the cicatrized surface, and yielded much
more readily in its neighborhood. Possibly the relief of
the parts from the irritating presence of the enlargement
had some influence in this direction.
In conclusion, I may be permitted to sa^, and it is a
verdict that has not been arrived at hastily, that the very
best means possible for preserving a healthy chest and
throat are to be found in nasal respiration. In fact, a
being who breathes as nature intended should not
suffer from any throat affection, or at all events should
enjoy considerable immunity therefrom. Bronchial
asthma is most common in mouth-breathers, and mouth-
breathing is as hereditary as asthma. I do not go too
far when I assert boldly that a healthy state of the lining
of the pharynx, larynx, and lungs is incompatible with
any form of respiration but the nasal. I have thus
briefly and incompletely endeavored to draw your atten-
tion to what I am free to consider one of the prevailing
disorders of the day. I do not claim to have announced
anything new, but rather to have emphasized our duty
to society in regard to this most important but elemen-
tary point.
Nephrectomy for Calculous Pyelitis. — Dr. A.
Salomoni {La Gazetta degli Ospitali^ August 31, 1884),
reports a case in which Professor £. Bottini, of Milan,
successfully removed the kidney. The patient, aged
twenty-seven, had had two calculi removed by lateral
lithotomy fifteen years previously. Three years after
that operation an abscess formed in the right iliac fossa.
It opened spontaneously, and after a few months reap-
peared in the lumbar region, when it was opened with
caustic potass. A permanent fistuala resulted, and
proved intractable to all local and constitutional treat-
ment The patient lying on the left side, under chloro-
form. Professor Bottini, under strict antiseptic precau-
tions, made a vertical incision through the whole ilio-costal
space, three inches outside the quadratus luniborum.
The kidney having been isolated, the renal artery was
secured m one ligature, the vein and ureter in Another.
The space having been well cleared and all bleeding
stopped, a drainage-tube, about one-third of an inch in
diameter, was introduced. The walls of the fistula were
excised, and the wound united by one deep metallic su-
ture and eight superficial silk ones. The operation
lasted a little over an hour. The antiseptic dressing was
renewed daily, the metallic suture was removed on the
third, and the silk ones on the fourth day, when the
drainage-tube was shortened. It was withdrawn on
the eighteenth day. Progress was uninterrupted. The
highest temperature, 99.5°, was reached the second day;
urine in normal quantity and without deposit was passed
without pain or trouble. The patient left his bed on the
sixth, and went home the eighteenth day, when only a
slight sinus remained, about an inch deep. The fistula
led into the pelvis of the kidney, which was dilated,
with thickened and suppurating walls, and contained, be-
side some uric-acid sand, two small calculi about the
size and shape of grains of barley.
570
THE MEDICAL RECORD.
{November 22, 1884.
The Medical Record:
A Weekly journal of Medicine and Surgery.
GEORGE F. SHRADY, A.M., M.D., Editok.
PUBUSHSD BY
WM. WOOD & Co.. Nos. 56 and 58 Ufayette Place.
New York, November 22, 1884.
ON THE LIMITATIONS OF THE KNOWLEDGE
REGARDING CHOLERA,
It is only by constant reiteration that knowledge is
finally inculcated and public opinion afifected. In this
we find a justification for the firequent and discursive
contributions to the subject of cholera which are at pres-
ent filling the columns of the secular and medical press.
The inquiring reader begins each article with fi-esh ex-
pectation of enlightenment. But all the knowledge of
our most erudite sanitarians and eminent pathologists
seems reducible to this : that cholera is communicable
and portable, that it affects filthy localities and people,
that rigid municipal and personal sanitation, and a dis-
criminating use of quarantine measures should be en-
forced.
That there is some kind of a cholera germ all believe,
but what it is none know. It has been very generally
agreed that this germ requires a special nidus for its de-
velopment, that for the spead of cholera there must be
a something which has been called '' epidemic constitu-
tion." But modem sanitary reformers assert that this
so-called " constitution " is only an intensity of filth. In
the city of Hygeia there are no epidemic constitutions.
And such is the safest practical view to take, whether it
be an absolutely tme one or not.
As for quarantine, some dissenting voices here echo
the English opinion as to its non-utility. We had best
go, however, by^what our past experience has taught us,
and that is, that quarantine is a valuable means of pro-
tection. It should be applied sensibly and with discrim-
ination, however, and should bear most of all upon the
immigrants, who have heretofore been the primary dis-
pensers of the hypothetical bacilli of cholera in the
United States.
The cholera germ may be positively discovered any
day, meanwhile Koch's bacillus theory has not, as was first
hoped, thrown any flood of light upon cholera problems,
and as for its prophylaxis it is still expressed in these three
phrases: Rational quaraniiney municipal cleanliness^ per-
sonal hygiene.
REGULATING MEDICAL PRACTICE IN MISSOURI.
The stirring attack made some time ago by Dr. King
upon quackery in Missouri has already borae fmit.
The Sute created a board of health in July, 1883, and
gave to it a certain amount of power in regulating medi-
cal practice and putting down quackery.
The provisions of the law are much like those of Illinois,
and it contains the '* itinerant quack " section compel-
ling travelling venders of nostrums and persons publidy
professing and advertising to cure disease to pay a
monthly license of $100 Attempts to enforce such a
section naturally create some trouble, and we learn from
the Kansas City Medical Index that the efibrts of the
State Board to enforce the law in that place have been
violently opposed by the quacks and the public presfr-
two social forces which often work harmoniously together
by reason of the profits of advertising.
The Index puts the matter very fairly : "The law call-
ing into existence the Board and also governing its actioD
was enacted for the benefit of the public, and not for the
benefit of physicians, as some of the papers try to repre-
sent These papers receive large amounts of money
from these pretending doctors for advertising, and hence
they cry out because their ox is gored."
We would remind the Index also that the creation and
enforcement of regulating laws is based not only upon
the need of protecting the public health and of purifying
the medical body, the State of Missouri obliges medtctl
men to report all births and deaths, thus giving to &em
sm official duty and in a measure an official position.
The State, on this ground, can rightly insist on passing
upon the qualifications of its medical practitioners.
THE MEETING OF THE NEW YORK STATE MEDICAL
ASSOCIATION.
The New York State Medical Association held a pleas-
ant and harmonious meeting in this city during the past
week. The attendance was very good, especially of out-
of-town phjTsicians. The medical contributions, thou^
not destined to make new epochs in science, were, many
of them, of excellent character and likely to reflect credit
upon the State. Indeed, it is a matter of some pride to
New Yorkers to find that the State can creditably sap-
port and contribute to two organizations.
New York Cityis a pleasant and alluring place for
medical meetings, and so long as the Association assem-
bles here, and does good work, it will receive support
from and be a source of benefit to its members. The
issue which started it is already nearly forgotten, and
sensible men recognize that its practical significance is
now trivial. It is not upon any point in casuistry diat
the Association can stand or hold together, but upon its
merits as a medical society.
THE UTILITY OF QUARANTINE IN CHOLERA.
Dr. John H. Rauch takes the view that cholera is pre-
eminently a quarantinable disease, because " no single
case of cholera, no one shipload of cases has ever yetsof*
ficed to establish an epidemic of Asiatic cholera on this
continent It has only been after repeated importationi
of the contagion in the persons of thousands of inmup
grants and in their infected baggage and household goodf
tiiat it has effected a lodgment, and has reproduced itself
and multiplied into an active epidemic agency."
In proof of this he cites the history of previous epi-
demics of cholera in this country. Dr. Rauch appean to
forget, however, that, even if his factsjare correct for the
United States, in the past .they do not fit the history of
November 22, 1884.]
THE MEDICAL RECORD.
571
cholera elsewhere. And the proposition that an epi-
demic of cholera can not be started by a single case is
utterly untenable.
For all this cholera is undoubtedly quarantinable, and
if Congress will do its duty there is a good chance that
the disease may be kept from us.
Death of Dr. Samuel M. Bemiss. — ^We regret to an-
nounce the death on November 17th of Dr. Samuel M.
Bemiss. He was Professor of the Theory and Practice
of Medicine and of Clinical Medicine in the University
of Louisiana, and during the epidemic of 1878 was the
representative of the National Board of Health in New
Orleans. He was sixty-three years old, and served as a
surgeon in the Confederate Army. He was a graduate
of the medical department of the University of New York.
Cholera and Rags. — Experience shows that cholera
has been brought to this country heretofore by passengers,
and especially immigrants and their baggage. It is very
certain, however, that the disease can be carried by rags
and this source of danger ought to be carefully watched.
A complete embargo on rags from all ports or even a
compulsory disinfection of them is unnecessary.
State Medical Association Notes. — It may happen
that the New York State Medical Association, which met
in this city during the present week, will prove to be an
agent of value to the State Society and the profession at
large. At least the Society may learn from it several
lessons. One of these is that New York City is an ex-
cellent place in which to hold annual medical meetings.
Taking it all in all, the means of reaching it are as good,
if not better, than those of reaching Albany, while the
acconunodations and general attractions are superior.
The Association has shown also that by energetic work
papers can be obtained from physicians all over the State,
and that the bulk of the literaiy work need not fall upon
New York City.
As for the Association doing any injury to the State
Society, this is not to be thought of, and is not probably
intended except by the embittered few. The rural practi-
tioners throughout the State recognize the slight practical
importance of the ethical issue, and feel no ill-will toward
the Mother Society, which has what the Association has
not, a past. Perhaps this is in noway better shown than
by the indifference felt toward the fact (for it is a fact of
which there is absolute proof) that the President, Dr.
Didama, has consulted with homoeopaths, excusing the
practice under the disingenuous plea that he treats the
homoeopaths who call him in as nurses.
The papers read at the Association were in many cases
too long, and little chance was given for profitable discus-
sion. The question of section meeting was naturally
raised ; it is one that the State Society has considered
and will doubtless have in time to adopt
Dr. Samuel A. Fisk, aged sixty-three, ex-President of
the Massachusetts Medical Society. Lecturer at Smith
College, and Trustee of the Clarke Institute for Deaf
Mutes, died at Northampton, on November i6thy of or-
ganic disease of the heart.
Pennsylvania Hospitai On November loth, says
the Philadelphia Medical Times, a notable ceremony was
held at the Pennsylvania Hospital, the occasion being
the restoration, after an absence of fifty years in another
department of the institution, of the celebrated picture of
Christ Healing the Sick in the Temple, which had been
originally painted for and presented to the hospital by
Benjamin West.
A Mistake. — Our usually careful contemporary, Tke
Boston Medical and Surgical Journal, states that the
New York County Medical Society unanimously voted
to admit to membership two homoeopaths. This is a
mistake. The gentlemen in question have distinctly re-
nounced dogmatic horiiceopathy.
Death of a Physician from Self-Administration
OF Chloroform. — It is a practice which we fear is not
very uncommon among physicians to inhale chloroform
when suffering from severe pains. The Weekly Medical
Review reports the death through this practice of Dr. C.
M. Whiting, of Ogle County, 111. Reference is made
also to the death some years ago, in a similar way, of a
young physician who had just graduated and was prac-
tising in the suburbs of Chicago.
The Cholera in Paris. — Cable reports show that
from forty to fifty deaths from cholera occur daily in
Paris. This represents about one hundred cases daily,
and indicates a considerably less prevalence of cholera
than often exists of diphtheria, or typhoid fever. There
is no panic, and the disease at date of writing is declining.
A Crematory for New York. — The comer-stone
of a crematory temple was laid at Mount Olivet, Long
Island, on November 20th. The proposed edifice is
being built by the United States Cremation Company,
which expects to complete its work by February next
Twenty bodies already await incineration. The cost of
the building is about $10,000, that of incineration $10
to $25. The building is in the shape of a Greek temple
40 by 72 feet Incineration will take place at a tem-
perature of about 2,500^ F. It will require about forty
minutes per hundred pounds of the subject, and will
leave about four per cent, in weight of a pure pearly ash.
No smoke will be visible and no odor perceptible during
incineration. The basement will also contain a refrigi-
darium, where bodies may be kept when desired await-
ing the arrival of friends from a distance ; also a calidarium
for cases of possibly suspended animation, the high tern*
perature of which will induce speedy evidences of life or
death, as the case may be. There will be, also, in the
basement an culicularium, or urn room, and an ateliei:.
This last will be used, also, for making autopsies, which
will be required in all cases wherein it is not clear that
death is the result of natural causes. The body of the
building, or the ground floor, will be fitted up as a chapel,
where any service desired may be held.
A Contribution Toward the Medical Education
of Women. — ^The Calcutta Medical College has received
from the Maharani Surnamayi of Cossim Bazaar, Moor-
shedabad, one of the millionaires of Bengal, a lakh and a
half of rupees, $75,000, toward the scheme for providing
separate classes for female medical students at the Col-
lege, and has promised to increase the gift to eight lakhs
($400,000), should a separate college be provided.
572
THE MEDICAL RECORD.
[November 22, 1884,
^f^avts 0t SacUtUs.
NEW YORK STATE MEDICAL ASSOCIATION.
jFirsf Annual Session^ held in New York City^ November
18, 19, and 20, 1884.
Tuesday, November i8th — First Day — Morning
Session.
The Association was called to order at 9.45 a.m., by
Dr. Gouley. The Secretary announced the registra-
tion of Fellows. The Chairman of the Committee of
Arrangements, Dr. Gouley, then welcomed the Associa-
tion in a short address.
The President also delivered an address, and an-
nounced the following as the Committee on Scientific
Contributions : Dr. E. S. F. Arnold, of New York
County ; Dr. Simeon T. Clark, of Niagara County ; Dr.
William Gilles, of Franklin County ; Dr. George W.
Avery, of Chenango County ; Dr. J. C. Hannon, of
Rensselaer Count)'.
The Secretary then read the report of the Council, and
on motion of Dr. Arnold the report was adopted
Representatives from the Vermont Medical Society and
the Pennsylvania State Society were received.
The annual report of the Treasurer was made and ac-
cepted.
The special committee on the organization of district
associations reported in favor of the establishment of five
such associations. After some discussion the report was
adopted.
THE ADDRESS ON SURGERY
was then delivered by Dr. E. M. Moore, of Monroe
County.
The object of the paper was not to enumerate all the
late discoveries in surgery, but to dwell upon a few facts
in connection with transfusion of blood. Various methods
of transfusion have been proposed, but none have given
general satisfaction. When first discovered great ex-
pectations were founded on it, but on account of some
unfortunate accidents the practice was condemned. That
it has great value cannot be disputed. All surgical
practices to be successful must be simple. Complicated
apparatus is to be discarded and some simple surgical
device instituted. In 1657 Sir Christopher Wren sug-
gested the possibility of this practice. At first it was
tried only on animals. These experiments were the
natural outcome of Harvey's discovery. Some denounced
the practice as legalized murder. After 1668 the interest
seems to have disappeared. Up to 18 19 only arterial
blood was used, but since, all kinds have been employed.
The blood of those species nearest of kin has been most
successfully used. Transfusion from the lamb to man
has been more or less successful, but blood obtained from
the same species answers best We cannot obtain arterial
blood from human beings, and hence must take venous.
To avoid danger from coagula, defibrinated blood is
sometimes used. The question was raised whether this
was true blood, and answered in the negative by the
author. Various medicated substances have sometimes
been used, but blood answers best The distention of
the vessels by simple saline solutions has at times given
temporarily great benefit The principal dangers of
transfusion are from ingress of air and formation of
coagula. The special point made by the author was
that the time of operation should be short and definite.
Most operators tsdce from two to three minutes. The
operation should never exceed the limit of one minute.
There is a period of transition from normal blood to ab-
normal during the passage through the canula, hence the
absolute rule of shortness of time. An assistant should
read off ten seconds, twenty seconds, thirty seconds, etc.,
during the operation. The transference of venous blood
is a difficult problem. A longitudinal slit should be
made in the vessel and the syringe held perpendicularly.
The writer then exhibited a canula and mandrel devised by
himself, which has been successfully used. By rounding
the edges coagulation is prevented The instrument can
be extemporized in case of emergency by using a goose,
quill for a canula. Dog's blood coagulates quicker than
human blood, but the author had succeeded in experi-
ments with his instrument upon the dog. Transfusion is
especially indicated after sudden great losses of blood,
and in anaemia from exhaustive discharges. It does not
seem to avail in the exhaustion from phthisis and like
diseases.
Dr. Townsend, of Genesee County, opened the dis-
cussion by narrating an instance in which Dr. Moore and
himself had practised transfusion in fifty seconds. The
operation was successful at the time, but the patient after-
ward died of exhaustion. It was then moved and carried
to postpone the further discussion until after the reading
of Dr. Hutchinson's paper on transfusion.
Dr. Detmold, the president of the County Medical
Association was then introduced to the meeting. He
stated the objects of the Association and announced tiie
titles of the papers that had been read during the past
year. It was carried to transfer these papers to the
Council of the State Association.
A recess was next taken, during which there were
meetings of the five district associations, in which the
time and place of next meeting were appointed and
secretaries named.
Afternoon Session.
The Association was called to order by The President,
who remarked that it might be necessary, owing to the
large number of papers announced, to divide the work
between two sections, a medical and a surgical. This
would be determined by the members during the present
session.
The first communication was by Dr. J. C. Hutchin-
son, of Kings County, upon
TRANSFUSION.
Although this operation had been practised five hun-
dred years ago, it was still but rarely undertaken, and
had certainly not fulfilled its early promises of utility and
ready applicability. The present epidemic of cholera in
Europe has invested the subject of the transfusion of
blood and other substances with fresh interest, and the
author believed that the procedure might now become
popularized were the means of its application simplified,
the dangers diminished, and the apparatus improved.
An instrument was then exhibited which seemed to fulfil
the indications of simplicity and ease of management It
consisted of a glass cylinder, terminating below in a per-
forated metal cap, and above in a rubber stopper through
which was inserted a thermometer. The side of the cyl-
inder was marked off in sections of half an inch. Sur-
rounding the cylinder was a double fubber jacket with a
slit on one side to permit a view of the markings on the
glass. This rubber jacket was to be filled with hot water
(of 140^ to 150^) in order to keep the injecting material
warm. A rubber tube is fastened to the lower end of the
cylinder by one extremity, the other extremity being at-
tached to a canula. This canula is provided with a stop-
cock by means of which the rapidity of flow of the trans-
fused material is regulated. The author had not seen
the instrument exhibited by Dr. Moore before writing
his paper, but thought it excellent, and should himsdf
always use the canula there shown.
It was formerly supposed that the reviving power of
transfused blood lay in its corpuscles, but this has been
shown to be erroneous, for the corpuscles are quickly de-
stroyed. Recent experiments have demonslrated that
the principal thing necessary is to restore the volume of
the circulating fluid. The danger after hemorrhage lies
in the disturbed relations of the blood-vessels to tfaeir
contents, hence it is not necessary to employ blood, and
indeed a saline solution is preferable. Experiments have
shown that the blood of another species, when injected
November 22, 1884.]
THE MEDICAL RECORD.
573
into the circulation, may cause acute nephritis and im-
peril life. Milk is objectionable, for the undigested
casein when transfused into the blood is unassimilable,
and the butyric elements may give rise to chyluria and
other disturbances. Experiments made upon animals
bled to syncope have shown that consciousness could be
restored and life preserved by the injection of simple
saline solutions, and the value of this material for trans-
fusion has also been demonstrated clinically. The au-
thor quoted the statistics of the transfusion of saline solu-
tions, and related five cases in which he himself had
employed this method in the resuscitation of cholera pa-
tients. All the patients were in the stage of collapse,
indeed were moribund, "the temporary effects of the
transfusion, however, were most marked, although all the
patients eventually died.
The temperature of the solution should be not lower
than 98.5° and not above Io5^ The quantity used should
be from twelve to twenty-four ounces. But one of the
roost important points in the operation is the rapidity
with which the ^uid is allowed to enter th^ vessels ; the
rate should not bv above one ounce a minute. The me-
dian basilic vein is v -ually selected to receive the trans-
fused material, though lately arterial injections have been
urged as offering equal facility, and obviating the chief
danger of embolism of the brain (since all organic parti-
cles or clots are detained in the systemic capillaries), of
the entrance of air, or of overpowering the heart by a
sudden afflux of fluid. In concluding, the author said
that if the results already obtained by transfusion should
be confirmed by further experience, the operation was one
deserving of more honor than it had as yet obtained
Dr. Rochester, of Erie County, related a case in
which a speedy and permanent improvement had fol-
lowed upon the transfusion of less than two ounces of
blood, and he thought that this demonstrated that it was
not alone to the quantity of fluid that the good effects of
transfusion should be referred, but that the nature of the
material employed was also to be considered. He also
had seen wonderful improvement following the injection
of saline solutions in the stage of collapse of cholera,
but these results were only temporary, for the patient?
invariably died.
The next paper read was by Dr. Alfred I^ Carroll,
of Richmond County, on the
DURATION OF CONTAGIOUSNESS AFTER ACUTE INFECTIOUS
DISEASES.
The object of his remarks, the speaker said, was rather
to direct his hearers' attention to the importance of
studying this subject and recording their observations by
the plan of collective investigation, than to present any
certain data upon which they could yet base their con-
duct in any given case. The subject was one that had
received but scant attention, and upon which there was
but little unanimity of opinion, and yet a little consider-
ation would show how important it was to be able to de-
termine just when the isolation of a convalescent might
with safety be removed. The author had addressed a
communication to a number of well-known medical
teachers and practitioners, in order to ascertain whether
there were any consensus of opinion on this point, and
he presented to his hearers a condensed summary of the
answers obtained. As regards small-pox, nearly all of
his correspondents were agreed that there was dan-
ger of contagion until all the crusts had been removed,
although one stated his belief that there was little danger
to be apprehended from the scabs on the palms and
soles, provided there were none remaining on the other
parts of the body. In respect to the other contagious dis-
eases there was less accord. In typhoid fever and in chol-
era it was the general opinion that the contagion resided
in the discharges, and that the danger ceased when con-
valescence had been established. Many of the corre-
spondents, with whom the author also agreed, regarded
filth-poison as of prime importance in diphtheria, and
doubted the existence of a direct personal contagious-
ness. Yet one writer maintained that there was danger
as long as any trace of inflammation remained. In
measles one would release the patient from quarantine as
soon as the fever and eruption had disappeared, while
others would prolong the period of isolation to from one
to three weeks after desquamation had ceased. The
greatest diversity of opinion existed in regard to scarla-
tina. Many released the patients as soon as desqua-
mation had ceased and a bath had been given ; others
confined them for a period varying from six to eight
weeks. The author had found in some cases that no
contagion occurred even when the children mingled
with their playmates before the period of desquamation
was over. He thought that this fact was to be explained
by assuming that the last scales thrown off were not in-
fectious, but were the expression of a secondary derma-
titis, the scales first appearing being the ones that con-
tained the poison.
Dr. John S. Jamison, of Steuben County, then read
a communication on
chronic intestinal CATARRH.
The most frequent cause of this condition is an improper
diet, as regards either quantity or quality. Another
potent factor in the production of the disease is found in
meteorological conditions — a prolonged high tempera-
ture or a change to cold, damp weather. It may arise
from impaired stomach digestion, from disease of the
liver or pancreas, or from any condition causing obstruc-
tion to the portal circulation. The malarial poison is
another occasional etiological factor. An acute diarrhoea
is often neglected and may then pass, after successive
attacks, into a chronic intestinal catarrh. The symptoms
of this condition are not always sharply defined, for
diarrhoea is not necessarily present, and there may be no
severe pain. There is often a dull sense of pressure and
abdominal fulness. The author had frequently observed
a displacement downward of the transverse colon, and
he regarded it as a sign of considerable value in the
diagnosis of this disease. Sometimes mucus, in coherent
masses or even in the shape of intestinal casts, is passed
at stool. In the treatment the author regarded pepsine
and pancreatine as of great utility.
A paper by Dr. Frederick Hyde, of Cortland
County, was read by title only, the author being absent
Dr. Edward R. Squibb, of Kings County, then fol-
lowed with a paper entitled
THE modern progress OF MATERIA MEDICA.
The author did not refer to the introduction of new
remedies, now becoming so fashionable, but rather
wished to consider the elements of progress in the treat-
ment of disease among that large class of intelligent and
practical physicians who read much but write little, but
who are none the less good, sound, and sensible practi-
tioners. The progress of materia medica among these
men cannot be learned from their writings, since they
do not write, but is to be judged of by knowing the drugs
which they order and use. Medical men now realize the
fact that their success in their profession depends upon
their utility to the public ; they must direct their -energies
to the prevention of disease, to its management when it
occurs, and to the reparation of its ravages. The phy-
sician does not now rest content with a diagnosis, but
seeks as far as he may to conduct his case to a success-
ful ending. We hear less and less of expectancy in the
treatment of disease ; indeed the danger now is of rushing
into the opposite extreme by trying all the new remedies
that are spoken of. The author pictured the armamen-
tarium of a physician in one of the new Western towns ;
this consists of a thermometer, urinometer, litmus paper,
often a plain serviceable microscope, and sometimes even
a sphygmograph. He has a good selection of some
twenty or thirty of the standard remedial agents, but few
non-oflicinal drugs are found in his stock. More pharma-
copoeias are sold now than formerly, and physicians are
574
THE MEDICAL RECORD.
[November 22, 1884.
learning to make their own tests and to judge for them-
selves of the parity of the drugs supplied to them. Few
physicians nowadays undertake <* cures," but they en-
deavor to conduct the disease to a successful issue. Few
believe that drugs cure diseases, and hence they seek to
manage their cases according to the indications as they
arise. Another advance that has been made in the last
few years is, that practitioners are learning to throw off
the trammels of arbitrary doses. They now look only for
effects from remedial agents, and they accordingly push
the drug until they obtain these effects. The use of in-
dicating doses for drugs, the writer thought, will in the
future be only to show where we are to start in their ad-
ministration, the stopping-point being different in differ-
ent cases, and to be determined only by observation of
the effects produced. Physicians use fewer drugs than
formerly, but those that they do use are more effectual.
The combination of many agents in one prescription is
less frequently resorted to. The form of the agent now
used is also worthy of note. The dilate and uncertain
preparations are being called for with less and less fre-
quency, and the fluid extracts, as the most concentrated
and most reliable forms, are growing daily in favor.
There is, however, a tendency to the use of alkaloids, of
the so-called active principles of drugs, which the author
did not approve. The active principles so-called, he
maintained, are not the same as the drug, for they are
often produced by some chemical change occurring in the
course of their manufacture. They are furthermore not
always permanent, but are liable to split up and form
new chemical compounds with totally different effects.
Thus, the author concluded, although in the main the
progress has been in the right direction, yet not all the
changes of late have been improvements.
Dr. W. H. Robb, of Montgomery County, read a
paper on the
MANAGEMENT OF CRIMINAL ABORTION.
Control hemorrhage as soon as possible with ergot and
digitalis given hypodermically and in full doses. Stimu-
lants should be given by the same method until the pa-
tient has rallied. The ergot should be given as soon as
the patient is seen, and should be continued until the
uterus has contracted and the ovum has been entirely
removed. Locally, various astringents, as ice, tincture
of iodine, hot carbolized solutions, and other remedies,
may be used. When these means fail to control the
hemorrhage, the tampon should be introduced. The
tampon should be removed every six hours, and its re-
moval should be followed by a hot carbolized injection.
The injections are best given by introducing a soft
rubber tube into the uterus. The Fountain syringe is
the best, as by its use no force can be exerted and no air
can enter the organ. The womb should be emptied as
soon as possible, so that all danger of decomposition
may be prevented. The safest and most efficient instru-
ment in removing the ovum is the finger. If the cervix
is not dilated, tents should be used. The removal of the
ovum should be followed by a hot douche.
Dr. Vandewaker, of Syracuse said the danger in abor-
tion before the third month is due to loss of blood and
poisoning from decomposition. He had never seen a
good result from the use of ergot in criminal abortion.
The machinery of the uterus is not fully developed before
the third month, hence the uterus does not contract
firmly, but spasmodically. If the physician is called late
at night, and no other means are at hand, the tampon
may be used ; but it should never be used unless abso-
lutely necessary. The quickest way to stop the hemor-
rhage is to relieve the uterus of its contents.
Dr. Moses C. White, of New Haven said the action
of ergot in abortion at the third month is not to expel the
contents, but to contract the uterus and thus prevent its
expulsion. He uses ergot, not to bring on but to prevent
abortion.
Pr. Sabine, of West Point, explained the dangers of
using the tampon, and gave the history of a case of
rupture of the fundus of the uterus, followed by the death
of the patient, due to its use. Tampons are very danger-
ous unless used with great caution.
A paper on
intestinal obstruction,
by Dr. Avery Segur, of Kings County, was then read by
title.
Dr. Charles Bulkley, of Monroe County, read a
paper on
chronic mercurial poisoning.
He presented the history of a case in his own practice in
which the poisoning was due to wearing a hard robber
plate with false teeth. All the symptoms were present
while the plate was used, but disappeared when its use
was discontinued. He also presented the histoiies of
several other cases due to the same cause.
Dr. R. H. Sabin read a paper on
A CASE OP ACUTE LEAD POISONING RESULTING FATAUY.
The case was that of a young man who was poisoned
while working in a paint shop. There was a rapid infus-
ion into the brain, causing insensibility, and this was fol-
lowed by a peculiar algid condition.
The session then adjourned until evening.
Evening Session.
Dr. H. E. Mitchell, of Rensselaer County, read a
paper on
ERRORS OF REFRACTION, THE IMPORTANCE OF THEIR
RECOGNITION AND CORRECTION IN EARLY LIFE.
Defects of eyesight due to errors of refraction are on the
increase. A description of the coats of the eye and the
contents of the ball was then ^ven. Myopia may be ac-
quired or congenital. Statistics show an increase of the
congenital form. The acquired is the most important to
consider. The minus or double concave glass should be
used. Myopia in young persons shows a tendency to
increase.
Dr. K D. Ferguson, of Rensselaer County, read a
paper on
THE USB OF THE ASPIRATOR IN HYDROTHORAX.
A case was cited in which after several aspirations were
performed for pleuritis, empyema set in. The author
has had three such cases. He now abstains from aspira-
tion unless the dyspnoea is extreme. When the opera-
tion is performed only a slight amount of fluid should be
abstracted. Since following this rule, he has not had a
case of empyema in practice. The innocuousness of the
operation is assumed by most text-books, the only warn-
ing being to stop when there is constriction at ep^as-
trium. By suddenly emptying the chest of fluid, support
is taken from the vessels, which results in increase d
blood with resulting tendency to suppuration. Eight
ounces is the greatest quantity that should be taken at
one time in pleurisy.
Dr. Thomas F. Rochester, of Erie County, next
read a paper entitled
A NEW procedure IN PARACENTESIS THORAaS.
The histories of three cases of empyema were given, in
all of which there was great difficulty in enlarging the in-
cision sufficiently to hold a tube. The doctor has found
that by inserting his finger into the incision and thus en-
larging the opening, all such difficulty is overcome.
Dr. Austin Flint did not believe that the aspirator
caused as much damage as claimed by Dr. Ferguson,
although doubtless it sometimes did harm.
Dr. Moore thought that all surgical instruments
occasionally did harm. In empyema the best practice is
to draw off a little pus each week by the aspirator. Ib
abscesses, the walls of which cannot contract, all pus
should not be drawn out at once.
Dr. Rochester thought that from eight to tea QVPC^
Very Important Announcement
To THE
MEDICAL PROFESSION
OF THE
United States and Canada
1884
WILLIAM WOOD & COMPANY
PUBLISHERS
N Ew York
1
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GENERAL PATHOLOGY AND THERAPEUTICS, SURGERY,
GYNECOLOGY, NEUROLOGY, OTOLOGY, OPHTHAL-
MOLOGY, OBSTETRICS, &c., &c., &c.,
have been asfigned to writers who are experts in their respective departments.
Wood-cut illustrations of the best character will be introduced wherever
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In a work of such magnitude and importance, the question of the size of
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pages — which comprised a dozen or more volumes.
The
REFERENCE HANDBOOK
Medical Sciences
will, therefore, be limited to a series of from
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It is with pardonable pride that the Editor and Publishers present herewith
the list of eminent contributors who have already accepted the invitation to write
on certain specified topics. It is believed no such number of prominent writers
and teachers have ever before been associated together in the preparation of a
work specially designed for the Medical Profession.
As comparatively few subjects still remain unprovided for, the list of names
here presented will not be materially extended, though some will be added from
time to time in the progress of the work.
EDITOR OP THE HANDBOOK,
Albert H. Buck, M.D.
CONTRIBUTORS.
APPLIED ANATOMY.
FRANK BAKER, M.D.,
WASHINGTON, D.C.,
Prof, of Anatomy, Medical Department of Georgetown
University.
SIMON H. GAGE, B.S.,
ITHACA, N. v.,
logy
I'echnology, Cornell University.
R. L. MAC DONNELL, M.D.,
MONTREAL, CANADA,
Demonstrctor of Anatomy and Lecturer on Hygiene, McGill
University.
FRANCIS J. SHEPHERD, M.D.,
MONTREAL, CANADA,
Prof, of Anatomy, McGill University.
BENJAMIN F. WESTBROOK, M.U.,
BROOKLYN, N. Y.,
Lecturer on Anatomy, Long Island College Hospital Medical
School • Phystcian-in-Chief to the Department for
Diseases of the Chest, St. Mary's Hospital.
BURT G. WILDER, M.D..
ITHACA, N. v..
Prof, of Physiology, Comparative Anatomy, and Zoology in
Cornell University.
MICROSCOPICAL TECHNOLOGY.
GEORGE C. FREEBORN. M.D.,
NEW YOKK, N. Y.,
Aural Surgeon, N. Y. Eye and Ear Infirmary.
BIOLOGY, MORPHOLOGY, AND EXPERIMENTAL PHYSIOLOGY.
E. A. BIRGE, Ph.D.,
MADISON, WISCONSIN,
Prof, of Zoology, University of Wisconsin.
L. BREMER, M.D.,
ST. LOUIS, MO.
W. K. BROOKS, PH.D.,
BALTIMORE, MD.,
Aswxiate Prof, of Morphology, Johns Hopkins University;
Director of the Chesapeake Zoological Laboratory.
LESTER CURTIS, M.D.,
CHICAGO, ILL.,
Prof, of Histology, Chicago Medical College ; Lecturer on Dis-
eases of the Throat and Chest, South Side Dispensary ;
Visiting Physician to Mercy Hospiul.
H. GRADLE. M.D.,
CHICAGO, ILL.,
Prof, of Physiology, Chicago Medical College.
LEWIS L. McARTHUR, M.D.,
CHICAGO, ILL.
CHARLES SEDGWICK MINOT, M.D.,
BOSTON, MASS.,
Instructor in Histology and Lecturer on Embryology, Harvard
University.
HENRY F. OSBORN, Sc.D.,
PRINCBTON, N. J.,
Prof, of Comparative Anatomy, Princeton University.
ISAAC OTT, M.D.,
BAfTON, PA.
T. MITCHELL PRUDDEN, M.D.,
NBW YORK, N. V.,
Lecturer on Normal Histology, Yale College ; Director of the
Physiological and Pathological Laboratory of the
Alumni Association, College of Physicians
and Surgeons, New York City.
WILLIAM B. SCOTT, Ph.D. (Heidelberg).
PRINCBTON, N. J.,
Prof, of Geology, Princeton University.
WILLIAM T. SEDGWICK, PH.D.,
BOSTON, MASS.,
Assistant Prof, of Biology, Massachusetts Institute of
Technology.
EDWARD O. SHAKESPEARE, M.D.,
PHILADELPHIA, PA.,
Ophthalmic Surgeon and Pathologist to the Philadelphia
Hospital.
JAMES K. THACHER, M.D ,
NEW HAVEN, CONN.,
Prof, of Physiology, Yale College.
W. G. THOMPSON, M D.,
NEW YORK, N. Y.,
Assistant Physician to the New York Hospital, Out-Patient
Department; Physician to Roosevelt Hospital,
Out-Patient Department.
PHYSIOLOGICAL AND PATHOLOGICAL CHEMISTRY; TOXICOLOGY.
RUSSELL H. CHITTENDEN, Ph.D.,
NEW HAVEN, CONN.,
Prof, of Physiological Chemistry, Yale College.
WILLIAM B. HILLS, M.D.,
BOSTON, MASS.,
Assistant Prof, of Chemistry, Harvard University.
T. WESLEY MILLS. M.D.,
MONTREAL, CANADA,
Demonstrator of Practical Physiology and Histology, McGill University.
PATHOLOGICAL ANATOMY.
W. T. COUNCILMAN, M.D.,
BALTIMORE, MD.,
Associate Prof, of Pathological Anatomy, Johns Hopkins
University, Baltimore.
WILLIAM W. GANNETT, M.D.,
BOSTON, MASS.,
Assistant in Pathological Anatomy, Harvard University.
J. WEST ROOSEVELT, M.D.,
NEW YORK, N. Y.,
Assistant Pathologist and Curator, Roosevelt Hospital
E. C. WENDT, M.D.,
NEW YORK, N. Y.
HYGIENE AND PUBLIC HEALTH.
SAMUEL W. ABBOTT, M.D.,
BOSTON, MASS.,
Health Officer of the Massachusetts Sute Board of Health,
Lunacy and Charity.
PETER H. BRYCE, M.B. (Toronto University),
TORONTO, CANADA,
Prof, of Chemistry, Ontario Agricultural College; Secretary
of the Provincial Board of Health.
WILLIAM S. CHEESMAN, Jr., M.D.,
Al-BIRN, N. Y.
EDWARD COWLES, M.D.,
SOMBRVILLB, MASS.,
Superintendent of the McLean Asylum ; late Superintendent
r>f the Boston City Hospital.
GEORGE W. LEONARD, M.D.,
NEW YORK, N. V.,
Formerly House Surgeon, New York Hospital.
WILLIAM RIPLEY NICHOLS, S.B.,
UOSTO.V, MASS.,
Prof, of General Chemistry, Massachusetts Institute of
Technology.
WILLIAM OLDRIGHT, M.D. (Toronto Univ.),
TORONTO, CANADA,
Lecturer on Sanitary Science, Toronto School of Medicine;
Chairman, Provincial Board of Health.
FREDERICK N. OWEN, E.M.,
NKW YORK, N. Y.,
Civil and Sanitary Engineer.
^f?:^' ^' r * . • ' '
MILITARY AND NAVAL MEDICINE, HYGIENE AND
SANITARY SCIENCE.
ALBERT L GIHON, M.D.,
WASHINGTON^ D.C.,
Medical Director, United States Navy; President of the
American Public Health Association.
CHARLES R. GREENLEAF, M.D.,
coli;mbus barkacks, 01110,
Surgeon, United States Army.
CHARLES SMART, M.D.,
WASHINGTON, D.C.,
Surgeon, United States Array.
JOSEPH R. SMITH, M.D.,
SAN ANTONIO, TBXAS,
Medical Director, United States Army.
ALFRED A. WOODHULL, M.D.,
David's island, new vork harbor.
Surgeon, United States Army.
CLIMATOLOGY, HEALTH RESORTS AND MINERAL SPRINGS.
HUNTINGTON RICHARDS, M.D.,
NEW YORK, N. v.,
Assistant Aural Surgeon, N. Y. Eye and Ear Infirmary.
BEAUMONT SMALL, M.IX,
OTTAWA, CANADA.
MEDICAL JURISPRUDENCE.
BENJAMIN VAUGHAN ABBOTT,
NEW VORK, N. v..
Author of "Abbott's Law Dictionary," and various Digests.
WILUS J. ABBOT, LL.B.,
CHICAGO, 11.1..
GENERAL PATHOLOGY AND THERAPEUTICS. AND
PHYSICAL DIAGNOSIS.
M.D..
I. EDMONDSON ATKINSON
BALTIMORR, MD.,
Prof, of Pathology and Clinical Professor of Dermatology,
University of Maryland.
DALLAS BACHE, M.D.,
FORT ADAMS, R. I.,
Surgeon, United States Army.
G. BAUMGARTEN, M.D.,
ST. LOUIS, MO.,
Prof, of Physiology, St. Louis Medical College.
ALBERT N. BLODGETT, M.D.,
BOSTON, MASS.,
Prof, of Pathology and Therapeutics, Boston Dental College.
ISRAEL T. DANA, M.D.,
PORTLAND, MB.,
Attending Physician, Maine General Hospital, Portland.
N. S. DAVIS, M.D.,
CHICAGO, ILL.,
ProC of Principles and Practice of Medicine and of Clinical Medi-
cine, Chicago Medical College ; Physician to
the Mercy Hospital.
HAROLD C. ERNST, M.D.,
BOSTON, MASS.,
Assistant Pathologist to the Boston City HospitaL
R. H. FITZ, M.D.,
BOSTON, MASS.,
Shattuck Professor of Pathological Anatomy, Harvard University.
WILLIAM H. FLINT, M.D.,
NKW YORK, N. Y.,
Physician to the Roosevelt Hospiul, Out- Patient Department;
Assistant to the Chair of Principles and Practice of
Mediane, Belle vue Hospiul Medical College.
EUGENE FOSTER, M.D.,
AUGUSTA, GA.,
President of the Board of Hodth of Augusta.
JAMES M. FRENCH, M.D.,
CINCINNATI, OHIO,
Assistant Demonstrator of Pathology and In^^tructor in Physical
Diagnosis, Medical College of Ohio, Cincinnati
DOUGLAS GRAHAM, M.D.,
BOSTON, MASS.
CHARLES E. HACKLEY, MD,,
NBW VORK, N. v..
Attending Physician, New Vork Hospital.
HENRY N. HEINEMAN, M.D.,
Ni£W YUKK, N. Y.,
Attending Physician, Mount Sinai Hospital : Surgeon to the N. Y.
Hospital, Out-Patient Depairtmeni, Section of
Diseases of Children.
FREDERICK P. HENRY, M.D.,
PHILADBLPHIA, PA.,
Prof, of PatholcNnr and Microscopy, Philadelphia Polyclinic and
College for Graduates in Medicine ; Physician to the Hos-
pital of the Protestant Episcopal Church.
MORRIS L. KING, M.D.,
NKW YORK, N. Y.,
Late House Surgeon, Roosevelt HospitaL
ALFRED L. LOOMIS, M.D.,
NSW YORK, N. Y.,
Pro! of Pathology and Practice of Medicine, University Medical
College, New York : Physidan to Bellevue HospiuL
WALTER MENDELSON, M.D.,
NKW YORK, N. Y.,
Late House Physician, New York Hospital.
WILLIAM OSLER, M.D.,
MONTREAL, CANADA,
Prot of the Institutes of Medicine, McGill University.
GEORGE ROSS, M.D ,
MO.VTKSAL, CANADA,
Prof, of Qinical Medicine, McGill University; Physician, Montreal
General Hospital.
THOMAS E. SATTERTHWAITE, M.D.,
NKW YORK, N. Y.,
Prof, of Pathology and General Medicine, New York Post-Oail-
uate Medical School ; Pathologist to the Presbyterian Hospital.
EDWARD W. SCHAUKFLER, M.D.,
KANSAS CITY, MO.
;
General Pathology and Therapeutics, and Physical Diagnosis — ObnUnued,
FREDERICK C. SHATTUCK, M.D.,
BOSTON, MASS.,
CUnkal Instructor in Aufcultation and Percussion, Hanrard Med-
ical College: Physician to Out-Patients,
Mass. G«neral Hospital.
GEORGE B. SHATTUCK, M.D.,
BOSTON, MASS.,
Visiting Physician, Boston City Hospital.
GEORGE M. STERNBERG, M.D.,
FORT MASON, CALIVOKNIA,
Surgeon* United States Army.
WILLIAM H, THOMSON, M.D.,
NBW YOKK, N. Y.,
ProC Materia Medica and Therapeutics and Diseases of the Ner-
vous System, Medical Department of the University of
the Gty of New York ; Visiting Physician to
fidlevue and Roosevelt Hospitals.
SAMUEL B. WARD, M.D.,
ALBAMY, N. Y.*
Prof, of Pathokwv, Practice, Clinical Medicine and Hygieae,
Albany Medical College, ; Attending Surgeon,
Albany HospitaL
LEONARD WEBER, M.D.,
NBW YORK, N. Y.
WARREN WEBSTER, M.D.,
FORT PRBBUB, MAINS,
Surgeon, United States Army.
JAMES T. WHITTAKER, M.D.,
CINCINNATI, OHIO,
Prof, of Physiology, Medical College of Ohio, Cincinnati.
GEORGE WILKINS, M.D.,
MONTRJEAL, CANADA,
Prof, of Medical Jurisprudence, McGill University.
MATERIA MEDICA, MEDICAL BOTANY, AND PHARMACOLOGY.
W. P. BOLLES, M.D.,
BOSTON, MASS.,
Prof, of Materia Medica and Botany, Massachusetts College
of Pharmacy ; Instructor in Materia Medica,
Harvard University.
EDWARD CURTIS, M.D.,
NEW YOSK. M. Y.,
Prof, of Materia Medica and Therapeutics, College of Phy-
sicians and Surgeons, Mew York.
F. PEYRE PORCHER, M.D.,
CHARLESTON, S. C,
Prof, of Materia Medica and Therapeutics, in the Medical
College of the State of South Carolina : One of the Phy-
sicians to the City Hospital, Charleston.
CHARLES RICE, Ph.D.,
NEW YOKK, N. Y.,
Chairman of the Committee of Revision and Publication of the
Pharmacopoeia of the United States of America (1880-1890).
JAMES STEWART, M.D.,
MONTREAL, CANADA,
Prof, of Materia Medica and Therapeutics.
SURGICAL PATHOLOGY AND GENERAL SURGERY.
EDMUND ANDREWS, M.D.,
CHICAGO, ILL.,
Prof, of Clinical Surgery in the Chicago Medical College ;
Surgeon to Mercy Hospital, Chicaga
CHARLES S. BRIGGS, M.D.,
NASHVILLE, TBNM.,
Prof, of Surgical Anatomy and Operative Surgery in the Medical
Department of the University of Nashvule and
Vanderbilt University.
JOSEPH D. BRYANT, M.D.,
NEW YORK, N. Y.,
Prof, of Anatomy and Associate Pro£ of Orthopedic Surgery,
Bellevue Hospiul Medical College, New York.
A. T. CABOT, M.D.,
BOSTON, MASS.,
Surgeon to Out-Patientii, Massachusetts General Hospiul, Boston.
GEORGE W. GAY, M.D.,
BOSTON, MASS.,
Surgeon to the Boston City HospitaL
WILLIAM H. HINGSTON, M.D.,
MONTXKAL, CANADA.
JOSEPH W. HOWE, M.D.,
NEW YORK, N. Y.,
Visiting Surgeon to the Charity and St. Vincent*s Hospitals.
CHARLES B. KELSEY, M.D.,
MHW YORK, N. Y.,
Surgeon to St. PanPs Infirmary for Diseases of the Rectum.
E. M. MOORE, M.D.,
ROCKESTEB, N. Y.,
Attending; Surgeon, St. Mary^s Hospital, Rochester, N. Y.; for-
merly Prof, of Surgery, University of BufiBsdo, N. Y.
H. H. MUDD, M.D.,
5T. LOUIS, MO.,
Prot of Anatomy and Clinical' Sutigery, St Louis Medical College.
ALFRED NORTH, M.D.,
WATSRBURY, COttS.
ROSWELL PARK, M.D.,
BUFFALO, N. Y.,
.Prof, of the Principles and Practice of Surgery, University of
Buffido, N. Y.
L. S. PILCHER, M. D.,
BEOOKLYir, N. Y.,
Adjunct Professor of Anatomy, Long Island College Hospital
Medical School.
ABNER POST, M.D.,
BOSTON, MASS.,
Surgeon to Out-Patients, Boston City Hospital.
JOSEPH RANSOHOFF, M.D.,
CINCINNATI, OHIO,
Prof, of Descriptive Anatomy and Qinical Surgery, Medical
College oi Ohio ; Sturgeon to the Good Samaritan
Hospittu, Cincinnati.
THOMAS G. RODDICK, M.D.,
MONTRSAi., Canada,
ProL of Qinical Surgery, McGill University; Surgeon, Montreal
General Hospital.
N. SENN, M.D.,
MILWAUKEE, WISCONSIN.
LEWIS A. STIMSON, M.D.,
NEW YORK, N. Y.,
ProC of Physiobgy, University of the City of New York : Vinting
Surgeon, Bellevue and Presbyterian Hospiuls.
L. McLANE TIFFANY, M.D.,
BALTIMORE, MD.,
ProC of Surgery, University of Maryland.
ALBERT VAN DERVEER, M.D.,
ALBANY, N. Y.,
Prof, of the Principles and Practice of Surgery and Clinical Surgery,
Albany Medical College : Attending Siugeon, Albany Hospital
WILLIAM L. WARD WELL, M.D.,
NEW YORK, N. Y.,
Surgeon, Eastern Dispensary ; Assistant Surgeon, New York
Polyclinic
J. COLLINS WARREN, M.D.,
BOSTON, MASS.,
Assistant Prof, in Surgery, Harvard University: Surgeon to
Mass. General Hospital.
LEROY M. YALE, M.D.,
NEW YOKK, N. Y.,
Visiting Surgeon, Presbyterian Hospital ; Lecturer Adiunct 00
Diseases of Children, Bellevue Hospital Medical College.
ORTHOPEDIC SURGERY.
EDWARD H. BRADFORD, M.D.,
BOSTON, MASS.,
Assistant in Clinical Surgery, Harvard University : Surgeon to th?
Children's Hospital, Boston.
V. p. GIBNEY, M.D.,
NKW YORK, N. V.,
Prof, of Orthopedic Surgery, New York Polyclinic ; Assistant
Surseon. Hospital of the New York Society for the
Relief of the Ruptured and Crippled.
CHARLES T. POORE, M.D..
NKW YORK, N. Y.,
Surgeon to St Mary*s Free Hospital for Children.
A. SYDNEY ROBERTS, M.D.,
PHILADKLFHIA, PA.,
Visiting Surgeon to the Philadelphia Hospital and the Orthopedic
Dispensary of the University Hospital : Instructor in Ortho-
pedic Surgery in the University of Pennsylvania.
NEWTON M. SHAFFER, M.D.,
NKW YORK, N. v.,
Clinkail Lecturer on Orthopedic Surgery, University of the City of
New York : Attending Surgeon-m- Chare e of the New
York Orthopedic Dispensary and Hospital.
THOMAS L. STEDMAN. M.D.,
NKW YORK, N. Y.,
Assistant Surgeon, New York Orthopedic Dispensary and Hospital.
OBSTETRICS AND GYNAECOLOGY.
F. E. l^ECKWITH, M.D.,
NEW HAVKN, CONN.,
Prof, of Obstetrics and the Diseases of Women and Children, Yale
College.
J. H. EMERSON, M.D.,
NBW YORK, N. Y.
JAMES H. ETHERIDGE, M.D.,
CHICAGO, ILL..
Prof, of Materia Medica and Medical Jurisprudence, Rush Medi-
cal College.
FRANK P. FOSTER, M.D.,
NKW YORK, N. Y.,
Assistant Burgeon, Woman's Hospital in the State of New York.
WILLIAM GARDNER, M.D.,
MONTREAL, CANADA,
Prof, of Gynaecology, McGiU University.
MATTHEW D. MANN, M.D.,
BUFFALO, N. Y.,
Prof, of Obstetrics and Gynaecology, University of Buffalo, N. Y.
EDWARD L. PARTRIDGE, M.D.,
NBW YORK, N. Y.,
Prof, of Obstetrics, New York Post-Graduate Medical School and
Hospital ; Physician to the Nursery and Child's Hospital ;
Gynaecologist to the Out-Pattent Department o«
the New York HospiuL
THEOPHILUS PARVIN, M.D.,
PHILADBLPHIA, PA.,
Prof, of Obstetrics and Diseases of Women and Children, Jeffer*
sou Medical College.
J. C REEVE, M.D.,
DAYTON, OHIO,
Formerly Prof, of Materia Medica and Therapetitics, Medical
College of Ohio ; Chief of Staff of St. Elizabeth's Hospital,
Dayton.
GEORGE M. TUTTLE, M.D.,
NEW YORK, N. Y.,
Asustant to the Chair of Obstetrics, College of Physicians and
Surgeons, New York ; Gynaecologist to Roosevelt
Hospital, Out-Patient Department.
C. F. WITHINGTON, M.D.,
BOSTON, MASS.
W. GILL WYUE, M.D.,
NBW YORK, N. Y.,
Prof, of Gynaecology, New York Polyclinic ; Gynaecologist to Bellevue Hospital ; Surgeon to St. Elisabeth's Hospital.
DISEASES OF CHILDREN.
W. J. CONKLIN, M.D.,
DAYTON, OHIO,
Prof, of Diseases of Children, Starling Medical College.
ELBRIDGE G. CUTLER, M.D.,
BOSTON, MASS.,
Physician to Out-PatienU, Mass. General Hospital ; Physician
to Carney Hospital.
WILLIAM P. NORTHRUP, M.D.,
NSW YORK, N. Y.,
Pathologist to the New York Foundling Asylum.
DISEASES OF THE MIND AND NERVOUS SYSTEM.
HENRY W. BERG, M.D.,
NSW YORK, N. Y.,
Assistant Surgeon, N. Y. Orthopedic Dispensary and Hospital.
CHARLES L. DANA, M.D.,
NBW YORK, N. Y.,
?rof . of Diseases of the Mind and Nervous System, and of Medi-
cal Electricity, New York Post-Graduate Medical School
and Hospital ; Physician to the Northwestern
Dispensary, Nervous Department.
W. B. GOLDSMITH, M.D.,
DANVKRS, MASS.,
Superintendent of the Danvers Lunatic Hospital.
ALLAN McLANE HAMILTON, M.D.,
NEW YORK, N. Y.,
Prof, of Diseases of the Mind and Nervous System, New York
Polyclinic.
THEODORE H. KELLOGG, M.D.,'
NBW YORK, N. Y.,
Late AssisUnt Resident Physician, New York City Lunatic
Asylum, Blackwell's Island, and Physician-in-Charge of
New York City Asylum for the Insane, Ward's Island.
JAMES J. PUTNAM, M.D.,
BOS ION, MASS.,
Physician to Out- Patients, Department of Diseases of the Nervous
System, Massachusetts General Hospital ; Instructor in
Diseases of the Nervous System, Harvard Medical
College.
L. PUTZEL, M.D.,
NEW YORK, N. Y.,
Visiting Physician to Randall's Island Hospital.
M. ALLEN STARR, M.D.,
NKW YORK, N. Y.,
Late House Physician, Bellevue Hospital ; Attending Physician,
New York Dispensary.
GEORGE L. WALTON, M.D.,
BOSTON, MASS.,
Assistant in Out-Patient Department for Dii
of the Nervous System, Massachusetts General Hospital.
DISEASES OF THE SKIN.
LUCIUS D. BULKLEY, M.D.,
NBW YORK, N. Y.,
HENRY W. STELWAGON, M.D.,
PHILADELPHIA, PA.,
Phrtictan to the Philadelphia Dispensary for Skin Diseases
Chief of the Skin Dispensary of the Hospital, and Instructor
in Dermatology, University of Pennsylvania.
ARTHUR VAN HARLINGEN, M.D^
PHILADSLPHIA, PA.,
Prof, of Diseases of the Skin in the Philadelphia Polyclinic and
College for Graduates in Medicine : Consulting Physician
to the Dispensary for Sldn Diseases.
JAMES C. WHITE, M.D.,
BOSTON, MASS.,
Prof, of Dermatology, Harvard University.
HENRY WILE, M.D.,
PHILADELPHIA, PA.,
Clinical AssisUnt in Dermatologv in the University of Pennsylvania ; Assistant ?hyaician to the
iladelphia Dispensary for Skin Dii
Surgeon to the New York Ho8i>ital, Out-Patient Department,
Section of Skin Diseases.
JAMES E. GRAHAM, M.D.,
TORONTO, CANADA,
Lecturer on Diseases of the Integumentary System, Toronto
School of Medicine.
ROBERT B. MORISON, M.D.,
BALTIMORB, MD.,
Prof, of Dermatology and Syphilis, Baltimore Polyclinic and
Post- Graduate Medical School.
Philadelphia Dispensary for Skin Diseases.
LARYNGOLOGY AND DISEASES OF THE NOSE AND THROAT.
FRANCKE H. BOS WORTH, M.D.,
NEW YORK, N. V.,
Prof, of Diseases of the Throat, Bellevue Hospital Medical Col-
lege ; Physician-in-charge of the Clinic for Diseases of
the Throat in the Out-Door Department of
Bellevue Hospital.
D. BRYSON DELAVAN, M.D.,
NBW YORK, N. Y.,
Surgeon to Department of the Throat, Demilt Dispensary.
GEORGE M. LEFFERTS, M.D.,
NKWYORK, N. Y.,
Prof, of Laryngology, College of Physicians and Surgeons, New
York; Throat Surgeon, N. Y. Eye and Ear Infirmary.
JOHN N. MACKENZIE, M.D.,
BALTIMORB, MD.,
Surgeon to the Baltimore Eye, Ear and Throat Charity HospitaL
OPHTHALMOLOGY.
ADOLF ALT, M.D.,
ST. LOUIS, MO.
CHARLES S. BULL, M.D.,
NBW YORK, N. Y..
Lecturer mi Ophthalmology and Otology, Bellevue Hospital
Medical College ; Ophthalmic Surgeon, N. Y. Eye and
Ear Infirmary.
HASKET DERBY, M.D.,
BOSTON, MASS.,
Ophthalmic Surgeon, Massachusetts Chariuble Eye and Ear
Infirmary, Boston.
RICHARD H. DERBY, M.D.,
l<OSTON, MASS.,
Ophthalmic Surgeon, N. Y. Eye and Ear Infirmary.
EZRA DYER, M.D.,
NEWPORT, R. I.
JOHN GREEN, M.D.,
ST. LOUIS, MO.,
Lecturer on Ophthalmology, St. Louis Medical College.
B. JOY JEFFRIES, M.D.,
BOSTON, MASS..
Ophthalmic Surgeon to the Mass. Charitable Eye and Ear Infir-
mary, the Carney Hospital, and the New England Hospital
for Women and Children.
W. OUVER MOORE, M.D.,
NBW YORK, N. Y.,
Prof, of the Diseases of the Eye and Ear, N. Y. Post-Graduate
Medical School ; Assistant Surgeon to the New York
Eye and Ear Infirmary.
SAMUEL THEOBALD, M.D.,
BALTIMORB, MD.,
Prof, of Diseases of the Eye and Ear, Baltimore Polyclinic and
Post-Graduate Medical School; Surgeon to the Balti-
more Eye, Ear and Throat Charity Hospital.
EDWARD ALLEN FAY,
WASHINGTON, D. C,
Editor of '* American Annals for the Deaf and Dumb.'
DEAF-MUTISM.
I E. M. GALLAUDET, Ph.D., LL.D.,
WASHINGTON, D. C,
President of National Deaf-Mute College, Washington.
CAROLINE A. YALE, .
NORTHAMPTON. MASS.,
Associate Principal of the Clarke Institution for Deaf-Mutes.
OTOLOGY,
GORHAM BACON. M.D.,
NBW YOKK, N. Y.,
Aural Surgeon N. Y. Eye and Ear Infirmary.
CLARENCE J. BLAKE, M.D.,
BOSTON. MASS.^
Instructor in Otology in Harvard University ; Aural Surgeon,
Mass. Charitable Eye and Ear infirmary.
ALBERT H. BUCK, M.D.,
NBW YORK, N. Y.,
Formerly Instructor in Otology in the College of Physicians and
Surgeons, New York, and Aural Surgeon to the New York
Eye and Ear Infirmary.
FRANK BULLER, M.D.,
MONTREAL, CANADA,
Prof, of Ophthalmology and Otology, McGill University.
CHARLES H. BURNETT, M.D.,
PHILAOBLPHIA, PA.,
Prof, of Otology, Philadelphia Polyclinic and College for
Graduates in Medicine ; Aurist to the Presbyterian
HospitaL
J. ORNE GREEN, M.D.,
BOSTON, MASS.,
Aural Surgeon, Boston City Hospital; Clinical Instructor in
Otology, Harvard University.
D. B. ST. JOHN ROOSA, M.D.,
NBW YORK, N, Y.,
Prof, of Diseases of the Eye and Ear, New York Post-Graduate
Medical School ; Surgeon to the Manhattan Eye
and Ear Hospital.
W. W. SEELY, M.D.,
CINCINNATI. OHIO,
Prof, of Ophthalmology and Otology, Medical College of Ohio,
Cincinnati.
SAMUEL SEXTON, M.D.,
NBW YORK, N. Y.,
Aural Surgeon, N. Y. Eye and Ear Infirmary.
H. N. SPENCER, M.D.,
ST. LOUIS, MO.,
Prof, of Diseases of the Ear, St. Louis Post-Graduate School
of Medicine, Polyclinic and Hospital Association ; Aural
Surgeon to the St. Louis Free Hospital for Children.
SUPPLEMENTARY LIST OF CONTRIBUTORS.
(The foregoing classified list was prepared early in the autumn, and the following names have been
added since that date.)
WILLIAM R. BIRDSALL, M.D.,
NKW YORK, N. Y.,
Assistant Physician, Department for Nervous Diseases, Man-
hattan eye and Ear Hospiui.
EDWARD B. BRONSON, M.D.,
NBW YORK, N. Y.,
Prof, of Dermatology, New York Polyclinic; Dermatologist to
the Northern Dispensary.
HOWARD M. BUCK,
BOSTON, MASS.
M.D.,
WILLIAM N. BULLARD, M.D.,
BOSTON, MASS.,
Physician to Department of Nervous Diseases, Boston Dis-
pensary.
DONALD M. CAMMANN, M.D.,
NEW YORK, N. Y.,
Instructor in Diseases of the Chest, New York Polyclinic;
Visiting Physician to the Orphans* Home and Asylum.
WILLIAM H. FORD, M.D.,
PHILADBLPHIA, PA.
GEORGE B. FOWLER, M.D.,
NSW YORK, N. y..
Prof, of Physiolojfical Chemistry, New York Polyclinic; Physi-
cian to the New York Infant Asylum.
WALTER R. GILLETTE, M.D.,
NBW YORK, N. Y.,
Prof, of Obstetrics, New York Polyclinic; Visiting Physician
to Bellevue and St. Francis Hospiuls.
GEORGE S. HUNTINGTON, M.D.,
NEW YORK, N. V.,
Member of the Resident Surgical Staff, Roosevelt Hospital.
HENRY KOPLIK, M.D.,
NSW YORK, N. Y.,
Assistant in Normal Histology, Physiological and Pathological
Laboratory of the Alumni Association of the College
of Physicians and Surgeons.
F. HOWARD LOMBARD, M.D.,
BOSTON, MAS.S.,
District Physician, Boston Dispensary; Late Interne at the
Sntbindungsatutalt in Dresden, Germany.
JULIAN A. MEAD, M.D.,
WATBSTOWN, MASS.,
Medical Examiner for Middlesex County, MassachusetU.
MIDDLETON MICHEL, M.D..
CHAKLSSTON, S. C,
Prof, of Surgery in the Medical College of the State of South
Carolina; one of the Surgeons to the City Hospital,
Charleston.
WILLIAM H. MURRAY, M.D.,
NBW YORK, N. Y.,
Late House Surgeon, New York Hospital House of Relief;
Attending Physician, New York and Northern Dis-
pensaries.
IRVING C. R08SE, M.D.,
WASHINGTON, D. C.
A. N. TALLEY. M.D.,
COLUMBIA, S. C.
CHARLES WARE. M.D..
NBW YORK, N. Y.,
AsBisUnt Gynecologist, Out- Door Department
Hospiui.
of Roosevelt
MOSES C. WHITE, M.D.,
NBW HAVBN, CONN..
Prof, of Pathology, Medical Department of Yale College.
EDWARD S. WOOD, M.D.,*
BOSTON, MASS.,
Prof, of Chemistry, Harvard Medical School.
JOHN McG. WOODBURY, M.D.,
NBW YORK, N. Y.
SAMUEL B. WOODWARD, M.D..
WORCBSTBR, MASS.
Please make your order on the following blank, tear it off, and forward
it to the publishers at once.
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Messrs. WILLIAM WOOD & COMPANY:
Gentlemen : — You are hereby requested to enter my name upon your hooks
as a subscriber to the
REFERENCE HANDBOOK OF THE MEDICAL SCIENCES.
Edited by A. H. BUCK, M. D.,
to be published by you in Eight Volumes, imperial octavo* This subscription is for the
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[Naiuo of express ofBce above this line.]
November 22, 1884.]
THE MEDICAL RECORD.
575
were enough to take out at one time. He believes in
the drainage tube, and has had no success with fistulous
openings.
Dr. Feifield, of Boston, has used his finger to en-
large the opening in empyema for some time.
Dr. Austin Flint, of New York, read a paper dn the
DIETETIC treatment OF DYSPEPSIA.
Some authorities give the term dyspepsia as synonymous
with the term indigestion ; but he maintained that the
terni dyspepsia denotes an affection distinct from indi-
gestion. He then gave the local or stomach and general
symptoms of the affection. The appetite may be im-
paired, but is sometimes increased. The mind plays an
important part in the etiology of the affection. The old
method of treatment was to strictly regulate the diet,
drink very little or no fluids, and always leave the table
hungry. Such treatment is entirely wrong. Dyspepsia
may be developed by the attempt to regulate the diet by
rules intended to. prevent the affection. I always ask
a patient, Do you regulate your diet ? and he always an-
swers in the affirmative. I have never known a dyspeptic
to get well who attempted to regulate his diet. Regulate
by the appetite, the palate, and by commqn sense. A
patient may ask. Am I not to be guided by personal
experience and avoid such articles as I have found to
disagree with me ? I answer that personal experience
is very deceptive. An article that would disagree to-day
would agree to-morrow. Do not adopt the rules of eating
only twice or thrice a day. Be governed by the appetite.
Those articles are most digestible which are most ac-
ceptable to the palate. Do not leave the table hungry.
Take animal and vegetable products, and drink accord-
ing to the want of instinct. The diet which in healthy
subjects is conducive to health is the best diet for dys-
peptics. It is a fallacy to suppose that in dyspepsia the
organs of digestion need a prolonged rest. Patients
should not be afraid to rely upon their digestive powers.
Perfect cures have been obtained byfoUowing the in-
stincts of nature. Dyspepsia is most common in the
better educated classes, because they endeavor to regu-
late their diet on scientific principles.
A paper on
DOUBLE SYNCHRONOUS AMPUTATIONS
was read by Dr. W. C. Lynde, of Erie County, in which
he presented the statistics of a large number of cases.
The same writer then read a paper on the
FUNCTIONS OF THE AURICLES.
He maintains that the auricles do not contract, and that
a suction force is exerted on the part of the right
ventricle.
Dr. Austin Flint, Jr., said although the walls of the
auricles are much thinner than the walls of the ventricles,
they are composed of muscular tissue, and do contract.
He had seen them contract many times in operations on
the lower animals. In man there are no valves guarding
the openings of the veins into the auricles. The con-
traction of the muscular fibres constricts the openings of
these veins and prevents the regurgitation of the blood.
He does not believe in the suction force of the ventricles.
Dr. Austin Flint, Sr., described the contraction of
the auricles and the production of a heart-murmur which
was caused by the contraction.
Dr. Moore, of Monroe County, described some ex-
periments made by him and others in 1838, at a time
when we knew little or nothing of heart disease. This
was the starting-point of our knowledge of heart-sounds.
The contraction of the auricles is as easily seen as the
contraction of the ventricles. It requires simply to be
looked at in order to be known.
Dr. Austin Flint described the jugular pulse as due
to the contraction of the right ventricle and also to the
contraction of the auricle. The presystolic murmur is
due to the contraption of the auricle and is produced, not
by a passive flow of blood from the auricle to the ventricle,
but by an active force.
Dr. Ross related a case of rupture of the risht ventricle^
from which he argued that the force to produce this re-
sult must have been due to the contraction of the auricle.
The President asked
WHAT WAS THE USE OF HAVING A MUSCLE IN THE
WALL OF THE AURICLE
if it had no action ?
Dr. Lynde closed the discussion. He had many times
experimented on different animals, by introducing a
canula and trochar directly into the auricle, and had never
seen the blood well up in the canula^ while, when the
same instrument is introduced into the ventricle, the
blood is thrown to some distance. It would not do to
have the veins empty directly into the ventricles.
Wednesday, November 19TH — Second Day — Morn-
ing Session.
The Association was called to order at 10 a.m.
Dr. Gouley suggested a plan that the Association
should have
A CITY HEADQUARTERS, A PLACE THAT COUNTRY MEM-
BERS COULD REGISTER AT.
This would include the founding of a library under the
direction of the Council. There was already formed the-
nucleus of a library, and forty journals had been prom-
ised. He further suggested that a voluntary fund be
started, to be divided into a library fund and a sinking,
fund, for putting up a building. This plan was put in the-
form of a motion.
Dr. Moore seconded the motion, and stated that the
desirability of such a plan was obvious, although there-
might be pecuniary difficulties.
The resolutions were carried.
It was then carried that
THE LETTERS ** F.S.M.A." PLACED AFTER A NAME IN ANY
SCIENTIFIC PAPER SHOULD BE OFFICIALLY KNOWN TO
REPRESENT THE ASSOCIATION.
Dr. S. B. Hubbard, of New Haven, and Dr. H. B..
Ransom, of Iowa, were invited to sit as delegates.
Dr. Allen, of Rensselaer County, read a paper on
DIARRHOEA FROM DISEASE OF THE PANCREAS.
The history of a case was given that the doctor called
ADIPOSE DIARRHCEA,
in a man about sixty years of age. The stools were not.
very fluid, but contained matter looking like melted fat.
There was pain at umbilicus and borborygmi just before
the stools. The patient had three or four movements a
day, the odor of which was unbearable. The faeces pre-
sented bundles of fasciculi surrounded by fat ; appetite
variable. Pepsine and pancreatine, aa. gr. v., Li.d., and an
opiate constituted the treatment. For diet, soft-boiled
rice, milk, toast, and tea. Under this treatment there
was less adipose matter in the stools. There was coldness
of extremities noticed to be present. The patient im-
proved, but had a relapse from eating pork. He grew
rapidly worse, and sank into a deep stupor; urine partially
suppressed, and an examination showed one-quarter part
sugar, one-sixth albumen, with epithelium, hyaline casts^.
and broken down blood-corpuscles. The patient died
in coma and no autopsy was permitted. The case was
presented to the Association as a remarkable one.
THE ADDRESS ON OBSTETRICS AND GYNECOLOGY,
was delivered by Dr. T. Gaillard Thomas, of New York..
The author was asked to give an estimate of the pres-
ent status of obstetrics and gynecology. Obstetrics has.
always existed as an art, but not as a science. William
Hunter first elevated it to the position of a science..
Since his time there has been a steady advance. One-
great advance has been the discovery of the relation of
the low monads and micrococci floating in the atmos-
phere to diseased processes. This discovery has been
of as great importance in obstetrics and gynecology as
in general surgery. In the parturient process the open
576
THE MEDICAL RECORD.
[November 22, 18841
mouths of vessels afford opportunity for the absorption
of pmson from without. In the near future, antiseptic
obstetrics will probably be the rule. It never does any
harm, and if only one life in a hundred should be saved,
the extra trouble would not be unavailing. To free the
parturient act from septic dangers will be to save millions
of lives in the future ages. The germ theory has revolu-
tionized the treatntent of puerperal fever. Instead of
quinine, opium, and poultices, antiseptic intra-uterine in-
jections, containing bichloride of mercury or carbolic
acid are now used. Quiet pain by hypodermics of mor-
phine. Lower temperature at once, by a coil of running
water. Give a milk diet and perfect rest. Extra-uterine
pregnancy is now successfully treated by the foeticide
power of the strong galvanic current. The early diagnosis
and treatment of tubal pregnancy is becoming more sat-
isfactory. The methods of inducing premature labor have
beconie so safe and practicable that in placenta-praevia,
uraemia, etc., it should be oftener resorted to. The ob-
stetric forceps is the most life-saving instrument ever de-
vised in surgery. There have been few real improve-
ments in this instrument. Tarnier has recently made
an improvement by adding tractors. Two substitutes
have been employed in place of Caesarean section : Porro's
operation and laparo-electrotomy. The writer thinks
the results of the latter operation are better and safer.
A successful case by Dr. Pilcher was reported. The
gynecology of the future will be more allied to surgery
than medicine. Instead of applying caustics to an ul-
cerated OS, the lacerated cervix is now sewed up. Trache-
lorrhaphy has done much good and will do more. Extir-
pation of the ovary for various causes is now legitimate
and useful, although liable to abuse. In uterine defor-
mity the forcible dilatation of the cervical canal is being
tried. Among drugs the permanganate of potash is the
best emenagogue.
Afternoon Session.
Dr. T. B. Reynolds, of Saratoga County, Vice-
President, presided.
The first paper read was by Dr. Darwin Colvin, of
Wayne County, on
venesection in the convulsions of prjegnant and
parturient women.
The speaker based his remarks upon a combined ex-
perience of his father and himself, extending over a total
period of ninety-two years. Most of the cases recorded
in his father's note-books occurred at a time when chloro-
form was unknown and before albuminuria was heard of,
while his own cases belonged to a later period, when an-
esthetics were in daily use, bleeding was out of fashion,
and the pathology of puerperal eclampsia was beginning
to be better understood In none of his father's cases
did convulsions occur when venesection had been prac-
tised upon the appearance of threatening symptoms, and
even in those in which convulsions had already occurred
a prompt withdrawal of blood averted the fatal issue.
When the writer himself began practice, chloroform was
just coming into use, and he was anxious to make use of
it in puerperal eclampsia. In a case seen with his father
a convulsion had occurred, and consent was given re-
luctantly to make trial of the anaesthetic. This was
done, but the convulsions were not averted, the patient
grew worse and worse, until finally phlebotomy was in-
sisted on. Thirty ounces of blood were removed, the con-
vulsions did not again recur, and the patient recovered.
The author related a number of cases occurring in his
own practice in later years in which chloroform, chloral,
the bromides, and opium were used persistently, but the
patients continued to grow worse ; but when, finally, vene-
section was with many misgivings resorted to, improve-
ment at once took place, and the lives of the women
were saved. In every case cathartics were given early,
and the uterus was emptied of its contents as speedily as
possible, yet no favorable change occurred until the
blood-letting had been practised. Irregularity of the
pulse was insisted upon as an imperative indication for
the abstraction of blood. The author had never seen a
fatal case either in his father's practice or in his own
when venesection was practised, and he asserted that if
this measure was resorted to before consciousness had
been abolished the patient would not die of eclampsia.
The lancet was the sheet-anchor in convulsions of preg-
nant and parturient women. The author laid down the
following rules, which should be followed in every case of
pregnancy : i. Always see the patient at least two
months before the completion of her term ; 2, test the
urine frequently ; 3, if there is much persistent headache^
open a vein and bleed until the headache is relieved ; 4,
warn the patient against indulging in an improper diet ;
5, keep the 4>owels open ; and 6, if the patient be seen
for the first time at the beginning of labor, and convul-
sions are threatening, resort at once to venesection.
Dr. Moore, of Monroe County, had had a somewhat
less happy experience than the author of the paper, and
he had seen cases that did not yield to blood-letting.
He believed that the only real cure was to be obtained
by eliminating from the blood the poison that occasioned
the convulsions, and the way to do this was to produce
abundant catharsis. He preferred for this purpose Ae
saline cathartics. But the action of cathartics is not in-
stantaneous, and in order to ^ain time it is necessary to
avert the threatened convulsion by some ready means.
Blood-letting will do this ; but ether, not chloroform, will
also do this and do it better. He always gave ether, in
puerperal convulsions even, and especially, when there
was unconsciousness with stertorous breathing. He
gave plenty of it, and kept the patient profoundly under
its influence, for hours if necessary, until the cathartic had
produced a copious evacuation of the bowels.
Dr. Pomeroy, of Monroe County, related a case in
which convulsions ocairred again and again, in spite of
the use of chloroform, and did not cease until the bowels
had acted thoroughly. He thought the lancet was use-
ful in certain cases, but the thing of prime necessity was
free catharsis.
Dr. Hovey maintained that the main thing to do in a
case of puerperal eclampsia was to empty the uterus.
Dr. Thayer, of Kings County, agreed with Dr.
Moore as to the value of ether, but preferred veratrum
viride. The treatment of convulsions by means of this
agent was very extensively practised in Brooklyn, but
the doses, to be effectual, must be large — a drachm of the
tincture. This drug reduces the rapidity of the circula-
tion speedily and permanently, and when the pulse is low-
ered the convulsions will cease. Drachm doses may be
repeated every hour, according to the indications afibrded
by the pulse.
Dr. Cronin, of Erie County, mentioned the former
division of eclampsia into apoplectic, epileptic, and hys-
terical. It is in the epileptic form that bleeding is usefiiL
In closing the discussion, Dr. Colvin insisted again
upon the irregularity of the pulse as an indication for
phlebotomy. When this irregularity occurred, he main-
tained, death was near, and nothing could ward it off but
blood-letting.
A paper by Dr. B. L. Hovey, of Monroe County,
on " The Practice of Medicine Forty Years A^o, with
Comparative Position at Present," was read by title.
Dr. C. C. F. Gay, of Erie County, then read a paper on
FRACTURE OF THE BASE OF THE ACETABULUM.
It has been said that this fracture rarely occurs, and
that when it does, it is due to a violent injury over the
trochanter. But the object of the present paper was to
show that it is of not so infrequent occurrence, and that
it may be produced by comparatively slight causes. There
may be a simple straight fracture, or the base of the
acetabulum may be shattered and broken up along the
lines of union of the original bones. The finicture may
occur alone, or maybe complicated with a fracture of the
November 22, 1884.]
THE MEDICAL RECORD.
577
innominate bone, and the head of the femur may or may
not be displaced. It may occur at any age. The author
related a case seen by him in which the patient had fallen
sixteen feet, striking on* the right hip. Upon examina-
tion, under ether, there was found a slight eversion of
the foot, with no shortening, and it was stated that crepi-
tus was present. Extension of a few pounds' weight was
applied and afforded relief to the severe pain complained
of. The following day another examination was made,
and the same signs observed, except that no crepitus
could be obtained. Some days later the limb was again
examined. Soon after, symptoms of septicaemia pre-
sented themselves, and the patient died. At the autopsy
the joint was found filled with pus, which had found exit
into the abdominal cavity. The base of the acetabulum
was fractured in three directions, following the original
lines of union of the bones. The only prominent symp-
tom in fracture of the base of the acetabulum is severe
and persistent pain, increased by movement or by press-
ure against the trochanter ; there is no shortening, no de-
formity, and no crepitus. This accident, when there is
no displacement of the head of the femur, is not fatal,
nor even dangerous, provided the patient be let alone.
It is the frequent manipulation and examination that
causes the change. The management of a case of fract-
ure of the base of the acetabulum consists simply in giv-
ing perfect rest to the joint. When fracture is suspected,
the patient should be kept in bed with the limb resting
in an easy position, and extension may be made or not
according to the amount of relief which it aflfords to the
patient.
There was no discussion of this paper, but several of
the members thanked the author for his communication,
as having indicated to them the correct diagnosis in sev-
eral perplexing cases which they had under treatment at
the present time.
Dr. J. G. Orton, of Broome County, then related
A CASE OF TUBAL ^REGNANCY, AT FULL TERM, OF
FOURTEEN YEARS* STANDING.
The patient had passed through what seemed to be a
normal pregnancy, at the expiration of which some abor-
tive attempts at delivery were made. These subsided in
a little while, and as time went on and no further symp-
toms were developed the conclusion was arrived at that
a mistake in diagnosis had been made. The patient's
health declined, and for eighteen months she was very
ill ; but at the end of this time she began to improve,
menstruation returned, and she was soon perfectly re-
stored. The tumor remained, however, and fourteen
years later she began to have a considerable fluid dis-
charge. On examination an opening was found in the
rectal wall, through which a hard and movable body was
felt. A bullet forceps was introduced, and brought
away the femur of a full-grown foetus. In numerous sub-
sequent sittings, held about every second day, about one
hundred bones were removed. The patient was then at-
tacked with a diarrhoea prevalent at the time, and died.
At the autopsy the right Fallopian tube was found greatly
enlarged, and on opening the sac the remaining bones
of a full-term foetus were found.
Dr. Nathan Bozeman, of New York County, then
presented a communication on
TWO CASES OF EXTRAUTERINE PREGNANCY, CONSIDERED
IN RELATION TO DIAGNOSIS AND TREATMENT.
The first case was one of rupture of the tube, with
profuse hemorrhage into the abdominal cavity. Laparot-
omy was performed, but the patient died thirty-three
hours after the operation. The second case was one in
which abdominal pregnancy had occurred, but gave rise
to no more dangerous symptoms than a veiy severe pain
in the abdomen, which was controlled by morphine. The
patient continued for three years in excellent health, ex-
cept that she suffered from violent facial neuralgia. At
this time menstruation ceased, and the woman was found
on examination to be again pregnant. She was taken
with pains, and was delivered of a seven-and-a-half
months' still-born foetus. At the time of delivery a hard
body was felt presenting in Douglas' cul-de-sac. An in-
cision was made, and the bones of a dead foetus, almost
entirely deprived of the soft parts, were removed. The
patient made an excellent recovery, and is now perfectly
well.
The credit of being the first to insist upon early laparot-
omy in the case of rupture of a tubal pregnancy belongs,
the speaker said, to the late Dr. Stephen Rogers, of New
York. Since then, the successful results obtained by Mr.
Lawson Tait have placed this operation in the foremost
rank of availability. The treatment of tubal pregnancy
in the early months consists in the destruction of the
foetus by electricity. In this way we are able to avoid
the graver operation of laparotomy which becomes im-
perative upon rupture of the tube.
Dr. Arnold, of Albany County, stated that thece was
a specimen in the Albany museum of a tubal pregnancy
in which the foetus had been carried for fifty-two years.
Dr. Newman, of New York County, related a case of
delivery of the bones of a foetus through the rectum very
similar to that reported by Dr. Orton. The speaker ap-
proved of electricity in the early stages.
Dr. Bozeman, in concluding, related a case of tubal
pregnancy, with threatened rupture, now under treatment
by electricity. An interrupted galvanic current from'
fourteen cells is used, the negative electrode being passed
up by the side of the uterus with the positive pole on the
abdomen. One or two applications are supposed to be
sufficient to cause the death of the foetus, but four are
generally made to ensure success.
Dr. C. S. Bull, of New York County then read a
paper on
HYDROCHLORATE OF COCAINE AS A LOCAL ANiESTHETIC
IN OPHTHALMIC SURGERY.
The first knowledge which we had received of this new i
application of the alkaloid of coca, was obtained, the
speaker said, through a letter of Dr. Noyes published in
The Medical Record. The author gave the results
of a number of experiments made with this substance.
In one hundred and fifty cases he had obtained complete
anaesthesia of the conjunctiva in all but three. The mid-
riatic effects of cocaine are less marked than those of
atropine. Dilatation of the pupil occurs more slowly and
recedes more rapidly than when the latter agent is used.
As regards accommodation, the range is shortened and
the near point recedes. Recession of the near point
begins within twenty minutes after instillation of the four
per cent, solution, increases during fifteen or twenty
minutes, and then diminishes. Complete paralysis of
accommodation was never observed. The effects of the
alkaloid as an anaesthetic are chiefly superficial, though
the deeper structures are slowly affected. Anaesthesia
of these parts, however, can be obtained by injection of
the solution into the anterior chamber. The author re-
lated a number of cases of operation upon the eye in
which no pain was experienced. He believed that every
operation in ophthalmology, with the possible exception
of enucleation of the eyeball, might now be painlessly
performed, and he predicted that ophthalmologists would
in the near future be released from the thraldom of ether.
By means of this anaesthetic also paracentesis of the drum
membrane could be performed without pain. It was
also of value in acute nasal catarrh. By an application,
by means of a probe armed with cotton, to the mucous
membrane of the anterior and posterior nares an acute
coryza could be cured. After such an application in
his own case the respiration became perfectly free, and
remained so for five hours : a second application then
completed the cure.
Dr. Mitchell, of Rensselaer County, desired to add
his testimony to all that had been said of the value of
cocaine hydrochlorate. He had used bromide of ethyl
very largely in ophthalmic practir^, and considered it^of
578
THE MEDICAL RECORD.
[November 22, 1884.
great value. Prompt effects were obtained in one or
two minutes and the recovery is almost as speedy, and it
was, he thought, absolutely safe in short operations.
But this new anaesthetic agent seemed destined to super-
sede all others. He thought it especially useful for diag-
nostic purposes in the case of young children, as even
the most timid would allow the eye to be handled with-
out shrinking when they found that manipulation caused
no sensation.
Dr. Squibb, of Kings County, said that he had re-
ceived over three hundred letters asking for cocaine im-
mediately after the publication of Dr. Noyes* letter in
The Medical Record. He had tried to extract the
alkaloid from coca leaves, but had as yet succeeded in
obtaining only about enough to show that it really was
the hydrochlorate of cocaine. The price of the drug
was formerly $2.50 per gramme (15 grains), but was now
about fifty cents a grain, and was likely to be more ex-
pensive before it became cheaper.
Dr. P'rederick W. Putnam, of Broome County, read
a paper entitled
A report of a cask of dislocation of the first
PHALANX OF THE THUMB FORWARD.
Few such cases have ever been reported. In the case
cited, a boy ten years of age fell from a swing, dislocat-
ing the first phalanx of his thumb forward. There was
severe pain but very little swelling. The luxation was
readily reduced, and the case did well. (The original
report of this case appeared in vol. xxv. of The Medi-
cal Record.)
Dr. Jonathan Kneeland, of Onondaga County, had
his paper on " Common-Sense vs. Hypothetical Medica-
tion in Treating Chronic Diseases, ** read by title.
Dr. John P. Gray, of Oneida County, next read his
paper entitled
insanity — preventive measures.
• The idea of his paper was to give a few hints on the
prevention of insanity. Modern science has suggested
health boards which are authorized to proclaim the laws
of hygiene and enforce them. In contagious diseases
persons can even be removed from their homes and iso-
lated. Compulsory vaccination is the extremest step
that has been taken in this direction. In ordinary dis-
eases, however, the individual is left to his own discre-
tion. Insanity is a disease of frequent occurrence, and
to a great extent within legal control. This is a neces-
sity to protect the public as well as the patient Over
twelve thousand persons are confined in asylums iii New
York State. Medical men have a sreat responsibility in
this matter, as only they can commit to asylums.
CAN ANYTHING BE DONE BY GENERAL PRACTITIONERS TO
PREVENT THE BEGINNING OF INSANITY?
The habits of body and mind, emotions, disposition, etc.,
must all be carefully considered. Insanity means sickness
of body producing sickness of mind. The average medical
man thinks of insanity as the last thing liable to happen.
Physicians in large practice often say they see very little
of insanity. The reason of this is probably that persons
having a family physician are less liable to suffer from se-
vere depreciation in health, which leads to insanity. An
early recognition of 9k flagging of the nervous system is of
the first importance. Rest and food are then of greater
importance than travel. Sedatives and narcotics disorder
nutrition, and do more harm than good ; if they are much
used, the patient is apt to go from hypochondriasis to
melancholia, often ending in suicide. . Chalybeates, milk,
and malt, and nourishing food, do better than sedatives.
CHILDREN AND YOUTH ARE SENT TO SCHOOL TOO SOON
AFTER RECOVERING FROM DISEASES LIKE SCARLATINA
AND MEASLES.
They are thus apt to contract such affections as hys-
teria and chorea. An early recognition of changes in
the character is of the. greatest importance. An unnatu-
ral timidity or anxi 'f i*are among the earliest changes.
Patients must be taught to resist such tendency, and
their nourishment be increased in every way. They
must be treated as sick persons when in this uncertain
mental state, due to disordered health. At the same
time the patient's apprehensions should not be aroused
— loss of sleep and too little food generally precede such
a state. The early stages of alteration in health and
character can be often best recognized and overcome by
the family physician.
Evening Session.
Dr. Gross, of Philadelphia, being present, was invited
to sit as a delegate.
Dr. Stephen Smith, of New York, submitted the con-
clusions of a paper on
excision of the knee in preference to amputation
IN CERTAIN deformities OF THE LEG.
The class of cases referred to were described as flexions
of the leg due to chronic disease of the joint, or from
other causes, which prevented the limb from being straight-
ened so as to bring any part of the foot to the ground.
In these cases the joint is not always seriously com-
promised, but the long-continued flexion has led to such
a contracture of parts that it is impossible to put the limb
in a useful position without excision. The operation
gives much better results as regards future usefulness of
the limb than amputation.
Dr. 'Gross, of Philadelphia, described an operation
devised by his father, by which the partial anchylosis of
the knee may be overcome.
Dr. E. M. Moore, of Rochester approved of excision
in the class of cases referred to in the paper.
Dr. George Harrison, of New York, read a paper on
THE CURETTE, ns PLACE AND ITS POWER IN UTERINE
THERAPEUTICS.
Two problems presented themselves as to its use.
First, to determine what conditions demand its use, and
second, the best method of using it. It was very useful
in removing morbid, soft structures from the inner sur-
fajce of the uterus.
A paper on
THE RELATIONS BETWEEN TUBERCULOSIS, JOINT DIS-
EASE, AND GENERAL TUBERCULOSIS,
was read by Dr. Dennis, of New York.
Recent pathological researches have shown that joint
disease are primarily generally due to tuberculosis and
very rarely to traumatism. Clinical facts show that a
close relation exists between acute miliary tuberculosis
and local tuberculosis. Tuberculosis starts from a focus,
and this focus is a diseased lymphatic gland. The central
cheesy foci situated in diseased glands afford means for
the development of the disease. He then gave the his-
tory of a case in which a cheesy mass was taken from a
diseased wrist-joint, and the microscope showed it to
contain bacilli tuberculosis. The patient some weeks
after died of acute miliary tuberculosis. This is the roost
important link showing the relation between the two
affections. Acute miliary tuberculosis is an infectious
disease, and may be developed by inoailation or by in-
haling tuberculous material. The removal of the cheesy
glands which contain the foci of the disease is the easiest
means of eradicating it. Marked improvement in cases
will generally follow the removal of the cheesy masses.
P^xamine the character of the discharges in every case to
determine the presence of bacilli of tuberculosis. The
greatest danger from tubercular joints is acute miliaiy
tuberculosis.
Dr. Gross said primary articular tuberculosis was iden-
tical with tuberculosis of testicle and other parts of the
body, and this connection was shown in the cause of death.
He advocated the bpening of the joint and removal of dis-
eased tissue and then sprinkling the parts with iodoform.
Dr. Dennis then presented some specimens of the
disease.
November 22, 1884.]
THE MEDICAL RECORD.
579
Dr. W. T. Lusk read a paper on
THE MANAGEMENT OF BREECH CASES IN WHICH BOTH
LOWER EXTREMITIES ARE BENT UP PARALLEL TO THE
ANTERIOR SURFACE OF THE CHILD.
In these cases Nature most often fails to finish her
work. Emergencies rarely arise before the breech has
descended into the brim. Many object to the use of in-
struments in these cases, but experience recommends
their use in cases where manual manipulation is of no
avail The chief objection to the forceps is that it is de-
signed to take only the head. If applied to the breech
it may slip off or break the pelvic bones, lacerate the
toft parts, or kill the child, sometimes injuring the soft
parts of the mother. Since the introduction of the trac-
tion-forceps a new impulse has been given to the use of
forceps. The use of forceps is inadmissible unless the
breech does not engage the brim of the pelvis. The ex-
traction of the child must not be made an exhibition of
strength. But little force is needed Traction force is
most successfully used during the pains. If the forceps
fails from any cause, or is inadmissible, the employment
of the fillet is admissible. Dorso-posterior position
calls for especial caution when traction is made from the
groin. The main drawback to the use of the fillet is the
difficulty of passing it around the thigh in most of those
cases in which it is most useful. The objection to the
blunt hook is due not to inherent defects in the instru-
ment, but to want of care in its use.
Dr. Thomas H. Manley read a paper on
WOMEN AS MIDWIVSS,
in which he advocated their employment among the
working classes, and the opening of schools for their
education.
Thursi>av, November 2oth — Third Day — Morning
Session.
The Association wad called to order at 9.30 a.h.
A preamble and resolutions on the death of Dr. John
G. Adams wer# offered by Dr. Purple and adopted by
the Association.
dr. GOULEY THEN ASKED EVERY MEMBER OF THE ASSO-
CIATION TO FURNISH HIM WITH THEIR PICTURE.
Cards containing an order on a photographer would be
furnished them, and he only wished to have one picture
left for himself. He abready had their autographs and
he wished to remember them all personally.
Dr. Flint, Sr., then offered resolutions thanking
Messrs. Carnegie and Vanderbilt for their recent mu-
nificent gifts to the cause of medical science. Unani-
mously carried.
The committee on nominations reported the following
officers FOR THE ENSUING YEAR :
President — Dr. John P. Gray, of Oneida County.
Vice-Presidents— ^cxya^ District, Dr. W. H. Robb,
of Montgomery County ; Third District, Dr. J. G. Orton,
of Broome County; Fourth District, Dr. Joseph O.
Greene, of Erie County ; Fifth District, Dr. J. C. Hutch-
inson, of Kings County.
New Members of Council— Ynst District, Dr. William
Gillis, of Franklin County ; Second District, Dr. R. C.
McEwen, of Saratoga County ; Third District, Dr. Fred-
crick Hyde, of Cortland County ; Fourth District, Dr.
Darwin Colvin, of Wayne County ; Fifth District, Dr. J.
W. S. Gouley, of New York County.
Report unanimously adopted by the Association.
Dr. Austin Flint then delivered an
ADDRESS ON MEDICINAL AND NON-MEDICINAL THERA-
PEUTICS.
The scope of his remarks was to define the term
therapeutics, which may denote drugs only, or, in a
broader sense, any means or appliances for the cure of
disease. It is popularly considered to be the chief
business of physicians to use drugs. The prevailing
sentiment at present is that a doctor without drugs is
like the play of " Hamlet " without Hamlet. A case
was cited in which a patient who had recovered from
pneumonia without the use of drugs complained of the
inattention of the physician. Professional visits without
a prescription are often deemed useless by the patient.
In the popular sense, medicine means drugging. A
knowledge of anatomy and physiology are not appre-
ciated by the public. A physician should not be con-
sidered only as a dispenser of drugs. It often takes
better judgment to withhold drugs than to give them.
Nothing is easier than to give drugs. The time will come
when the doctor will be considered a mediccU counsellor^
and this reformation must take place in the public mind.
Nature is always the efficient curative agent, and most
diseases tend by themselves to recovery. It is to this
fact that irregular systems of medicine owe their popu-
larity, especially in regard to infinitesimal doses. There
is considerable diversity of opinion among physicians as
to the effects of drugs ; some are too confident of their
powers, and others too sceptical.
There are pharmacomaniacal doctors as well as pa-
tients. Each new remedy is eagerly accepted and the
old one discarded. The sceptical doctor shows the re-
verse picture, and the truth lies somewhere between
these extremes. We must be satisfied that potential
drugs are clearly indicated before using them. Clinical
experience is the only rational ground upon which drugs
are to be used, and hence the importance of close obr
servation. The results of experiments on lower animal^
must be accepted with caution. It was empiric knowl-
edge that first led to the use of such drugs as cinqhona
and mercury, although now we think they may act as
parasiticides. Theoretical knowledge has rarely been of
much clinical use. The parasitic idea of the etiology
of disease offers a great future for therapeutics in the
line of discovery of parasiticides. Non-medicinal thera-
peutics are not much appreciated by the pharmacomani-
ac Harm may be done by the use of non-medicinal agen-
cies as well as b^ an injurious use of drugs. Diet is an
essential factor m therapeutics, and we must keep in
view that there is never danger from over-nutrition. The
lethal agency in exhausting diseases is always denutrition
and starvation. If patients can digest and assimilate food
they cannot be overfed. The best principles of thera-
peutics are in accord with common sense. There must
be a regard for nature's wants, and appetite and taste
generally show what is needed. In cases like the essen-
tial fevers, where the appetite is gone, reliance must be
placed on milk and eggs. With regard to beef-tea, ex-
tracts, etc., the nutriment is almost ni7, although they
act as stimulants to the digestive fluids. Beef-toa has
been compared to urine. Leube^s solution contains the
equivalent of solid flesh, and Rosenthal has made it
more palatable. Most nervous diseases are due to de-
ficient nutrition. Is alcohol a food ? To a certain extent
it is, inasmuch as it is not expelled from the body as al-
cohol. It should not be withheld in disease, even if it is
not always desirable in health ; the tendency of late years
has been to use alcohol rather more restrictedly.
In certain cases of phthisis, alcohol retards the disease
and it sustains life in typhoid fever. It prevents tissue
waste and has antiseptic properties. The term to catch
cold is indefinite and does harm among the laity. Sick
rooms are poorly ventilated, and sponging deemed haz-
ardous; in pneumonia, especially, is there a popular
prejudice againt cold. Few diseases are due directly to
cold, and a fever patient never catches cold. The men-
tal influence of the doctor on the patient is important
Some never succeed because they cannot inspire confi-
dence^faithy and hope. One class of physicians are too
sanguine, and thus err in prognosis ; another class are
too pessimistic. A gloomy prognosis may contribute to
its fulfilment. Faith cures show the influence of the
mind on the body, and physicians may learn something
from them. The introduction of the term neurcuthenia
i
58o
THE MEDICAL RECORD.
[November 22, 1884.
has done harm. Too much introspection must be
avoided, and the sanitary effects of work not overlooked.
Resohitions of sympathy with Dr. Sayre in his illness
were carried.
RESOLUTIONS OF THANKS TO DR. J. W. S, GOULEV FOR
THE ENERGY DISPLAYED BY HIM IN CONNECTION WITH
THE ASSOCIATION
were also carried.
Dr. John P. Gray, the President-elect, then took the
Chair. He made a brief speech in which he stated that
the Association was not an offshoot, and represented
neither new code, old code, nor no code, but was in-
tended to keep up the fellowship and feeling that had for-
merly existed in the profession.
Afternoon Session.
The first paper read was by Dr. Caspar Griswold,
of New York County, on
FALSE ALBUMINURIA.
There were two classes of cases considered by the
speaker : i. Those in which the urine does not contain
albumen, but in which a precipitate resembling albumen
is thrown down by the ordinary tests. 2. Cases in which
the urine does contain albumen, but this albumen is not
excreted by the kidneys, and consequently is not a sign
of nephritis. The author described the methods used by
himself in order to discriminate between different precip-
itates, and concluded by insisting upon the necessity of
correct methods in testing the urine for albumen.
Dr. Samuel W. Smfth, of New York County, then
presented a communication entitled
THE early use OF THE KNIFE IN NiEVUS OF THE CAV-
ERNOUS ANGIOMA VARIETY AS CONTRASTED WITH
OTHER MODES OF OPERATION FOR REMOVAL.
The author urged an early operation by the knife, be-
cause of the rapid growth of the tumors, and reported
two cases in support of his preference.
The following papers were
READ BY TITLE
and referred to the Committee on Publication.
" Stretching of the Nasal and Infraorbital Nerves in
Ciliary Neuralgia," by Dr. C. G. Ross, of Chemung
County ; a case of " Ovarian Cyst with Operation," by
Dr. T. M. Lloyd ; " Organic Disease of the Brain not
a Constant Factor in Insanity," by Dr. Simeon T. Clark,
of Niagara County ; ** Supporting the Perineum in the
Act of Parturition," by Dr. Jacob Hardtman, of New
York County ; ** Report of a Case of Gunshot Wound
of the* Stomach, Recovery," by Dr. John H. Hinton, of
New York County.
Dr. E. G. Janeway, of New York County, next read
a paper on
ABSCESS OF THE LIVER.
The doctor has seen a comparatively large number of
cases of abscess of the liver during the past year, and
thinks that the disease is not so infrequent in this cli-
mate as is usually supposed. The abscess may be single
or multiple. The idiopathic form is to be distinguished
from that ocurring when there is infection through the
portal circulation. Sometimes several small infective
abscesses may coalesce and form a single abscess, resem-
bling the idiopathic form. During the present year the
doctor has met seven cases ; of these three died and four
recovered. Of those that recovered, in three cases the
abscess was opened by operation and one opened spon-
taneously.
Dr. J. Lewis Smith, of New York County, then read
ajpaper on
DIPHTHERITIC CROUP. ^
He stated that croup was usually, but not always, a
local manifestation of diphtheria. Any severe inflam-
mation of the larynx might result in the formation of a
pseudo-membrane. He related a case of membranous
croup in a child, twenty-five months of age, due to
"catching cold." * Croup did not occur always from
propagation of the specific inflammation from the
pharynx and fauces, but might be the first manifestatioD
of the disease. It might also occur in the course of
diphtheria, notwithstanding the most thorough disinfec-
tion of the faucial exudation. Whenever in a case of
diphtheria the patient became hoarse or presented any
other signs of implication of the larynx, treatment by
inhalations of lime-water was imperative. When any
marked dyspnoea was present, not more than one in
eight patients could be saved without tracheotomy. The
room should be filled with steam from a croup-kettle or
atomizer ; to the lime-water in the atomizer liquor po-
tassae, in the proportion of one and a half per cent, being
added.
Dr. Rochester, of Erie County, related a case in
which he employed a mixture of iodoform and bismuth
(one part to two) in insufflation ; no other treatment was
given except stimulation.
Dr. Reese, of Kings County, since he had used kero-
sene in inhalation, had never had a fatal case of croup.
Dr. Moore, of Monroe County, had found frequent
insufflations of bicarbonate of soda most efi*ectual for dis-
solving membrane. '
Dr. Austin Flint, Jr., related
SOME TYPICAL CASES OF DIABETES MELLITUS NOT BEFORE
REPORTED.
They illustrated the value of arsenite of bromine (three
to five drops of Clemens' solution three times a day) in
conjunction with a rigid anti-diabetic regimen. In con-
clusion he quoted a statement of Cantani that diabetes
was readily curable provided only that treatment be be-
gun in an early stage.
Dr. Clark, of Vermont, said that in his own case he
suffered greatly from dyspepsia when starchy foods were
excluded. He found sugar in his urine #hen the specific
gravity was reduced to 1.003.
Dr. Fifiene, of Boston, related the case of his son,
who suffered from diabetes after the bite of a bull-dog.
He did not believe that dieting would ever cure diabetes
in the young, and if it did in the old it must be because
of some constitutional difference.
Dr. T. W. Ross, of Chemung County, reported a case
of
RUPTURE OF THE UTERUS,
occurring in a woman with narrow pelvis, who had had
nine previous pregnancies, none of them, however, going
to term.
Dr. Bontecou, of Rensselaer County, then exhibited a
patient illustrating
A CASE OF CONSERVATIVE SURGERY AND ITS RESULTS.
The patient was shot in the late war and suffered a
very extensive injury of the shoulder-joint Exsection
was performed some month later, as much of the perios-
teum having been saved as possible. There had been
a considerable reproduction of the shaft of the humerus.
A paper was then read by Dr. J. W. S. Gouley, of
New York County, entitled "Report of a Case of Liga-
ture of the Primitive Iliac Artery for Diffuse Aneurism
of the External iliac Artery."
The session was then adjourned.
At the close of the session on the third day two hun-
dred and thirty-eight members had redstered.
The Fellows residing in New York County entertained
the Association at supper in the evening at the Murray
Hill Hotel.
The programme for Friday included surgical opera-
tions at Bellevue Hospital at 10 a. m., an exhibition of
various bacilli at 1 1 a. m., and an excursion to the hos-
pitals on Blackwell's, Ward's, and Randall's Islands at
noon.
November 22, 1884.]
THE MEDICAL RECORD.
581
(£>owesvion&ence.
OUR LONDON LETTER.
(From our Special Correspondent)
CHANGES IN THE ARMY MEDICAL DEPARTMENT — EX-
AMINATION FOR PROMOTION — ANOTHER MEDICAL
JOURNAL — ^VICTORIA AND LONDON UNIVERSITIES
MEDICAL DEGREES — CRISIS IN THE LONDON MEDICAL
SCHOOLS — PROPOSED UNION OF THE TWO LONDON
COLLEGES — REFORM OF THE COLLEGE OF SURGEONS —
SIR LYON PLAYFAIR AND MEDICAL REFORM.
London, November z, 1884.
Considerable changes are being effected in the Army
Medical Department, and some of them are giving rise
to disaffection, if not hostility. First of all the De-
partment is to be furnished with a brand new name —
** The Medical Staff. " This is not sufficiently dignified for
some, who think it entitled at least to the prefix " Royal,"
which has indeed been recommended by two important
committees of inquiry ; but for some reason, compre-
hensible perhaps to the official mind, has been withheld.
It is said, however, that it may even yet be conferred.
I do not know that it will do our army surgeons much
good, but if they desire an empty distinction of the kind,
their arduous services entitle them to the horior.
Army surgeons have a further grievance : honors and
distinctions are conferred freely enough on combatant
officers, even when they have run no particular risks, but
are only grudgingly awarded in the fewest possible cases
to surgeons whose lives have been freely exposed in the
performance of their duty. It is a curious thing to ob-
serve that the name of the head of the Medical Depart-
ment appears in the army list without any military
decoration. There has always been a jealousy between
combatant and non-combatant officers. The former
have affected to look down upon their surgeons, except
of course at the time their services were m actual de-
mand.
Another important change is also to be inaugurated.
An examination for promotion to the rank of Brigade-
Surgeon is to be instituted ; and the feeling with which
this regulation is received by those who will have to be
examined is naturally the reverse of pleasant. The
Duke of Cambridge stated before a parliamentary com-
mittee that to " examine a man up to fifty years of age is
hardly fair, and that if the heads of the department do
their duty they ought to judge of the fitness for promo-
tion of medical officers without examination.'' Speaking
as a civilian I should think His Royal Highness must be
right There are some people who think examination
can test everything. It would open their eyes if they
were examined themselves. One defender of the new
proposal says that a good administrative officer requires
tact as well as temper. Fancy examining a man to as-
certain whether he possesses such qualifications ! An-
other defender asserts that the examination is optional.
Of course it is, but passing it will be necessary for pro-
motion ; the option, therefore, is of the kind known as
** Hobson's choice." I observed some time ago that this
question of examination for promotion had been fully
discussed in The Record in reference to the regulations
of the United States Army. American Army surgeons
can therefore sympathize with their British brethren in
the infliction to which they are about to be subjected.
At first it was actually proposed to examine surgeons-
major in operative surgery ; but I hear that this rule is
to be modified, and further that fellows of one of the
Royal Colleges of Surgeons are to be exempted from the
new examination.
A new periodical, Tlhe Medical Chronicle^ appeared
in October. It may be regarded as the organ of the
Manchester Medical Sdiool, as it is issued under the
authority of an influential committee in that city. But it ]
proposes to give a full abstract of current medical litera-
ture. As Manchester is the seat of the new Victoria
University and of numerous medical charities, there may
be room for such an organ.
Speaking of the " Victoria " reminds me that that uni-
versity has just missed a great chance of at once becom-
ing one of the most important medical institutions by
confining its degrees to the students of its own colleges.
Had it thrown open its portals to all qualified practitioners
who could pass its examinations, hundreds would have
applied for its degree, to whom the condition of residence
renders such a distinction inaccessible. But the Victoria
does not accept the examinations of other universities,
not even of the London, on whose evil model it has so
largely framed its regulations.
To other nations it must be almost incomprehensible
that the great bulk of English practitioners do not hold a
university degree. It is not because they do not desire
it, but because the English universities have so franaed
their regulations as to drive men to the colleges which
confer a membership or fellowship, but have no power to
grant degrees. That the magic M.D. or M.B. is coveted is
proved by the fact that hundreds go abroad to get it, and
thousands go to Scotland. Only twenty per cent of
practitioners in England have any connection with the
English universities, while nearly sixty-two per cent
hold Scotch degrees. In Scotland itself, ninety-eight per
cent, of the practitioners are graduates. You will say
that we have a university in London, but that body has
devised such a stupid set of regulations that a very small
number of students attempt to comply with them, and of
those who begin the medical career mapped out for them
and pass the earlier medical examinations only ten per
cent obtain the full degree. Was there ever such a
specimen of " how not to do it ? "
Just now the medical teachers of London are very
much concerned about the facts I have named above,
and no wonder their best men are leaving them, going
off to inferior schools, because the metropolis with its
unrivalled facilities for education is unable to crown the
edifice with the recognized distinction. The list of en-
tries at the medical schools for the winter session s
now completed, and a genuine "eye-opener" it proves
to be. The paltry University of Durham with its affili-
ated school at Newcastle has a larger entry than sev-
eral of the London schools. Why ? Because residence
at Newcastle enables the student to take a degree, but
residence at London does not No one can suppose
that medicine can be better taught at Newcastle In-
firmary than at our great London hospitals ; and yet
these Newcastle students will soon come out as full-
fledged M.B.*s or M.D.'s, with a legal right to call them-
selves Doctor, while students of Gu/s, St. Bartholomew's,
St Thomas', and the London Hospitals, must be con-
tented to style themselves plain Mr., or to append to their
names half a dozen or a dozen letters, which are for the
most part incomprehensible to the public. I have al-
ready informed you that there was a talk of making our
two Royal colleges into a university, and this notion has
gained ground, until to-day it has obtained the support
of The Lancety and many teachers would rejoice to see
it accomplished. It ought to be easier with the mate-
rials thus to hand to inaugurate a medical university in
close connection with the metropolitan schools, than to
establish an absolutely new university in all the faculties.
Our two colleges have agreed to unite and give a full
diploma, which will qualify for practice in every depart-
ment ; but those who take that diploma, though they may
be members of both colleges, will still have to call them-
selves Mr., will still be unable to sign themselves M.D.,
while their rivals and neighbors who hail from New-
castle or Aberdeen may write Dr. before their names or
M.D. after. Unless something is done to remedy this
injustice the ruin of the London schools is to be antici-
pated. In New York, I understand, the College of Phy-
sicians and Surgeons confers the degree of M.D. But on
582
THE MEDICAL RECORD.
[November 22, 1884.
your side of the water you can go ahead and rejoice in
your strength ; here we are overburdened with our a^e,
and when we attempt to disturb the dust of centuries
we are suffocated for our pains.
We have now in working order two Societies lor the
Promotion of Reform in the London College of Surgeons,
and both bodies have put forth their grievances. The
Association of Fellows have issued a series of recommen-
dations, which are decidedly liberal, so far as they are
themselves concerned, and inasmuch as they recognize
the existence of Members ; but they have no notion of
making the latter an integral part of the corporation. As
the recommendations will be shortly discussed and may
be considerably modified, I need not more fully describe
them. The Association of Members is rather more am-
bitious, and has actually petitioned the Prime Minister to
assign two Members of Parliament to the medical men of
the country. I do not suppose the petition will produce
more than a faint smile m official circles. No profession,
as such, enjoys parliamentary representation, and we
may be pretty sure that such an innovation will not be
made by a Government of which most of the members
are opponents of ** fancy franchises."
The mention of Parliament reminds me that the shadow
of a coming election is already perceptible in several quar-
ters, and in one is of special interest to our profession. The
seat of Sir Lyon Playfair is again threatened ; at the last
election he was only returned by a small majority. He
had deeply offended a large section of his constituents
by his action on medical reform, and a medical man was
put in opposition ; he was, however, again returned for
the Universities of Edinburgh and St, Andrews. Since
then he has again played fast and loose with medical re-
form. He has no doubt pleased some of the Scotch cor-
porations, but the majority of his numerous medical con-
stituents are disgusted with his tergiversation, and those
who are of the same political party think his time-serving
spirit unfit for the representative of an academical constit-
uency. This week, therefore, they have brought for-
ward a candidate, who has promised to contest the seat
on the first opportunity. Unfortunately he is a lawyer ;
and we have too many lawyers in Parliament. He is a
thorough-going Conservative, and it is certain that the
constituency is rather Liberal than otherwise. Further,
though a large part of his address, about half, is taken up
with medical politics, he completely misunderstands them,
and would be quite as unendurable to medical men as
their representative, as Sir Lyon Playfair himself. Only
a medical man ought to be M.P. for the Universities of
Edinburgh and St. Andrews. It was a mistake when Sir
Lyon Playfair, as a Professor of Chemistry, was thought
to be a suitable substitute for a medical candidate.
COCAINE HYDROCHLORATE IN MINOR'
SURGERY.
To THE Editor op The Medical Recokd.
Sir : As the subject of cocaine hydrochlorate is some-
what prominent just now, I trust the following case will
not be entirely without interest, your editorial of last
week being partly responsible for the occurrence. At
the semi-annual meeting of the Fairfield County Medical
Society, held to-day at the Bridgeport Hospital, one of
its members. Dr. Wright, of this city, kindly permitted the
following experiment :
The doctor had a small fatty tumor upon his forehead.
I passed the needle of an ordinary hypodermic syringe
through the skin on one side, and tried to pass it across
the tumor between it and the skin, but did not succeed,
and so passed it through the tumor. Then while slowly
withdrawing it, injected about six minims of a two per cent,
solution of cocaine hydrochlorate, obtained from Foucar
about three weeks ago. I then rubbed a few minims upon
the skin over the tumor with my finger. In five minutes
I thrust the needle into the skin over the tumor so as to
draw blood. The doctor felt what he described a "sense
of pressure," 1.^., he knew that I was doing something but
felt no pain. In fifteen minutes there was apparently
some return of sensibility. I then injected four minims
more from the side opposite to that from which the first
injection had been made. Dr. Weir, of New York City,
who was present with us by invitation, then removed the
tumor through a single straight incision about an inch
and a half long.
The sensations of Dr. Wright during the operation
are given in his own words. No one timed the different
steps of the experiment accurately. I give my own esti-
mates above and the doctor gives his below.
" The first injection by the hypodermic needle was
quite painful to me, but as it was my first experience in
its use upon myself I presume not m'ore painful than to
anybody else. In about two minutes I felt a benumbing
sensation in and about the tumor, and suggested to Dr.
Wilson that it was anaesthetic. He pricked it with the
needle, but I only felt the pressure. In about eight
minutes I felt as though sensation was returning to the
tumor, but probably I was wrong, for in about ten min-
utes the second injection was given, of which I felt the
initial prick, but was unable to locate from the feeling
the place of injection, or the direction in which he ran the
needle. In less than five minutes Dr. Weir began the
operation, at which time the forehead and face felt anaes-
thetic for a radius of three or four inches. I felt the
first cut through the skin, but it did not seem painful, or.
at most, not more so than the scratch of a pin. Then I
could feel the blood flowing down my cheek, and hear
the grating of the knife, but felt no pain at all. I could
barely distinguish the prick of the needle when the two
stitches were taken. During and subsequent to the oper-
ation I felt elated and buoyant, and was less conscious
than usual of fatigue during the long exercises of the
afternoon, though on my feet the whole time. At no
time have I felt sleepy, and though at the present time
of writing, about seven hours after the operation, I have
scarcely had time to sit down, I do not feel tired, and
expect to visit several patients before bed-time. Such
excitement and unusual exertion generally gives me a
headache, of which now I have not a particle.
J. W. Wright, M.D."
There can be no question that in this single instance
the subcutaneous injection of cocaine hydrochlorate
transformed a very painful operation into a compara-
tively painless one. You will notice that Dr. Wright
lays most stress upon the pain of the first injection of
the drug. F. M. Wilson, M.D.
317 Statk Strekt, Bridokport, Comn.,
November ii, 1884.
OUR CINCINNATI LETTER.
(From our Special Correspondent.)
CINCINNATI MEDICAL SOCIETIES — COLLEGES GUNSHOT
SURGERY — MIDWIVES.
The medical societies, though baffled through the month
of September by the excessive heat, are now down to a
working basis, and promise some interesting meetings
for the winter. Foremost and oldest of all is the Cin-
cinnati Academy of Medicine. This society has Dr. W.
H. Wenning, of St. Mary's Hospital, as President, and
George A. Fackler, M.D., as Secretary. It has a large
membership and, except on election nights, a fair attend-
ance.
At a recent meeting, Dr. A. Ravogli reported a case
of elephantiasis of the leg which he had seen during
Dr. Connor's absence. The calf measured three feet
four inches in circumference ; the whole limb was in-
vaded. Patient was eighteen years of age. The disease
had its initial stage in early childhood, which is unusual.
The boy weighed three hundred pounds, of which one
hundred and eighty pounds were attributed to the leg.
•November 22, 1884.]
THE MEDICAL RECORD.
583
He continued in good health till twenty four hours pre-
vious to death. The speaker was inclined to attribute
death to an embolus. Said it might have been from
pyaemia from excessive lymphangitis. Much interest
was taken in this case.
At the meeting next in order, Dr. Hottendorf read an
article on " The Abortive Treatment of Typhoid Fever."
He reported as occurring in his practice during the last
six years twenty-three cases of typhoid fever, fifteen in
adults and eight in children. All he treated on the abor-
tive plan, viz., calomel. He gave one-half-gramme
doses every day, or more seldom if the case required,
during the first week of the disease. He had had most
gratifying results, viz., recovery in every case.
The Cincinnati Medical Society is younger, has fewer
members, and a lighter attendance than the Academy of
Medicine, yet it has some very live men and some very
live meetings. The younger members of the profession
seem to have a prominent part in its affairs and do the
most of the work. While the Faculty of the Medical
College of Ohio belong to the Academy, the Faculty of the
Miami Medical College belong to the Cincinnati Medi-
cal Society. This is 3ie differential diagnosis.
Dr. Dun, at a recent meeting, reported a case of
severe shock from electricity — a femsde clerk of high
nervous sensibility. The wires of the electric light
became crossed with those of the cash-ball system while
she was operating, and she received a terrible shock.
She uttered a piercing cry and fell to the floor uncon-
scious. By appropriate treatment she recovered. The
doctor said we may expect to see more of this class of
cases in the future.
At a more recent meeting Professor W. H. Taylor,
one of the physicians on obstetric duty at the Cincinnati
Hospital and Professor of Obstetrics at the Miami Medi-
cal College, reported the obstetrical department for the
last four months he was on duty. He began with a de-
scription of the obstetrical wards, which showed very
perfect isolation and care. In the after treatment he
spoke of a ^^^ injection of the bichloride of mercury
twice a day for ten days. Pulse and temperature are
taken twice a day, and if any patient gives evidence of
sepsis she is taken to other quarters at once. During
the four months there were 79 deliveries, exclusive of
abortions ; 42 primiparae, 37 multiparae ; youngest, 16 ;
oldest, 44. Hyperaemius gravidorum was experienced
by 47 in the earlier stages of pregnancy, 32 escaped
altogether. Of abnormal presentations there occurred —
left occipito-posterior, i ; foot, hand, and cord presented
together in one instance. The forceps were used five
times and podalic version twice. The reporter con-
tinued with an extended temperature chart and brief
reports of six cases of difficult labor, two cases of puer-
peral fever, and one of scarlatina.
Dr. Davy objected to the use of injections in perfectly
normal labor, because unnecessary; they disturb the
parts, and trouble may ensue from the contact of parts
with the hands of attendants and the atmosphere.
Dr. Stanton thought that care in the use of injections
would overcome the objections to them. He was in
favor of the use of injections, but thought much of the
benefit was derived from the water, though the bichlor-
ide was not objectionable, and in some cases advanta-
geous.
The Cincinnati Obstetrical Society pursues the even
tenor of its way, and is not much known by the general
public. It has nearly twenty members, two of whom are
of the gentler sex. The members meet monthly at each
other's ofiices or residences.
Our medical colleges are suffering from a decrease in
receipts. The number of students has fallen ofif about
thirty per cent, in each. Cause : the requirement of
preHminary examination on entering. This has relieved
the intestinal tract of the colleges of offending material
as promptly as a good cathartic usually acts on the
human intestine. Let the good work go on. Despite
this decrease in attendance the names enrolled on the
lists of private quizzes and private and extra courses
has increased, showing a much better class of students
than formerly.
The Cincinnati Hospital has been noticeably empty
during the past summer. The Hospital of the Good
Samaritan has been in much the same condition.
A remarkably interesting case of rodent ulcer oc-
curred at the St. Mary's Hospital in July last. It was
of twenty years' standmg, in a man sixty-five years of age,
and involved the whole right orbit cheek and nose,
wanting but three lines of the inner angle of the left eye.
Strange to say, after the immense destruction of tissue,
the patient appeared in almost perfect health, and was
always in good spirits. He left the hospital for his home,
of course unimproved. A case of so-called " shaggers "
fever, dengue, ** break -bone" fever, was one of the
curiosities at the same hospital during September last
The patient had been working on the Panama Canal,
and brought the disease back with him. He had been
sick a year.
The clinics at the Good Samaritan and Cincinnati
Hospitals have been very profitable, so far, this term.
Our surgeons have been treated with an experience in
gunshot injuries recently which they have not seen the
equal of since the war. The terrible Court House riots
of last March and the election riots of the present month
furnished them with about two hundred gunshot injuries.
One difference the old surgeons noticed between those
made by the militia during the late riot and those made
by the soldiers of the late war is that the bullets of the
latter day do not stop, but go clear on through. I be-
lieve that in no one instance in a wound made by a
militiaman's bullet in the riot last March did the ball
remain in the person wounded. The day of " probing
for the ball " is, it seems, in reality gone by.
Thirty per cent, of the births in Cincinnati are attended
by midwives, and yet almost five hundred physicians eke
out an existence.
Abracadabra.
October 34, 1884.
RECOGNITION . OF PRELIMINARY WORK.
To TUB Editox or Tub Mbdical Rscord.
Sir : In a late issue of The Record, I observe an
editorial under the title : " Recognition of Hard Pre-
paratory Work." From time to time criticism of the
kind you have made appears now in this medical journal,
now in that; now in this form, and now in another.
That some complaint is justified by the facts is admitted
by all ; that the existing evil should receive deserved
correcting is the wish of every one. Why, then, does the
evil stand, and complaint mock itself? Simply because
of the incompetency of the means thus far adopted.
[The writer having discussed the various means here-
tofore tried and their failure, continues :]
The concluding paragraph of the article referred to
above has this also : '* Hard preliminary work deserves
a little recognition other than the slow and uncertain
recompense furnished by the public." Herein is sug-
gested a method of correction which most assuredly will
prove competent, because it is based upon the strongest
and most constant passion of the human heart — pride.
The method is this : Distinguish by some universal in-
signia or item of dress the graduate in medicine ; and
also, by modifications of this same, the degree of pre-
paratory education. For instance, let the graduate in
medicine be distinguished by some modest decoration,
or some suitable device, whatever it may^e, to be uni-
versally worn and acknowledged. Then, for the doctor
of medicine who has been previously graduated in letters
with the degree A.B., an additional ribbon or another color
added to the M.D., decoration which will secure the de-
served recognition ; and so on, the degrees B.S., and
A.M. and LL.D., etc., may thus receive recognition and
584
THE MEDICAL RECORD.
[November 22, 1884.
distinguish the '* careless and half-educated'* from those
who have ** trained themselves thoroughly." These
decorations should be conferred by the same authority
and at the same time with the diploma. They should
mark no lower course in letters than that of the high
school or academy, and the decoration for this course
should be the basis or ground upon which the decoration
for higher courses, B.S., A.B., A.M., etc.* etc., are dis-
played. Crossing all these decorations for literary train-
ing, should be displayed those of professional significance,
one for medicine, one for law, one for theology, etc.
This scheme will be ridiculed, I know, and chiefly by
those who would be niaile conspicuously deficient thereby.
It may also be ridiculed by those of so severe taste as to
be offended by anything that in any way distinguishes.
It may also be opposed by some as altogether " too
silly," etc., etc. However, to the first I would say, your
opposition is its very best argument ; to the second, it
is not at all a question of individual likes and preferences;
to the third, what one among you would decline the red
ribbon of the Legion of Honor if it were oflfcred ?
J. D. Kelly, M.D.
Utica, N. Y.
PROTRACTED PREGNANCY.
To TUB Editok or Thb Mkdical Rrcord.
Sir : I wish to put on record a protracted pregnancy.
The case referred to is Mrs. P , aged thirty-two ;
Irish-American ; medium-sized. This was her fourth child.
The third was bom November 24, 1882. She menstruated
regularly from the time she began after the birth of her
third child until September 22, 1883, on which date the
menstrual flow began and continued in the usual manner
until September 25th. That was the last time she men-
struated until she was delivered of a healthy living child
(male) weighing eleven and a half pounds on August 21,
1884, in the evening. The time of parturition was about
three hours.
The duration of pregnancy was just three hundred and
thirty days. The above dates I can vouch for, for the
following reason : The woman was desirous of not having
more children, and kept on a calendar the dates of her
menstruation, and had not passed her period but a few
days before she came to me to see if something could
not be done.
The longest case I can find on record is from Leish-
man's "Midwifery,*' page 175, where the duration was
three hundred and twenty-two days. Professor Atlee re-
cords several of one yearns duration, I believe, but I
never have seen the records myself.
Yours truly,
J. W. Wright, M.D.
THE MORAL EFFECT OF MEDICAL EDUCA-
TION ABROAD.
To THK Editor of Thb Mbdical Rbcord.
Sir : With regard to the ** demoralizing influence " of
medical education abroad I must say that, whatever may
be the case in the continental cities, the statements made
can in no way be applied to the London schools. By
no means the least of the advantages of a London educa-
tion, especially to a young man, is the high moral tone
that pervades the profession, and the refining influence
that intimate association with men of as high character
as the London teachers are, must necessarily impart.
I think I can speak without bias on the subject, being a
graduate of two prominent universities in this country,
and having subsequently passed through the entire cur-
riculum at a London school of medicine. And I venture
the assertion that the moral atmosphere of the lecture
rooms, dissecting halls, and hospitals in London compare
most favorably with any in this country or elsewhere.
Any one who has had more than a casual view of the
working of a London hospital and of the deportment of
its attaches cannot fail to have noticed that the welfare
of the patients is the prime object with all concerned,
and that in no place is woman held in greater respect or
treated with greater delicacy and consideration.
I am, sir, very truly yours,
Thomas Greaves, M.D., M.R.C.S., Etc,
Adjunct Professor of Medicine^ Medical ColUg* of Virfuiia.
" CONGENITAL HAEMORRHOIDS."
To the Editor of The Medical Rbcokd.
Sir : I have a curious lusus natunz here in Brooklyn.
A baby, female, was born October 2 2d, of healthy
American parents, aged twenty-nine and twentyfour
years respectively, bemg the first child. The mother has
always been the picture of health, excepting chronic
constipation and its natural result, haemorrhoids, which
have been many years a torment to her, and were natu-
rally extremely aggravated by pregnancy.
At birth the little girl, otherwise well formed, presented,
at the verge of the anus, on the right side, a fold of skin
projecting three to four millimetres from the normal
level of epidermis and five millimetres long by three
millimetres broad. This is cpvered with healthy, normal
integument, of natural color and sensibility. It is, then,
an imitation of a pile, just where the mother's most an-
noying tumor was located. The little tumor seems to be
merely an excess of skin at that point, and is in color
and texture so like healthy skin as to show that it cannot
be the result of inflammation.
The mother was very anxious to know if her baby
''had piles," as she had suffered so much herself, and
said '' she had been praying for months that her child
might be spared an affliction which had caused its mother
so much suffering." Is this z.post hoc or z, propter hod
Certainly the mother directed her thoughts continu-
ously for many days at a time toward this spot on her baby.
Is a similar case reported ? Yours,
A. B. DE S. SiZER, M.D.
Brooklyn, N. V., October 30, 1884.
THE AMERICAN MODE OF GIVING POTAS-
SIUM IODIDE.
To THB Editor of The NIbdical Record.
In your editorial of November i, in the article headed
" American Mode of Using Iodide of Potassium," you
state, "The writer also shows that the method originated
with the late Dr. Van Buren of this city, and became
gradually adopted as the result of practical experience by
a number of New York physicians. . . . It is essen-
tially an American, and more essentially a New York
idea." I beg to inclose a copy of a prescription I gave
in a case of syphilis in July, 1859 :
5. Potassii iodidi 3 vj.
Ext. sarsae fluid 5 U-
Mucilag. acacise | iv.
M. Two tablespoonfuls four times daily, to be fol-
lowed by a tumbler of flax-seed tea.
This prescription bears the date (as copied from my
note-book) of July 26, 1859.
It will thus be seen that the method of giving iodide
of potassium in large doses is by no means a New York
method, but was used in New Orleans twenty-five years
ago.
As I had only been in this country about five years at
that time, it might more correctly be termed an English
method. I do not claim any especial credit for giving
the remedy in these doses, but, if there be any it should
certainly be given to the one who originated it.
J. L. Crawcour, M.D., M.R.C.S., Eng.
Z94 Camp Street,
New Orleans, La^ November 4, 1884.
P.S. — I would State that the above prescription, with
some trifling modifications, was persevered in until
November 22, 1884.]
THE MEDICAL RECORD.
58s
August iTth, when it was given in gradually diminishing
doses. The result was an absolute cure, the patient
remaining under my observation for twenty years without
any recurrence of the disease.
[Many physicians have doubtless given large doses of
iodide of potassium. The merit of doing this systemati-
cally, of recognizing and teaching it as producing specific
therapeutical effects, belongs, so far as we yet can learn,
to New York physicians.]
"^exo %nstvximc\its.
A CORRECTED DESCRIPTION OF THE CON-
TINUOUS INDUCTION COIL.
With an Illustration.
By a. D. ROCKWELL, M.D.,
NBW VOBK.
The accompanying diagram is here presented and de-
scribed as it should have been in my article on *' The
Induction Coil : Its Varieties, and the Differential In-
dications for their Use," which appeared in this journal,
November 8, 1884.
** These coils are, for convenience of illustration, rep-
resented by the upper straight lines I, II, III, IV,
termed, respectively, the primary, first, second, and third
induction coils. The letters A, B> C, D, E represent the
different posts of the continuous coil apparatus to which
the conducting cords are attached, while the numerals i,
2, 3, 4, etc., indicate the combinations by which are ob-
tained ten different qualities of current. The short line
marked i, starting from A, represents the current from
the short, thick, primary coil marked I. Second line
(2), current from the primary and first (I, II) induction
coils combined. Third line (3), current from the primary
and first and second (I, II, III) induction coils. Fourth
line (4), current from primary, first, second, and third
Assigned to duty as Post-Surgeon at Fort Wingate, N. M.
S. O. 217, Department of Missouri, November 4, 1884.
Owen, Jr., Willlam O., First Lieutenant and Assist-
ant Surgeon. Relieved from duty at Fort Canby, W.T.*
and ordered to Fort Spokane, W. T., for duty. S. 0. 169,
Department of Colorado, November 4, 1884.
Qficiai List of Changes in the Medical Corps of the U. S.
Navy^ during the week ending November 15, 1884.
Beardsley, Grove S. Promoted to the grade of Medi-
cal Inspector. April 24, 1884. November 14, 1884.
Heffenger, A. C, Passed Assistant Surgeon. Duty
at Portsmouth, N. H., continued till December 12, 1885.
November 11, 1884.
Wieber, F. W. F., Assistant Surgeon. To the receiv-
ing ship Vermont, at New York. November 12, 1884.
Contagious Diseases — Weekly Statement. — ^Re-
port of cases and deaths from contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the week ending November 15, 1884 :
Week Ending
Casu,
November 8, 1884. .
November 15, 1884.
Deaths.
November 8, 1884. .
November 15, 1884.
ft
f
107
I 11
III
(I, II, III, IV) induction coils. Fifth line (5), current
from the first (II) induction coil only. Sixth line (6),
current from the ^st and second (II, III) induction
coils. Seventh line (7), current from the first, second,
and third (II, III, IV) induction coils. Eighth line (8),
current from the second (III) induction coiL Ninth
line (9), current from the second and third (III, IV) in-
duction coils combined. Tenth line (10), current from
the third (IV) induction coil only."
OfficiallMtof Changes in the Stations andDuHes of Officers
serving in the Medical Department^ United States Army,
from JVovember 9 to November 15, 1884.
Byrn£, C. C, Major and Surgeon. Granted four
months leave of absence from November 16, 1884. S.
O. 265, A. G. O., November 11, 1884.
Tremaine, W. S., Major and Surgeon. Granted
leave of absence for one month on surgeon's certifi-
cate of disability. S. O. 233, Department of the East,
November 12, 1884.
Wilson, William J., Captain and Assistant Surgeon.
Granted leave of absence for four months, with permis-
sion to go beyond sea. S. O. 262, A. G. O., Nov. 7, 1884.
Shufsldt, R. W., Captain and Assistant-Surgeon.
Opium in Mitral Insufficiency, with an Ethical
Episode. — ^T'he fact that opium (in small doses) has
been frequently
IV recommended
1 of late as a
I heart tonic,
j makes the fol
! lowing case, as
-; well as that of
* Dr. Edson, of
especial inter-
est. Dr. George T. ^TcCoy, of Columbus, O., writes
that he was called in to see a man, aged sixty-one, who
was suffering from congestion of the lungs, with a
troublesome cough and severe attacks of dyspnoea at
night. Five grains of Dover's powder at night caused an
alarming attack of dyspnoea. * Dr. McCoy then found
that the patient had mitral insufficiency and a dilated
heart. D3/spnoea and insomnia continued, and a Dr.
L was called in consultation. Our correspondent
says : "I received a note shortly after Dr. L ^'s visit,
informing me that that gentleman (?) had assumed charge
of the case, and my services were no longer needed.
Dr. L went to work to • give his patient rest,' * he
was simply dying for want of rest-' Administered tr.
opii, gtt. XXV., every three hours until patient was able
to go to sleep. Patient made two attempts to lie down,
but the dyspnoea was so aggravated by change of posture
that he was fain to be propped up in a chair again. After
taking one full dose, and at the third hour half the quan-
tity (in all thirty-five drops) he was enabled to sleep
very quietly about four hours, when his breathing became
labored, and death ensued without his return to con-
sciousness again. The death was reported by Dr. L
at the Health Office, as due to * acute congestion of the
lungs." My opinion then, as now, was paralysis of the
heart due to opium-poisoning. I am led to make this
report by perusing the article of Dr. Edson, in a recent
number of The Record, the cases being so nearly
586
THE MEDICAL RECORD.
[November 22, 1884.
alike in everything except the position of the patient
preceding death."
[It is unfortunate that an autopsy was not obtained in
order to verify the diagnosis. Not unlikely there was
some condition other than those discovered by Dr.
McCoy. The best and latest authorities — Bramwell,
Allbutt, Sansom, and others — in the continuous dyspnoea^
orthopncea, and insomnia of uncompensated mitral insuf-
ficiency.— Ed.]
Accommodation and Presbyopia. — M. Martialis, who
is presbyopic, resorts to the following manoeuvre when he
is without his glasses and wishes to read : He introduces
the pulp of thcf index finger rather deeply between the
external border of the orbit and the globe of the eye on
that part covered by the upper lid, making somewhat
firm pressure. He states that the characters then be-
come visible and he is able to read with ease. M. Mar-
tialis thinks that this would be useful in the diagnosis
between a simple presbyopia and paralysis of the retina,
crystalline opacity, etc. He sees in this a proof of the
r61e played by the straight and oblique muscles in the
function of accommodation. — Lyon Mhiical^ October 5,
1884.
In Dr. Millard's letter, in our issue of November
8th, on the Prevalence of Consumption at Various Ages,
page 528, seventh line from the top, 27,771,728 should
read: 2,771,728.
The Responsibility of Physicians for Furnishing
Proper Certificates of Insanity in cases before them
is a matter of great importance, considering the rapidly
increasing number of instances where the services of a
skilled physician are called for. In a recent case in a
New England State the action was brought for damages
against a physician for falsely certifying, through malice
or negligence, that a person was insane, and thereby ac-
complishing her commitment to an insane asylum. The
pleadings in the suit raised the question as to the actual
condition of the person at the time she was declared to
be insane, and as the presumption was in favor of the
certificate being correct, the burden of proof was upon
the persons alleging that she was sane. The court said :
** In such an action the falsehood, and not the insufiiciency
of the certificate, is the ground of action against the
certifying physicians. Without statutory provisions to
that effect there cannot be a civil action for damages
against a physician based upon the insufficiency of the
methods which he pursued in reaching and certifying a
correct conclusion. In such an action it is open to the
defendants to prove precisely what were the circum-
stances under which they acted, what inquiry, investiga-
tion, and examination they made, and what the informa-
tion was on which they proceeded. If such testimony
did not go to the extent of a justification in case their
certificates should be found to be false on the question
of insanity, it was proper evidence to be considered in
awarding damages. If physicians who have certified to
the insanity of a person, have not made the inquiry and
examination which the statute requires, or if their evi-
dence and certificate in any respect of form or substance
is not sufficient to justify a commitment, the municipal
officers should not commit, and if they do, it is their fault
and not that of the physicians, provided they have stated
facts and opinions truly, and have acted with due profes-
sional skill and care."
Professional Dignity and What Sometimes Comes
OF IT.—Our London Correspondent sends us the following:
" Many doctors are very fond of talking about the dig-
nity of the profession, and how we should all of us do our
best to uphold it. An eminent London physician once told
me, in conversation, that he makes a point of never thank-
ing his patients for his fee when he takes it, but simply
pockets it as a matter of course as his due. I presume
he would similarly disdain to ask for it should the patient
depart without offering to pay. They sometimes do this.
A friend of the writer's who was once treated thus by a
lady richly attired, stopped her just as she was making
her exit, and in the blandest of terms begged to be allowed
to look at the prescription again for a moment. He
looked at it for a few seconds, and then, tearing it across,
threw it into the fire. * Ladies in silks and satins,' he
said, * can generally afford to pay,* and calmly rang his
bell for his servant to usher in the next patient. Doctors
occasionally get the worst of it though, when they stand
too much on their dignity with patients. One of the
local practitioners in a country town I have frequently
visited, was one day sent for to visit a child in the family
of one of his patients. On arrival he found his little
patient had been ailing for some days, and asked why he
had not been called in before. • Oh,' said the mother,
* we have been giving it a bottle of E 's stuffi' mention-
ing a patent medicine prepared by a veterinary surgeon
well known in the county, and a bottle of which she had
obtained at the chemist's. * What 1 * exclaimed the doc
tor, * expect me to attend after a horse-doctor ? ' and he
marched off in great indignation. The father of the
child was a baker, and supplied the doctor's family with
bread. Next day no bread was delivered at the doctor's
house. The doctor's wife put on her bonnet and shawl
and went out to call on the baker, respecting the omis-
sion. On entering the shop she saw the baker's better
half, and politely intimated that she had called to say that
no bread had been left as usual, and she would be glad to
have some sent. * Oh, no,' was the reply, 'your husband
won't attend us as a doctor, so we shan't supply him with
bread,' and they didn't The doctor was forced to deal
with another and inferior baker, as similarly the baker had
on the previous day been forced to send for another doc-
tor. By the time this appears in your pages medical
students and professors alike will be preparing for the
opening of the winter session, which is always heralded
by the first of October. The Scotch schools do not begin
till the first of November. It seems a pity in each case
that the studies could not be so arranged as to give more
summer holiday, say by beginning in the middle of Septem-
ber and continuing until the first week in July, with only
fortnightly vacations at Christmas and Easter, instead of
having April as an idle month, and sweltering in town till
the last week in July. Some of the medical examinations
are even held during August."
The Cost of Sickness. — I think, then, that we can-
not escape from the reasons to believe that we lose in
England and Wales every year, in consequence of sick-
ness, 20,000,000 weeks' work ; or say, as much work as
20,000,000 healthy people would do in a week. The
number is not easily grasped by the mind. It is
equal to about one-fortieth part of the work done in each
year by the whole population between fifteen and sixty-
five years old. Or, try to think of it in money. Rather
more than half of it is lost by those whom the Registrar-
General names the domestic, the agricultural, and the
industrial classes. These are more than 7,500,000 in
number, and they lose about 1 1,000,000 weeks ; say
for easy reckoning, at ;^i a week ; and here is a loss of
;^ 1 1,000,000 sterling from what should be the annual
wealth of the country. For the other classes, who are
estimated as losing the other 9,000,000 weeks' work, it
would be hard and unfair to make a guess in any known
coin ; for these include our great merchants, our judges
and lawyers, and medical men, our statesmen and chief
legislators ; they include our poets and writers of all
kinds, musicians, painters, and philosophers ; and our
princes, who certainly do more for the wealth and wel-
fare of the country than can be told in money. — Sir James
Paget
Value of Veratrum Viride as a Prophylactic
AGAINST Peritonitis after Surgical Operations in-
voLviNG the Opening of the Peritoneal Cavity. —
Dr. James Roane, of Yankton, Dak., writes : " On
August 25 th, assisted by Drs. D. F. Etter, and W. H.
Turkopp, I operated upon R. S , a short and spare
November 22, 1884.]
THE MEDICAL RECORD.
587
Bohemian, aged fifty-five, for the relief of strangulated
hernia (right, complete oblique inguinal). A careful and
thorough trial of the taxis, at first without the aid of
anaesthetics, and subsequently when they were admin-
istered to the surgical extent, had failed to produce re-
duction. Owing to the urgency of the symptoms, the
operation was performed at night, and was more pro-
tracted than it would otherwise have been on account of
the very poor light of a single lamp. The intestine was
found to be deeply congested, but showed no signs of
disorganization. The constriction was at the internal
ring, and its division was followed by the escape of about
two ounces of sanguineous serum. The hernia having
been reduced, the upper three-fourths of the incision
were closed by sutiures, and the lower fourth left open
for drainage. Throughout its various steps the operation
was conducted under strictly antiseptic precautions — a
solution of corrosive sublimate, one to two thousand, be-
ing used for that purpose. A pledget of absorbent cotton,
soaked in this solution, was placed over the wound ; this
was covered by a larger pad of cotton, and the whole was
held securely in situ by a few turns of a roller bandage.
On coming from under the influence of the anaesthetic
the patient vomited stercoraceous matter profusely. He
was put to bed, given one-fourth of a grain of morphia
hypodermically, and placed upon one minim of Nor-
wood's tincture of veratrum viride, and ten minims of
deodorized tincture of opium, every two hours — day and
night. This treatment was followed up to the morning
of the 28th, when it was discontinued because of the fall
of the temperature, the total absence of any of the signs
of peritonitis, and the increasing prostration of the pa-
tient The physiological action of the veratrum viride at
this time was very marked, manifesting itself in the sense
of extreme muscular weakness, and in the slow, moder-
ately full, but soft pulse, which became very rapid on the
patient's making the least exertion. At no time after
the operation were there any of the local signs of peri-
tonitis, such as pain, tenderness, or tympanitis. The
highest temperature (taken under the tongue) was ioo.8°;
and this occurred on the evening of the 26th. On the
29th the temperature was normal, and subsequently it
did not rise above 99°. In that portion of the incision
which was closed by means of sutures, union took place
by first intention. A slight serous discharge oozed from
the lower fourth, left open for drainage for forty hours,
but thereafter no stains could be detected on the cotton
dressing, and the wound rapidly closed. On September
9th a well-fitting truss was applied, and the patient dis-
charged.
The Modern Iter ad Astra — ^a Medical Fable,
— Once upon a time a poor but humane physician was
riding along a road which led by a dark forest, when he
saw by the wayside a sick and miserable dog which had
lain down to die. Moved with pity he got down from
his carriage, picked up the poor animal tenderly, and
gave it some food and drink. Suddenly the dog van-
ished, and he saw standing before him a beautiful fairy.
" You have saved me from a miserable doom by your
compassion," she said. " Command now anything you
wish, and it shall be yours."
The astonished physician replied, '' I am a poor man.
I should like to be rich."
The fairy waved her wand, and extended to him a
piece of paper and a bottle filled with a dark-colored
fluid. " Here," she said, " is a prescription for an In-
fallible Compound Hair-Restorer. It will never fail,
and it has been indorsed by all the leading clergymen on
both continents. The world is yours ! Do you wish
more ? "
" I am a quiet man," replied the doctor, " and little
known. I should like to be famous."
" You shall be more ; you shall be immortal." Wav-
I ing her wand again, she presented to him a small, dark,
and curiously shaped instrument. " See," she exclaimed,
"it is a new and * Unquestionably Perfect Pessary.' It
radically restores every malposition. Your name is
blown into the side. Generations of suffering women
and successful doctors will read, and bless you. I have
tried it myself," she added, blushing a little, and van-
ished.— Boston Med, and Surg, Journal,
Renal Calculi and their Removal by Manipula-
tion.— Dr. J. P. Shafer, of Parkersburg, VV. Va., sends
us the history of a patient, a married lady, thirty-four
years of age, who for two years suffered greatly from
pains in the back, left iliac region and hip, and retention
of urine. This finally culminated in hip-joint disease,
an abscess breaking into the vagina, the left limb being
shortened one and a half inch. She had also cystitis,
and later some hysterical symptoms. In the course of a
year she developed violent symptoms of renal colic on
the left side. She passed gravel in the urine. Feeling
sure that she was passing calculi through the ureters. Dr.
Shafer conceived the highly novel plan of helping them
along by manipulation. He describes this in the follow-
ing language : " The patient being placed upon her
stomach, so that I could get with my fingers down upon
the kidney, by firm pressure, working my fingers, press-
ing and pulling toward me, I soon found I had changed
the seat of pain to another point a little forward, which
she could locate by the touch of her finger over the lo-
cation of the stone, and so I continued this manipulation
at intervals, removing each time the stone several inches
before stopping to rest again, and each time before again
commencing she would locate the point at which the
stone was, and so I proceeded until I felt, as well as she,
it pass from under my fingers, as I supposed, into the
bladder, and which afterward proved to be true. As
soon as it passed into the bladder the agonizing pain and
muscular spasms ceased at once and the patient became
cheerful. She being relieved for the time was happy,
and I having performed this feat, the like of which I had
never read, heard, nor dreamed of before, of course I
was quite well pleased at my success." From this time
forward, for the next ten days, she passed calculi every
day, the passage being assisted by Dr. Shafer. Then she
passed no more for fourteen months, when the attacks
began again and continued in the same way and with the
same treatment. Dr. Shafer secured some of the calculi,
one of which, he says, measures one to one and one-eighth
inch in length, by one-half to three-eighths inch in
width. He states that he forwards to us some speci-
mens. We have not, however, received them. The pa-
tient is still living, and has been seen and manipulated
by other physicians. Our correspondent says truly that
the case is a very extraordinary one. The fact that the
woman is hysterical, suggests the probability of some
voluntary or involuntary deception.
Acute Iodism after Three Five-grain Doses of
Potassium Iodide. — J. B. Parker, M.D., Surgeon U.S. N.,
writes : " Extracted (torn Journal de Medecine et de Chirur-
gie Pratiques, in The Record of the 6th ult, is men-
tion of a case of acute iodism after a smgle dose of fifteen
grains of iodide of potassium. I beg to present the fol-
lowing case, as probably equally severe, after the admin-
istration of the same quantity of iodide of potassium in
three five-grain doses — ^morning, noon, and night. Pa-*
tient, aged forty, a man of superior physique and health,
had acute rheumatism in right shoulder. The first even-
ing he came under observation one-sixth grain of mor-
phia sulph. was administered hypodermically, after local
dressing with warm laudanum, flannel, cotton, and rubb'er
cloth. Following day patient was given ten grains of
bromide of potassium, p. r. n., to relieve pain and induce
sleep. This failing to afford the relief desired at night,
it was discontinued, and a solution of bromides of potas-
sium and sodium, of each ten grains, and of lithium five
grains, was directed to be taken during the day if re-
quired, and hourly at night if pain prevented sleep. The
succeeding day (fourth) no medicine was taken save three
or four doses at night of the bromide mixture, as was
[
588
THE MEDICAL RECORD.
[November 22, 1884.
taken during the previous night. The acute symptoms
having in great part subsided, he was directed, for the
fifth day, five grains of iodide of potassium morning,
noon, and night. On the sixth day patient suffered
severely from iodism, which he ascribed to taking cold
during the night, yet was much puzzled to explain its
origin, as he had not left his bed and was not aware that
a current of air could reach him. When the real cause
of his suffering was mentioned he remarked that the
remedy was as severe as the disease and preferred not to
continue it The symptoms, which disappeared in
twenty-four hours when the medicine was discontinued,
were as follows : Pain and constriction in region of fron-
tal sinuses ; pufHness and suffusion of eyes, with lachry-
mation ; sneezing and secretion from nose ; soreness of
jaws and mucous membrane of mouth and throat ; ptyal-
ism ; cervical glands on left side enlarged and painful ;
small but painful abscess on helix of left ear, . which
suppurated and was discharged.''
A Breach of Professional Etiquette. — The fol-
lowing story is told of the celebrated Oppolzer. Shortly
after his arrival in Vienna he was consulted by an invalid,
whom he advised, after a somewhat hasty examination,
to go to Pistyan, in Hungary, and take the waters. After
several months the man, whom the professor had for-
gotten, again presented himself, with an aggravation of
all his symptoms, and said he had just returned from a
course of the Pistyan waters. The professor examined
him, this time rather more carefully, and then, with some
wrath, asked him what confounded ass had advised him
to go there, as it was the worst thing he could possibly
have done. Moral : Always speak well of your neighbor.
Whiskey as an ANiESTHETic. — In his address as Presi-
dent of the Ninth Annual Session of the Arkansas State
Medical Society, Dr. Keller is reported to have spoken
as follows on the subject of whiskey as an anaesthetic :
•* To Dr. Link, of Indiana, are we indebted almost en-
tirely for having gone far toward placing whiskey not only
along with ether and chloroform as an anaesthetic, but
also in discovering its antiseptic power, equally as safe
and effective as any other. So well satisfied is that gen-
tleman from long use of it as his only anaesthetic and
antiseptic in amputations, that he asserts he has discarded
all others, and in his reports of several hundred cases, he
says that he has seen no manifestation of pain during any
amputation, no unhealthy action in any stump, and not
a single death to mar the report." The manner of anaes-
thetizing the patient seems to be to administer one or
two ounces of whiskey by the mouth every ten minutes
" until complete drunkenness is reached," and then, with
or without one or two inhalations of ether or chloroform,
to proceed to operate. On the face of it, this procedure
appears to be open to righteous condemnation. It is
well known that acute gastritis may be set up by such
means, and the onus of proving that such large imbibi-
tions of alcohol are inoffensive rests with Drs. Link, Kel-
ler, and others who may choose to employ the drug. It
is possible — anything is possible in medicine — that such
treatment may be innocuous ; but until more accurate
knowledge is forthcoming we prefer to believe to the con-
trary.— Lancet
Every-Dav Physiology. — The weight of a full-grown
man should be 154 pounds, distributed as follows : Mus-
cles and their appurtenances, 68 pounds; skeleton, 24
pounds ; skin, 10^ pounds ; fat, 28 pounds ; brains, 3
pounds ; thoracic viscera, 3^ pounds ; abdominal vis-
cera, 1 1 pounds ; blood which would drain from body, 7
pounds. This man ought to consume per diem : Lean
beefsteak, 5,000 grains ; bread, 6,000 grains ; milk, 7,000
grains ; potatoes, 3,000 grains ; butter, 600 grains ; and
water, 22,900 grains. His heart should beat 72 times a
minute, and he should breathe 18 times a minute. In 24
hours he would vitiate 1,750 cubic feet of pure air to the
extent of one per cent. ; a man, therefore, of the weight
mentioned ought to have 800 cubic feet of well-ventilated
space. He would throw off by the skin 18 ounces of
water, 300 grains of solid matter, and 400 grains of car-
bonic acid every 24 hours, and his total loss during the
24 hours would be 6 pounds of water, and a little above
2 pounds of other matter.
Dogmatic Therapeutics. — The following, from the
Clinical Record^ is an interesting bit of dogmatic teach-
ing, illustrating its attractiveness and its dangers. Item
by item it is, if not absolutely incorrect, an expression of
half-truth. For chronic constipation, Professor DaCosta
has found kneading the bowels to be far more eflfectivc
than electricity. The best American water for this
trouble is Saratoga Congress, but no water should be
used continuously. Aloin is the best medicine, and
" nothing can be better than a pill of aloin, rheum, bel-
ladonna, and capsicum, all in small doses."
Gastric Hysteria and Reflex Uterine Vomiting.
— Dr. E. Frank Lyceston propounds four queries upon
the above subject. As a general answer we can only
say that gastric hysteria and hysterical vomiting may be
quite independent of ovarian or uterine irritation.
Shakespeare's Physician. — In the churchyard at
Fredericksburg, Va., is a tombstone on which may be
deciphered these words :
" Here lies the body of
EDWARD HELDON,
Practitioner in Physics and Chirurgery. Bom in Bed-
fordshire, England,'in the year of our Lord 1542. Was
contemporary with, and one of the pall-bearers of William
Shakespeare, of the Avon. After a brief illness his spirit
ascended in the year of our Lord 16 18 — aged 76."
Increase of Epidemics in Paris. — All epidemics,
except scarlet fever, have increased in Paris since 1865.
The deaths from measles have increased from 31 to 46
per 100,000 ; from pertussis, 10 to 19.5 ; from 43 to 100.
Dr. Jacques Bertillon, who gives these facts, thinks that
there ought to be a more careful medical supervision of
public schools.
Mistakes in Words. — In an editorial criticism upon
this subject the Medical I^ews, says the Medical Press
and Circular^ " falls into the error, common in republics,
of assigning the quality of nobility to the title Sir, since
he writes that William Klame, who had been quoted by
Siredy as Sir William Klame, is a poor substitute for
William Klapp, and it isnot compensated for by the title
of nobility which precedes it"
An Observation Regarding Menstruation in
Animals. — Dr. S. A. Evans, of Conway, N. H., writes :
" For several years past I have kept a nop pregnant cow,
for the purpose of supplying my family with milk. Have
kept a record of periods of heat. Find they recur once
in twenty-one days. Are accompanied, first, by a dis-
charge of gelatinous material from vulva, which, after
some hours, becomes slightly tinged with blood. The color
becomes gradually more pronounced, until within twenty-
four hours it appears to be pure blood Periods last
about forty-eight hours. At these periods only can the
cow become impregnated, which would seem to show
that in her case ovulation and menstruarion are simultane-
ous- These observations have extended through three
winters, and in two different animals.''
Half a Ton of Serum from the Abdominal CAvmf.
—Dr. D. Dickinson, Surgeon U. S. N., Mare Island,
Cal., sends us the following note : ** Nicholas G ,
seaman, native of Greece, aged twenty-eight years and
two months, was admitted from the Naval Hospital,
Yokohama, Japan, on August 18, 1884, and discharged
for transportation East, August 31, 1884, as he was
anxious to reach Greece before he should die. His hos-
pital ticket stated disease to be dilatatio cordis (et ascites).
Within the past seventeen months his abdomen has been
aspirated sixty-nine times, withdrawing nine hundred and
forty-four pints (nearly half a ton) of serum."
The Medical Record
A Weekly yournal of Medicine and Surgery
Vol. a6, No. 22
New York, November 29, 1884
Whole No. 734
(J^rtfiitmX ^xXitUs.
THE APPROACH OF THE CHOLERA AND THE
NECESSITY OF BACTERIOSCOPY.
By EDMUND C. WENDT, M.D.,
NBW YORK.
The epidemic of cholera which commenced last June at
Toulon, has already killed many thousands. It still con-
tinues to spread, fortunately, however, with diminished
fatality. Nevertheless, the experience of past epidemics
should warn us of the possibility — nay, even probability —
of its being carried across the ocean to our own shores.
Indeed, most authorities confidently anticipate its ap-
proach next year. Now, unless we take efficient action
in the matter while there is yet time, the dreaded scourge
may find us so poorly prepared that widespread disaster
must inevitably result.
As has been pointed out by Sanitary Engineer Win-
gate in a leading daily, published November 23d, " de-
spite the precautions taken by the health officials, no one
who is at all familiar with the sanitary condition of New
York City can doubt that if the plague once gains an en-
trance into the metropolis, it will find many nesting places
among the dives and slums in certain quarters, whence
its baleful influence will spread far and wide. Chief
among these hotbeds of disease which constantly invite
infection, are the Italian and Hebrew quarters, the former
occupying the region of Mulberry, Baxter, and Crosby
Streets, and the latter the district in the vicinity of Lud-
low, Essex, Hester, and Forsyth Streets." The nuisances
on the east side of the city are likewise a source of con-
stant discomfort and serious danger. The same journal
has the following editorial comment relative thereto :
** This evil is none the less great because of its long
standing. But legal obstacles, red tape, procrastination,
or what not, have resulted in the continued exposure of
our citizens to the emanations of manure heaps, stagnant
drainage, and reeking vats. Here is added cause for
Herbert Spencer's wonder at the long-suffering and pa-
tience of Americans under imposition. A complaint has
been lodged before the State Board of Health, and a
heroic band of Beekman Hill women have invaded the
pestilential haunts of the malodorous offenders and
secured testimony for the consideration of the Grand
Jury. These women have pluckily taken in hand duties
which devolve upon our Health Department. They
have had the courage of their convictions. Where are
the courage and the convictions of the officials supposed
' to care for the sanitary conditions of this city ? "
I At present ** it is more important than ever before that
I the people of this city should live under the best sanitary
conditions. The east side nuisances have been endured
too long. They should have been abolished long ago.
They must be done away with now."
Such impressive warnings should not go unheeded.
And it is quite creditable to our Quarantine Department
that it shows renewed vigilance in the matter of pre-
venting contagious diseases from entering our city.
Nevertheless, the fact that a fatal case of yellow fever
has been quite recently introduced into the city through
the failure of the authorities to detect the disease, shows
that the medical service of Quarantine is not altogether
what it should be. This is still further shown by a reso-
lution adopted at the last meeting of the State Board of
Health, held a few days ago, calhng the attention of the
Governor to the bad condition of the buildings and equip-
ments at Quarantine, and recommending that proper
steps be taken for putting them in perfect order.
In the London Practitioner for November, 1884,' there
appears a careful report of the present cholera epidemic in
Continental Europe, which shows conclusively that the
secret of success in carrying into effect the system of
medical inspection and isolation is to be prepared before-
hand. And it is impossible to urge too strongly upon
local authorities, whether on the coast or inland, the
adoption of such an organization and the establishment
of such means of isolation as shall enable them to deal
with imported infection in its earliest stage.
Dr. Buchanan, F.R.S., in an excellent article on "Pre-
cautions against the Infection of Cholera," points out
that, it is important for the public very distinctly to re-
member that pains taken and costs incurred for these
pui^poses cannot in any event be regarded as wasted.
The local conditions which would enable cholera, if im-
ported, to spread its infection in any country, are con-
ditions which day by day, in the absence of cholera,
create and spread other diseases : diseases which, as
being never absent from the country, are in the long run
far more destructive than cholera itself. The sanitary im-
provements which would justify a sense of security against
any apprehended importation of cholera would, though
cholera should never reappear, give amply remunerative
results in the prevention of those other diseases.
The Practitioner says further as having a bearing on
this point, "It is also worthy of note that the value of
being prepaied in advance has been strikingly illustrated
during the course of the Italian epidemic. The contrast
between Naples and Rome supplies the illustration. In
Naples cholera, when once imported, found in the results
of centuries of sanitary neglect a soil congenial to its
rapid development, and terribly the city has suffered in
consequence. But Rome had learned a lesson which even
the history of previous epidemics had not impressed on Na-
ples. The Eternal City had provided itself with an abun-
dant and wholesome water supply, and with an efficient
system of sewerage, and it had, in addition, adopted other
measures calculated to promote the health of its inhabit-
ants; the result being that, although cholera was on five sep-
arate occasions imported into the city,no difficulty was expe-
rienced.by means of measures of isolation and other sanitary
precautions, in preventing any spread of the infection."
It is to be hoped that such positive lessons may not
prove barren of practical results. But while physicians
and sanitarians are fully alive to the danger before us,
they have neglected one point that may be, and probably
is, of the highest importance. It is obvious that the
earliest possible recognition of the very first case of
cholera that might appear" among us, would give us the
best chance for prompt action to prevent any extension
of the disease. Now, it is a lamentable fact that the most
careful analysis of symptoms does not always enable us to
distinguish, in a given case, cholera morbus from genuine
Asiatic cholera. Indeed, it is held by some physicians
that the two diseases differ in degree only, and not in kind.
Without stopping to consider this point, we must yet
face the fact that our usual methods are inadequate to
differentiate with absolute certainty an attack of violent
and fatal cholera morbus from one of true cholera. The
kind of reasoning hitherto employed by physicians has
necessarily been of the d posteriori variety. That is to
say, if a suspicious case recovered, and was not soon fol-
L
590
THE MEDICAL RECORD.
[November 29, 1884.
lowed by other and rapidly fatal cases, the disease was
classed as cholera morbus. If, on the other hand, the
first suspicious case was quickly followed by an increas-
ing number of fatal cases, the diagnosis of Asiatic cholera
was subsequently made. Manifestly, a method of this
kind might give the cholera a chance to secure a danger-
ous foothold before being recognized as such ; and one
need not be an alarmist to entertain grave apprehensions
should such a misfortune befall us. But in view of recent
discoveries, it now seems possible to decide positively
and in a very short time whether we are dealing with the
comparatively benign cholera nostras, or with the emi-
nently mali^ant Asiatic cholera.
The findmg of the specific organism of cholera by
Koch was no surprise to those who had long since con-
cluded, without this final and convincing evidence, that
cholera must be a parasitic disease caused by a particular
and distinct microbe. The grounds on which Koch
based his assertion that the comma-bacillus was the
causative agent of cholera were, that it was found to be
present in all well-marked cases of the disease, and,
further, that it was never present in the healthy body or
in cases of any other disease.
Koch's conclusions were accepted without hesitation
by those who know him best, and who have had occasion
to witness his conscientious and painstaking methods of
conducting all scientific work. Thus, in Germany, Herr
Von Gossler, Minister of Public Worship, Education, and
Medical Afifairs, has already ordered that a certain num-
ber of medical men are to be summoned to Berlin every
year to go through a course of study, lasting from a fort-
night to three weeks, in order to learn the new methods
of investigation connected with bacteria and micro-
organisms, but chiefly to become acquainted with every-
thing connected with the comma-bacillus and the methods
of cultivating it according to Koch's method The several
Federal Governments have been likewise officially re-
quested to select a number of medical men for this
course, and to inform them to hold themselves in readi-
ness to come to Berlin. According to the latest Berlin
advices these courses are now in active operation, and
are very largely attended.
In our own country, however, there is still, even in the
ranks of the medical profession, an unfortunate disposition
to regard the entire subject of bacteria as trivial or fan-
ciful, and unworthy of serious consideration. There are
of course some notable exceptions to this rule. Thus Dr.
Austin Flint, Sr., in a recent paper on cholera expressed
his unqualified belief in the truth of Koch's assertions.
He showed that, wherever cholera appeared the com-
plete destruction of the parasite directly it left the body
could be secured, and by this means every case of the
disease would be rendered sterile. Koch had proved
that the cholera microbe was readily killed by drying,
while cold did not destroy its vitality, The local con-
ditions under which the parasite would thrive best out-
side the body were not yet definitely known, but there
could be no doubt whatever that filth was very favor-
able to its development. Inside the body Koch had
shown that the acidity of the gastric fluids was inimical
to it. In order that an individual should contract chol-
era it was probable that there should be a predisposition
or susceptibility to it, as was the case in tuberculosis.
Hence when we hear it credibly reported that Dr.
Klein, of London, a member of the English Cholera
Commission now investigating the disease in India,
in order to show his disregard for, and lack of faith in,
Koch's comma-bacilli, made a meal of them, we can well
afford to laugh at such puerile business. Indeed, the
Berliner Klinische Wochenschrift ^2.y% : " We had looked-
for something better from Dr. Klein, and must confess
that this so-called auto-experiment gives us no great idea
of the discernment and powers of criticism of the above-
named gentleman." And the British Medical Journaly
fully appreciating how ridiculous the affair is, states that
everybody in London ridicules the experiment.
To-day there seems no longer any possible doubt about
the significance of the cholera bacillus. In the German
Medical Weekly of November 6, 1884, just to hand,
Koch has finally disposed of the various objections that
had been made against the binding force of his asser-
tions. He has proved by actual scientific demonstra-
tions that the comma-bacillus is the specific micro-or-
ganism of genuine Asiatic cholera. The disease has also
been artificially produced in animals by the introduction
of pure cultures of the parasite in question.
It is not necessary here to reproduce Koch's last article;
enough has been said to show that in scientific bacterios-
copy we have quite possibly a ready means of detecting
with certainty the existence of cholera. But in order to
familiarize ourselves with the necessary details of these
modem methods, earnest study and some experience are
essential I hold that we have not the right to ignore
the light that has been shed on the true nature of in-
fectious diseases by the keenly searching spirit of mod-
ern experimental inquiry. In my opinion, it is the duty
of our Government to imitate what has been already
done abroad. Physicians, or other competent persons,
should be sent to Berlin at the expense of individual
States, or the Federal Government, to join the classes
that have just been organized under Koch^s supervision.
They should become personally familiar with every step
of his painstaking and strictly scientific methods. In a
few weeks, or at most months, they could return and be
experts and teachers of modern bacteriology.
Should this be found impracticable, however, then let the
State Health Boards organize properly equipped labora-
tories for the purpose of affording suitable facilities for
this kind of study and research. Individual physicians
with sufficient time and private means should take
an active interest in all that relates to the examination
and cultivation of bacteria. Is the medical profession
of our country to be put to shame by its attitude of
apathy toward matters of serious concern to the public
welfare ? Are we to be made the laughing-stock of oar
transatlantic confreres ? Two well-known physicians of
our country have already attempted to overthrow the
diagnostic significance of the bacillus of tubercular con-
sumption, the one by claiming it to be a fat-crystal, the
other by asserting its identity with shreds of fibrin. But
neither the one nor the other had at the time of his pre-
tended discovery ever beheld the true bacillus tubercu-
losis. To avoid similarly ridiculous errors we need ex-
pert teachers of bacterioscopy. This new and highly
important branch of medicine should be made an essen-
tial and obligatory part of the regular medical curriculum.
That scienti.nc bacteriology is as yet in its infancy all
will admit. But let us not blindly ignore its actual ac-
complishments. We may never be able perhaps to com-
pletely eradicate consumption or suppress all contagious
diseases, but at present we are without the slightest
doubt nearer to such a desirable consummation than we
were before the era of bacterioscopy. This is a most im-
portant epoch in medicine, and it has been well said by
an eminent physician of New York : ** It would be to the
present era that posterity would look back as the time
when those signal discoveries were made which led to
the final adoption of the parasitic theory of the origin of
all infectious diseases. Was the medical profession in
this country to have an active share in this great work of
investigation and in these brilliant discoveries, or was it
to be content to wait patiently until the announcements
of the results of their labors were made by the scientific
men of Europe ? There was certainly no lack of ability
on the part of American medical men, but it seemed to
him that there was, at all events, a certain want of self-
reliance and energy." • If our State authorities are unable
or unwilling to help the good work, let the munificence
of private citizens proclaim to the world that democracy
is at least not inferior to paternal forms of government
in producing noble specimens of the genus homo.
xoa East Fifty-sevknth Strbkt, November as, 1884.
\
November 29, 1884.]
THE MEDICAL RECORD.
591
CASES OF STRANGULATED HERNIA, WITH
REMARKS ON TREATMENT/
By GEORGE F. SHRADY, A.M., M.D.,
NBW YORK.
During the past few months in my service at St. Francis'
Hospital, I have had rather an unusual experience with
strangulated hernia, in the number of cases treated with-
in a short period. It rarely happens in the general sur-
gical practice of our hospitals that any surgeon is called
upon to operate upon eight cases within a period of seven
months. To this number majr be added one occurring in
private practice, in consultation with my friend Dr. Mc-
Crecry, making a total of nine. When it is also stated
that in these herniotomy was successfully performed, we
can scarcely go farther in estimating the results of a desir-
able experience. It has occurred to me that, with the risk
of not presenting anything strikingly novel to the surgeon,
some remarks addressed to the general practitioner, and
based upon personal experience in these and other cases,
might under present circumstances be acceptable.
A leading physician in a rural district once remarked
that it was always interesting to him to learn what was
the treatment of the ordinary diseases in the large metro-
politan hospitals. Even the details of such practices,
commonplace as they might appear to be, were assur-
ances to him that nothing better was known. With a
view also of making a contribution from such a stand-
point these cases are presented, in the hope that the
consideration of some practical points connected with
them may elicit discussion. It is not proposed to give
more than a brief outline of their histories. In so doing
I have availed myself of the notes of Dr. J. H. B. Brown-
ing, House-Surgeon to St. Francis' Hospital.
It is presumably unnecessary to say that in all these
cases there were well marked symptoms of strangulation,
inability to return the gut by judicious taxis, and unmis-
takable local evidences of firm constriction of the gut it-
self demonstrated by the operations.
Case I. — Jacob P , aged forty, was admitted to
St. Francis' Hospital, New York, March 4, 1884, the third
day after the appearance of symptoms of strangulated
hernia. Vomiting was stercoraceous, pulse small, feat-
ures pinched, surface cool, with other symptoms of general
prostration. The hernial tumor in the right groin was
not noticed by the patient until immediately after a
strain, three days before. The patient was etherized,
and judicious taxis having failed, herniotomy was per-
formed without delay. A single knuckle of small intes-
tine was involved. Its surface was of a brownish hue,
was mottled with extravasations, but at no point was it
gangrenous. After dividing the point of constriction at the
neck of the sac, the circulation of the gut was restored un-
der the application of hot moist towels, and the hernia duly
returned. The wound healed by first intention, and the pa-
tient was discharged well, April 2, 1884, with the advice to
maintain inguinal support for a period of several months.
Case II. — Catharine B , aged sixty-five, was ad-
mitted to the same hospital, March 15, 1884, with so-called
dyspeptic symptoms, associated with a tumor in the left
^oin. A careful examination revealed the existence of an
ureducible femoral hernia, but the patient could give no
intelligible account of symptoms of strangulation. In
the course of a few hours persistent vomiting with col-
icky pains occurred. It was then ascertained that these
were the dyspeptic symptoms from which she had sufifered
for the previous two days, and that up to that time she
had been able to *^put the bowel back." In short, the
case turned out to be one of strangulated femoral her-
nia, and was operated upon without delay.
The gut was found to be gangrenous at a point where
it impinged upon the edge of the unyielding crural open-
ing. The sloughing portion was removed, the edges of
the wound in the gut closed, and in turn attached to the
» Read before the Practitioners' Sodcty of New York, November 7, 1884.
margin of the ring. The two or three lower stitches of
the wound gave way at the end of the fourth day, and
through the opening thus made there was a small dis-
charge of fecal matter. By means of compress dressings
the fecal fistula closed after a week or more, the re-
maining wound healing by granulation. This patient,
just as she was ready to leave the hospital at the end of
the fifteenth day, was seized with a double pneumonia,
from which she died on the third day. This, it is true,
was a case of death, but not as the result of a successful
operation, as the grim humor of an old saw might have it.
Case III. was that of G. P , aged seventy-three.
He was admitted to St. Francis' Hospital March 27, 1884.
Two days before, an old inguinal hernia on the left side
had come down after a slight strain, and could not be
returned. A physician was sent for who made vigorous
efforts at taxis. Vomiting then took place, and continued
more or less until he was seen in the ward. The hernial
tumor was very tender and turgid. The pulse was very
feeble, and the patient was quite exhausted. The strict-
ure, which was at the neck of the sac, was divided, and
the mahogany-colored gut was nursed in hot moist cloths
for a full half hour before it could be returned. The
wound healed by second intention, the granulations and
subsequent cicatrization completely plugging up the
hernial opening. The case progressed without a bad
symptom, notwithstanding the bowels did not move until
the fourteenth day after the operation.
Case IV. — John B , aged forty-one, was admitted
to St. Francis* Hospital, April 23, 1884. The day be-
fore, while in the act of lifting a heavy box, an old hernia
in his left groin was forced down, and became very hard
and immovable. Pain and emesis occurred two hours
after, and continued at short intervals during the follow-
ing night. Stercoraceous material was being vomited on
admission. The usual signs of strangulation were pres-
ent Fortunately, but little taxis had been employed out-
side the ward. Herniotomy was performed without delay.
One large knuckle of gut was found to be firmly constricted,
diffusely mottled, and mahogany colored. Wound healed
by first intention. Patient discharged. May 25, 1884.
Case V. — James R , aged sixty-one, began to
suffer from strangulation of an old hernia on the morning
of May 10, 1884, and was admitted twelve hours after
with well-pronounced symptoms, including stercoraceous
vomiting. There had been so much taxis employed pre-
vious to admission that the parts were much swollen, in-
flamed, and tender. Portions of gut and omentum were
involved in strangulation. The gut, when exposed, was
found to be of a dull brownish color, and somewhat
oedematous. The fluid in the sac was . dark-colored.
Omentum was deeply congested. Circulation in gut re-
stored under hot applications. The strangulated omen-
tum, which was of small size, was duly excised. The day
after operation tlie temperature was ioi^° F. Subse-
quently there was nothing worthy of note, save that the
stitches gave way in the wound, the latter closing by
granulation, and apparently permanently curing the her-
nia. The bowels moved on the seventh day. Patient
wasdischarged June 9, 1884. '
Case VI. — Theodore J , aged sixty-two, had an
old inguinal hernia also, which became strangulated after
a violent effort at coughing, on June 10, 1884. He was
admitted to the hospital the same day in an extreme state
of prostration from a persistent vomiting of several hours.
Herniotomy was performed within eighteen hours after the
accident. A large knuckle of gut was in a dark -brownish,
mottled condition, but its circulation was duly restored un-
der application of towels wrung out of hot water. A portion
of omentum, also strangulated, was ligated and removed.
The wound healed by granulation. Patient was discharged,
apparently radically cured of hernia, August 3, 1884.
Case VII. — F. W , aged forty years, while lifting
forced down an old inguinal hernia, which became stran-
gulated. Within a very little while after the accident he
grew faint, was nauseated, and vomited the stomach con-
592
THE MEDICAL RECORD.
[November 29, 1884.
tents. In spite of a determination to continue at his
work he was forced to go home, when vomiting recurred
and continued more or less for two days. When admitted
to hospital at the end of that period, August 20, 1884, he
was much exhausted. He was unable to retain water in
his stomach, and the slightest movement was attended
with a retching gulp. Herniotomy was performed as
soon as the patient could be anaesthetized, forty-nine hours
after strangulation. The ^t, which was a single knuckle,
was firmly constricted in its whole circumference, but not
gangrenous. The wound healed by first intention, and the
patient, when discharged, September 15, 1884, gave no
evidences of a return of the hernia. The bowels moved
naturally on the fifth day.
Case VIII. — A. G , aged eighteen, while adjusting
a portion of the load on his truck felt a giving way in his
right groin, and immediately after found a good- sized ob-
long tumor extending into his scrotum. Feeling very faint,
and suffering frorp considerable pain, he went to his home.
There the pain increased and free emesis occurred. A
physician was sent for, who, recognizing the condition, at-
tempted to reduce the gut and failed. The patient was
allowed to rest until next day, when efforts at taxis were
renewed, also without avail. Vomiting by this time had
become so violent and persistent that the patient was
sent to the hospital, after having suffered from symptoms
of strangulation for three days. The diagnosis of con-
genital strangulated hernia was then made and subse-
quently confirmed.
On slitting open the sac there was a gush of dark
venous blood, which came from the previous rupture of
a vein in a lafge mass of strangulated omentum. To-
gether with this epiplocele there was an cedematous,
ashy-colored, mottled knuckle of gut, which at first sight
appeared to be hopelessly gangrenous. The omentum,
which had forced its way into the sac of the tunica vaginalis,
was withdrawn, and found to be so suspiciously mottled and
inflamed that its veins were at first carefully ligated sep-
arately and then en masse, and the whole was cut off.
This portion of omentum measured 15^ inches in one
diameter, and 8^ in another. The omental stump was
used as a plug for the hernial canal. There were recent
adhesions between the strangulated gut, which were care-
fully severed. It required fully twenty-five minutes of
soakage of the gut in hot, moist towels to insure its being in
a proper condition for return. The wound, on account of
previous inflammation around it, did not close by first in-
tention throughout. It opened at its lower portion, and
eventually healed by granulation, leaving the hernia, as
I believe, radically cured. The bowels moved on the
ninth day.
When Dr. Browning, the House-Surgeon of St. Francis'
Hospital, called on me with the foregomg histories, which
he had kindly prepared for my perusal, I found that there
were but eight cases instead of nine, as I expected. By
a curious coincidence my friend and neighbor. Dr. J. A.
McCreery, called the same morning (October 13, 1884),
asking me to operate on the following case of strangu-
lated femoral hernia in his practice :
Case IX. — Mrs. M , aged thirty-five years, had
suffered from a reducible femoral hernia for years, wear-
ing a truss most of that time. On the evening of the
day before she was seized with a severe fit of vomiting,
which she thought was due to the gastric disturbances
of pregnancy, she being three months advanced in that
condition. When she recovered from the attack, she
discovered that the hernia was much larger and im-
movable. After several fruitless attempts to return the
gut she summoned Dr. McCreery, who in turn asked me
to see her with him. I did so without delay, discovered
a strangulated femoral hernia, and performed herniotomy
at once, with the result of relieving immediately all the
urgent symptoms. The sac contained darkly colored
gut and a small nodule of omentum. These were both
restored, and returned after the stricture was liberated.
The patient has made a perfect recovery.
So much for the synopsis of the cases. It is always
worth our while in noting successes to explain, as best we
can, the reasons for them. Even if for the most part
they be not new, they have at least the merit of being
true, thus adding weight to practical experience. Such,
at least, is a healthy offset to methods which may be new,
and yet not true. But let us remark on the matter, in a
general way, that we may lake a short cut to conclusions.
My experience with cases of strangulated hernia has
taught me that taxis is very much overdone. Hardly a
case comes to us which is not the worse for it. The
temptation to use more or less force is too great for most
men to resist. The late Professor Oilman, in his admi-
rably impressive lectures on obstetrics, would charge his
hearers not to grasp the cord in attempting to deliver the
placenta. *' If you have a temptation to pull it, it is bet-
ter not to touch it at all.*' Discreet teachers of surgery
tell their students to use only a soft catheter to empty
the bladder, and for a like reason. Few beginners un-
derstand what is meant by merely guiding a solid instru-
ment through the deep urethra, as 3iere is almost always
an irresistible tendency to push it along its course. I
would say to the practitioner who is not prepared to
operate for strangulated hernia, that a safe rule is not to
persist in taxis after the first judiciously gentle efforts at
reduction. If he goes beyond this he rarely appreciates
how much force he is apt to employ before he is willing
to give up the fight to another. The patient generally
has the best chance with no taxis at all until he is ether-
ized for a possible herniotomy. No time is thus lost, and
the operation can be performed as soon as it is decided
that taxis availeth not.
Every one knows the rule to operate at once on
an irreducible strangulated hernia. This goes with-
out the saying. I am convinced, however, that there
are many who do not appreciate its full force, even
when cases are recognized early. There seems to be
a temptation to hope against hope that an operation
may be avoided. And yet the operation in itself is not
dangerous. Even in case of doubt in diagnosis, and there
are not a few of such to which this remark will apply, it
is safer to herniotomize the patient than to let him alone,
trusting to chances. Every practitioner of large experi-
ence can call to mind cases mistaken up to the last
moment, when hope for saving has virtually passed, and
when herniotomy is blamed for throwing the balance on
the wrong side.
Even such cases should not, however, be looked upon
as absolutely desperate ones. Mr. Birkett refers to a
femoral hernia which had been strangulated for fourteen
days, and upon which successful herniotomy was finally
performed. In view of this fact it is the duty of every
surgeon to operate upon cases of long-continued strangu-
lation, unless the ])atient be actually moribund at the
time. In one of the successful cases reported the symp-
toms had lasted for forty-nine hours.
It is, of course, not always easy to decide whether or
no strangulation actually exists. The rule should always
be to give the benefit of the doubt to the operation, and
act promptly. The main tests for strangulation are pain, .
tenderness, and continuous vomiting, with a recently irre-
ducible hernial tumor. Men in hospital practice, who see
a great deal of hernia, always examine the groin when
persistent vomiting exists. The candidate at hospital ex-
amination who would neglect to mention vomiting as a
symptom of strangulated hernia would get a black mark.
To say that herniotomy is a comparatively easy opera-
tion might surprise one who has never tried it, and who
has timidly folded his knowledge in the seven anatomical
layers. Certain drawbacks are naturally to be expected,
and should be overcome on general principles. Living
anatomy has a way sometimes of dodging the per-
ceptions of the most expert operator. In herniotomy
it is the rule. The layers are always ready to compro-
mise their individuality under a becomingly cautious use
of the director. The main thing to be sure of is when
November 29, 1884.]
THE MEDICAL RECORD.
593
the sac is reached, no matter whether the operator di-
vides six or six times six layers before he gets to it.
And sometimes in very old hernias he can take his
choice.
The making of clean, free cuts, and always in the
same line, invariably gives the best results. As a rule I
prefer to open the sac, as I believe it does not add
to the gravity of the operation, while it insures safety in
other directions. I have not seen a case in which I 'was
willing to do otherwise, and I do not believe I have lost
one in consequence.
Too much stress cannot be laid upon the necessity of
having the strangulated portion of gut in the best possi-
ble condition before returning it into the abdomen. Time
is well spent in such endeavors. Nothing will accomplish
the end in view more efficiently than the direct application
of towels wrung out in a hot antiseptic solution. I have
kept a suspicious knuckle of gut covered by turns in this
way for nearly an hour, with the result of a perfect res-
toration of the circulation.
In the treatment of this as well as any other operation
wound, the indications for cleanliness, drainage, and rest
are carefully followed, nothing more. I have never be-
lieved that the antiseptic spray was necessary for a good
result in any operation. You gain every bit as much,
and with half the trouble, by thoroughly irrigating the
wound with an antiseptic solution after the operation is
completed. Corrosive sublimate solution (in the propor-
tion of I -1 500) was used in my cases in this way.
I do not think it is a calamity for a herniotomy wound
not to heal by first intention, as by granulation and subse-
quent cicatrization the hernial opening and sac are more
likely to become occluded. The aim is, of course, for
first intention. While closing the wound, and after in-
serting a decalcified drainage-tube, it is well to take
several deep stitches through the entire substance of the
sac at different points, with the chance of exciting adhe-
sive inflammation, and thus obliterating the sac cavity.
I succeeded by this method in four cases. After closing
the wound, firm pressure is maintained, upon a warm,
thick, moistened pad of sublimated gauze, by means of
an ordinary spica bandage. The dressings are not dis-
turbed as long as the temperature is normal, or until the
wound is healed.
Partly as a precautionary measure against traumatic
peritonitis, but principally for purpose of absolute rest,
my patients are kept under the influence of morphine
during the first four or five days after the operation. The
bowels generally take care of themselves, and require no
help unless evidences of intestinal irritation manifest
themselves. One of the cases did not obtain an evacua-
tion until the end of the fourteenth day, and made no
complaint because he thought it was natural under the
circumstances*
* 247 Lbxincton Avenue.
The Antidote Bag. — Mr. Martindale, of London,
who was the first to adopt a suggestion to produce a
bag fitted with every remedy and appliance likely to be
needed in the treatment of a case of poisoning, has now
further improved upon it by omitting some articles, as
the stomach-pump, enema, catheter, etc., which are al-
ways at hand, and has thus not only rendered the bag
more portable, but has been enabled to supply it at a
greatly reduced cost. This smaller bag contains the fol-
lowing antidotes, which are labeled with directions for
their use, viz. : dialysed iron, syrup of chloral, chloroform,
aromatic spirit of ammonia, spirit of chloroform, oil of
turpentine, acetic acid, tincture of digitalis, nitrite of
amyl c^p$ules, sulphate of zinc, ipecacuanha, bromide
of potassium, calcined magnesia, tannin, and a hypoder-
mic case with syringe and solutions of acetate of morphia,
apomorphia, nitrate of philocarpine, sulphate of atropia,
and nitrate of strychnine. — London Lancet^ September
27, 1884.
SOME NEW FACTS AND CONSIDERATIONS
IN THE DIAGNOSIS OF CANCER OF THE
STOMACH AND CANCER OF THE PAN-
CREAS.
By MIDDLETON GOLDSMITH. M.D.,
RUTLAND, VT„
BRBVKT LIKUTRN A NT-COLONEL AND SUKGBON, POKMRKLY PKOFBSSOR OF
SURGKRY IN CASTLETON MEDICAL COLLSGB, AND HONORAkY MRMBSR OP TUB
NBW YORK PATHOLOGICAL SOCIKTY, STC, BTC.
It is pretty generally and well agreed that the diagnosis
of primary cancer of the pancreas is always uncertain, if
indeed it is ever possible ; or, in other words, there are no
agreed-upon signs surely diagnosing primary cancer of
the pancreas. About the sum and substance of what
our best diagnosticians lay down is to the effect that a
painful tumor in the epigastrium, unattended by gastric
derangement, such as anorexia, vomiting of coffee-ground
like ejecta, or even bloodless vomiting, pain after eating,
etc., may be set down as cancer of the pancreas.
When it is remembered that there are many cases of
cancer that present during life no symptoms of gastric
disturbance and no signs of epigastric tumor, it is apparent
that the foregoing is not very reliable ; and still further,
when it is remembered that a cancer of the pancreas may
exist and have the exact symptoms of simple stomach
cancer minus only the hemorrhage, the physician attempt-
ing to determine as between cancer of the pancreas and
cancer of the pylorus is adrift without a star or compass
to guide him.
Now, it so happens that within the last two years I
have met with three cases, one of cancer of the stomach,
which had but one certain symptom and that one not
laid down in the books ; and also two cases of primary can-
cer of the pancreas, both of which had a symptom by
which they could be diagnosed.
A Mr. B , a butcher by occupation, aged between
fifty and sixty years, for more than a year had been ailing.
About two months before his death he consulted me on
several occasions. His appetite was pretty uniformly
good ; his digestion was good to all appearance ; he had
no pain in his epigastrium; he had no coffee-ground
vomiting, and indeed had vomited but once in six
months. There was no tumor in the epigastrium. The
abdomen was fiat, collapsed like one suffering from
chronic diarrhoea, and flexible all over save that at the
epigastrium, and for a hand's breadth below the ensiform
cartilage, the abdominal wall, from costal margin to
costal margin, felt like a concave bridge of sole leather
and unyielding to moderate pressure. Percussion was
not dull enough, I thought at the time, for an hypertro-
phied left lobe of the liver. The patienfs face had the
look of a marked cancerous cachexia. He had a
peculiar feior to his eructations. It was not the rotten-
egg odor — nor the odor of any of the ordinary fermenta-
tions of food, but the odor was that of the most odorous
uterine cancer — once smelled, not easily forgotten. I
have never seen this symptom mentioned. It is not a
symptom laid down in the books. Fetor of the breath is
often mentioned, but, as far as my observation has gone,
it is not to be relied upon. A bad breath is so common
in so many conditions ; it comes of so many causes ; it
is so inconstant to cancer, apart from the indigestion it
implies, but not always present in that disease, that it
cannot be justly called pathognomonic. The fetid mat-
ters in the breath come from the lungs, bronchi, pharynx,
mouth, or teeth. The fetor of eructations is from the
contents of the stomach. A stomach whose contents
would stink when opened after death, barring post-mor-
tem putrefaction, is one from which the eructations might
be supposed . to give off in life the odors of the
stomach opened after death, and before cadaveric putre-
faction. Besides, the kind of odor is cancerous in these
cases, not putrefactive. The two odors are different and
distinguishable. To smell a cancerous womb and then
a putrefying cadaver is to learn the distinction.
Inasmuch as many cancerous stomachs opened after
594
THE MEDICAL RECORD.
[November 29, 1884.
death have no cancerous odor, so many and a large
majority of those having cancer during life have not fetid
eructations. Yet when the eructations have that canonical
fetor, that fetor is pathognomonic. From these considera-
tions, cancer of the stomach was the best guess I could
make. It proved to be correct on post-mortem. The
left lobe of the liver had become adherent at some time
to the stomach, and had been drawn, stretched out and
thinned by the stretching, so as to cover the whole space
mentioned above as being resistant to pressure. On
lifting up the liver, to get at the stomach below, I tore
the softened stomach open and there came a whiff of the
odor of his eructations, an odof so pungent as to make it
necessary for some of us to change our clothes before
we could go home to dinner. It was a simple case
of soft cancer involving the greater part of the stomach,
as well as I could judge from a very brief examination
before the autopsy was surrendered to the younger folks
then and there present The microscope proved it to be
encephaloid. Now, here was a case of outrageous gastric
cancer with not a single symptom peculiar to it «ave one,
which attaches not so much to the organ diseased as
the putrefaction of the matters contained in it, and
that not one of the symptoms laid down by authors.
Nor does this case stand alone. I remember seeing a
cadaver placed on table for examination in Louisville, a
good many years ago, in which the diagnosis had been
pernicious anaemia, the case having not shown a single
symptom belonging to cancer of the stomach. I re-
member the surprise with which the cancer of the stomach
was ^eeted. There afe on record a good many cases
of this kind besides Abercrombie's celebrated one. So
that it may be said there are in some cases of cancer of
the stomach no stomach symptoms to exclude.
Of the two cases of pancreatic cancer, the first was
that of a healthy-looking, spare little woman who came to
me from Indiana for the treatment of what proved to be
gall-stones. She had the usual symptoms which attend
upon the passage of gall-stones from the gall-bladder, as
well as the dark urine or the icterus which follow it. She
was one of the few persons whom I have met in whom
the projecting gall-bladder felt like a bag of beans. She
passed large numbers of faceted calculi as well as some
crystallizing and jagged specimens, which had not been
long residents of the gall-bladder.
Along toward what seemed to be the approach to con-
valesence from the gall-stones, the appetite, which here-
tofore had been good, began to fail. Her pains, which
had heretofore been at intervals (marking the passage of
gall-stones), came to be continuous and gradually grew to
be more and more intolerable. She had vomiting, but
there was no blood in the vomit, she had an intensely
sour stomach, gastric catarrh, and constipation. There
was no increase of the stomach pain after eating.
Meanwhile her face began to show a cachectic look.
About this time I thought 1 could perceive a very small
hard lump a little below the pylorus when the stomach
was not full of food. The tumor would always disappear
after eating a full meal. This little tumor was hard, and
somewhat painful to the touch. It was fixed. It did not
ascend or descend, or otherwise alter its position as
tumors of the pylorus do sometimes. All the while the
patient kept taking opium to keep the pain subdued.
But for all that the face, besides its cancerous suggestion,
showed that cast of expression whose only name is the
cachexia of pain. Then came a curious semi-delirium,
with a far-off look which I have seen but twice. The
most careful inquiry elicited no signs of fatty stools.
There could be found no tumor of the liver, no disease
of any other portion of the body ; there were no glandu-
lar enlargements. So that I was compelled to the diag-
nosis of primary cancer of the spleen in addition to gall-
stones.
After death, which occurred some six months subse-
quent to the discovery of the little neoplasm, below the
pylorus, we found the liver (save a number of gall-stones
in it) and the abdominal viscera healthy. There was no
disease of the stomach save extreme atrophy, and the
little tumor of the pancreas proved, under the micro-
scope, to be a spindle-celled carcinoma. . . .
The third case was that of a Mrs. H , living at that
time at Factory Point, some thirty miles from Rutland
I saw her twice. I found her greatly emaciated and quite
feeble. She had anorexia, occasional vomiting, and pain
about the pylorus after eating. She stated that her pains
were not all related to the times of eating, but she had
other and greater pains during the ni^ht, which were some-
times relieved by changes of position, but would often
endure all night.
When I first felt the epigastrium, she being recumbent,
and the stomach empty, I found a tumor apparently about
as big as a pullet's egg. The lump was round, hard, and
to the touch nodular. It was painful to the touch, and
seemingly could not be moved. Of that, however, I wa«
not so sure, because manipulation hurt her so much I did
not push this branch of the inquiry. I did not see the
matters vomited, or notice the drooling her doctor after-
ward told me about. Her attendant had noticed nothing
unusual in her stools or vomit.
At my next visit the symptoms were unchanged, except
her body was failing and na tumor could be felt in tkt
epigastrium. I found out after her death that on the
morning when I first saw her she had eaten nothing, and
that at my last visit she had just taken her usual meal
The trains would arrive at Rutland a little after 11 A.M.,
and arrive at Factory Point a little after 12 m., so that
my arrival at the house — about a mile from the railroad
station — would occur commonly about a quarter past
twelve and half-past twelve — and half- past twelve is the
canonical dinner hour for all Vermont.
The following is a history of the CAse from Dr. Wyman,
of Factory Point, who, though not at the time in attend-
ance, had seen of her more than her later physician :
" Last April she first consulted me in regard to hernot
being well. She complained of a neuralgic or rheumatic
pain in the left side under the short ribs, and in the pit
of the stomach. She had no appetite — guessed she was
^ lazy,' as she was weak and tired. I prescribed for her
two or three times during the month.
*' In May she appeared about the same, only the pain in
the side was at times worse. She had spells of it about
10 o'clock A.M., and I learned her nights were sleep-
less, and often she could not lie down on account of the
pain. It was worse three or four hours after eating. She
looked sallow and tired. The pain was dull and con-
stant, at times more severe. It would start in the left
hypochondrium, or a little above, and extend to just
below the ensiform cartilage, and the space there was
tender to pressure. She complained also of pain under
the right shoulder-blade. Her bowels were regular,
urine normal, tongue not coated, but color a little
too dark, but not purplish. She seemed almost like
one who some time had had malaria (she lived for
two or three years, a few years ago, in Central New
York), and I thought, perhaps, there was some remnant
of that lurking in her system. So she continued, not very
sick, but ailing, growing weaker and thinner ; appetite
fickle, often a perfect loathing of food ; no thirst, and
pains about the same until the middle of June, when she
was taken worse ; pain intense, but more in dorsal region,
but alternating between that and side and stomach ; quite
a relax of the bowels, constant nausea, and once or twice
she vomited. The ejecta was simply a watery fluid,
slightly tinged yellow. On account of tlie pain in the
back I exs^mined the urine, but as its appearance was so
natural I only tested it for sugar and albumen, and found
none. The stools she described as being like those
which occur in simple diarrhoea, and I did not examine
them, as I could not ascertain that there was anything
strange about them. I regret now that I did not see
them.
" About this time I went West, leaving the case. She
November 29, 1884.]
THE MEDICAL RECORD.
595
had grown much more comfortable, although she failed
very perceptibly during this aeute attack. The remedies
which I left for her will give you a key to my diagnosis,
viz, : Creasote in one-tenth drop doses and arsenicum
alb., although a careful exanfiination of the abdominal
viscera failed to find any tumor or swelling of any kind,
neither any tenderness to pressure in any place except
over the coeliac axis or plexus. She urged me while
pressing over the stomach and bowels not to be afraid to
use as much force as I wanted, as there was no pain result-
ing. The diarrhoea lasted but a day or two, and then the
bowels moved naturally every, or every other day. About
ten days after I left her to go away she became fearfully
constipated. Dr. Trull was called, and as he attended
the case thereafter until death terminated the suffering,
he will give you the further report.
" One thing I often noticed. Beside her bed she had
lying upon the floor a piece of paper, say ten or twelve
inches square, and this would be covered with a thick,
viscid, and sometimes frothy sputum. She did not cough
it, for she had no cough ; she did not vomit it, for, while
under my care, she only vomited at the time mentioned
above. She just seemed to *spit' it as it came into her
mouth. And for some reason she seemed remarkably
shy in speaking about it. Taking your tabulated symp-
toms of diagnostic points, I will indicate what symptoms
she had while I saw her professionally: Emaciation
rather rapid, but not extreme ; no tumor in epigastrium ;
severe pain in epigastrium, side, and back ; stools de-
scribed as natural ; no sugar in urine (I mentioned that
I tested for albumen, but found none) ; impaired appe-
tite, disordered digestion ; loathing of food ; pain worse
three or four hours after eating (marked) ; vomiting but
the time mentioned. She had then anorexia, debility,
emaciation, a flow of saliva-like fluid from the mouth,
coeliac -neuralgia ; dull, heavy, aching pain deep down in
the epigastric region, radiating or extending to the back
and lumbar region, relieved by rubbing and assuming
erect position or sitting up in bed ; worse by paroxysms
and at night ; no jaundice, no thirst, no increase in tem-
perature, a slightly increased pulse, a sallow, but not
greenish-yellow complexion ; urine and stools natural, so
far as observed. These constitute the array of symptoms
as far as I observed them. Their change Dr. Trull will
notice. The family history revealed a cancerous dia-
thesis. Some fourteen years ago she went to you in
Rutland, and you removed a tumor from the back of her
hand. Have you any recollection or record of its char-
acter ? The large gsJl-stone which was found in the gall-
bladder I send you by mail with this. Its weight was
3 iss. If you have no further use for it after examining
and keeping it as long as you desire, will you kindly re-
turn it to me ?
** I have thus hurriedly tried to give you the salient
points in the case. If I have failed in any of them please
interrogate me further. Hoping it will be satisfactory,
however, I am, sincerely yours, E. L. Wyman."
Now, here was a woman, about sixty years of age to
appearance, with a family history of cancer, with a cachectic
look, pale, and rapidly emaciating, with more or less con-
stant pain radiating from the epigastrium, having occa-
sional vomiting and anorexia, and an increase of pain a
few hours after eating, and a tumor at the epigastrium.
Could there be a plainer case of cancer of the pylorus ?
Yet the post-mortem examination showed it to be a
case of primary cancer of the pancreas, with dilatation of
the stomachy and one big non-faceted gall-stone in the
gall-bladder.
These two cases are worthy of comment, for in the
study of them I think we may find something to make the
diagnosis of this confessedly undiagnosable disease pos-
sibly diagnosable.
Dr. Jenner says, in effect, no symptoms are pathogno-
monic of pancreatic disease. Dr. Wardell, in ** Reynolds'
System of Medicine," vol. iii., p. 428 : " Da Costa has
professed to diagnose cancer of the pancreas from its
other maladies, but the truth is we have no just rules of
observance to point out any real distinctions." Da Costa,
in his "Medical Diagnosis," p. 605, says ; "As regards
cancer (of the pancreas) the most trustworthy symptoms
are a tumor in the epigastric region, pain in the back,
not increased by the takmg of food, but usually augmented
by the erect posture; progressive emaciation and de-
bility; an appetite capricious rather than diminished,
and, in some instances, indeed a ravenous desire for
food ; constipation at times, but far from invariably." It
seems to me that the two cases of primary cancer of the
pancreas above related point to a diagnostic rule of great
value, so far as two cases can go toward making a rule.
In the first case it is to be noticed that the little tumor
could be felt almost all the while, and that at the times
at which it could not be felt the stomach was distended
by recently eaten food. What probably made it possible
to feel the tumor at almost any time or any posture was her
emaciation, and the small quantity of food in her stomach.
The post-mortem examination, in disclosing the atrophy of
her stomach, accounts for the fact that her cancer of the
pancreas was so seldom overlaid by that viscus distended.
In the second case the tumor was seldom felt during life.
Indeed I don't think it was felt more than once. When
it was felt she was recumbent^ and had not been eating.
The post-mortem in revealing a very considerable disten-
tion of the stomach, revealed the reason why, and how
the cancer of the pancreas was aproned over most times
during life.
Cancer of the pylorus sometimes appears and disap-
pears ; I saw one such a case a few years ago. A man,
from Salem, N. Y., came to see me on account of a
stomach trouble which had been pronounced cancer.
On examination of him, as he lay on my operating-table,
I could feel no tumor at the epigastrium, and I was inclined
to doubt the diagnosis of his former attendant, whom I
knew very well, and knew to be a practitioner of con-
siderable ability. I bethought me to make the patient
stand up. In an instant the pyloric tumor was there as
plain as a pike-staff. I wrote to his attending physician
and asked him to follow the case and get a post-mortem
if he could. He did, and answered that the case was one
oi cancer of the pylorus, not of the pancreas. But it ap-
pears that the erect posture brought the pyloric tumor
within the region of touch, and in doing so would not
have uncovered, but rather hidden a pancreatic cancer.
Hence, in examining a suspected pyloric tumor, the
fact that it cannot be felt in conditions which allow
the stomach to get over it, and can be felt only when
the stomach cannot get in front of it so as to apron it ;
or, in other words, if the suspected tumor can always
be felt when the stomach is empty, but disappears
whenever the stomach is distended, and if the tumor
commonly is more obvious in the recumbent than in
the erect posture, I feel quite confident we should be
justified in making the diagnosis of pancreatic tumor even
in the presence of some of the symptoms of stomach
cancer, such as anorexia, pain after eating, or occa-
sional bloodless vomits. Another diagnostic point which
seems to me as of considerable value is the character of
the pain as well as its persistence. In the first place,
the pain is more continuous than in cancer of the pylorus.
In the second place, the pain radiates in more directions
than in cancer of the pylorus. In the third place, the
pain is more dismal, more dolorous. It is a pain that
seemingly has no ending. It is a disheartening pain. It
does not become more endurable by having been en-
dured. It is a pain which has no leaven of hope in it.
It will be noticed in Mrs. H 's case that there was
pretty constant (for a time) spitting of a saliva-like fluid
from the mouth. Frerichs attributes to this symptom
considerable importance, but says, ** We must be careful
in considering such an increased salivary secretion as due
to disease of the pancreas, for as yet there are no re-
corded cases of primary uncomplicated pancreas disease
in which this symptom was definitely present " (Fried-
596
THE MEDICAL RECORD.
[November 29, 1884.
reich, in "Ziemssen's Cyclopaedia," vol. viii., p. 567,
to whom I must refer the reader for further consideration
of the value of this symptom).
P.S. — The writer is not unaware of the extreme rarity
of primary cancer of the pancreas. Dr. Putnam, of this
place, saw the first case with me, and attended the post-
mortem. The other case was witnessed by Drs. Trull,
Wyman, and others, I think, at Pactory Point, Vt.
JEQUIRITY OPHTHALMIA.*
By JOSEPH A. ANDREWS, M.D.,
OPHTHALMIC SI/KGBON TO CHARITY HOSPITAL, NKW YORK.
Having quite recently ' considered, at some length, the
subject of jequirity ophthalmia, I desire here to limit
my remarks to a brief review of certain papers that have
appeared on the subject in question since my own com-
munication alluded to above was published.
First, is jequirity directly responsible for the disas-
trous results which have been placed on record as having
followed its use ?
Has it a constant and regular action, and are there any
dangers to be apprehended from its employment, even
according to the directions which I have indicated in my
paper (loc. cit., p. 251)?
In order to answer the first question, it will be neces-
sary to examine the evidence which has been adduced to
show that jequirity is to blame for the mischief to the eye
which has resulted during its use.
Jacobson • records a case in which jequirity produced
purulent infiltration of the cornea, perforation of the lat-
ter, and exposure of the entire iris. This would certainly
seem to be a grave reproach to the use of the remedy in
question. In this particular case, the ophthalmia pro-
duced was certainly not true jequirity ophthalmia, and
yet this circumstance would not be a sufficient defence
of the remedy ; but I am convinced that the real source
of mischief is to be sought in the strength of the infusion
and the manner in which it was employed, Jacobson
having, namely, instilUd the infusion (five per cent.) into
the conjunctival sac, and kept up the action of the drug
with compresses wet with the infusion. This was follow-
ing Dr. de Wecker's first instructions regarding the use of
jequirity to the letter ; and that Dr. de Wecker obtained
uniformly favorable results before he had modified his
manner of applying the drug, is certainly very remarkable
and providential. But in Dr. Knapp's two cases,* al-
though true jequirity ophthalmia was not produced, a
violent pyorrhoea having followed the use of the infusion,
and affected the other not inoculated eye, nevertheless
this case is a most instructive one. Dr. Knapp treated
the two cases in question according to Dr. de Wecker's last
directions, making a single brushing of a fresh three per
cent, solution, macerated for three hours, over the entire
upper lid ; and yet this single application was followed
by violent reaction and perforation of the cornea. If it
be possible with jequirity to produce a purulent oph-
thalmia, then we cannot defend the remedy in a given
case in which it has produced mischief by the substitution
of a purulent for a genuine jequirity ophthalmia. Never-
theless, I confidently believe that the dangers to be ap-
prehended from the drug may, in a very marked degree,
be avoided by observing the strictest caution in its use.
The facts which should be seriously borne in mind are,
that all eyes are not afiected in the same degree by the
remedy, a three per cent, infusion in one instance being
followed by violent reaction, while in others a stronger
infusion may ^ve rise only to slight reaction. Therefore
I believe that the safest plan to observe is to begin with
a weak solution, say two per cent., even where there is
1 Read before the American Ophthalmological Sociecjr, 1884.
* Trachoma and the Etiology of Jequirity Ophthalmia. Archives of Medicine,
vol. xi., No. 3, iJp. 321-261, June, 1884.
' Herliner klinische Wochenschrift No. 17, April 28, 1884, p. 258.
* Archives of Ophthalmology, vol. xlii., No. i.
pannus, and one per cent, when the cornea is not in-
volved, and keep in mind the fact that there is a period
of incubation which may exceed twenty-four hours. The
berries should be husked, crushed, and macerated far about
six hours in cold distilled Ivaier, then filtered; and after
a single thorough brushing of the palpebral conjunctiva
with cotton wrapped about the end of a match. Thirty
hours are allowed to elapse before renewing the brushing ;
then, according to the susceptibility of the patient to the
action of the remedy, we may repeat one, two, or three
times daily, always proceeding with caution, and never keep
up the action of the drug with compresses wet in the infu-
sion. By following these directions I have never yet
seen an untoward result, and I have used the remedy in
one hundred and forty cases of diseases of the cornea and
conjunctiva.
Pre-existing purulence is a positive contra-indication to
the use of jequirity. Papillary hypertrophy of the con-
junctiva is not favorably influenced by the remedy.
Hippel says, the more hyperaemic the conjunctiva is, the
more intense will be the reaction. De Wecker says this
is an error ; but from my own observations I feel disposed
to believe that Hippel's statement is, in a measure, cor-
rect. However, this much is true ; the nearer the con-
junctiva approaches a normal physiological condition, the
more certain and intense will be the impression produced
by the infusion. The most violent reaction I have seen
follow the use of an infusion of jequirity occurred in a
case of sclerosis of the cornea, in which the conjunctiva,
for all practical purposes, was normal. But the patient
in this instance took upon herself the responsibility of
departing from my instructions, and instead of a single
application, and awaiting the lapse of the number of hoars
indicated, s\iQ poured i\ie infusion (three per cent., cold,
macerated for six hours) into the eye four times during
the day. The result was a most intense chemosis and
swelling of the lids and corresponding side of the face,
and nasal mucous membrane ; and in the region of the
frontal sinus the pain was so violent that the patient de-
clared that she did not sleep for three nights ; and I am
convinced that her suffering must have been very acute. \
With violent inflammatory reaction there was extensive
formation of a croupo-diphtheroid membrane, and a re-
sulting symblepharon, and what is most instructive for us
to remember is the circumstance that it was a case of
genuine jequirity ophthalmia, no purulence having oc-
curred at any time in the course of the inflammation.
And yet the vision was improved from an ability to per-
ceive light, to counting Angers at fifteen feet.
Dr. de Wecker says,* " without any doubt, the cornea is
not exposed to any danger'' in jequirity ophthalmia.
But the first case in which I employed the remedy taught
me that this was a most pernicious error, and that the
cornea is endangered. However, if we compare the
number of authors who have declared themselves for and
against the jequirity treatment, we find that the former
are conspicuously predominant, and it would seem that
those authors who do not favor the remedy, such as Vos-
sius, Galezowski, and Nicolini, might change their views
if their experience were extended to a larger number of
selected cases.
Scrofulous pannus and sclerosis of the cornea are favor-
ably influenced by jequirity, and I have had very gratifying
results in this class of cases in improving the vision ; but
I have never used the remedy, as Dr. Wecker has, in
torpid ulcers of the cornea, firstly, because I could not
satisfy myself that the cornea was not placed in still
greater danger by its use ; and secondly, I felt that I could
rely on safer and really more satisfactory means. How-
ever, of course, mere conjecture should not be permitted
to weigh against the results of experience, and Pr. de
Wecker's experience seems to speak in favor of the rem-
edy in this class of cases.
40 West Twbnty-fourth Strbet.
> Graefe*s Aichiv ftlr Oph., Bd. xxx., A. i., p. 367.
November 29, 1884.]
THE MEDICAL RECORD.
597
New Treatment of Strangulated HiCMORRHoms.
— Dr. Monod advises a new treatment for strangulated
haemorrhoids, which he has practised with great success.
It consists in forcibly dilating the anus, as in case of fis-
sure. Verneuil had already recommended this method
for the cure of simple piles, and has been followed by
most of the young surgeons, who have entirely abandoned
every other treatment. To effect the dilatation Verneuil
employed specula of different dimensions, and only in the
case, as has been just stated, of the ordinary condition
of haemorrhoids. On the contrary, he says that •* when
the piles are the seat of sphacelus he always waited until
the complication disappeared." Monod, who has imi-
tated Verneuil with the best results in those simple cases,
goes still farther, and instead of regarding strangulation
as a counter-indication to the operation, considers that
his fact renders it the more necessary. He cites a case
n point He was called by one of his confrh^es to see a
gentleman who had been suffering excruciating agony
for two days from strangulated piles, and on whom ice
fomentations, narcotics inius and eoUra were tried with-
out effect. Local examination showed no more than is
ordinary in such cases — a ring of tumefied external haemor-
rhoids surrounding a packet of internal turgescent haem-
orrhoids, with a dark spot in the centre, announcing the
commencement of sphacelus. The least touch was pain-
ful, and the patient demanded relief at any price. Par-
tisan of the treatment of haemorrhoids in general by
dilatation, he thought that he would be doing right in
employing it in the present case, knowing that by sup-
pressing the action of the sphincter the pain would cease.
Accordmgly, the patient was put under the influence of
chloroform, and the hemorrhoidal tumors reduced, and
then Monod largely dilated the anus with his fingers. A
few minutes afterward the patient awoke free from all
pain, and in a few days he had the satisfaction of not
only feeling that the strangulation had entirely disap-
peared, but that he was for ever quit of his piles. This
case of Monod^s proves that the hand dilates just as well
as the speculum, and consequently the operation is re-
duced to its simplest expression. — Medical Press^ Sep-
tember 24, 1884.
Naphthaline in Diarrhcea and Cystitis. — For the
last three years Professor Rossbach, of Jena, has em-
ployed naphthaline in all the cases of diarrhoea that have
come under his care. He concludes that it is of great
service in all cases of chronic intestinal catarrh, with or
without ulceration, attended by chronic diarrhoea, and in
all cases the stools in the course of from five to fifteen
days become of normal frequency and consistence. Some
of the naphthaline given passes over into the urine, and
the e£fect in the case of urinary troubles was noted to be
exceedingly favorable. Pus, blood, and vibriones quickly
disappeared from the urine after its administration. It
was given in doses of thirty to forty-five grains per day.
After half a grain daily the appetite was often improved.
--The Medical Press^ October 15, 1884.
Migraine and Tabes. — ^Among the various prodro-
mal symptoms of tabes dorsalis, attention was drawn
by Duchenne, and later by Pierret, to the occurrence of
neuralgic seizures closely simulating hemicrania. The
recent brochure of Berger mentioned this fact as a novel
observation. Dr. H. Oppenheim, of the Berlin Charity,
points out (BerL Klin. Wochenschr,, No. 38, 1884) the
priority of the French authors, and supplies some inter-
esting details of twelve cases, from a total of eighty-five
tabetics, who either were at the time of observation or
had previously been subject to migraine, ten of the pa-
tients being females. The study of these cases leads him
to conclude that hemicrania is far too frequent a feature
in the history of tabes dorsalis to be considered an acci-
dental event, and that it is far more common among
tabetic women — e.g.^ ten times in thirty-two cases — than
among men. The relations which the hemicrania bears
to tabes are various. Generally it has been present
many years before the initial symptoms of tabes, and the
hemicranial attacks increase in frequency, intensity, and
duration as the disease advances. Or the migraine may
coincide with the onset of declared tabetic symptoms, or
be associated with vomiting and gastric crises. In rare
cases the hemicrania does not appear until tabes is
developed. On these grounds, Oppenheim thinks it the
duty of the physician, especially in migraine of increasing
severity, to be on the alert for the recognized early symp-
toms of tabes-— especially the absence of knee-jerk.
Tonsillotomy. — Dr. de Saint-Germain, believes that
the tonsillitome of Velpeau, also of Luer, are very un-
satisfactory instruments, and better not used. The op-
eration is frequently mcomplete, and the tonsils are often
left untouched. The best method is removal by means
of a straight bistoury. The tonsils should be held firm
in a pair of forceps. An incision made close to the
edges of the instrument by means of a bistoury removes
the entire tonsil without any danger of injuring either
the palate or the pillars. When the right tonsil is re-
moved, the left hand must perform the operation, which
is decidedly inconvenient. Amygdalotomy thus per-
formed on children is never followed by accidents, nor
by hemorrhage of an alarming nature. The author men-
tions instances where excision of the tonsils among
adults provoked hemorrhage, which resulted in the death
of the patient. In young girls, fourteen or fifteen years
of age, who have not menstruated, the tonsils ought not
to be removed ; the hypertrophy frequently disappears
after the menses appear. Dr. de Saint-Germain affirms
that the tonsils ought not to be removed, unless by their
size they impede free breathing.
The Symptomatic Treatment of Typhoid Fever.
— Professor Ebstein read a paper on " The Treatment
of Typhoid Fever," at the recent meeting of the German
Scientific Association, at Magdeburg. He gave his ex-
perience for the past seven and a half years, at the Clinic,
in Holstein. The number of cases treated was 235.
The mortality was only 5.5 per cent., reduced to 2.5 per
cent, by the exclusion of inevitably fatal cases. The
author concludes that the so-called ** abortive treatment"
with calomel is useful and to be recommended. In the
absence of any causal treatment, this can only be symp-
tomatic, i.e.y measures based on a consideration of the
morbid phenomena and individual conditions. Above
all, attention must be paid to judicious dietetic treatment
and the maintenance of the nutrition of the patient. The
control of high temperatures, even if of long duration, is
only called for when they are associated with severe car-
diac or nerve symptoms, or when the temperature attains
such a height as to threaten life. The principles of
treatment enunciated are, says Ebstein, far more satis-
factory in practice and in their results than an exclusive
adoption of "bath treatment," or other methods of strict
antipyresis. Baths he regards as of value for their pow-
erful stimulant action, and he would employ them where
other methods seem to be insufficient. — London Lancet^
October 18, 1884.
The Germ-Theory of Malaria. — In a paper read
by Dr. Hart, of Arkansas, before the Medical Society of
his State (Gaillards Medical Journal^ September, 1884),
he asks some rather pertinent questions of the believers
in the bacillus malariae. He wishes to be enlightened
on the following points : i. How does the bacillus
malariae generate, thrive, and prosper under such diverse
circumstances and surroundings ? 2. How can it mani-
fest itself in such diversified effects, and produce so many
different diseases ? 3. Will not the §ame pathogenetic
cause always produce the same disease as its effect ? 4.
Will different bacilli produce the same diseases ? 5. It
will not do to invoke the aid of any other bacillus to do
the work of the malarial bacillus, though the existence of
598
THE MEDICAL RECORD.
[November 29, 1884.
fifty or a thousand others be proven. 6. If there be a
bacillus malariae, and quinine be its destroyer or germi-
cide, why is it not equally effective and potent in all dis-
eases produced by it ? 7. To determine the existence
of a malarial bacillus three propositions must be proven
and established; First, it must be discovered; second,
it must be cultivated ; third, it must be capable of being
reproduced. 8. The existence of a germ determined and
established as above, three propositions must be proven
to establish its causative relation to malarial disease :
First, that it will always produce the same disease and
nothing besides ; second, that nothing else will produce
it ; third, that malarial disease will always be produced
by it and nothing else. The above propositions, he
concludes, must be proven to a demonstration to estab-
lish the existence and causative relation of germs to
malarial disease, and without this proof palmella spores
and algae, and pyrogen and pigmentary elements, and all
the bacillus twaddle of germ theorists, amounts to nought,
and is but fit rubbish for the waste-basket.
The Rbmoval of Tattoo Marks. — India-ink mark-
ings in the skin are often the source of much annoyance
in after life to those who have been tattooed in youth.
The editor of the Medical Press states that nothing but
the knife or an active escharotic will produce a satis-
factory result. He holds that the cutis must be de-
stroyed. Dr. Neale, of London, however, claims that
he has secured good results with sodii ethylas, first sug-
gested by Dr. B. W. Richardson. He cites the case of a
gentleman who, in his younger days, had a palm tree
tattooed on his arm and an elaborate bracelet on his
wrist, who has quite lost all the dark matter, etc., the
skin being left in many places quite natural, although, of
course, there is still more or less of a scar, but this
diminishes month by month.
Resorption of a Pleuritic Effusion following
Erysipelas of the Chest. — Dr. M. Schmidt relates the
case of a strong man, fifty-five years of age, who was ad-
mitted to hospital suffering from pleurisy with efifusion.
He was treated by poultices to the chest and opium in-
ternally, and subsequently by the application of a large
blister. No improvement followec^ but about a week
later the temperature suddenly ran up and an erysipelas
began, starting from the wound of the blister, and soon
spreading to the entire surface of the chest both front
and back. Four days subsequently it was found that the
effusion had almost entirely disappeared. The erysipelas
attacked the head but finally yielded and the patient
made a good recovery. The author does not advocate
Fehleysen's practice of inoculating the patient with ery-
sipelas in order to promote absorption of the fluid, as
one death has been thus caused. But he thinks that by
means of Pasteur's method of culture and attenuation it
might be possible to obtain a modified virus which could
be inoculated with entire safety. — L Union Medicate^
September 25, 1884.
Ephemeral Rheumatismal Periostitis. — At the re-
cent meeting of the French Association for the Advance-
ment of Science at Blois i^V Union M^dicaUy No. 133,
1884), Professor Verneuil read a paper on an affection
not hitherto described in the text-books, but of which he
had observed two examples. The disease presents under
the form of a tumefaction, hard at first, but becoming
elastic and soft after a certain time. At one period the
sense of fluctuation was so marked that it was thought
that pus was present, but the fluctuation disappeared
and the swelling gradually subsided. There was no
hyperplasia as in ordinary surgical periostitis, no fever,
and no discoloration of the skin. At certain points
the swelling disappeared spontaneously, at others it
at first diminished and then increased again in size.
There was in the* latter case a very appreciable con-
gestive element, for one of the patients having taken
cold, a tumor situated on his face increased suddenly to
twice its former volume. There was no previous history of
syphilis, but the patients had repeatedly had rheumatbm.
As usually happens when cases are related of previously
undescribed conditions, many of the members present
had seen similar cases, and they related the histories of
their several patients, which agreed in general with those
described by the author of the paper. Professor Verneuil
proposed to call the affection ephemeral rheumatismal
periostitis.
Palliation of Epilepsy by Apomorphia. — It is stated
in the Revue Medicale of September 20, 1884, that a
German physician has succeeded in cutting short epileptic
attacks by subcutaneous injections of muriate of apomor-
phia. He injected three or four drops of a one per cent
solution. The patients experienced some nausea but
there was no vomiting. Whenever the injection was
made during the aura the impending convulsion was
nearly or entirely averted, and the more prolonged the
aura usually was, the more pronounced was the success
of the injections.
Decoction of Valerian in the Treatment of Con-
tusions.— Upon the suggestion of Dr. Grehant, Dr. Ara-
gon has made a ntimber of trials to determine the value erf
a decoction of valerian root as a dressing for woundsy and
especially for contused wounds. The decoction used was of
the strength of thirty grammes of valerian root to one litre
of water. The cure was no more rapid than that which
obtains with other dressings, but from the first application
the pain was completely abolished. This is a point of
considerable importance if it should prove to be sustained
in further trials. — Lyon Midieal, September 21, 1884.
Treatment of Elephantiasis by Electricity.--
Dr. Vicira de Mello has recently published a monograph
on this affection, based upon the study of upward of one
hundred and fifty cases. He shows that the causes capap
ble of producing lymphangitis are also the causes of ele-
phantiasis, since the latter is developed in consequence
of successive attacks of lymphangitis. This accounts
also for the comparative frequency of the aflfection in
warm countries where the causes of external irritation
are so numerous. During the attacks of Ijrmphangitis
the lymph transudes into the subcutaneous tissues, and
is not there absorbed. The surrounding parts are chron-
ically inflamed, proliferation takes place, and after sev-
eral successive attacks of this nature the elephantiasis
becomes established. Death from elephantiasis is of
very exceptional occurrence, due to abscess or some
other complication. The author has never observed the
termination by gangrene, as is mentioned by some pa-
thologists. The attacks of lymphangitis are usually
treated by the administration of quinine in large doses,
purgatives, and locally by antiseptic applications. Bat
Dr. de Mello asserts that the only method of treatment
which has given any satisfaction in elephantiasis is that
by electricity. He has employed both galvanic and fara-
dic electricity with excellent results, and in this his ex-
perience is in accord with that of Drs. Silva Aranjo and
lA.OTMCort^,— Journal de Medicine de PariSfOctoheT 4, 1884.
How TO Shrink Hypertrophied Tonsils by Caus-
tic Applications. — Among the various caustics for local
use in causing shrinkage of tonsillar hypertrophies, Dr.
Chisholm {Virginia Medical Monthly) has found the
chloride of zinc the most available and the least annoy-
ing to the patient. He employs it in the following man-
ner : A wire, the size of a fine knitting-needle, is rough-
ened for a half inch from one end, so that it may hold a
fibre of absorbent cotton twisted upon it. Dip this into
a saturated solution ;of chloride of zinc, and thrust it to
the very bottom of the crypt, and keep it there several
seconds. When withdrawn the whitened orifice marks the
cauterization. By renewing the cotton for each follicle,
several may be thoroughly cauterized at the same sitting,
without causing any annoying irritation to the throat
A very few applications will cause the gland to shrink,
as will be seen one week after the destructive cauteriza-
tion has been made to the interior of the follicles.
November 29, 1884.]
THE MEDICAL RECORD.
599
Explosive Drugs. — Several instances are related in
the Deutsche Medicinal-Zeitung of September 29, 1884,
oi injuries resulting from the explosion of compounds
ordered in physicians' prescriptions. A gargle was or-
dered of chlorate of potassium, chloride of iron, and gly-
cerine. It was prepared, and five minutes later the bottle
exploded in the purchaser's pocket, wounding him quite
severely with the fragnjents of glass. A mixture of hy-
pophosphite of lime, chlorate of potassium, and lactate
of iron exploded and nearly killed the prescription clerk
who was componnding it. Even the simple trituration
of calcium hypophosphite is dangerous ; a young phar-
maceutist was killed by an explosion which was caused
by the shaking of a solution of this substance. Physi-
cians not infrequently order a solution of chromic acid
in glycerine. But when the acid is added quickly and
all at once to the glycerine a readily explosive substance
like nitro-glycerin^ is formed. Chlorate of potassium
when mixed with tannin or muriate of morphia often ex-
plodes. The combination of iodide and preparations of
ammonia must be made cautiously, as iodide of nitrogen
is formed, which explodes on the slightest touch. In-
deed one ought to be very careful in ordering and com-
pounding mixtures in which easily reducible substances
enter — such as the chlorates, the hypophosphites, the
nitrates, preparations of iodine or ammonia, chromic
acid, glycerine, permanganate of potash, etc If physi-
cians would but remember the danger of explosions in
preparing such compounds, they would less often put
the lives of druggists and of their own patients in
jeopardy.
Th* Antipyretic Action of the Alkaloids of
Quebracho. — ^At the recent meeting of the French As-
sociation for the Advancement of Science at Blois, a
paper was 'presented by Drs. Huchard and Eloy on this
subject (Le Frogris M^dicaly October 4, 1884). There
are many alkaloids of this drug, no less than six having
been already isolated. Numerous experiments upon rab-
bits having demonstrated the antipyretic action of these
alkaloids, the authors were led to make trial of them in
the human subject In a certain number of patients
with typhoid fever, to whom quinine had been given with-
out effect, a notable reduction of temperature was ob-
tained by the hypodermic injection of the muriate of
aspidospermine in doses of one and a half to three
grains. This latter amount should never be» exceeded.
The authors noted especially the rapid reduction of tem-
perature following the exhibition of these several alka-
loids, and also remarked upon the changes occurring in
the blood after their administration. The blood is
changed in color in a way very similar to what occurs
after poisoning by carbonic oxide.
Paralysis Caused by the Use of Crutches. — Dr.
Vinay reports the case of a man, sixty-three years of age,
who suffered from paralysis of the extensors of the fore-
arms and of the long supinators following upon the use
of crutches. The crutches were of very rude construc-
tion and had no supports for the hands. All the affected
muscles, with the exception of the right triceps, reacted
to the faradic current. A treatment by means of sulphur
baths and electricity was instituted, and at the end of a
month all the muscles were restored to their normal
function, except the right triceps. The use of the poorly
made crutches was, of course, abandoned. The author
believes that paralysis of the triceps from this cause is
of much more frequent occurrence than is generally sup-
posed. He advises a treatment of this condition by the
faradic current, friction, and sulphur baths, and removal
of the exciting cause. — Deutsche Medicinal- Zeitung^ No.
77, 1884.
Syphilitic Arteritis. — At the meeting at Blois of the
French Association for the Advancement of Science, Dr.
Leudet related a case of syphilitic arteritis, accompanied
by cerebral symptoms, occurring four years after the ap-
pearance of the initial sore. The superficial temporal
arteries of both sides became cord-like, and the pulsa-
tions ceased in them. The cerebral symptoms, pain and
loss of memory, occurring at the same time indicated a
concomitant lesion of the brain. Under the influence of
iodide of potassium all these troubles subsided, the ar-
teries lost their indurated feel, the pulsations returned,
and the cerebral symptoms gradually passed away. The
author thought this case was important as showing the
curability both of syphilitic arteritis and of cerebfal sy-
philis.— Lyon Medical, October 5, 1884.
Biliary Calculus Passed by the Rectum. — Drs.
Secr^tan and Larginer relate the case of a man who suf-
fered from frequent attacks of hepatic colic. These at-
tacks ceased for the time after the expulsion of a lumbri-
coid worm by the mouth. But they soon recurred, and
were accompanied by violent nervous crises, acute mania,
left hemiplegia, and loss of the intellectual faculties, espe-
cially of the memory. Three months later these nervous
symptoms suddenly ceased upon the expulsion by the
anus of a large biliary calculus, nearly three inches in
length by an inch and a half in thickness. The patient
had never presented any symptoms of intestinal obstruc-
tion, and the reporters believed that a fistula had been
established between the gall-bladder and the colon. —
Revue de Chirurgie^ October 10, 1884.
The Mechanism of Rotation of the Forearm. —
Heiberg is of the opinion that in rotation of the hand the
radius does not simply turn around the ulna, but that
both radius and ulna rotate around an axis lying between
the two. Dr. v. Meyer agrees with Heiberg that this
may occur in certain cases, but regards it as occurring
only exceptionally, and in cases in which the ligaments
of the elbow are stretched to a very considerable extent.
He concludes, therefore, that this rotatory movement of
the ulna is not normal but is due to a partial subluxation.
—Ceniralblati fur Chirurgie, No. 38, 1884.
A Prepuce Dilator for the Treatment of Phim-
osis WITHOUT Operation. — Dr. Richmond writes in the
Medical Pressy October i, 1884, concerning a new instru-
ment which he has devised for the treatment of phimosis
by gradual stretching. He says that the only method of
treating phimosis, in common practice, is by operation.
There are, however, a great many patients suffering from
this malady who absolutely refuse to undergo any opera-
tion for its relief. Numbers of cases are constantly
presenting themselves of men considerably advanced in
years who have never been able to get their foreskins
backy and have consequendy suffered continually from
discharges attributable solely to the irritation attendant
on this condition. Yet many such patients will rather
pass their lives with the inconvenience and risk which
this state of things involves than submit to the knife.
There can, however, be only one other possible means
of treating phimosis, and that is by stretching the prepuce.
But this method appears to be very seldom put into prac-
tice, for when it is tried it generally results in failure. I
can see no reason, however, why the skin and mucous
membrane surrounding the glans penis should not be as
freely dilatable as in other parts of the body. The reason
of the failure, I take it, is simply that no proper instru-
ment has been invented for the purpose. Extemporized
instruments, such as dressing forceps, aneurism needles,
or blunted hooks, are painful and inadequate dilators.
An instrument proper for the purpose should possess
blades which could be introduced separately; th^ blades
must be of suitable size and shape to suit the case ; and
it should be possible to open them parallel to one an-
other or at any angle. The instrument which I have
devised for the purpose consists of two rods, connected
together by means of two long screws. At one extiemity
they are bent inward, and fixed to two blades. These
blades can be removed, and may be of any size and
shape. The rod is of tuning-fork shape, with a screw-
nut sliding in the groove between the two branches of the
fork. Through the nut is passed a long screw, the end
6oo
THE MEDICAL RECORD.
[November 29, 1884
of which is received into a cup working on a hinge-joint
attached to a cylinder, which slides along the bar. The
screw-end may be detached from the socket by depress-
ing a little spring. The blades are passed separately
down between the foreskin and glans. Very small blades
are used at first, and they are, of course, previously oiled
to facilitate their passage. They are then attached to the
rods, which are united by fixing the end of the screw
into the cup-joint. Gradual extension can then be ap-
plied by turning the nuts. Since there is a joint at the
cylinder, the blades may be opened parallel to one an-
other or at any angle, and, in fact, the relative position
of the blades may be altered in an^ direction. The idea
is not to stretch the foreskin forcibly and at one sitting,
but to dilate it gradually in the same manner as a strict-
ure of the urethra is dilated, by repeatedly passing a
catheter. If the instrument be used once or twice a
week for about ten minutes at a time, the foreskin will
in most cases go back in a month or six weeks. The
larger blades are used to thoroughly stretch the tissues
and complete the treatment. The foreskin may thus be
dilated to any reasonable extent, and will, after a time,
easily roll back over the corona. The instruments are
made by Messrs. Arnold & Sons, of Smithfield, England.
An Autodidactic View of Diabetes. — In the Ga-
zette des Hdpitauxy a physician has published a confrere's
autobiography in so far as it relates to the careful ob-
servations of his own case, which was one of pronounced
diabetes mellitus. The physician in question, having
kept an eye on himself for many years, finally decided
that |;lycosuria was a symptom of active and chronic
hepatic congestion dependent upon gout Like the latter,
it should be treated by regulating the diet and not by the
exhibition of useless drugs. He believes in white meat,
^ggs )fish, chicory, spinach, artichokes, and lettuce. Ab-
solute abstention from fruits, sweets, farinaceous foods,
as well as coffee and all alcoholic beverages, is insisted
upon.
I^HPeritonitis Resulting from Diseases of the Ver-
miform Appendix. — Professor With, dealing with this
subject before the International Medical Congress, said
that the inflammation of the right iliac fossa, known by
the name of perityphlitis, very often began in ulceration
and perforation of the vermiform appendix. Peritonitis
of this origin was called appendicular peritonitis, and was
met with under three forms or conditions, generally well
marked ; as adhesive appendicular peritonitis (before
perforation), and appendicular peritonitis, local or gen-
eral (after perforation). As regarded treatment, the chief
indication was to give the intestinal canal as complete
rest as possible. To this end, sufficiently large doses of
opium and morphia should be used, as well as complete
abstention from laxatives and enematas, kept up for a
period of twenty-four hours, if that were thought neces-
sary. By means of this treatment, the indication for sur-
gical interference underwent a considerable restriction.
AsEPTOL. — A phenol compound, termed orthoxyphe-
nylsulphurous acid, has been recently introduced into
therapeutics under the name of ** aseptol," this title hav-
ing been given to it on account of its remarkable germi-
cide qualities, which excel those of carbolic and salicylic
acids. Aseptol is an amber-colored fluid, of a density
of 1,400 ; it has a slight odor, but is more pleasant to
the smell and is less poisonous than carbolic acid. Last
Novemoer, Drs. I^eroy and Van den Shrieck, of Ant
werp, studied the therapeutic applications of aseptol, and
reported most satisfactory results as an antiseptic. It
has the following advantages over antiseptics in common
use : I. It is very soluble in water. 2. It is very slightly
caustic. 3. It is free from irritative qualities, and may
be applied for a long time to the skin, the eyes, the blad-
der, etc. 4. Finally, its slight toxicity, which permits its
use internally in considerable doses, and also the appli-
cation of concentrated solutions in diphtheritic i^haryn-
gitis and laryngitis. — La France Midicale.
^jedical Stjems.
'Contagious Diseases— Weekly Statement.— R^
port of cases and deaths from contagious diseases r^
ported to the Sanitary Bureau, Health Department, for
the week ending November 22, 1884 :
Week Ending
Cat€s.
November 15, 1884
November 22, 188^
Deaths.
November 15, 1884
November 22, 1884
h
1^
I
107
"5
Bell's Law Discovered by Magendie. — Professor
Chapman says the credit of demonstrating the functions
of the anterior and posterior roots of the spinal nerves
belongs to Magendie, and not to Sir Charles BclL
When Magendie, in 182 1, published the correct idea,
Bell collected and destroyed, as he thought, the whole
edition of his own pamphlet, printed in 181 1, which ad-
vanced the idea that the posterior roots are trophic only,
and quickly published another containing the true idea.
Professor Chapman has seen a copy of Bell's treatise oC
181 1 which escaped destruction, and is now owned by
the celebrated Richard Owen.
GoNORRHCEA AND Chordee. — Troublcsome gonor-
hoeal cases do not fail to occur except in the experience
of those who are in the possession of unfailing remedies.
A retired army surgeon, without apparently expecting
such good results, ordered for an officer, some fifteen
years ago, who was just about to present himself for duty,
but who was suffering from gonorrhoea associated with
an intense chordee at night, the following two prepara.
tions: aquae, 3 vij., mucilago acaciae, 5J.i ext belladon-
nae, gr. xx., and zinci sulph., gr. xx. A teaspoonful in-
jected frequently. The other is an external application
consisting of unguenti spermaceti 3 iv., unguenti hydrarg.,
3 iv., ext* belladonnae, gr. x.,ext. opii, gr. x., to be smeared
freely along the perineum and around the crura penis at
night. " Complete cure " occurred within a week. The
following injection for gonorrhoea is also recommended
It is claimed to be superior to any other single injection:
g. Pulv. iodoform, 20; acidi carbolici, 10; glycerini, 80;
aquae destillatae, 200.
Heart Beats. — Dr. N. B. Richardson, of London,
says he was recently able to convey a considerable
amount of conviction to an intelligent scholar by a
simple experiment. The scholar was singing the praises
of the "ruddy bumper," and saying he could not get
through the day without it, when Dr. Richardson said
to him : " * Will you be good enough to feel my pulse
as I stand here?' He did so. I said, * Count it care-
fully; what does it say?' *Your pulse says 74.' I then
sat down in a chair, and asked him to count it again.
He did so, and said, * Your pulse has gone down to 70-'
I then lay down on the lounge, and said : * Will you take
it again?' He replied: 'Why, it is only 64; what an
extraordinary thing!' 1 then said: *When you lie
down at night, that is the way nature gives your heart
rest. You know nothing about it, but that beating orgar
is resting to that extent ; and if you reckon it up it is a
great deal of rest, because in lying down the heart is
doing ten strokes less a minute. Multiply that by sixty,
and it is six hundred ; multiply it by eight hours, and
within a fraction it is five thousand strokes different; and
as the heart is throwing six ounces of blood at every
November 29, 1884.]
THE MEDICAL RECORD.
601
stroke, it makes a difference of thirty thousand ounces of
lifting during the night When I lie down at night with-
out any alcohol,* that is the rest my heart gets. But
when you take your wine or grog you do not allow that
rest, for the influence of alcohol is to increase the num-
ber of strokes, and instead ol getting this rest, you put
on something like fifteen thousand extra strokes, and the
result is you rise up very seedy and unfit for the next
da/s work till you have taken a little more of the "ruddy
bumper," which you say is the soul of man below.' " —
Gaillards fournai.
The Treatment of Stammering. — A correspondent
in the London Lancet of September 37th writes that
anyone may be cured of stammering by simply mak-
ing an audible note in expiration before each word.
Stammerers can sing as easily as other persons. Jacky
Broster, of Chester, who made a large fortune by curing
stammering, simply made his pupils say her before each
word beginning with a consonant.
The Pecuniary Value of Enterotomy. — Dr. Sutton,
of Pittsburg, having performed enterotomy on the wife of
a wealthy resident of that city, removing four inches of
intestine, was encouraged, by the fact of her complete
recovery, to send in a bill of $1,000 for the operation
and twenty-two days of attendance in the after-treatment.
Each member of the jury, who finally adjudicated the
matter, wrote on a slip what he thought would be a proper
fee, and the sum total of the amounts thus voted, divided
by twelve, was agreed upon as the verdict. The dividend
was $330. One of the jurors thought about $10 would be
a fair price, and another was willing to allow $30. — Age.
Lata or Miryachit. — In Java, according to the Brit-
ish Medical Journal^ miryachit is known by the name of
lata. The person affected with it is compelled to imitate
everything he sees or hears. Our contemporary mentions
an amusing case in which an Irish butler who was famil-
iar with the symptoms of the disease took advantage of
his knowledge to secure a glass of much-coveted wine :
A doctor dined with a friend, with whom he discussed the
peculiarities of the disease. The host pushed forward a
bottle with the request to "try that, doctor; it's ten
years old." The doctor took a stiff glass, and, smacking
his lips, pronounced it " tip-top." Suddenly Barney, who
had been present during the conversation, seized a glass
and, filling it to the brim, drank it off, smacked his lips
and pronounced it "tip-top." "Confound you/' shouted
the infuriated host, "what do you mean, sir?"' "Shure,
sir," demurely replied Barney, " oi'm afeard oi'm afflicted
wid the latha."
Regulatory Albuminuria. — Rosenbach defines regu-
latory albuminuria as an albuminuria in which the quan-
tity and quality of the urine are normal (except in con-
taining albumen), and in which there are present no
products of inflammation, such as tube-casts or blood-
corpuscles. In such cases the kidneys are for the time
functionating more than they normally do, and the
albuminuria arises from anomalies of the blood or of
tissue-change, and not from any disease of the kidneys
themselves. It is to be remembered that in these cases
the blood may be either absolutely or relatively richer in
albumen than is normally the case. In the first of these
cases the blood holds absolutely more albumen in solu-
tion than normal, and this may be due to a great absorp-
tion of albuminates from the food, to the transfusion of
blood, or to peptonuria and the absorption of large pus
collections. In the second case, the blood contains re-
latively more albumen than normal — relatively, that is,
to its power of combining albumen — and this arises from
increased loss of water through the skin or intestine, from
diminished supply of water to the system, or from dimin-
ished functionating power in the white blood-corpuscles.
In both these cases the excretory organs strive to reduce
the albuminous concentration of the blood to the normal
level, and hence the regulatory albuminuria. Rosenbach
holds that the only characteristics of nephritis in its
strictest sense are white (and the so-called "fatty")
blood-corpuscles, and the tube-casts which are formed
out of these corpuscles. He holds the hyaline corpuscles
only as an indication of the presence of albumen, since,
as is well known, they often occur when there can be no
question of renal lesion. The red blood-corpuscles are
only indications that the process possesses considerable
acuteness. — Zeitschrift fiir Klinische Medizin.
The Milk of Pregnant Cows Unfit for Infants.
— Dr. Ernest Mammen, of Bloomington, III., expresses
an opinion below which is important if true, but which
will be received with some incredulity. He says:
" I have read with much interest the articles by Drs.
Binnie and Vidal in recent issues of The Record (Sept-
ember 13th and October 25th), and I heartily agree with
these writers in their advocacy of cow's milk, fresh and
pure, as the best substitute for mother's milk. But there
is one factor which, in my experience, is often productive
of harm that neither of them has mentioned. The milk of
the pregnant cow is unfit for consumption by the human
infant. This fact is too often overlooked, when by care-
ful investigation the disturbance of stomach and bowels
in cases of infantile diarrhoea could be traced to the use
of milk. Where mixed milk is used the danger is that a
proportion of it comes from pregnant cows. All
hygienic care of the animals cannot make up for this
condition of the milk, neither can the addition of sod.
bicarb., common salt, lime-water, etc., destroy the
deleterious principle, therefore my rule is to avoid it.
I have recently had under personal observation a child
weaned at six weeks, and put upon cow's milk. A
good healthy animal was selected, and her milk, with
the proper dilution and additions, agreed perfectly
for three months, and that, too, during the summer.
At the end of this time the cow was found with calf,
and the infant's digestion was immediately disturbed. An
obstinate diarrhoea set in, which could not be controlled
until another cow, not pregnant, was substituted, when
the child recovered and digestion was restored. I could
cite other similiar instances, but the above illustrates the
importance of this matter."
Ozone in the Treatment of Rheumatism. — Dr. E.
Br6mond Fils has devised an apparatus for the application
of vapor-baths of turpentine in cases of rheumatism,
vesical troubles, lithiasis, etc. Ozone is evolved in the
process, and is believed to be the active curative agent.
The Chloroform Treatment of Tapeworm. — We
have received several communications upon the above
subject Dr. John H. Thompson, of this city writes :
" Chloroform is not a dangerous remedy for tapeworm if
properly used, but where any one gives a dose six times
as large as necessary of a deadly drug then it may be-
come dangerous. I have thirteen feet of taenia solium,
with the head, that came from a patient March 27, 1870,
after having suffered with it for fifteen years, and been to
London and Paris to be treated for it. I, too, had tried
pumpkin seeds, filix mas, and some other remedies, but
succeeded with: 5- Chloroformi, 3j. ; simple syrup,
I j. M. One-third given at 7, 9, and 1 1 o'clock, fol-
lowed at 12 o'clock by ol. ricini, 3J., and the worm
came at 1.30 p.m. from the happiest man I almost ever
saw. I had caused my patient to fast absolutely for the
twenty-four hours previous to taking my prescription, ex-
cept allowing him to chew slipper}- elm bark. I have
used the remedy in the same manner since with success."
Dr. F. H. Enders, of Wailuku, Sandwich Islands, writes :
" I have treated five cases of tapeworm at the Malulani
Hospital successfully with the following : ]$ . Chloroform,
fi. ext., filix mas, &a 3 j. ; emuls. ol. ricini, | iij. M.
To be taken in the early morning. No food allowed
until thorough action of the bowels. The entire worm
was brought away in each case, with no unpleasant re-
sults." Dr. Charles H. French, of Waterbury, Conn.,
writes that he succeeded with the following : 5 . Olei
tiglii, gtt. j.; chloroform, 3j.; syr. glycyrrhiza, §j. M,
602
THE MEDICAL RECORD.
[November 29, 1884*
The Medical Record:
A Weekly yournal of Medicine and Surgery.
GEORGE F. SHRADY, A.M., M.D., Editor-
Published BY
WM. WOOD & Co., Nos. 56 and 58 Lafayette Place.
New York, November 29, 1884.
KOCH'S DEFENCE OF THE CHOLERA
BACILLUS.
Soon after the announcement by Koch of his discovery
of the specific microbe of Asiatic cholera, the now well-
known comma-bacillus, there appeared in the medical
press various doubts concerning the diagnostic importance
of this newly fledged organism. We have kept our readers
amply informed in regard to the various criticisms of-
fered, as well as the protests made, against the accept-
ance of Koch's conclusions.
In the Deutsche Medizinische Wochenschrifi of No-
vember 6, 1884, the distinguished German bacteriologist
has just published a comprehensive reply to his critics.
The most profound scepticism can hardly hold out longer
against the new evidence adduced by Koch in support of
his former claims, touching the relation of the comma-
bacillus to Asiatic cholera.
Dr. E. C. Wendt, of this city, in an article published
on page 589 of the present number of The Medical
Record, alludes to these later investigations, and
infers therefrom the necessity of scientific bacterio-
scopy. Without wishing to subscribe to all his sugges-
tions, we must nevertheless admit that the profession
of our country is not as familiar with modem bac-
teriological methods as could be wished. It may yet
be shown that the practical utility of finding certain mi-
crobes in suspected cases has been overrated. But
to deny them all diagnostic importance is to assume
a voluntary blindness. From the accumulated evi-
dences now before us, it would seem that the burden
of proof rests with those who deny or dispute the valid-
ity of Koch's statements.
With especial reference to cholera, Koch shows, in the
article referred to, that the comma-bacilli can be recog-
nized as such only through the totality of their proper-
ties. Any single attribute, such as their peculiar shape,
or a certain behavior toward stains, is not sufficiently char-
acteristic to differentiate them from other and possibly
quite harmless bacteria.
The alleged comma-bacillus ordinarily found in the
mouth, and claimed by Lewis to be identical with the
cholera microbe, has long ago been examined by Koch
with negative results as to any discoverable relation be-
tween the two. Again, as regards the well-known allega-
tions of Prior and Finkler, Koch shows that they em-
ployed faulty methods and, therefore, secured results
devoid of significance. The specimens of their comma-
bacillus which they submitted to him were found by
Koch to contain four separate kinds of bacteria, but no
cholera bacilli. For a detailed account of the essential dif-
ferences between the true comma-bacillus and Prior's
pseudo-bacillus we must refer to Koch's original paper.
It is further stated by the indefatigable German scientist
that in three cases of undoubted cholera morbus he
found an abundance of various bacteria, but in no single
instance any comma-bacilli. Moreover, Koch and his
stafif of collaborators have already examined the alvine
evacuations in hundreds of cases of diarrhoea, dysentery,
and other affections, as well as in health. Comma-bsk
cilli were never found.
In a rapidly fatal case of arsenical poisoning, when the
intestines and their contents showed naked-eye appear-
ances closely resembling those of true cholera, no com-
ma-bacilli could be detected.
And, finally, to crown all, cholera or fatal choleraic
symptoms have been experimentally induced in various
animals by the introduction of pure cultures into their
intestines. Almost invariably the dead animals showed
an abundance of the characteristic comma-bacilli in the
intestinal tract. Koch reiterates, therefore, with added
emphasis, his former assertions that the comma-bacillus
is the specific microbe of Asiatic cholera, and occurs
neither in health nor in any other disease. The sole
point now on which the doubter can stand is that of deny-
ing the specific character of the inoculated disease. There
does not seem, however, sufficient strength in this posi-
tion to excuse either individuals, health boards, or govern-
ments from refusing to act upon the theory that Koch is
right. And in this connection Dr. Wendt's suggestion,
that we familiarize ourselves with scientific bacterioscopy,
seems eminently proper, and should be strongly urged
upon our authorities.
Koch's discovery is one of the grandest steps which
have been taken in this century toward giving certainty to
clinical medicine. And one must think almost with dis-
may of the tremendous collapse of scientific hypotheses
and dogmatic teaching which its confirmation must pro-
duce. If it can be shown (and this yet remains to be
done) that the bacillus is alone a sufficient cause of chol-
era, that it needs no prepared ground or special epidemic
influence, the revolution of views necessitated will be
indeed most extraordinary. But even should more ex-
tended observation show that the commas-bacillus can
produce cholera only under peculiarly favorable condi-
tions, its diagnostic significance would yet remain. And
the early discovery of the microbe having all the weight
of a pathognomonic symptom, would still give us a better
chance of promptly suppressing^ an incipient epidemic
than was ever before afforded us.
THE PRESENT STATUS OF THE QUESTION CONCERN-
ING THE TREATMENT OF GOITRE.
Although goitre is by no means a frequent malady in
our country, there is, nevertheless, among the foreign-
bom population enough of it to keep alive a certain in-
terest in the disease, and especially as regards the means
at our coDomand for overcoming the annoyance of great
disfigurement, if not the turning aside of grave danger-
Hence neither physician nor surgeon can well afford to
November 29, 1884*]
THE MEDICAL RECORD.
603
ignore any positive advances in the therapy of this per-
plexing affection. In No. 244 of the Sammlung Klin-
ischer Varirdge^ October 8, 1884, Dr. P. Bruns, of Tubin-
gen, publishes an instructive review of the subject in its
most recent aspect, but more particularly from the point
of view of the surgeon.
The author explains that it is a serious error, still
prevalent in some quarters, to suppose that the steady
growth and enlargement of a goitre constitute its chief
dangers. A large experience has shown him that fre-
quently the most formidable in volume are, at the same
time, the most harmless tumors. It is the small-sized
struma, and more particularly the substernal variety,
that is potent for mischief, and often leads to a fatal issue.
Death, indeed, happens unexpectedly in some cases
where no violent symptoms of any kind had warned
patient and physician of impending danger. The
lightning-like rapidity of such an accident is explained
by asphyxia and cardiac paralysis, following a sudden
bending and collapse of the wind-pipe. Tracheotomy per-
formed at the earliest possible opportunity has repeatedly
failed to save life in cases of this class. All this would
certainly show that persons afflicted with goitre are not
to be dismissed with some consoling words in regard to
the innocuousness of their tumors, but that their disease
constitutes a legitimate cause for timely remedial inter-
ference.
The kind of treatment must necessarily vary with the
nature of the thyroid swelling. Parenchymatous goi-
tre should never be confounded in this respect with the
cystic variety. In the former, treatment by iodides,
both externally and internally, is always advisable before
recourse is had to more energetic, but also more dan-
gerous therapy. Experience has shown that iodides will
prove of decided and lasting benefit only in those cases
where marked effects quickly follow their first use.
Parenchymatous injections of iodine are at times very
efficacious. But it is to be borne in mind that they are
not without danger. Fatal consequences have resulted
in more cases than one. The only radical measure of
relief, however, consists in removal of the offending
tumor. For all other operative procedures have been
found to involve greater dangers and extend smaller
chances of success than extirpation.
Cystic goitre is not amenable to treatment by the
iodides. Puncture of the cystic cavities, followed by the
bjection of tincture of iodine, has been found to succeed
in some cases. Billroth, indeed, claims twenty-nine cures
out of a whole number of thirty-five cases treated in this
way by him. From a careful study of a large number of
cases of this class Bruns concludes that patients showing
signs of disturbed lar3mgeal innervation should not be
subjected to treatment by injection. As regards the
operation of extirpation, the author pronounces it almost
devoid of danger in uncomplicated benign struma. But
he warns against complete removal of the thyroid body.
For wherever and whenever this was done, a typical con-
dition was sooner or later developed in the patient. It
has been quite aptly termed by Kocher cachexia strumi-
priva. The most prominent symptoms of the latter con-
sist in severe progressive cachexia, leading to a creti-
noid condition of the sufferer, who soon shows a char-
acteristic puffiness of the face. In addition there are
alterations of the skin, general weakness, and decided
awkwardness in all movements, without any diminution
of muscular power, however, and finally, a pronounced
loss of mental capacity.
From an analysis of this group of symptoms a remark-
able resemblance to myxcedema becomes at once ap-
parent. Add to this the fact that in m3rxoedema the
thyroid body commonly atrophies, and the similitude
seems still closer. Of course explanatory facts are en-
tirely wanting to account for either the spontaneous
development of myxcedema or the supervention of
strumous cachexia after total extirpation of the thyroid.
Various hypotheses have been advanced, but their dis-
cussion here would seem unprofitable.
As the final practical consequence of the most recent
experience with struma it may be said that partial ex-
cision should always be practised. And in the individ-
ual case, before attempting operative interference, the
surgeon should make sure that a portion of the gland can
be left in situ. Total extirpation of the thyroid body, on
the other hand, should never be performed. For it is
physiologically unjustifiable, arid should once for all be
stricken from the list of permissible operations.
AN INTERNATIONAL HEALTH EXHIBITION IN NEW
YORK.
The International Health Exhibition at London closed
on October 30th. During its continuance from May to
November there was a grand total of 4,167,000 visitors,
or 37,000 per diem., and both from a financial and pop-
ular point of view it was one of the most successfiil
exhibitions ever held in any country. This was due in a
large measure to the concerts, restaurants, and various
other " side-shows ; " but despite all these the sanitary
exhibits attracted much attention, and unquestionably a
powerful impulse was given to sanitary studies and a
knowledge of healthful living. The library of 7,000 vol-
umes was very extensively used, lectures and conferences
upon sanitary subjects were well attended, good work
was done at the biological laboratory, while the very
practical and objective teaching of the insanitary houses
and similar exhibits could hardly fail to have impressed
the most obtuse.
The exhibition conveys a lesson to Americans which
we cannot believe will be long ignored. There should
be a sanitary exhibition in this country, and in no part of
the country more appropriately than in New York City.
We believe that America is ripe for such an enterprise.
Sanitary problems have been studied, sanitary organiza-
tions established, and sanitary literature read more and
more every year. The approach of the cholera has
awakened a keen interest in the subject of municipal
hygiene and maritime quarantine, and this interest will
not subside until the danger is over or the epidemic has
come and gone. The fact that the London exhibition
was not only a popular success but that it might even be
said that there is money in it will appeal with force to
the minds of our money-getting countrymen. Apart
from this there is economy in spreading abroad a knowl-
edge of hygiene and inoculating the average mind with
irrefragable proofs that healthfulness is worth working
for and paying for. Let us have an International Hy.
gienic Exhibition in the United States.
6o4
THE MEDICAL RECORD.
[November 29, 1884.
^ews 0f thz WSie&U.
What is the CoRREcr Name for the New Local
ANiESTHETic ?— Dr. D. K. Shute, of Washington, writes :
'* It strikes me that the correct, technical name for this
drug is 'chloride of cocaine.' In an editorial of The
Record for November 8th, it is stated that * cocaine
unites easily with dilute acids to form crystallizable salts,'
therefore, if it unites with dilute hydrochloric add it
forms a crystallizable salt, which crystallizable salt is a
* binary compound ' and no/ a * ternary ' one. Modem
scientific works on chemistry make the characteristic
termination of 'binary compounds' »ide and not -a/e,
* Ternary compounds ' have the characteristic termination
-o/^. A scientific chemist never speaks of the * hydro-
chlorate of ammonia ' as the result of the combination of
hydrochloric acid (HCl) and ammonia (NH.) ; but he
calls the resulting compound chloride of ammonia or am-
monium chloride (NH.HCl) or, more properly, NH^Cl).
It is no more correct to say hydrochlorate of morphine,
or hydrochlorate of cocaine, than it is to say hydro-
chlorate of ammonia. The result of the union of cocaine
(C„H,jNOJ and hydrochloric acid (HCl) is, as stated
above, a * binary compound.' Therefore, to be correctly
specified, this * binary compound ' should be written co-
caine chloride (C„H„N0,C1). It is proper to say sul-
pho/^ or nitr^/^ of cocaine, because the union of nitric
and sulphuric acids with cocaine forms 'ternary com-
pounds.' I write these few lines in the hope that a drug
having such brilliant properties may be dignified by being
called by its proper scientific name, viz., cocaine chloride,
chloride of cocaine, or cocainae chloridum."
The Hospitals in New York Bay have been sadly
in need of repair. The last Legislature stupidly refused
to appropriate money for the purpose, but through the
energy of the Health Officer and the liberality of the
steamship companies, three [thousand dollars was se-
cured, and work is now in progress. Yellow fever cases
go to Swinburne Island, small-pox and cholera to Hoff-
man Island.
Prior and Finkler vs. Koch. — While expressing as
we have done elsewhere our great confidence in the su-
perior skill and absolute trustworthinessiof Koch, it is
impossible to deny any credit to the entirely antagonistic
views regarding the diagnostic and pathogenetic signifi-
cance of the comma-bacillus expressed by Finkler and
Prior. A correspondent of the Allgemeine Medicinische
Central'Zeitung of November 8th, writes from Genoa
under date of October ist and states that Professor
Finkler and Dr. Prior, of Bonn, have just finished their
cholera studies at the Laboratory of the St Andreas Hos-
pital. He says : " The view maintaining the morpho-
logical similarity of the comma-bacillus and spirillum of
Asiatic and sporadic cholera has been beyond question
confirmed. So far as experiments here could determine,
no difference in the cultures was observable. The va-
rious preparations of both kinds of bacilli show such a
resemblance that no specialist could determine by micro-
scopic examination the difference between Asiatic chol-
era and cholera nostras. By changes in methods of cul-
ture marked differences in the form and size of both
kinds of bacilli may be produced. The pretended dif-
ference between the very thin bacilli of Asiatic cholera
and the plump bacilli of cholera nostras is entirely arti-
ficial and not of the slightest importance."
These statements are utterly at variance with the re-
cent announcement of Koch. We can only say at pres-
ent that Koch is an investigator of long experience and
established repute. Finkler and Prior are new in the
field, and, furthermore, the report above quoted is anon-
ymous and unofficial.
Notes on the Use of Cocaine. — ^The Baltimore
Surgeons have been using cocaine extensively in eye and
venereal diseases. The reports are as enthusiastic as any
published in this city. Dr. Michael found it very useful
in opening buboes and cauterizing venereal sores.
Dr. E. E. Holt, of Portland, Me., reports successful
application of cocaine in eye cases {Boston Medical and
Surgical Journal). Dr. W. E. Ground, of Toledo, 0.,
has also had uniform success with the drug.
In Vienna the drug is being more and more used.
Recent reports upon it have been made by v. Schrotter,
Storck, Konigstein, and Jelinck. The solutions employed
are stronger (ten to twenty per cent.) than those which
have been found adequate here. England and France
have as yet had little to say about it, but wherever used
the reports are unanimous in its favor.
Mr. Vanderbilt's Gift. — The letter of Mr. William
H. Vanderbilt, announcing his munificent gift of $500,-
000 to the College of Physicians and Surgeons has been
made public. Mr. Vanderbilt says in his letter, which
is dated October 17, 1884 :
" The health, comfort, and lives of the whole commu-
nity are so dependent upon skilled physicians that no
profession requires more tare in the preparation of its
practitioners. Medicine needs a permanent home where
the largest opportunities can be afiforded for both theory
and practice. It seems wiser and more practical to en-
large an existing institution, which already has great fa-
cilities, experience, and reputation, than to form a new
one. I have therefore selected the College of Physi-
cians and Surgeons because it is the oldest medical school
in the State and of equal rank with any in the United
States. I have decided to give the College $500,000, of
which I have expended $200,000 in the purchase of 29
lots situated at Tenth Avenue and Fifty-ninth and Six-
tieth Streets, the deed of which please find herewith;
and in selecting this location I have consulted with your
Treasurer, Dr. McLane. The other $300,000 (please
find inclosed my check for. The latter sum is to form a
building fund for the erection thereon from time to time
of suitable buildings for the college."
The Price of Quinine is now about one dollar an
ounce, but some druggists continue to charge at the rate
of three or four dollars.
The Cholera in Paris was, at last reports, abating.
A cable report to the New York Times says: The
cholera has been handled very well in Paris. A laige
majority of the cases in the hospitals have been cured.
The difficulty with the remainder has been either that
the patient's system had already been ruined by alcohol
or privation, or that the patient arrived at the hospital too
November 29, 1884.]
THE MEDICAL RECORD.
605
late. The latter is really the chief trouble everywhere.
Dr. Chapman's treatment with ice-bags on the spine and
Dr. Hayem's venous injections of a salt solution have
both been successful. The old wrangle for and against
Dr. Koch's theory continues, with the tendency to dis-
credit it rather stronger than the contrary tendency.
The Value of the Hospital Collections. — In an-
swer to a charge that the Hospital Saturday and Sunday
collections have been an absolute detriment to the Lon-
don hospitals, because of the diminished voluntary contri-
butions at other times, the Secretary, Mr. Baker says :
So far as Hospital Sunday in New York is concerned, it
cannot be regarded otherwise than as a movement result-
ing in almost unmixed good. From the annual state-
ments of the Associated Hospitals it is seen : i, That dur-
ing the past three years $201,651.44 was expended on
the enlargement of accommodations ; 2, that there has
been an increase of $9,780.12 in the income from in-
vested funds ; 3, that there has been an increase of
$43,036. 73 from paying patients, at the same time that
the number of free patients treated has increased from
6,698 in 1881 to 7,188 in 1883 ; while, 4, the increase of
income from contributions toward current expenses other
than derived from the Saturday and Sunday collection is
represented by $22,774.84.
The Quack Triumphant, — Despite much talk and
protestations, Professor Schweninger has begun his duties
at the Charite Hospital, Berlin.
The Carnegie Laboratory. — We learn that Dr.
Paul Grawitz has been unable to accept the position of
Director of the Carnegie Laboratory and Professor of
Pathological Anatomy at Bellevue Hospital Medical
College.
Monument to the Late Professor Cohnheim. —
The friends and pupils of the late Professor Cohnheim
are arranging to collect funds for the purpose of erecting
a monument to the memory of the deceased pathologist.
At the Recent Examinations for the Externat
in the Paris hospitals there were 347 applicants, among
whom were 6 women and i Turk.
Australia Refuses to Recognize American Medi-
cal Diplomas. — The Queensland Medical Board has
passed a resolution refusing to register American diplo-
mas, unless the professional knowledge of their holders
is certified to by the passage of an examination at either
of the Universities of Melbourne or Sydney. ** It is much
to be regretted," says the Australian Medical Gazetity
"that there is not sufficient backbone in the other colo-
nies to take a similar firm stand. The longest time re-
quired by the American colleges to be passed in study
before the candidates are admitted for examination is
three years, twelve months less than the shortest time
required in the United Kingdom." It is to be regretted
that Australians do not temper wisdom with their firm-
ness and refuse registration only to colleges whose cur-
riculum and requirements are below a good standard.
The Prudent Physicians of Italy. — Dr. A. La-
gorio, writing from Chiavari to the Chicago Medical
Journal and Examiner^ relates some facts that may
have a pertinent bearing here. He says : " At the first
outbreak of the epidemic in Italy the Government made
an earnest appeal to physicians to volunteer their work
and skill in suppressing the disease and in treating its
victims. This appeal had very little effect, for few re-
sponded ; but through the presidents of the several med-
ical societies of the State, our physicians assured the
Government that they were willing to risk their lives as
sanitarians and citizens ; but, before doing so, they asked
for a law making them equal to officers of the army, so
that if the Government desired them to sacrifice their
lives for the public health, it should assure them that
their families would not have to suffer without receiving
a suitable pension. The Government has not yet taken 1
the matter in consideration." For physicians with a
family and no money to leave for them such a proposi-
tion does not seem more than just. We shall certainly
advocate the giving some help by the city or State to the
families of poor physicians who die from epidemic dis-
ease contracted in discharge of duty.
A New Source of Lead-Poisoning. — Dr. Edson, of
the Health Department of this city, has unearthed a new
food adulteration quite startling in character, namely, the
coloring of vermicelli with chrome yellow, a pigment con-
taining lead, used for- this purpose in lieu of eggs and
saffron. Dr. Waller, chemist to the Department, analyzed
a number of samples of vermicelli colored in this man-
ner, and found in them an average of three grains of
metallic lead to the ounce of food 1 Six manufacturers
of the stuff were arrested and promptly fined at the
Court of Special Sessions. The counsel defending them
mov^d to have the cases dismissed because the Health
Officers were unable to cite a single case where lead
poisoning had been caused by vermicelli. The defence
also brought witnesses who swore that they had eaten
vermicelli colored with chrome yellow for long periods
without injury. The publicity given the subject has,
since the trial, brought to light one case of lead poison-
ing, the cause of which had been hitherto unexplained,
in a person who had been in the habit of daily consuming
a quantity of vermicelli purchased from a dealer whose
stock, subsequently examined, was found to be colored
with chrome yellow. Making our deductions from the
amount of lead found in the vermicelli, we belieVe that
other cases of poisoning must exist, caused by this prac-
tice, not recognized because practitioners have not had
their attention called to this article of food as a possible
source of lead-poisoning.
The Bismuth Test for Sugar. — Dr. D. Brown, of
this city, writes ; "In an editorial article in The Record
for November ist you call attention to : * A New Bismuth
Test for Sugar,' and credit its discovery and introduc-
tion to Aimer and Nylander. Permit me to call your
attention, to the fact that the late Professor Rand, of
Jefferson Medical College, taught that test to his class
in 1872 ; and you will also find it in his students' text-
book, published the same year (see ' Elements of
Chemistry,* pp. 373). Should he not therefore have
priority?"
The Privacy of Hospital Records. — Dr. J. P.
Fessenden, of Salem, sends us a reply to the Superinten-
dent of St. Luke's Hospital, but we are unable to give
further space to the controversy.
6o6
THE MEDICAL RECORD.
[November 29, 1884.
The Intelligent Interest in Medical Affairs
displayed by the daily press is strikingly illustrated in the
following description taken from a daily ptper of this
city : '* For several years the physicians of this State have
been considering the advisability of holding an anniuJ
meeting for the purpose of bringing together in consulta-
tion the leading, members of the profession. The plan
took form some time ago. This morning representatives
from every section of the State assembled for the purpose
of holding the first annual session." We are then told
that Dr. Didman is President, Dr. Henton, Treasurer,
and that Dr. Austin Flinn, Jr., was among the members
present. More care is exercised in reporting glove fights.
Some Interesting Facts Regarding the Mainte-
nance OF Sick Seamen. — ^Seamen who may require sur-
gical or medical attendance by reason of accident or
disease, while employed on all classes of vessels, are at
liberty to go either to a United States Marine Hospital,
where the Government bears all the expense, or to call
in the best outside surgical and medical attendance in
the country, and the owners of the vessel are by law
compelled to pay the bills. Therefore, if the Congress-
ional appropriations for the maintenance of the Marine
Hospital Service should give out, and the hospitals were
closed up, all the sick and disabled sailor would have to
do would be to put himself in charge of a first class doc-
tor, who would have no difficulty in collecting his usual
and legitimate fees from the vessel owner. *'The repeal
of the Marine Hospital tax," says The Nautical Gazette^
''has opened a new field for impecunious physicians, and
we may soon see our water-front graced by runners for
doctors, just as runners solicit business for tow-boats,
ship chandlery, etc." "Already two respectable phy-
sicians have called our attention to this condition of
affairs, by requesting us to furnish them with copies of
The Nautical Gazette in which was published a recent
decision of a United States court upholding the constitu-
tional right of a sick seaman to be cared for by a physi-
cian of his own choice, in a large seaport where the
United States Marine Hospital had a corps of surgeons
and one of the most perfect hospitals in the country.' '
Dr. W. M. Fuqua, of Hopkinsville, Ky., has been
recently elected to the Chair of Anatomy in the Memphis
Hospital Medical College.
Sir Spencer Wells on the Revival of Ovariot-
omy.— Sir Spencer Wells, in an address delivered at the
opening of the Midland Medical Society on the revival of
ovariotomy and its influence upon modern surgery, gives
the following interesting risumi of the subject : " Before
1858, the operation, like all good things, had been of
slow growth. One hundred years ago it was but a germ
that might be descried in a lecture by John Hunter.
Ten years later it was seed that fell from the hand of
Bell. In little more than another decade it germinated
as a living vitalizing reality in Kentucky. Sixty years
ago it was transplanted to the land of its philosophical
conception. In twenty years more we find it a sapling
on English soil — ^growing slowly at first, and up to 1858
looking as if it might prove no more than a withering
gourd. But by 1865 its root had struck firm, its stem
stood erect, its branches were wide and strong, known
and sought as a refuge by the sick and dying. That it
was no withering gourd has been proved by all that the
world has since seen. Thousands of perishing women
have been rescued from death ; many more thousands of
years of human life, health, enjoyment, and usefulness
have been given to the race ; and to all future victims of
a malady before inevitable in its fatality, it gives conso-
latioDy hope, and almost certainty of cure.'*
Unapprkoated Opportunities for Young Physi-
cians.— It is a somewhat curious fact that for a number
of years there have be«n a considerable number of vacan.
cies both in the Army and Navy Medical Departments]
The Examining Boards meet again and again, but appli.
cants do not come in sufi[icient numbers or with sufficient
preparation to fill the vacant positions. It is difficult to
understand why so many young men prefer long yean
of hard work and impecuniosity to the immediate receipt
of a handsome salary and a good position.
Deaths from Cholera in New York in Past Epi.
DEMics, — Dr. John T. Nagle reports that in 1832 there
were 3,513 deaths firom cholera in this city, at the rate
of 15.64 in every 1,000 persons. In 1849 there were
5,071 deaths, or 11.24 P^r cent. In 1854 there were
3i5o7 people died, or 3.95 per cent. In 1866 the deaths
were 1,137, an average of 1.28 per cent. The epidemic
of 1866 was of a virulent type, 583 persons who died
having been attacked in the streets.
THE SIMS MEMORIAL FUND.
To the Medical Profession and Others throughout 1k%
World:
The great achievements of Dr. J. Marion Sims call
for some more lasting testimonial than obituaries and
eulogies. To him medical science is indebted for mnch
brilliant and original work, especially in gynecological
surgery. Those who have been benefited by his teach-
ings and new operations, and such as have had the direct
advantage of his personal skill are among the first to
recognize and acknowledge this debt
To him is due the honor of giving the first strong im-
pulse to the study of gynecological surgery in America.
It is believed diat the medical profession everywhere,
the vast number of women who owe their relief fix)m
suflfering directly to him, and those who realize the
benefits he first made possible, will gladly unite thus to
honor the man through whose originsd and inventive ge-
nius such blessings have been conferred upon humanitj.
At the suggestion of many fiiends, therefore, the sab-
joined committee has been organized, and it is proposed
that a suitable monument be erected to his memory in
the city of New York.
To this end the active co-operation of the medical
profession and the many other fiiends of Dr. Sims
throughout the world is respectfiiUy solicited. Contribu-
tions of one dollar and upward may be forwarded to the
journal which has been constituted the treasury of this
fund — The Medical Record, New York.
FORDYCE BARKER, M.D., Chairman,
GEORGE F. SHRADY, M.D., Secretary^
Thomas Addis Emmet, M.D., New York.
T. Gaillard Thomas, M.D., "
William T. Lusk, M.D., '*
William M. Polk, M.D., «
Paul F. MundA, M.D., "
S. O. Vander Poel, M.D., "
Frank P. Foster, M.D., "
E. S. Gaillard, M.D., "
J^ovember 29, 1884*]
THE MEDICAL RECORD.
607
Alex. J. C. Skene, M.D., Brooklyn, N, Y.
Samuel D. Gross, M.D,, Philadelphia, Pa.
William Goodell, M.D., "
James R, Chadwick, M.D,, Boston, Mass;
William H. Byford, M.D., Chicago, lU.
A. Reeves Jackson, M. D., "
Thad. a. Reamy, M.D., Cincinnati, O.
C. D. Palmer, M.D., "
George J. £ngelmann, M.D., St. Louis, Mo.
R. Beverley Cole, M.D., San Francisco, CaL
H. F. Campbell, M.D., Augusta, Ga.
R. B. Maury, M.D., Memphis, Tenn.
E. S. Lewis, M.D., New Orleans, La.
J. T. Searcy, M.D., Tuskaloosa, Ala,
R. A. KiNLOCH, M.D., Charleston, S. C.
Hunter Maguire, M.D., Richmond, Va.
S. C. BusEY, M.D., Washington, D. C.
Harvey L. Byrd, M.D., Bdtimore, Md.
W. T. Howard, M.D., "
D. W. Yandell, M.D., Louisville, Ky.
Seth C. Gordon, M.D., Portland, Me.
Frank E. Beckwith, M.D., New Haven, Conn.
A. W. Knox, M.D., Raleigh, N.C.
L. W. Oakley, M.D., Elizabeth, N. J.
A. T. Woodward, M.D., Brandon, Vt.
Albert H. Crosby, M.D., Concord, N. H.
E. 8. DuNSTER, M.D., Ann Arbor, Mich.
Alex. J. Stone, St. Paul, Minn.
Additional List of Subscriber^.
F. Seraeleder, M.D., City of Mexico $10 00
P. A. Morrow, M.D., New York 25 00
Ellsworth Eliot, M.D., " 5 00
J. H. Fruitnight, M.D., '* 5 00
J. W. Bond, M.D., Toledo, Ohio 5 00
C. A. Kirkley, M.D., '' *» 5 00
A. N. Ellis, M.D., Hamilton, Ohio i 00
C. Falconer, M.D., " " 100
C. A. L. Reed, M.D., " " i 00
Dan. Millikin, M.D., " " i 00
Geo. C. Skinner, M.D., " '* i 00
H. Mallory, M.D., " " i 00
W. H. Scobey, M.D., " " i 00
A. Myers, M.D., " " i 00
G. W. PuUen, M.D., Logan, Ohio 5 00
J. H. Dye, M.D., " " 100
H. J. Donahoe, M.D., Sandusky, Ohio 5 00
A. J. Gawne, M.D., " " 2 00
Wm. Story, M.D., Costalia, Ohio 2 00
F. C. McConnelly, M.D., Vermillion, Ohio .... 5 00
Au E. Meerull, M.D., Sandusky, Ohio 2 00
A. E. Heighway, M.D., Cincinnati, Ohio i 00
F. Forcheimer, M.D., " " 5 00
Jos. Ransohoflf, M.D., " " 5 00
Jas. T. Whittaker, M.D., " " 5 00
R. L. Sweney, M.D., Marion, Ohio i 00
D. N. Keusman, M.D., Columbus, Ohio i 00
H. J. Shajrp, M.D., London, Ohio i 00
H. G. Landis, M.D., Columbus, Ohio i 00
John N- Beach, M.D., W. Jefferson, Ohio i 00
W.^ C. Denman, M.D., Marion, Ohio i 00
John Carson, M.D., Middletown, Ohio 5 00
Thad. A. Reamy, M.X)., Cincinnati, Ohio 100 00
glewiexirs mifSi ^otijcjes*
The Question of Priority in the Use of Forceps
in Breech Presentation. — Dr. H. T. Dunbar, of
Union, N. Y., sends us the title-page of a pamphlet en-
titled ** The Forceps in Breech Deliveries, with a De-
scription of a New Instrument, by A. J. Miles, M.D.,
Professor of Diseases of Women and Children in the
Cincinnati College of Medicine and Surgery. '^ It is taken
from the '* Transactions of the Ohio State Medical Soci-
ety for 1876." Dr. Miles antedates Dr. Fruitnight, there-
fore, by a year or more.
Daniel Gohl und Christian Kundmann. Zur Ge-
schichte der Medicinal-Statistik. Von Dr. J. Graetzer.
Pp. 155. Breslau : S. Schottlaender. 1884.
The author, Dr. Graetzer, gives a history of the origin of
medical statistics, and an account of the lives and works
of Gohl and Kundmann, the fathers of this science. The
work is well printed and will be of much interest to stat-
isticians and sanitarians.
Die Zuckerharnruhr mit einer ausfI^hrlichen
DiATETIK FtiR ZUCKERKRANKE. Vou UnIV. MeD.
Dr. Emerich Hertzka. No. i, Svo, pp. 181. Karls-
bad und Nizza : Feller's Didtetische Fiihrer,
This is the first of a series of " Diet Guides " which
promise to be very useful. Dr. Hertzka has given us a
very complete monograph on the diabetes mellitus, its
etiology, symptomatology, progress, complications, and
treatment It will be a useful work to those who have
these cases under treatment.
De la REPARTITION DU SaNG CIRCULANT DANS L'£cO-
nomie. Par le Docteur ^mile Spehl. Th^se d'A-
gr6gation, pr^sent^ ^ la Faculty de M^decine de Bru-
xelles. Bruxelles: A. N. Leb^gue & Cie. 1883. The
Distribution of the Circulating Blood in the
Economy. 8vo, pp. 230.
This doctorate thesis represents a series of elaborate in*
vestigations into the distribution of the circulating blood
in the brain, lungs, and muscles. The author has ob»
tained some definite figures to represent the fact that the
three organs referred to have more blood during func-
tional activity than during rest. Perhaps his most inter-
esting conclusion is that an environment of rarefied air
draws the blood to the free surface of the lungs, but not
of the skin.
lljepartB of Jiajcietijes.
MEDICAL SOCIETY OF THE COUNTY OF NEW
YORK.
Adjourned Annual and Stated Meetings November 24,
1884.
The adjourned annual meeting was called to order by
the retiring President, Dr. S. Oakley Vander Poel,
M.D., LL.D., who delivered the customary address, in
which he reviewed the work done by the Society during
the last year, its material and scientific prosperity, and
introduced his successor in office.
Before resiuning his place upon the benches he re-
turned his heartfelt thanks to the Society for the uniform
courtesy which had marked the conduct of the members
toward him as their presiding officer, and suggested that
more time be given to the discussion of the papers pre-
sented to the Society.
To do this the papers should not partake quite so
much the character of an essay, but rather be directed to
the elucidation of some particular point or method in the
field of medicine or surgery. Let the papers be short
and definite in purpose, and confined chiefly to contro-
verted points, or such as require fuller demonstration.
The same rules should regulate the debate. Nothing is
more wearisome than a rambling debate where the nar-
ration of opinion and experience is so b'ttle related to
the actual point under consideration. The remedy for
this lies in the Society.
On motion by Dr. J. C. Peters, the Society ex-
tended to Dr. Vander Poel a vote of thanks for the faith-
ful discharge of the duties of president during his term
of office.
The Society then adjourned.
6o8
THE MEDICAL RECORD.
[November 29, 1884,
Stated Meeting,
The Stated Meeting was called to order by the Presi-
dent, Dr. Daniel Lewis, who delivered his inaugural
address, in which he first expressed the deep and lasting
obligations which the Society owed to his distinguished
predecessor. He also expressed himself as profoundly
grateful for the trust which the Society had bestowed upon
him, and with its support would spare no effort to protect
and advance its important interests.
Special reference was made to the question of increas-
ing the membership of the Society, and also to the work
of enforcing medical laws. The suit against the Ek:lectic
Medical College is of such importance that no effort must
be spared to win the case, as it is a diploma mill of such
proportions as to almost rival the Buchanan College of
Philadelphia.
The President then directed attention to the impor-
tance of having State Examining and Licensing Boards.
A very important change needed was a provision for
revoking a license to practice.
Attention was then directed to the propriety of at once
taking steps to secure a more commodious place for hold-
ing the meetings of the Society, as one must necessarily
soon be secured on account of the recent good fortune
of the College of Physicians and Surgeons.
At the close of the address, the President appointed the
following
COMMITTEES FOR THE ENSUING YEAR.
Committee on Hygiene — Dr. Stephen Smith, Chairman ;
Drs. Alexander Hadden, E. H Janes, Cyrus Edson,
Wm. L. Hardy.
Committee on Ethics — Dr. George A. Peters, Chair-
man ; Drs. W. T. Alexander, Mark Blumenthal, C. C.
Lee, E. Waitzfelder.
Committee on Prize Essays — Dr. F. R. Sturgis, Chair-
man ; Drs. Frank P. Foster, W. R. Birdsall.
Auditing Committee, — Dr. P. Albert Morrow, Chair-
man ; Dr. Gorham Bacon.
On motion by Dr. Vander Poel, that portion of the
President's address which referred to change of place of
holding the meetings was referred to the Comitia Mi-
nora,
After the report of the Comitia Minora Dr. Simon
Baruch read a paper
ON THE THIRD STAGE OF LABOR,
in which he discussed at length the 'three plans of man-
agement—namely, expectancy, the Dublin, and Credo's
method, and the method which occupies a middle ground,
and which had been the most fruithful of good results.
Each plan was discussed in detail, with the citation of
opinions of a large number of authorities, and also sta-
tistical information.
Dr. Baruch regarded the expectant plan as a retro-
grade step in the management of the third stage of labor.
He also believed that the superiority of Credo's method
had been established by clinical experience and statistics.
This method he regarded as a prophylactic against reten-
tion of the placenta and hemorrhage.
Under the third head the author of the paper discussed
the physiological action of the uterus in removing the
placenta, consisting of tonic contractions for its separa-
tion, and clonic contractions for its expulsion.
The modification which he advocated consisted mainly
in the introduction into the vagina of two antiseptic
fingers to retard too rapid expulsion of the placenta, to
aid in removing it during a pain, and to secure removal
of the membranes without twisting, and in the interval
between pains.
Dr. Wm. M. Polk was invited to open the discussion,
and said he did not understand how any man could wish
to relegate Credo's method of expressing the placenta to
the useless things to be discarded. He was heartily in
accord with Dr. Baruch in his warning against discarding
this method.
Dr. BaruchTiad advised that the chloroform be discon-
tinued, at the last period of the second stage, and to that
view Dr. Polk took exception and remarked that he con-
tinued its use until the head of the child was expelled.
Dr. Polk also believed that no harm could come from
twisting the membranes, and he thought that by so doing
their delivery could be expedited.
Dr. R. a. Murray thought that the method practised
by most accoucheurs was that which took the place of
Credo's method ; namely, keeping one hand firmly upon
the fundus of the uterus as the child was expelled, and
with delivery following the uterus down and retaining
it there until permanent contraction of the u terns had
taken place. He believed that Credo's method was ap.
plicable chiefly in those cases where inertia of utenis
existed and there was threatened hemorrhage from chlo-
roform, powerless labors, instrumental interference, etc.
With regard to twisting the membranes, he regarded it
as most important in delivering the placenta, and further,
that it should be done during a pain. Aside from these
two points, he agreed thoroughly with the author of the
paper.
Dr. Fruitnight spoke of the efficiency of the modi-
fication of Credo's method, namely, guarding against too
rapid expulsion of the placenta, but he practised twisting
of the membranes and believed it was advantageous to do
so. Although the placenta might be retained within the
uterus for several hours without doing harm, yet he re-
garded it as a foreign body and one which should be re-
moved as soon as practicable.
Dr. Irwin said, concerning the practice of the Dublin
school, that while the general sense might be in favor of
the expectant method, yet interference was not precluded,
as active as might be necessary. He thought the Dublin
school could not be spoken of as either an interfering
or an expectant school, but one which acts with due
knowledge of the case in hand. The English school
advocated less interference than did the Dublin school
probably. With regard to twisting the membranes he
thought there could be no doubt concerning the pro-
priety of the procedure ; pulling on the membranes was
certainly objectionable.
Dr. Malcolm McLean spoke concerning the neces-
sity of inspecting the placenta after it had been delivered.
Dr. Baruch said that he withheld the chloroform only
at the very last moment of the second stage of labor.
He objected to twisting the membranes because it en-
couraged pulling upon them. He objected to downward
pressure under the circumstances mentioned by Dr.
Murray, because it had been claimed that the Dublin
method might produce inversion of the uterus. He
therefore would not depend uix)n Cred6*s method in
uterine inertia from chloroform, etc. In general he
thought we should be guided less by individual experi-
ence than by the results in well-recorded cases in large
numbers carefully watched.
Dr. Douglas, Treasurer, directed attention to the fui
that he was prepared to supply the members with copies
of
the transactions of the medical society of the
state
at one dollar a copy.
Dr. Piffard offered the following resolutions,^hich
were adopted :
register of members.
Resolved^ That a committee of three be appointed by
the President to prepare a register of the members of this
Society, to be entitled, "The Register of the Medical
Society of the County of New York ; " and to print the
same and distribute it to members without charge, said
Register to contain the names of active members, to-
gether with their addresses and office hours.
Resolved, That the Comitia Minora be requested to
make the necessary appropriations to carry the above
resolution into effect.
The Society then adjourned.
November 29, 1884.]
THE MEDICAL RECORD.
609
THE PRACTITIONER'S SOCIETY OF NEW
YORK.
Stated Meetings November 7, 1884.
A. B. Ball, M.D., President, in the Chair.
Dr. George F. Shrady read a paper (see p. 591) on
CASES OF strangulated HERNIA, WITH REMARKS ON
TREATMENT.
Dr. a. C. Post asked Dr. Shrady if he stated that in
several of the cases reported no hernial tumor existed
before the s3rmptoms of strangulation developed.
Dr. Shrady replied that no tumor had been reported
by patients in two cases until strangulation occurred, one
of the patients being about twenty, and the other about
forty years of age. It was quite evident that a small
hernia had existed in the latter case, and had been over-
looked by the patient. The other case was clearly one
of strangulated congenital hernia, the sac being the tunica
vaginalis.
Dr. Post believed it to be a very rare occurrence that
a hernia was strangulated when it first came down, except
when it entered the tunica vaginalis. There were cases,
usually in youn^ men, in whom the tunica vaginalis had
not yet closed, in which, from a violent strain, the intes-
tine sometimes descended for the first time to the bottom
of the scrotum and was strangulated. Some years ago,
during one of his terms of attendance at the New York
Hospital, a sailor was admitted, forty years of age, who,
while making violent exertion at the capstan, felt some-
thing give way in the abdominal walls. When admitted
to the hospital there was a large swelling of the scrotum
with great tenderness on pressure, constipation, and
vomiting. The case was specially interesting because it
had been seen by Dr. Valentine Mott, who said he would
stake his surgical reputation that it was not a case of her-
nia. The shape was so much like that of a swollen
testicle that Dr. Mott was disposed to disregard the
account given by the patient, and supposed that instead
of straining himself he had been struck by the capstan
bar, and that a traumatic orchitis had thereby developed.
Dr. Post had investigated the case very thoroughly, and
had made up his mind that it was one of strangulated
hernia ; but, if he remembered rightly, not one of the
surgeons of the hospital, all of whom saw the case, agreed
with him. One or two, however, expressed themselves
doubtful, while the remainder agreed with Dr. Mott.
Finally, consent was given to an exploratory operation,
when Dr. Post cut down upon a strangulated hernia in a
high state of inflammation, and the patient died from ex-
tension of the inflammation into the peritoneal cavity.
The strangulation, however, was relieved. Since that
time a number of similar cases had occurred in the prac-
tice of New York surgeons, but that one, he believed,
was the first to which attention had been called. Dr.
Knight, of New Haven, had met with a similar case.
With regard to the general remarks made by the author
of the paper, he was disposed to agree with him, though
not fully with regard to the subject of taxis. He thought
taxis was often carried to an injurious extent, but he did
not think it ought to be passed over so lightly as the
author of the paper would seem to do, and especially that
it should not be passed over without trying a change of
position. In a case of Dr. Rogers, in which he had made
arrangements to operate before a class of students, Dr.
Post requested an opportunity to attempt to reduce the
hernia by a change of the patient's position. He had the
nurse stand on a bed and raise the patient's feet over his
shoulders, and in that way the hernia was reduced and
the operation spoiled. Dr. Post had succeeded in reduc-
ing the hernia in that manner in a number of instances.
No violence was thus done, but the falling of the thoracic
and abdominal contents toward the head pulled upon the
hernia, which proved safer and more efficient than trying
to push it into the abdominal cavity.
In a case which occurred during one of his terms of
attendance in the New York Hospital, the patient had a
scrotal hernia which was somewhat inflamed and very
tender upon pressure. Before operating Dr. Post thought
it expedient to apply leeches. Half a dozen leeches
were applied in the early part of the afternoon, and, as
he had to attend the funeral of a distinguished member
of the profession, he intended to operate on his return,
but by that time spontaneous reduction had taken place,
produced by relaxation from local bleeding. In the main
he agreed with Dr. Shrady, that a great deal of harm was
done by violence in taxis ; but on the whole iie should
think that it were better to make judicious attempts at
taxis than to proceed at once to divide the stricture.
With regard to the operation, he believed that, as a
rule, a successful operation for strangulated hernia did
not prevent another descent — that is, the hernia required
as much support from trusses as before the operation, and
sometimes more, on account of greater relaxation of the
ring. He thought it better in all cases to seek to pro-
duce a radical cure. In an interesting paper published
by Mr. Banks, of Liverpool, the utility of that practice
had been demonstrated. The sac was divided at its neck,
dissected out, returned into the abdominal cavity, and
the ring was closed as far as possible with silver-wire
sutures, leaving room enough for the spermatic cord. He
gave a number of cases in which no dangerous symptoms
were caused by the closure of the ring, and in which
there was either an absolute cure effected, or the size of
the ring so much reduced that it was possible to retain
the hernia in its reduced position by a moderate amount
of pressure. Mr. Banks was in the habit of operating in
cases of hernia not strangulated ; in all cases in which the
hernia could not be kept in place by a truss. In a cer-
tain proportion of cases he effected a radical cure, and in
others the hernia could be kept well supported by a truss.
Dr. Post agreed with Dr. Shrady in the treatment of
the omentum, namely, that in all cases in which it had
been strangulated, or had existed in the sac for some
time, it was better to excise it than to return it.
Dr. McBurney said that Dr. Shrady was to be con-
gratulated on having had so many remarkable successes
in a large variety of strangulated hemiae. He supposed
the usual modem antiseptic precautions were observed.
Dr. Shrady replied that the wound was irrigated from
time to time with the sublimate solution, but that the
spray was not employed. He did not hesitate to expose
the gut to the atmosphere, and in two instances the mem-
bers of the house-staff" were allowed to feel of the stricture
before it was cut. In no case did peritonitis develop itself.
Dr. McBurney said there was one point in which he
had been much interested, namely, the old method still
used of employing taxis. Certain cases which had come
under his observation had led him to regret that taxis
was not more generally acknowledged to be a dangerous
as well as a valuable procedure in cases of strangulated
hernia. Under certain circumstances it could be used
with safety, but as Dr. Shrady had already pointed out, it
was capable of producing a great deal of injury. It ought
to be more commonly understood that some of the so-
called methods of inducing the return of the descended
hernia into the abdominal cavity were practically useless,
and the employment of such methods as cold, heat, or
even of position, if it occupied much tinie, might prove
very serious for the patient whose condition demanded a
speedy operation. He thought it a serious question
whether we had not gone sufficiently far with taxis when
we had given ether and made gentle manipulation with
the fingers in attempts to reduce the hernia.
Among a number of other cases in which taxis was
believed to have done the patient harm were the follow-
ing : A few years ago he saw a child in consultation in a
neighboring town, a strangulated hernia having existed
about twenty-four hours. Four or five physicians were
present, two of whom took the ground that taxis was a
vciy serious procedure in so young a child. They refused
to give their consent to the administration of ether, and
6io
THE MEDICAL RECORD.
[November 29, 1884,
thought taxis was entirely unjustifiable without it One
of the others would consent to taxis under ether, and the
fourth supported Dr. McBurney in the recommendation
of etherizing the patient, attempting taxis, and, failing, to
proceed to operate. The child was not under the influ-
ence of the anaesthetic a minute before the hernia was
reduced with the slightest manipulation.
About four years ago he saw a case in New Jersey
which, as he learned after his arrival, was under the
charge of two homoeopathic physicians. The physicians
refused to allow anything whatever to be done, saying the
patient was too old to justify an attempt at taxis, it being
a case of strangulated hernia, and an operation, they said,
should not be thought of.
It seemed to him it would be very useful if positive rules
could be given as to the kind and amount of taxis which
should be employed in cases of strangulated hernia. He
thought that the first important point to bear in mind
was that taxis should not be attempted before etherizing
the patient. By this means, he thought, we entirely
relaxed muscular action in the abdominal walls and re-
lieved all tension upon the strangulated parts, and then
by inverting the patient the best conditions would exist
for the return of the hernia. All local applications were
intended, he believed, to reduce inflammation and con-
gestion of the parts, but if it were intended to try to
reduce the hernia by manipulation he thought the earlier
it could be tried the better, and finding that it failed, an
operation should be performed immediately.
With regard to the treatment of the sac, although his
experience was slight he was inclined to agree in the view
expressed by Dr. Post that the method so largely practised
by English surgeons of late, of drawing together the pillars
of the inguinal canal by suture after freeing the peri-
toneum, and thought it would be likely to result in per-
manent cure in many cases.
Dr. V. P. GiBNEY had been much interested in the
remarks made with regard to taxis. For a number of
years he had seen a large number of cases of hernia, and
had effected reduction by taxis in many cases at all ages,
and he was not now able to recall a single instance in
which immediate or remote damaige had been done by
taxis as he employed it. It had been the custom at the
Hospital for the Ruptured and Crippled to first try taxis,
and that failing, to refer the patient to the consulting staff
for operation. But taxis succeeded in nearly all cases.
How nmch manipulation in attempts to reduce the hernia
had been employed by physicians before the patients
came to the hospital he was unable to say, but after their
admission he and two assistants would try taxis, then give
ether, or, if the patient were a child, chloroform, and at-
tempt reduction again, placing the patient in different
positions so as to favor the return of the hernial contents.
Sometimes gentle and persistent taxis would be employed
half an hour, and, failing, an anaesthetic would be admin-
nistered, and usually the hernia would finally be reduced.
Last year a child was brought to the hospital which was
said to have been suffering from a strangulated hernia for
twenty-four hours. There was some vomiting, a very
tense tumor, and marked signs of strangulation. Dr.
Gibney employed taxis for half an hour, then gave chlo-
roform, and after another half-hour's manipulation suc-
ceeded in getting the tumor about two-thirds reduced,
but not being able to produce any further effect, he direct-
ed the mother to take the child home and if the hernia
caused any further trouble to call in a physician. She
returned the next day and said that in carrying the child
home the hernia disappeared. This was not a solitary
experience.
Dr. Gibney was unable to understand how intelligent
taxis was going to do the harm which it had been claimed
that it would do. But he agreed with Dr. McBurney, that
there ought to be some definite rules for the employment
of taxis. If after taxis had been employed the surgeon
should lose the case by an operation, there would be a
natural tendency to attribute the bad result to the manip-
ulations employed by the physician who first saw the case.
He had seen a number of cases relieved by lifting the
patient by the hips, and other changes in position. He
supposed that when an anaesthetic was employed the ben-
eficial result was brought about in the manner described
by Dr. McBurney, both as to the action of ether and
chloroform.
Dr. John A . Wyeth had been surprised at the number
of successive successful operations for strangulated hernia
reported by Dr. Shrady, especially as in many of those
cases the condition had existed for so long a time as pre-
sumably to debar a good result. If he understood the
histories correctly, in a majority of the cases strangula-
tion had existed over twenty-four hours, and in some as
long as three days, which was a very long period for
strangulation to exist and still permit of recovery after an
operation.
It had been Dr. Wyeth's practice to operate early.
Since December 20, 1882, he had performed seven opera-
tions for strangulated hernia, all of the patients recover-
ing. He believed that the success of the operations was
due to the fact that they were performed early after
strangulation had occurred. In some of the cases, how-
ever, he could wish to have seen the patients sooner.
He believed that much of the danger of the operative
procedure was due to the previous improper use of taxis.
He regretted very much to hear so eminent an authority
as Dr. Gibney express himself so favorably toward taxis,
thus encouraging physicians, especially young men, to
place reliance upon this procedure in cases of strangulated
hernia. He doubted whether there was a surgeon pres-
ent who had not met with cases in which the patients had
been brought near the point of death from prolonged and
indiscriminate use of taxis. No man ought to touch a
strangulated hernia until the patient had been placed
under the influence of ether. He himself, however, was
loath to try taxis even after having anaesthetized the
patient. He had never yet been able to reduce a hernia
except by an operation. But then he had not pushed
and bored the gut back as some would do. He knew of
one case in which the hernia had been reduced within
the sac, and it was afterward necessary to operate to re-
lieve strangulation.
An operation for strangulation was as free from dan-
ger, when done under antiseptic precautions and early
enough, as any major operation could be. There was
one precaution which he took in performing the operation.
The inguinal ring when cut into acted as a funnel for
the conduction of fluids into the peritoneal cavity, and to
prevent any accident arising from this cause he inserted
his finger into the ring and thus obliterated it. The gnt
was thoroughly irrigated with the sublimate solution, then
returned, and the finger placed on the ring and retained
there until the completion of the operation. Two strong
sutures were passed through the entire thickness of the
edges of the wound, including the abdominal wound and
sac in one mass, and a drainage-tube was inserted. He
thought Dr. Shrady regarded the operation as being less
difficult than it really was. Out of Dr. Wyeth's first three
cases operated upon for strangulated hernia, two of ^c
patients died, and it was not improbable that the difficulties
of the operation and lack of experience had something to
do with the fatal issue. In femoral hernia there was
danger of injuring the obturator artery when derived
from the epigastric Femoral hernia occurred most
frequently in females, and it was in females that we found
this artery in every other case derived from the epigastric
branch of the external iliac. In all of the cases whid
he had found in which death had resulted from hemor-
rhage into the peritoneal cavity from injury to this vessd,
the accident occurred in women.
In his seven cases the strangulation had existed for
periods varying from two to forty-eight hours. Whflc
the gut in one or two instances was mottled, yet the cir-
culation was restored. In one case the condition of the
gut was such that he would have exsected a part, had it
November 29, 1884.]
THE MEDICAL RECORD.
611
not been that the operation was performed by candle-light
in a tenement house. The patient recovered.
Dr. J. W. Wright said with regard to taxis, that he
had always entertained the opinion expressed by some
of the speakers, that, as it was generally employed, it was
a very dangerous procedure in strangulated hernia. He
thought, however, that there was a way to employ taxis
which was safe, or at least by which it was not made a
very dangerous measure. Taking hold of the hernial
tumor which was strangulated, and pressing it violently
with all the strength of the hand, without using even the
ordinary and necessary skill to get the hernia back, if
possible, in the inverse order to that by which it had
come out, was a very dangerous procedure. So im-
pressed had he been with this idea that *he had come to
make it a law to himself never to attempt taxis in a
hernia which had been strangulated for a long time, until
the patient had been put under the influence of an anaes-
thetic, and then, if after one reasonable trial, not a very
violent one at that, he did not succeed in reducing the
hernia, he felt that the patient's chances of recovery
were infinitely better if he proceeded at once to operate.
With regard to the reduction of strangulated hernia by a
change of position, alluded to by Professor Post, he con-
sidered it a very important point He could recall two
or three cases in which demise had been strangulated,
and two or three attempts had been made at taxis by
men who were supposed to have the requisite skill, and
had failed, but the taxis had succeeded at the first trial
when the patient's position was changed. In two cases
which he recalled the reduction had been very easily ac-
complished by the operator standing with his feet upon
the bed, spreading the patient's limbs, taking him by the
knees, and lifting his body upon the body of the oper-
ator. It was not a very genteel position, especially if
the patient were a female, but in the male he had known
it to succeed very easily. One of these cases was that of
an unrecognized strangulated femoral hernia which had
occurred in connection with a double inguinal hernia.
Both of the inguinal herniae were down at the time, but
neither of them was strangulated, and yet the patient had
well-marked symptoms of strangulated hernia, and a very
careful investigation revealed the presence of a very
small femoral hernia which was irreducible by taxis in the
recumbent position, but which was reduced by taxis
when the patient's hips were elevated in the manner de-
scribed, and with immediate relief of the symptoms.
With regard to what should be done at the operation.
First, he did not regard the operation for the relief of a
strangulated hernia a very simple affair, because he felt
that every hernia was a hernia by itself, and the details
of the operation for any given case could not be learned
from books nor from lectures. Every hernia had certain
peculiarities of its own. With regard to the treatment
of the sac his impression was that the method described,
of dissecting it out, and stitching the walls through and
through, offered a nmch better support, and a much
greater probability of curing the hernia than the opera-
tion which was commonly resorted to. That plan had
been very clearly brought out by the gentleman to whom
Dr. Post had referred, Dr. Banks, of Liverpool, who in
performing the operation left the abdominal walls and
peritoneal surfaces as smooth as possible, so as to guard
against the formation of a new hernial pouch.
Dr- Post remarked that the urgency for an early
operation was greater in small than in old or large herniae,
the reason for which was apparent.
Dr. R. F. Weir agreed with most of the speakers,
that there was considerable risk attending taxis, but in
connection with the question of change of position it
would often be found that lateral motions would aid in the
reduction of the hernia. In cases in which strangulation
had existed for some time taxis had other risks than those
simply pertaining to manipulation. The gut might be in
such a condition that, on being thus reduced, circulation
would not return and it would give rise to a fatal peri-
tonitis. He had become so strongly impressed with this
danger that he had made it a rule, when called to see a case
of strangulated hernia which had existed for some time,
not to be satisfied with reduction by taxis, but to operate
and see what was the condition of the hernial contents
before returning them to the abdominal cavity. It was
to be taken for granted that a sufl5cient amount of taxis
had already been made before the patient had been
placed under the care of the surgeon.
He thought the treatment of the wound adopted by
Mr. Banks, and referred to this evening, was attended by
some risks, as in one case the patient died of what the
house surgeons supposed to be peritonitis resulting from
the operation, but, as the post-mortem showed, death took
place from . strangulation of a portion of gut in the nar-
rowed ring. He believed other surgeons had had a simi-
lar experience with this method.
Dr. Shrady, in closing the discussion, said the paper
was not intended to be an exhaustive one on the subject
of hernia. He had been more particularly interested in
the remarks made upon taxis, and he presumed that all
who had referred to this point were of one accord. He
thought it specially important that taxis should not be
attempted seriously until after the patient was under
ether, a point which he had already brought out in the
paper. That being the case, no one should attempt
taxis unless he was prepared to do herniotomy. Taxis was
tried in all the cases reported in the paper after the pa-
tients were etherized, but unsuccessfully.
With reference to cutting off the sac and securing it to
the abdominal ring, he had had one unfortunate experi-
ence. He thought that the method spoken of by Czer-
ny, about five years ago, was very promising from a
theoretical standpoint, and he tried it in one case of ir-
reducible hernia in which there was great adhesion of the
sac. He dissected out the sac, which was one of large size,
cut it off, secured the stump in the external ring, and thought
he had made a very nice operation until peritonitis de-
veloped, from which the patient died. Since then he had
not meddled with the sac in that way, but compromised
by sewing as high up in the neck of the sac as he could
by strong ligatures, taking a stitch through the pillars of
the ring, but leaving the sac in position. In four cases
he was quite certain there had been entire obliteration
of the sac. He had stated in the paper that the healing of
the wound by granulations was not a disastrous accident^
as thus the sac would become obliterated. Of course a
little pouch would be left, but by a support the patient
would be protected from further descent of the hernia.
The kind of taxis referred to by Dr. Gibney was
skilled, and of a different nature from that usually prac-
tised, by which the patient was much harmed before he
came under the care of the surgeon. He had often suc-
ceeded in reducing the strangulated gut by taxis, but
always preferred to give ether before resorting to it. He
believed that the method of changing the position of the
patient by suspending him by the legs, as recommended
by Dr. Post, was very often successful. Dr. Shrady
always tried it in connection with the other accepted
manipulations before resorting to herniotomy.
MODIFIED ELECTRODE.
Dr. Beverley Robinson presented a modification of
Dr. Lincoln's electrode for use in the naso-pharynx.
The original had a cup made of ebony, bone, or ivory,
and in his hands had split and came near entering the air^
passages of the patient. He had replaced this by a hard
rubber cup, which, besides not being likely to break, be-
came less rapidly hot ; but it was liable to take fire, and
also to become soft. Finally he had substituted an
electrode protected by a layer of asbestos, which seemed
to be open to none of the foregoing objections. '
general tuberculosis.
Dr. V. P. Gibney, presented a specimen from a case
of general tuberculosis, accompanied by the following
history :
6l2
THE MEDICAL RECORD.
[November 29, 1884.
G. R , aged three and a half months, came under
observation one month before death. Parents moder-
ately healthy, no history of hereditary tuberculosis being
traced. The mother had had seven other children, three
are living in fair health, the others were either still-born
or had died when a few months old, one with convulsions,
the others "wasting away." The child was a twin, the
brother having died at the age of seven weeks. It was
at birth of fair size, but had never thrived after the first
few weeks, although nourished at the breast. The bowels
were generally loose, the child having three or four pass-
ages a day. When it was first seen it was thin, but not
emaciated. No signs of inherited syphilis were present.
Nothing was found in the lungs but a few scattered r&les.
There was no vomiting.
The case was at first believed to be one of malnutrition,
but treatment was without avail. The case grew steadily
worse, and a slight febrile movement, somewhat irregular
in its occurrence, was noted. The emaciation finally
became extreme. The fontanelles were depressed ; there
was extreme nervous irritability, but never any convul-
sions. The bowels continued loose, and death occurred
from a progressive asthenia. There was slight tympanites
noted at times. Cough existed for two weeks preceding
death. At the last examination of the lungs, about ten
days before death, only the signs of diffuse bronchitis
were found.
Brain was found normal. Right lung adherent through
nearly its whole extent. A small sacculated pleurisy at its
lower anterior border containing about an ounce of fluid.
Both lungs studded with tubercles on the surface, and
through their substance. A small cavity about the size
of a pea near the root of right lung. Bronchial glands
enlarged and cheesy. Heart normal. Liver studded
with tubercles, as was also the spleen. This was about
twice its usual size. Many tubercles found in the great
omentum, but no lymph or pus. A few tubercles on the
surface of the kidneys.
The Society then adjourned.
NEW YORK ACADEMY OF MEDICINE.
Stated Meeting, November 20, 1884.
FoRDYCE Barker, M.D., I.L.D., President, in the
Chair.
Dr. a. C. Post exhibited a new hard-rubber syringe,
so arranged that it could be opened at both ends for m-
spection of the pistons, and could be worked with a
single hand.
The President introduced Dr. W. C. Wile, of Connec-
ticut, and Dr. M. F. Price, of San Francisco, ex-surgeon
of the United States Army, and invited them to seats
upon the platform.
the surgical management of rachitic deformities
OF the lower extremities.
Dr. V. p. GiBNEY read a paper on the above subject
in which he said, first, by the term surgical management
he wished to convey the impression that mechanical ap-
pliances as well as cutting instruments are surgical means
for effecting relief.
With reference to knock-knee, it was not every case
that demanded surgical interference. Exaggerated cases
have been known to recover spontaneously.
Dr. Gibney then referred to the definitions which had
been given by different authors, as Macewen, of Glasgow,
Little, of London, Poore, of New York, and others, and
asked, Do any cases of true knock-knee recover spon-
taneously ? It was his opinion that a fair proportion
of the -cases in the United States make a spontane-
ous recovery, and the statement was based upon the fol-
lowing reasons :
First, between the years 187 1 and 1877, at the Hospital
for the Ruptured and Crippled, he saw 252 cases in chil-
dren under fourteen years of age suffering with knock-
knee. The apparatus employed' was theoretically in-
operative, practically it seemed to be of some service.
In nearly all the cases the limbs were restored to their
normal position. The apparatus employed consisted of
a pair of springs which supported the limbs, but which
did not exert any force against the deformity.
Another reason for the belief in the spontaneous cure
of knock-knee was the scarcity of adult cases in this
city. Seldom does one see adults with this deformity
walking on the streets of New York. He felt safe in as-
serting that the larger number of cases have occurred in
children between three and eight years of age, in which
osteotomy has been performed for the correction of the
deformity of knock-knee.
With regard to bow-leg, he was sure that many gen-
eral practitioners could refer to children whose limbs
were bowed during early childhood, but which ultimately
became straight. Of the 1,005 children with this deform-
ity seen at the Hospital for the Ruptured and Crippled,
927 were in children under fourteen years of age. Only
three cases were seen in adults, and only five occurred
between the ages of fourteen and twenty years. In the
927 patients the age ranged from two to four years. Dr.
Gibney believed that he would be correct in the state-
ment that the great majority •f the patients operated up-
on in this city for bow-legs, had been under seven yean
of age.
The author of the paper then discussed the following
questions : First, What cases can be safely left to nature?
Of knock-knee and bow-leg he would say that children
under two years of age should not be subjected to operap
tion unless the deformity be very exaggerated ; also that
children under three years of age, with a moderate de-
gree of deformity, could safely be left to nature.
Knock-knee and bow-leg for the most part are due to
rickets, and therefore considerable was to be expected
from medicinal measures toward effecting a cure. Dr.
Gibney then spoke of climatic influences, and the use of
phosphates of lime and soda in the treatment of rickets,
and expressed the opinion that the latter were satisfac-
tory only as they improved digestion and general nutri-
tion.
In what cases should manual force and retentive
splints be resorted to ? In the first place, in those pa-
tients whose parents are unable to buy an apparatus or
too improvident to give any attention to the correction
and cure of the deformity. Second, when one has but
little time to effect a cure. Third, where the bones will
yield readily to such force, the other conditions being
present. Dr. Gibney quoted upon this point the con-
clusions reached by Macewen, that it may be safely
concluded that brisement force has served its time, and
cannot be practised in the presence of the more exact
methods of the present day. From his own experience
and from the drift of sentiment, he felt well assured that
Macewen' s conclusions would be more strongly sup-
ported at the close of 1884 than they were at the end of
1883 in the treatment of genu valgum.
With reference to apparatus. Little, of London, was
an advocate of mechanical appliances, while Macewen, of
Glasgow, was opposed to their use.
So far as bow-legs are concerned. Dr. Gibney had been
guided in their treatment by the principle; that if the
bones could be sprung into position by the use of a moder-
ate amount of force, a retentive apparatus, consisting of
springs, could be applied with benefit. If the femur is
curved and the inner condyle unusually long in a case of
knock-knee, he tests with his hands the ligaments of the
knee and the femoral curve, and is guided by the result in
his selection of cases for apparatus. The age beyond
which he found this test failing was four and five years.
All springs now in use are constructed upon one
principle, namely, force brought to bear against the con-
vexity of the curve at its apex. Dr. Little, of London,
applies continuous pressure ; Dr. Shaffer, of New York,
employs momentary pressure'; Dr. Poore, of New York,
November 29) 1884.]
THE MEDICAL RECORD.
613
reports that about thirty per cent, of the cases of genu
valgum are cured by mechanical appliances.
Osteoclasis. — ^This operation has not become popular
in this country, notwithstanding its popularity in France.
Osteotomy, — This operation has become applicable to
nearly all rachitic deformities of the extremities. For
the details of the operation Dr. Gibney referred to Dr.
Macewen's writings. He simply mentioned what Dr.
Mace wen had stated at the International Medical Con-
gress at Copenhagen, that in none of his cases had death
occurred due to the operation. The author of the paper
then spoke of the accidents which might occur in oste-
otomy, especially the hemorrhage. In speaking of the
applicability of osteotomy he made the positive state-
ment that he had never seen an anterior tibial curve
which had been corrected by apparatus of any kind.
In nine linear osteotomies and two cuneiform osteoto-
mies which he had performed within the last year, in
none of the cases had the temperature of the patient
risen above two degrees Fahrenheit. In one case of
supracondyloid osteotomy a result occurred which he
believed to be unique — namely, paralysis of the external
perineal nerve, due to injury by the callus.
From his experience in the performance of osteotomy
Dr. Gibney had learned the following lessons :
First, — Exaggerate the correction of the deformity.
Second. — Examine the limb at the end of a week and
ascertain whether the amount of the correction gained is
the amount desired.
Third. — Do not hesitate to refracture by manual force,
if necessary.
Fourth. — With strict attention to details in operating
and in the use of good plaster-of-Paris splints, cases can
be treated in dispensaries nearly as well as in hospi-
tals.
Fifth. — In dispensary cases do all the operating you
propose at one sitting.
Further, Dr. Gibney remarked that he had employed
and believed that Listerism possessed advantages, espe-
cially with reference to cleanliness. Support of the limb
for three months after the operation, by some form of
splint, was not too long.
The President invited Dr. Joseph D. Bryant to
open th^ discussion, who said, with reference to the cases
which can be safely left to nature, that he agreed with
Dr. Gibney entirely on the point that in a large number
of cases occurring in children the patients would, if per-
mitted to go untreated, ultimately make a complete re-
covery.
The cases, however, which can be safely left to nature
involved a broader question, namely, the cause of bow-
leg and knock-knee. The exact cause of bow-leg, it
was true, was not yet thoroughly determined. The
weight of the body had been regarded as one of the in-
fluences, and probably had much to do with the produc-
tion o£ the deformity. Muscular contraction had been
said to be one of the causes, although there was some
doubt on this point. The position of the child also, as
the majority of these children sit cross-legged, had been
alleged to be one of the causes.
If the weight of the body in walking and muscular con-
traction were among the physical causes of bow-leg, then
it was true that something could be done to correct the
deformity or prevent its complete development, and the
fact that many whom we see upon our streets do grow
up with bow-legs gives rise to the question. Can we safely
leave any of them to nature ?
So far as medication and hygiene were concerned in
the treatment of rachitic deformities, the question was
probably well settled, and he had nothing to add to what
had already been stated by the author of the paper.
With reference to ♦he application of manuai force, the
rule which he had adopted was this : If in connection
with bow-legs he found that by applying force he was
able to spring the bones into their normal position, he
had endeavored to rectify the deformity by making for-
cible pressure upon the convexity of the curve two or
three times a week.
Dr. Bryant then referred to a case of exaggerated an-
terior curve of the tibia, which he cured in this manner :
He placed the patient, a boy, under the influence of an
anaesthetic, then exerted as much force as he possibly
could, without fracturing the bone, in the direction of re-
ducing the curve, applied a simple retentive splint, re-
peated this operation a number of limes, and the result
was a complete cure.
He regarded this method of treatment as preferable to
osteotomy in all cases of this kind, aside from the fact
that in osteotomy we have a compound lesion.
With regard to apparatus, he believed that every case,
in which the deformity could be corrected by manual
force, was a proper case for the use of some form of re-
tentive apparatus. He was rather inclined lo favor the
use of springs which should not exert very much force,
only sufficient to correct the deformity without producing
any injury of the soft parts.
With reference to osteoclasis, so far as his knowledge
extended, it had been used in this city very little indeed.
He certainly never would resort to it where pressure was
to be brought at an angle involving the joint, as in genu-
valgum. The danger to the ligaments and to the syno-
vial membrane, and the danger of crushing the soft tis-
sue of the head of the tibia, were reasons for not
resorting to it in preference lo osteotomy. However, in
marked tibial or femoral curve, where the force could be
brought directly upon it without interfering with the
epiphyseal junction, there might be no very great objec-
tion to it, except in the anterior tibial curve.
With reference to osteotomy, Dr. Bryant regarded it as
one of the important advances in surgery in the present
century, especially when combined with antisepsis. He
had not seen any ill results in his cases in Belle vue Hos-
pital, and had not seen a drop of pus associated with his
operations. Dr. Bryant then referred to an aggravated
case of antero-lateral curve of the tibia, due to a badly
united fracture. He operated upon the patient in Belle-
vue Hospital, and found the bone so hard that the chis-
els were broken in attempting to divide it. The wound
was dressed antiseptically, and within eight months after
the operation the patient went out entirely cured. He
referred to the case merely as an illustration of the bene-
ficial effects produced by antiseptic dressings.
The oldest patient upon whom he had performed
osteotomy was sixteen years of age. He performed the
supra-condyloid operation. In that case there was a rise
of temperature on the third or fourth day, but this quickly
subsided, and no further rise occurred So far he had
not met with any 'accidents.
With reference to the applicability of the operation, he
should limit it to all those cases where consolidation of
the bone has taken place. He thought the general im-
portance of the subject was sufficient to engage the atten-
tion of all surgeons.
Dr. C. T. Poore thought that unless jthe real patho-
logical condition was taken into consideration none of
these deformities could be treated intelligently. In one
class of cases the deformity was not due to bone lesion.
When it was due to bone lesion he thought it was always
due to rachitis, leaving out traumatic cases. If that was
true the question arose. What shall be the mode of treat-
ment? In the early stages of rachitis the bone can be
bent and the deformity corrected, but if knock-knee is
due to enlargement of the internal condyle, or bending of
the femur, etc., or if the bones have become hardened,
they cannot be bent, and, therefore, the deformity cannot
be corrected in this way.
He had no personal knowledge of spontaneous cure
occurring in these cases of deformity of true bony origin.
Dr. Gibney had stated that he had seen such cases, and
the statement was to be accepted without question ; but
Dr. Poore did not think that they were very common.
The fact that we did not see on our streets many cases
6i4
THE MEDICAL RECORD.
[November 29, 1884.
jof knock-knee in adults he thought was due to the fact
that there was not so much of rickets in this country as
in some other countries.
He thought that the deformity could be cured by
mechanical treatment if taken in time, and splints were
properly applied. However, if after a time no further
improvement could be secured, there was nothing further
to be gained by the use of splints.
With reference to the date at which bones became hard,
each case must be judged by itself. One child may have
rachitis and recover with hard bone at three or four years
of age, while in another case the bones will not become
hard until eight or nine years of age. He regarded it
simply as a question of nutrition. After the bones have
become hard, he thought that the deformity could be
jcorrected only by operation.
With regard to osteotomy, he had nothing to add to
what had been said. In those cases in which hemorrhage
had occurred, except one in which the femoral artery
was injured by a spicula of bone, the accident was due
to causes which could have been prevented. In his own
cases he had not kept his patients in bed more than five
weeks. He removed the plaster-of-Paris dressings at the
end of four weeks, and probably the patient was out of
bed within a few days, and he had not had any recurrence
of the deformity, nor did he know of any in which the
deformity recurred after the patients left his charge.
With regard to osteoclasis, he thought that it was far
better than manual force, for the fracture could be made
at any point desired, provided that it was done at a suf-
ficient distance from the malleoli. He had never pro-
duced a fracture less than three inches above the malleoli,
and he had never seen an accident of any kind from os-
teoclasis, nor had he ever failed to correct the deformity
by resorting to this method of treatment. He had not
had any experience in bending bones by means of me-
chanical appliances.
With regard to osteotomy for bow-legs, it seemed to
him that in all cases of long curves the osteoclast could
be used with advantage ; the short angular curves are
better treated by osteotomy. In his operations he had
not resorted to Listerisra strictly speaking, nor did he
dress the wounds according to Mace wen's plan.
Dr. M. H. Henry had not, within the last three years,
performed osteotomy, but he had seen the operation per-
formed by his friends, and he was in perfect accord with
the statement which had been made by Dr. Gibney in
his excellent paper. For many years, while in charge of
the Immigrants' Hospital, he saw a large number of chil-
dren of foreign birth. There were no colored children,
and there were but few cases of deformity among the
Italian children. He mentioned these facts because
they served to account for the frequency of the disease
as it exists among the children of foreign parents. The
.children were mainly rachitic, and it might be interest-
ing to notice that under the benefits of better diet which
they received at the hospital, better beds, better ventila-
tion, and clothing, they invariably improved, and for the
most part got entirely well. The limit of their stay on
the island was five years, and it was noticed that when-
ever they were treated there for more than one year they
improved with but little surgical interference.
Dr. M. JosiAH Roberts remarked with reference to
the first question, What cases can be safely left to nature,
that the fact must not be overlooked that the death-rate
in childhood far exceeded that of any other period of life.
This was especially true of those children who were the sub-
jects of constitutional disease, and therefore might explain
the scarcity of these deformities seen in adults. Besides
this, recovery from the deformity was one of degree, and
we must distinguish definitely what was meant by a cure,
when complete recovery was spoken of; and when speak-
ing of complete cures, it was necessary to ascertain that
the cure did not fall short of the positive normal standard.
He would venture that he could show any gentleman
vwho would walk with him through the best parts of the
city numerous cases of knock-knees and bow-legs in slight
degree, and yet it would be found that the patients were
incapable of prolonged locomotion, or of standing upon
their feet for long periods of time. It did not always re-
quire, in a case of knock-knee, or in-knee, a deformity
of more than from two to five degrees to cause very con-
siderable inconvenience.
While he agreed with the author of the paper that
there were cases which recovered spontaneously, he
wished to impress the fact that all the cases which were
supposed to be cures were not complete recoveries.
Dr. Roberts then exhibited a series of photographs
illustrating the improvement which occurs from two
years of age upward until fourteen years of age is reached,
when the deformity was apparently completely removed;
but the photographs showed that it still remained to a
moderate degree.
With reference to the statement made by the author
of the paper, that in most cases of bow-legs the deformity
was due to the continuous curve from the hips to the
malleoli, he wished to take exception. While the de-
formity appears to be largely in the shaft of the femur and
of the tibia, these were in fact quite straight, and the de-
formity was confined mainly to the ends of the bones.
Dr. Roberts exhibited photographs illustrating this point,
and made the general statement that, in all cases of de-
formity we must expect the deforming influences to mani-
fest themselves where there is the greatest mobility,
namely, at the articulations. Next in frequency are the
points which are separated by cartilaginous substance, as
the diaphyses and epiphyses. In bow-legs the principal
changes had taken place at the articulations between the
epiphyses and the shafts of bones.
With reference to what cases can be left to nature,
while he admitted that certain cases did recover, he was
thoroughly convinced that in every case recovery might
be aided by surgical appliances, and that the patient
could get well in a much shorter time with surgical assist-
ance than when left to nature.
With reference to manual force, he agreed with Dr.
Poore, that it is applicable only in a limited number of
.cases, where the bones are very soft indeed. In nearly
all such cases cure can be effected by means of mechani-
cal appliances, and the limbs made absolutely straight, as
determined by goneometric observations.
Dr. Roberts then spoke of the necessity of using in-
struments of precision in determining the degree of de-
formity which is present.
With reference to mechanical appliances, the theories
once in use were good in their way, many of them were
excellent ; but he did not think that the ultimatum had
yet been reached in the application of force for the cor-
rection of deformities. He then described at some length
an apparatus for treatment by means of adhesive plaster,
devised by the founder of orthopedy in this country, Dr.
Davis, of New York. He also spoke to considerable
length concerning osteoclasis and osteotomy, and closed
with a description of his electro-osteotome, with which he
had performed a large number of osteotomies.
Dr. Hopkins referred to a case in which he performed
excision of the joint for knock-knee.
The President asked for information with regard to
one point, namely, what was the experience concerning
the influence of sex as affecting the frequency of the dis-
ease, and also as affiecting the frequency of spontaneous
cure. The reason he asked was because it had occurred
frequently to him to have anxious mothers express great
solicitude with regard to the presence of bow-legs or
knock-knee in their children. He had been in the habit
of saying to them, *' Wait and let us see what the result
will be," and in most instances perfect recoveries, so far
as he had been able to ascertain, had taken place before
adult life was reached.
Dr. Gibnev, in closing the discussion, remarked with
reference to the question asked by the President, that so
far as he was able to recollect the cases of bow-leg and
November 29, 1884.]
THE MEDICAL RECORD.
615
knock-knee occurred about equally in the sexes. One
of the results which he had noticed in these cases, how-
ever, had been what is known as flat-foot, and whenever
at the Hospital for the Ruptured and Crippled he had
seen a case of flat-foot he made further inquiry, and al-
most invariably found that the patient had during child-
hood suffered from bow-legs.
With reference to the death-rate among children, men-
tioned by Dr. Roberts as affecting the number of cases
of deformity of the lower extremities seen in adults, he
would remark that in Glasgow it was a notable fact that
bow-legs and knock-knees among adults were very numer-
ous, and therefore that the number was probably not af-
fected materially by the death-rate occurring in children
ID that city. The cases of adults which he had seen had
been mostly in stout persons, and belonged to the form
which Dr. Little, of London, had termed atonic knock-
knee, without the existence of bone deformity in early
life.
With reference to the class of cases referred to by Dr.
Hopkins, he could only say that his paper was restricted
to the treatment of rachitic deformities.
The Academy then adjourned.
OUR LONDON LETTER.
(From our Special Correspondent)
DISCUSSION AT THE MEDICAL SOCIETY OF LONDON ON
"LANCING children's GUMS " — MYXCEDEMA — EFFECT
OF EXTIRPATION OF THE THYROID BODY.
London, November 8, 18&4.
Our societies are all now in full work. On Monday
last at the oldest society, the entire evening was occu-
pied with the subject of lancing the gums in children.
This was introduced in a racy statement of his opinions
by Mr. Edmund Owen, Surgeon to St. Mary's Hospital
and to the Children's Hospital. His first reason for
bringing it forward was, he said, his slight practical ac-
quaintance with the subject, and though he told us that
he had carried a gum-lancet in his card-case for years,
he added that he found no work for it upon infantile
gums. This experience precisely agrees with my own.
In youth indeed I lanced many a baby's gums, it is to
be hoped with benefit ; but later on, as fashions changed,
I thought out what ought to be the reasons for doing so,
and resolved that I would look for the tumefaction and
redness I had been taught would certainly appear if
this necessary operation were delayed, or that I would
wait until such evident obstruction to the eruption of
teeth occurred as we sometimes see in the case of wis-
dom teeth in older patients. The result has been that
though I have sometimes assisted the emergence of an
adult's wisdom tooth, my baby-patients have escaped
scot-free. But to return to the discussion, Mr. Owen
said how often do we hear this remark, " My children al-
ways cut their teeth with diarrhoea or a large head," and
the explanation of this he considered was to be found in
improper feeding, an opinion which everyone who ob-
serves the folly of parents in this respect will be ready to
endorse. They stuff their babies' stomachs with food
which they cannot digest, and then declare that the diar-
rhoea and other disorders thus brought about are only
due to teething. But surely teething is a natural pro-
cess— not the efficient cause of the many disorders to
which the susceptible infantile body is liable. No doubt
when a gum is inflamed scarification would ease it, but
when it is not this remedy is not indicated. One very
significant suggestion was made by Mr. Owen, viz., to
keep a sharp lookout for essential paralysis, which
comes on so insidiously at a period when the symptoms
are likely to be attributed to dentition. In the discus-
sion which followed Dr. Clement Godson, Dr. Braxton
Hicks, and Dr. C. J. Hare, as well as others, put in a
plea for the ** good remedy out of fashion," and Mr. H.
Cartwright threw in his authority as a dentist in favor of
the notion. that diarrhoea and convulsions may be caused
by dentition. The chief indication he assigned for the
operation was a tense glistening state of the gum when
the tooth was about to come forward, or greatly swollen
or inflamed gums. Dr. W. A. Duncan had seen the op-
eration relieve diarrhoea and convulsions ; Dr. Ewart was
a firm believer in the lancet ; Dr. Drew thought it indi-
cated in a febrile condition with pain in the gums lasting
for two days, as well as in some cases of diarrhoea, bron-
chitis and otitis. Dr. S. Taylor would use it in a homy con-
dition of the gums ; and Dr. Webb had seen children on
the point of death saved by it. On the other hand. Dr.
Travers had not seen a single instance in which he felt
justified in lancing the gums in the last nineteen years.
Mr. Lowne said dentition was a physiological process
and nine out of ten cases of diarrhoea were caused by
improper feeding, and he could not understand how that
complaint could be brought about reflexly by dentition.
Dr. Sansom thought there was a liability to use the lan-
cet too frequently. Dr. Hall thought it had fallen into
disuse since the introduction of bromides, and some
other speakers " damned with faint praise " the instru-
ment with which most of them had probably in younger
days tortured their little patients. In reporting so fully
a discussion which some of your readers may perhaps
think trivial, it may be ri^ht to add that this was one of
the most interesting evenmgs of the session.
A case of myxoedema was brought forward at a recent
meeting of the Clinical Society, which was interesting
from a history of its commencement in a severe attack of
hemorrhage and the continuance of a hemorrhagic ten-
dency ; besides which the patient suffered from oc-
casional attacks of nervous restlessness, which are not
only unusual but may almost be thought to be incom-
patible with myxoedema. A curious circumstance may
also be added respecting treatment : the patient felt her-
self a good deal better while under half-drachm doses of
tincture of jaborandi, and there was at the same time a
great increase in the excretion of urea ; but no other ob-
jective improvement.
In connection with the case above mentioned, attention
was once more called to the effect of extirpation of the
thyroid gland. It will be remembered that last year Dr.
Kocher, of Berne, reported that he had observed after
this operation, in a number of cases, the development
of a cachexia closely resembling the condition of myx-
oedema; and a conjecture was ventured that this disease
might represent in adult life the state of cretinism at an
earlier period. Be that as it may, the number of Kocher's
cases was sufficient to show that excision of the thyroid
body is in some way related to the strumous cachexia
he had described, although partial extirpation was
followed by no such condition. The notion first put
forward by Dr. Semon, that this state was connected with
cretinism, received some confirmation from a case now
reported by Professor Paul Bruns. His patient, now
twenty-eight years old, had the thyroid removed eighteen
years ago. In 1867, five months after the operation, his
disposition had completely changed. From a bright, lively
child he had become very retired and quiet, and he now
is a dwarf and a cretin. After the operation the develop-
ment of the trunk and limbs had ceased and only the
head had grown to the size of manhood. The expression
is that of an idiot, the skin and mucous membranes are
pale. The whole integument is dry, brittle, and thick-
ened by a peculiar soft gelatinous infiltration. There is
also swelling of the tongue, palate, and tonsils, giving rise
to slow, difficult speech. Sensibility and muscular power
preserved, but the patient cannot work, can hardly walk
fifty steps. His mental faculties are less developed than
those of a boy of ten. This important case seems to
furnish us with a blending of myxoedema and cretinism,
and it was suggested that both conditions are due to the
6i6
THE MEDICAL RECORD.
[November 29, 1884.
loss of the thyroid gland. Certainly some of the other
facts recorded point in the same direction, but they seem
at present scarcely sufficient to establish so large a gen-
eralization, and in this case it would be easy to suggest
another explanation.
Official List cf Changes in thi StaHans and DuHes of Offices
servinfT in thi Medical Departnunt^ United States Army,
from November \(ito November 22, 1884.
McKee, James C, Major and Surgeon. Leave of
absence extended one month. S. O. 273, A. G. O.,
November 20, 1884.
GoDDARD, C. E., Major and Surgeon. Assigned to
duty at Fort Yates, D. T. S. O. 138, Department of
Dakota, November 15, 1884.
Cowdrey, S. G., Captain and Assistant Surgeon.
Granted leave of absence for one month. S. O. 237,
Department of the East, November 17, 1884.
Havard, Valery, Captain and Assistant Surgeon.
Granted leave of absence for four months, with permis-
sion to go beyond sea, to take effect when his services
can be dispensed with at his present station. S. O. 268,
A. G. O., November 14, 1884.
Taylor, A. VV., First Lieutenant and Assistant Sur-
geon. Relieved from duty at Fort Omaha, Neb., and
ordered for duty at Fort D. A. Russell, Wyo. T. S. O.
1 01, Department of the Platte, November 19, 1884.
Phillips, John L., First Lieutenant and Assistant
Surgeon. Assigned to duty at Fort Keogh, M. T.
S. O. 134, Department of Dakota, November 5, 1884.
%t\xs Instruments^
A RAPID METHOD OF CONTINUOUS SUTURE.
By p. J. PRENDERGAST, M.D.,
BROOKLYN, M. Y.
After having used the needle of Dr. Wackerhagen
with great satisfaction for interrupted suture, I have
found that it can also be used for the continuous suture,
and that by a very rapid method, without utilizing the
eye in the blunt end. The plan is as follows, viz. :
The thread having been passed under the bridge of
the needle, each portion being of equal length, the
needle-holder is applied ; the needle is then passed
through the tissues and a loop of thread is drawn out,
a piece of large size catgut is now passed through the
loops by an assistant, each time the needle is withdrawn.
By this process we possess a double advantage — non-
disturbance of the needle-holder, and one threading of
needle for ordinary cases. I doubt not this needle will
henceforth be used as frequently and satisfactorily for
the continuous as for the interrupted suture.
A NEW ELECTRIC OTOSCOPE.
By ROSWELL PARK, M.D.,
BUFFALO, N. Y.
To those who have a means of supplying by some
form of battery in their office an electric current of suf.
ficient power, this little instrument will commend itself
as a most convenient demonstrating otoscope, and one
by which searching examinations can be made irrespec-
tive of time of day or light.
It consists of an otoscope of conventional pattern,
much like Brunton's or Hasenstein's, from which the or.
dinary flaring, funnel-like side tube for collecting the
rays of artificial light has been removed, and in its place
a thimble inserted within which is the platinum coil made
white hot by the passage of the current. The battery
wires are connected with a perforated flange on either
side the thimble, and a little knob to be pressed down
by a finger of the hand which holds the instrument makes
the connection in its interior, so that the light islfunder
perfect control. Back of the coil is a dead white mirror
surface which serves to economize and intensify the light
The portion of the instrument corresponding to the ear-
speculum proper is made in three sizes, and of polished
metal, or of hard rubber, as may be desired. The thim-
ble fits easily in its socket, and is turned half round as
the instrument is changed from one ear to the other, so
that the knob may, if desired, always have the same rel-
ative position. And when sunlight or artificial light
from a lamp are wanted the thimble is entirely removed
and the funnel -tube inserted. The battery used may be
one of the little storage batteries accompanying Trouv^s
" polyscope," a cautery battery, or any other supplying
sufficient intensity.
MARCONI'S TONSILLITOME.
In this instrument the Mackenzie blade is combined
with Matthews' fork and handle, each of which are the
superior features in the respective instruments. The
advantages of this instrument will readily appear to those
within whose specialty of practice it falls.
A DENTIST at Triangle, N. Y., once received an order
for a block of teeth, as follows : ** My mouth is 3 inches
acrost, % inches through the jaw ; sum humocky on the
edge ; shaped like a horse-shoe, toe forward. If you
want me to be more particklar I shel hav to cum thar.
Yours truly, ."
The Medical Re
A Weekly yournal of Medicine and Surgery
oiTY r/osj
VoL a6, No. 23
New York, December 6, 1884
Whole No. 735
©rigtimX ^vticUe.
CONCUSSION OF THE SPINE AND ITS RELA-
TION TO NEURASTHENIA AND HYSTERIA.'
By C. L. DANA, A.M., M.D.,
PROFESSOR OF NBKVOUS AND MBNTAL DISEASBS IN THB NRW YORK F05T-GRADUATB
MBOICAL SCHOOL.
The physician who is called into court to testify in a case
of spinal injury witnesses a curious spectacle. The law-
yer for the prosecution waves before the jury a volume
of**Erichscn upon Spinal Concussion." He reads to
them, in impressive accents, the statement that every in-
jury to the spine, however slight, is full of danger to the
sufferer. He asks, with sonorous emphasis, if Mr. Erich-
sen is not a surgeon of world-wide fame ; and if he does
not say that slight injuries to the back may cause chronic
spinal disease of the most serious character. He sneers
at the work of a certain Mr. Page, who is known to be
professedly only a railway surgeon. He shows that his
client has paralysis, anaemia, meningitis, in fine, " spinal
concussion."
On the other hand, the lawyer for the defence bran-
dishes triumphantly a larger work, by Mr. Herbert Page,
on "Injuries to the Spine ;" "he reads to the jury cases of
malingering therein related, shows that Mr. Erichsen has
for years made a business of being an expert for people
with injured spines, but that he has never yet found a
case that proved fatal. He quotes Mr. Page's two hun-
dred and thirty-four cases of spinal concussion, in most
of which recovery resulted, and shows, through his medi-
cal expert, that the spinal cord is so admirably protected
that it could never possibly be injured by anything so ut-
terly trivial as a railway collision.
The medical experts themselves in these cases neces-
sarily testify in the most diverse way, according to their
natural bias or the particular surgical authority or pecu-
niary support upon which they rely. And authorities are
so unsettled and contradictory, and symptomatological
data so uncertain, that two medical men can with perfect
honesty, if they go by written works, support quite oppo-
site views.
It is on account of the existence of this uncertain state
of written medical opinion that I venture to present the
subject of spinal concussion now. I do not so much wish
to offer any original views of my own, or detail my per-
sonal experience (which has been sufficient to show me
in how unsatisfactory a state the subject of spinal concus-
sion is), but rather to lay down the mooted questions
regarding injuries to the spine and their sequelae, to
present what is in my opinion the just and proper view to
take of them, and to ask for corroboration or criticism
of my audience to-night.
Under the term concussion of the spine Mr. Erichsen
includes four.different conditions :
First, — Concussion of the spinal cord itself. Here ajar
* Read at a meetinc of the New York Neurological Society, November xi, 1884.
According to Poor (Railroad Manual. 1883), there are 389,190,783 passengers
carried upon the 113,329 miles of road in the United Sutes yearly (in 1882). This
IS about six times the total population. For the Middle States the number of
passengers is ten per cent, of the population, and for New York about fifty
milliOD. Among these fifty million there occurred in 1882-83, according to the
Kteort of the New York Railway Commissioners, 40 deaths and 194 injuries. In
addition to this there occurred to employes 175 deaths and 732 injuries, and to all
others 280 deaths and 250 injuries, making the total casualty returns in this State
for one year 495 deaths and 1,166 mjuries. Calculating upon this basis, the num-
wr of deaths annually among railway passengers would be about 232, the number
otuijuries 1,125. For the whole country the total number of deaths Mrould be not
ar trora 2,871 among passengers, employes, and others, while the total number
ofinjunes would be about 6,763.
or shake of the cord disorders or suspends its functions
without causing any detectable lesion.
Second. — Spmal hemorrhage and compression.
Third. — ^Acute and subacute inflammation of meninges
and cord.
Fourth. — Chronic meningitis and myelitis, consequent
upon simple concussions of the cord, apoplexies, or acute
or subacute inflammations.
He describes as accompanying or following these in-
juries symptoms attributed to general nervous shock.
These symptoms are those of cerebral irritability and
asthenia, spinal anaemia and irritation, and a long series
of visual troubles. Without going into any analysis I
think I can say from a careful reading of his book that
Mr. Erichsen' s teachings and their implications are some-
what as follows :
That there is such a thing as concussion of the spina!
cord, pure and simple, whereby the functions of the cord
are temporarily suspended.
That such a concussion of the cord may be followed
by recovery (and generally is), or by death or chronic
disease.
That there is such a thing as concussion of the spine,
wherein the whole vertebral column, with its envelopes
and contents, is jarred or injured in various ways.
That this term, " concussion of the spine," is one of the
widest inclusiveness, taking in symptoms of injury to the
cord, of injury to the vertebral column and muscles, and
of general nervous shock and its sequelae.
That an injury to the spine or body may prove most
serious (to the spine especially), and that even trivial in-
juries may cause grave organic disease of the cord or its
membranes.
That spinal anaemia, spinal irritation, hysteria, and allied
troubles may result from slight injuries to the spine, and*
the nervous shock of the accidents causing them.
That these last-mentioned symptoms, as well as those
of a supposed chronic meningo-myelitis, may develop
later, and slowly, after a period of comparative health,
and that they are very serious in character.
That malingering occurs and should be looked out for.
That serious visual troubles occur.
I might add here that Mr. Erichsen reports in support
of these views thirty-one cases in detail, of which nine
were the result of railway accidents.
Turning now to Mr. Page's work, already referred to,
it should be said in the beginning that it is by no means
an aggressive criticism of Erichsen alone. The writer
endeavors to produce a systematic treatise, and although
he. puts his arguments together badly, he has succeeded in
making an original and valuable contribution to the sub-
ject in hand. It is true, however, that much space is de-
voted to pulling down some of the pathological creations
of the London Hospital surgeon's fancy. Without at-
tempting at all to analyze his book, I propose to set off
the synopsis given of Mr. Erichsen's teachings by certain
propositions, which I believe to embody the opinions of
Mr. Page, and then to enumerate the mooted points
between them. The views of Mr. Page, so far as I under-
stand him, are :
That the existence of such a thing as concussion of the
spinal cord, pure and simple, is unproven and extremely
doubtful.
That the .spinal cord cannot be directly contused or
injured by shakes, blows, or violence to the body unless
there is a fracture or dislocation of the spinal column.
6i8
THE MEDICAL RECORD.
[December 6, 1884.
That so-called cases of concussion of the cord, fol-
lowed by softening and death, or by symptoms of myeli-
tis, are cases of spinal apoplexy, or of ^dislocation or
fracture with compression.
That the term concussion of the spine is arbitrary,
vague, and misleading.
That injuries to the spine very rarely, if ever, produce
chronic non-fatal forms of meningitis, myelitis, or menin-
go-myelitis, so called ; but that the symptoms attributed
to these conditions are the result of lumbago, strains,
and ruptures of muscle and ligaments, injury to periph-
eral nerves, and general nervous shock, setting up neu-
rasthenic and neuromimetic disorders.
That these neurasthenic and neuromimetic disorders,
though often serious, are not fatal, but tend toward re-
covery ; and that the patient and the litigation are often
responsible for many of them.
That the symptoms being mostly'subjective, it is diffi-
cult to exclude deception ; that some unconscious de-
ception often occurs, even with honest patients.
That no serious visual troubles follow in these chronic
functional disorders.
The general tenor of Mr. Page's work is to the effect
that the spinal cord is a very carefully protected and not
easily injured organ. From a comparison of these views
with those of Mr. Erichsen, we may learn what are the
disputed points regarding the effects of injuries to the
spine.
Put in the form of queries, they are as follows :
First, — Whether external violence can cause a simple
concussion, and perhaps contusion of the cord, of a char-
acter analogous to concussion of the brain, or whether
the cases heretofore so considered are really examples of
spinal hemorrhage, or of dislocation, separation, or fract-
ure with compression ?
Second. — Whether external violence or jars can cause
direct contusion of the cord, or produce a structural
change that ends in softening, there being no lesion of the
enveloping osseo-ligamentous parts ?
Third, — Whether blows or jars, ever or often, set up
a chronic meningo -myelitis or myelitis, no lesion of the
spinal column being present ?
It is to this last category that Mr. Erichsen relegates a
large portion of his reported non-fatal cases of concussion
of the spine, and we may put in here, therefore, the
counter-query :
Whether in a very large number of cases of chronic
nervous disturbance, following railway and other acci-
dents, cases usually diagnosticated in a routine way as
" concussion of the spine," or chronic meningo-myelitis,
the disease is not really mental (neurasthenia, hysteria,
hypochondriasis), or else partly mental and partly the
result of injuries to the spinal muscles, ligaments, and
nerves ?
Fourth, — Finally, the question is raised, Whether
serious organic visual troubles result from railway and
other accidents in which the spine or body is injured, but
not the eye directly?
Some of the foregoing queries have plainly a more
scientific than practical interest. As to the first one, for
example, that of the existence of a concussion of the
spinal cord, pure and simple. We know that after violent
blows or falls persons suffer from a temporary paraplegia.
^yhether this is due to a molecular disturbance of the
tissue of the cord or to a spinal hemorrhage, the clini-
cal facts are the same. But I believe that there is
enough evidence to justify one in retaining the term
^* concussion of the cord," a term sanctioned by ancient
authority and adopted by every surgical writer.
The evidence/r^ and con^ collected by Erichsen, Page,
and myself, is the following : Erb cites a case which he
iDelieves illustrates spinal concussion (** Ziemssen*s Cyclo-
paedia of Medicine," Art., Concussion of Spine), and
.guardedly admits its existence.'
' Se« bibliography.
Le Gros Clark also (op. citj thinks that the term
concussion of the spinal cord, used analogously to concus-
sion of the brain, is justifiable. He relates two cases appar-
ently illustrating this, but admits later that there might
be some organic lesion.
Shaw (op. cit.) cites a case where there was apparently
simple concussion, but the patient died and the autopsy
showed a hemorrhage in cord.
Dr. Abercrombie (op. cit.^ relates the history of a case
where a man was struck in the back with a rock and
rendered paraplegic for several weeks ; he ultimately re-
covered. Abercrombie's opinion, that there is a tnie
simple concussion of the cord, is apparently based on
this case, and on those of Boyer and Frank, to which
authorities he refers.
Dr. T. Buzzard {TheLancety 867, vol. i., pp. 389, 435,
509, 623) quotes a number of cases believed to illustrate
concussion of the cord, taken from Dr. J. L. Caspci's
** Ueber des Verletzungen des Ruckenmarkes," 1823, Ber.
lin. This author gives Frank's cases reported in his
** Kleine Schriften," also one by Valsalva and other old
authors.
Boyer (op. cit, p. 135) relates two cases. In one the
patient was struck on the back, in the other he strained
his back in a violent muscular exercise. Both became
suddenly paraplegic, died in a few weeks, and upon au-
topsy no lesion of the cord was discoverable.
These cases are not conclusive, because no microscopi-
cal examination was made. In the second case there
could not have possibly been any concussion^ as the man
was simply going through a difficult muscular exercise for
the amusement of his friends.
Mayo (op. cit.) expresses the opinion that concussion
of the spinal cord may cause complete suspension of its
functions. His illustrative cases may be explamed on
the theory of a hemorrhage.
Syme (" Principles of Surgery," Third Edition, p. 433)
states that the cord may have its functions suspended by
a concussion, as does the brain. He states, however,
that an efifusion of blood or serum probably complicates
these cases.
Dr. John A. Lidell {American Journal of the Medical
Sciences^ vol. xlviii., p. 305) expresses his belief in simple
spinal cord concussion, and relates three cases illustrating
it, as he believes. The paraplegia in these cases could
be explained, however, by the injury to peripheral nerves
or by hemorrhage.
Dr. S. Wilks (** Diseases of the Nervous System," p. 201)
states that he has more than once seen a man receive a
severe injury to the back, become paralyzed, and recover
in a few days. Here he thinks the cord is stunned.
He reports the case of a porter who received a severe
blow on the head (?) and back. He was stunned for a
time, but resumed work for three days, then developed
paraplegia and died. Autopsy showed only a very slight
granular and fatty change in the cord.
G. Fisher {Deut, Zeitsch. Chir,) cites the case of a
man, aged twenty-one, who fell, striking on his back.
There was complete paralysis of the extremities, trunk,
and spinal centres. Death occurred. Post-mortem
showed only a slight meningeal effusion. Paralysis was
referred to shock.
I have taken the trouble to bring these cases together,
adding a number not quoted by Erichsen or Page, because
in the works of those authors the clinical and patho-
logical evidence is not systematically arranged, and it is
by no means easy in reading Mr. Page's book to follow
his arguments and his evidence.
I. These cases may not of themselves positively prove
the existence of a concussion of the cord. In view of the
facts presented under the second query, however, show-
ing that shakes and injuries can cause a softening of the
cord, the certainty that it, in rare cases, can be " con-
cussed," so as to suspend its functions, becomes very
great.
II. As to whether jars and injuries to the spine can
December 6, 1884.]
THE MEDICAL RECORD.
619
cause direct structural change leading to softening of the
cord, there being no lesion of the spinal column —
Sir Benjamin Brodie (op. cit.) first laid down the view
that such a thing was possible. And though it is true
that he cites no illustrative cases, yet he writes with a
particularity which leads one to believe that he has seen
such cases. As slightly confirmatory of this view also, Gull
("Gu/s Hospital Reports," Series iii., 191, 1858, Case
xxiii.) reports the case of a porter, who received a severe
blow directly upon the cervical spine. There was
paralysis of motion in the left arm, and of motion and
sensation in legs. Post mortem showed softening, with a
slight ecchymosis in gray matter, and contusion of cord
opposite fourth and fifth cervical vertebrae. The spine
was normal, except for a separation of the bodies of the
fourth and fifth cervical vertebrae.
TA^ Lancet (April 19, 1877, P- S7i) contains the re-
port of the case of a Mr. John Jepson, who was bruised
and shaken in a collision. He attended to his business
for a fortnight Symptoms of spinal concussion then set
in : spinal tenderness, muscular twitchings, paraplegia,
mental symptoms. In six months he died of pneumonia.
Post-mortem showed considerable softening in the dorsal
portion of the cord.
Mr. Curling ("Transactions of Pathological Society,"
vol. viii.) records the case of a boy, aged eight, who fell,
striking on the buttocks, became paraplegic, and died in
three months and a half. Postmortem showed cord
softened in several places.
Dr. Lochner, of Schwalbach (Aerttliches Intelligenz-
hlait, October 19, 1875), reports two cases of softening
of the cord following a blow or fall, no lesion of the spinal
column being found. Dr. Abercrombie also cites a similar
case (op. cit, p. 343).
III. As to whether injuries to the spine, shakes, and
jars can cause a subacute or chronic myelitis or meningo-
myelitis, the spinal column not being injured. Un-
doubtedly some such cases do exist In judging of this
question, however, it is well to bear in mind that chronic
myelitis and meningitis are serious, and eventually fatal,
diseases. Therefore, if railway and other accidents pro-
duced them, pathologists would see them.
Mr. Page collects the histories of only two. One was
reported by Mr. Hutchinson [Medical Times and Gazettty
1879, ^o^- ^'s P- 34^)* ^^ ^^ ^ ^^^ ^^ paraplegia from
myelitis following injury to the back. The patient re-
covered. The girl had a typical acute myelitis of the
lower part of the cord. She had had inherited syphilis.
jr^A second case was that of concussion-lesion, with
myelitis and secondary degeneration, reported by Dr.
Bastian ("Transactions of the Royal Medical and Chirurgi-
cal Society," June 25, 1867, vol. 1.). Here the patient
died, and a rupture of the cord in the cervical enlarge-
ment was found to have been the starting-point of the
disease. Mr. Page considers this case unique.
I have under treatment now a patient suffering from
transverse myelitis and descending degeneration, of whom
the history is very similar to that of Bastian's. Before
reading Mr. Page's comments, I came across Bastian's
case, and was so struck with its clinical resemblance to
my own that I referred to it in exhibiting the patient to
my class at the New York Post-Graduate School
Dr. Edes reports (quoted in Hamilton's " Medical
Jurisprudence," p. 357) four cases of postero-lateral
sclerosis, the result of spinal concussion.
Petit, in his work upon the " Relation of Locomotor
Ataxia and Traumatism," shows that the injuries and ac-
cidents may at*least develop tabes in the predisposed.
Althaus in his recent work on ** Scleroses of the
Cord " states the same.
It seems to me to be proven beyond a doubt, despite
Mr. Page's arguments, that external violence and jars,
apart from any hemorrhage or other lesion, may cause an
acute, subacute, or a chronic myelitis, with softening or
secondary degenerations. Not many of these cases
have yet been reported, because they are rare and be-
cause there is not yet a widely diffused knowledge of the
methods by which the different forms of chronic myelitis
are diagnosticated. And it ought perhaps to be added
that a certain predisposition, syphilitic or neurotic, is
necessary for the development by traumatism of most
of these forms.
But it is claimed not only that myelitis, but that a
chronic meningitis or meningo-myelitis may be set up
by concussions of the cord. It is to this pathological
class that Mr. Erichsen relegates a very large part of his
reported cases. In doing this he had undoubtedly given
a more serious aspect to many of these cases than they
deserved. Meningitis and myelitis are, as we have
stated, serious diseases, yet the cases Mr. Erichsen de-
scribes do not die.
I fully agree with Mr. Page that a large proportion of
these cases, when analyzed, can be shown to be cases of
strain or rupture of muscular and ligamentous structures,
injury to nerves, or the results of a general nervous
shock, and that the spinal cord has no more to do with
the disease than the stomach.
I hesitate to say, however, that Mr. Erichsen is entirely
wrong in his pathology, or that there is not set up in some
of these cases a low grade of meningeal inflammation or
congestion ; or even if there be not, as in the case of
Mr. Jepson, patches of softening.
This is certain, however, that heretofore too little
stress has been laid upon the symptoms produced by
neuritis, strains, and general nervous shock.
Regarding these points some illustrative cases other
than those quoted by Erichsen and Page may be found,
Leyden {Archiv /• Psychiatr,^ 1878, viii., p. 31, quoted
by Hamilton) reports a case in which a patient suffered
from peripachymeningitis and compressive myelitis end-
ing in death.
I have reported a case of cervical pachymeningitis in
a syphilitic where the disease was undoubtedly started
up by a severe blow on the neck {^Journal of Nervous
and Mental DisecueSy January, 1882).
Dr. Allan McLane Hamilton reports a case (** Medi- '
cal Jurisprudence," p. 355, New York, 1883) ^^ which
he states that there was undoubtedly " serious organic
change in the brain and cord " as the result of spinal
concussion.
IV. As to the visual troubles, I doubt very much if the
chronic functional disturbances we have been speaking
of can ever produce any real organic trouble with vision.
Albutt, I believe, speaks of a chronic meningeal irri-
tation, which gradually creeps up from the cord to the
brain, and finally affects, by contiguity, the eye. I believe,
however, that there may be asthenopia, restricted vision,
hysterical disturbances of same, vascular changes in the
disc, but nothing else, unless organic disease of the cord
or brain sets in. Dr. J. G. Johnson gives a valuable
summary of evidence on this point. Vide bibliography.
Turning now to a discussion of the more practical and
important features in so-called spinal concussion, I would
state that without doubt in the largest class of troubles
resulting from accident and injury to the spine, the main
source of the symptoms is a general functional nervous
disturbance.
The fright, excitement,''and'more or less severe bodily
injury produce often a profound shock. From this the
nervous system gradually emerges into a state that may be
broadly characterized as one of asthenia, morbid irrita-
bility, and defective inhibition. The patient then fur-
nishes a clinical picture familiar to all.
Sleeplessness, irritability, states of depression, defec-
tive memory, inability to do mental or physical work,
headache, tinnitus, nervousness, vasomotor disturbances,
excessive sweating, asthenopia, large pupils, spinal pain
and tenderness, muscular weakness, tremor and twitch-
ings, and irregular pulse, are the ordinary symptoms.
Sometimes pronounced neuromimelic disorders develop.
The patient shows the symptoms of so-called spinal
anaemia, or of spinal irritation, or he develops paralyses
I
620
THE MEDICAL RECORD.
[December 6, i88^.
hemianaesthesia, and various hysterical phenomena. In
nearly all cases these symptoms are subjective. They
correspond with those of neurasthenia, as described
by Beard, Mitchell, Erb, Mobius, and Dowse, or with
those of the convalescent stage of cerebral concussion, as
described by Hutchinson ; they are included under the
neuromimetic disorders of Paget, and they have been
aptly termed railway hysteria and hypochondriasis by
Dr. Allan McLane Hamilton.
It is these cases which form the most puzzling prob-
lems for the physician, and which cause him the greatest
troubles perhaps bring him into greatest reproach before
the court.
This is due partly to the incompletely developed views,
to speak mildly, promulgated of late years regarding the
nature of spinal injuries, and partly to the natural and
inherent difficulties of the subject. As to the first point,
the spinal column has been held up as the most delicate,
responsive, and hyperaesthetic of all organs. It has been
made the focus for every jar, bruise, or shock to centre
upon, and " concussion of the spine " has been the shib-
boleth of every frightened passenger and prosecuting
attorney for twenty years. As Holmes once said re-
garding Bishop Berkeley and his belief in the universal
efficacy of tar-water : " Berkeley believed that the whole
material universe was nothing, and that tar-water was
everything," so in a measure the spinal cord has been
looked upon as everything — ^brain, muscle, ligament, and
nerve as nothing.
Not long ago, through the kindness of my friend Dr.
George E. Munroe, I was called to see three women who
all had very nearly similar symptoms, viz.: mentally they
were profoundly emotional and hysterical, physically
they were paraplegic, or nearly so, and suffered from
sensitive spines. In two the spinal pain and tenderness
were so very marked that the diagnosis of spinal irrita-
tion was made ; the third patient had what was termed
spinal anaemia. This last patient only was in a railway
• collision, and received a slight jar, but no serious physi-
cal injury. The other two received severe blows on the
head, causing concussion of the brain. Thus the fright
of a collision in one case produced a similar state to that
caused by the blows on the head in the other two. But
only the patient who was in the railway accident was
thought to have "concussion of the spine."
It may be laid down as absolutely established now,
that railway accidents produce severe shocks to the ner-
vous system which make persons neurasthenic or hys-
terical, oftener the former. This condition is a real patho-
logical one, and the sujfferers are unquestionably some-
times as much injured as if they had had a broken arm
or leg, or an actual injury of the cord. The practical
trouble is in determining how ill such people are, how
much they are malingering, how much the prospect of
heavy damages unconsciously or consciously affects their
symptoms, how much predisposed to disease they were
before the accident. For a road should not be called to
account because it does not provide perfectly for the
crippled, the paralytic, and the valetudinarian.
In illustration of these difficulties my learned friend
• Dr. Allan McLane Hamilton records, in his valuable
work on " Medical Jurisprudence," the history of a patient
of mine (whom he examined for a railroad company), and
adds this terminal comment : '* This man is an undoubted
malingerer." In opposition to this view, I have for the
three years since his accident thought him to have been
made by it a nuisance to his family and a burden to him-
self on account of his change of disposition, lessened ca-
pacity to work, and sciatic pains. If ever I attain a
position which will justify me in writing a medico-legal
treatise, I shall record the same case and say that this
man was undoubtedly a case of traumatic neurasthenia
complicated with neuritis. But who is ever to decide
whether my book will be right, or Dr. Hamilton's ?
It will be seen that it is an important matter to under-
stand and extend the means of diagnosing these conditions
where nearly every symptom is subjective. Into the
discussion of this I cannot enter, but would call attention
to the occasional evidence of hemianaesthesia of the body
and of the special senses as a sign of hysteria. Drs.
G. L. Walton and J. J. Putnam have especially drawn
attention to these signs, and to the occasional very
great value of the tuning-fork, aesthesiometer, and visual
tests.
The use of electricity in testing muscular and nerve ir-
ritability and degeneration when carefully applied is of
the greatest value. At the last meeting of the American
Neurological Association, I suggested that the test of
diminished or increased electrical resistance in affected
limbs might be of value in some cases. In one case in
which I tried it, the alleged lame and injured limb showed
slight diminished electrical irritability, and increased
electrical resistance on two successive trials on different
days.
The matter of prognosis, also, calls for more accurate
determination. Mr. Page is inclined to take a rose-col-
ored view of the prognosis in these cases. He thinks
that a large majority recover, and that nearly all tend to
recovery. He does not seem to have met cases like
those of Buzzard,* or where any organic disease finally
set in, as in Edes' cases, Petit's, and my own. He never
has met any serious results to vision, as have Wharton,
Jones, and Erichsen.
His views are rather too hopeful, and decidedly are not
always borne out by his own notes. " Patient improving
at last accounts," is a formula given, but it may mean
very little after all. Traumatic neurasthenia, or railway
hysteria, is generally recovered from in a great meas-
ure. In my experience traumatic neurasthenia is the
most amenable form to treatment. But it is very
often the case that the man who has had a severe ner-
vous shock is never entirely the same that he was before.
This is particularly the case if he has reached middle
life, or is of a neuropathic constitution. The very old
and the very young seem to suffer less.*
The object of my paper has been to show :
1. That the term spinal concussion is a misleading,
and often incorrect one, and that the symptoms which
are usually associated with that name are really symp-
toms of traumatic neurasthenia," hysteria, and hypochon-
driasis, associated, more or less, with symptoms of injury
to the vertebral ligaments and muscles, and to the spinal
nerves ; that, in other words, spii)al concussion is mental
shock and physical bruising.
2. That this traumatic neurasthenia is in a measure a
real disease, though it is very hard to say how much is
real and how much the patient puts on.
3. That it may be, and often is, simulated, and that it
requires the greatest care to detect skilled impostors.
4. That we need more objective tests for the purpose
of determining the existence of these subjective neuroses.
5. That the prognosis of railway or traumatic neuras-
thenia and hysteria is very good so far as steady improve-
ment is concerned, not so good as regards complete re-
covery.
6. That concussion of the spinal cord alone, followed
by temporary loss of function, or by myelitis, does oc-
cur in rare instances.
7. That, in the predisposed at least, injuries and jars
may set up chronic myelitis, without there being a lesion
of the spinal column.
8. That Mr. Erichsen has in his book on "Spinal
* Nearly twenty years a^o, Dr. T. Buzzard (Lancet, 1865 and 1867, loc
cit ) investigated the after-hisiorics of eight cases of cerebral and spinal conais-
siun. Two to four years later, none were found well, and one had died of pihlhi-
sis. The same author cites cases apparently showing that spinal concussion nuy
develop pneumonia, phthisis, imbeahty, convulsions, diabetes, aneurism. In hs
cases, however, there seems to have been an element of brain injury.
Moeli (Archiv f. Psych) relates the history of four cases of railway iojuxy
followed by mental disturbances.
3 It would be mteresting to learn of the cures which railway and other accidents
sometimes bring about. See H. Tuke's work on Body and ftlind.
* The term " traumatic neurasthenia " covers a well-recugnized sympiom-comnlex
which, in some cases, includes a lithaemic condition produced by active, healtiby
persons being suddenly obhged to lead a sedentary life.
December 6, 1884.]
THE MEDICAL RECORD.
621
Concussion" erroneously attributed functional troubles
to the results of organic spinal disease.
9. That Mr. Erichsen's book on " Spinal Concussion '*
has a strong tendency erroneously to attribute to a shak-
ing of the spine and a supposed ensuing meningitis,
symptoms really due to mental shock, peripheral injury,
or malingering.
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Nitrite of Amyl and Abortion. — Dr. Samuel W.
Francis reports that, hawig occasion to use a three-drop
pearl of nitrite of amyl to restore a feeble patient, a
young woman in attendance — and who, unknown to him,
had been pregnant some six months — was so seriously
aflfected by the vapor that she had to leave the room ;
and for several hours it was feared that she would abort.
The doctor adds : " Might it not be well, under these
circumstances, to study the action of nitrite of amyl as to
its influence on the parturient female ? "
LEAD-POISONING.*
By R. CHANNING M. PAGE, M.D.,
NEW YORK.
Paroxysms of abdominal pain and obstinate constipa-
tion are the prominent symptoms of what is commonly
called lead colic.
It is unnecessary to mention the many other well-
known names that have been applied to this condition.
Sometimes, however, it is called Madrid colic, but ac-
cording to Larry that complaint is due to atmospheric
vicissitudes and acid beverages, and not to lead-poison-
ing. The same may be said of the so-called West India
colic, if we are to believe Drs. Chisholm and Thomson,
who resided long in the West Indies. The symptoms
of lead colic had been described from early times, but
the real cause was unknown up to the time of Stock-
hausen, of Prussia, who first suggested it in a treatise
published in 1656. Afterward Henkel first proved by
actual experiment that lead and its compounds are the
sole substances which produce lead colic'
The etiology of the disease, as is well known, is the
introduction into the system of lead in some form, either
through the skin, the air-passages, or the stomach. The
various ways in which people become poisoned with lead
are well known, and need not be stated here. Suffice it
to say that painters who work inside (dryers) are affected
far more frequently than others. This is partly because
they are compelled to work with doors and windows
closed at all seasons of the year, and partly, I think, be-
cause the paint they use is mixed with turpentine, which
is a highly volatile substance. Outside painters, on the
contrary, not only have abundant ventilation, but the
paint they use is mixed with a fixed oil.
A pecson once attacked is more liable to a recurrence
of the disease, however thoroughly he may have been
cured before resuming'his occupation.
Men are much more frequently attacked than women,
for the obvious reason that they are much more frequent-
ly exposed to the cause. The season of the year does
not appear to have any influence in producing the dis-
ease. During the month of February, 188 1, 1 had more
cases to apply to me for treatment than at any previous
time, and I began to think that perhaps in cold weather
it might occur more frequently, but I have since noticed
that fully as many are affected in warm weather. Inside
painters have told me that they suffer more in summer
than winter, as they work with doors and windows closed
at all seasons. Vegetation suffers near lead furnaces,
and cattle and hogs in the neighborhood die firom lead-
poisoning.*
The symptoms of lead colic are so well known that I
need not repeat them all here, and the diagnosis is not
difficult Abdominal pain and obstinate constipation, as
already stated, are the prominent features of an attack.
The pain is sometimes intermittent ; at others it is never
entirely absent, but exacerbates and remits, so to speak.
The obstinate constipation is owing to an entirely differ-
ent cause from that which produces the general costive-
ness incident to lead-poisoning. The former is due to
the pain, as we shall presently endeavor to describe,
and sometimes fails to be overcome by drastic cathartics ;
the latter is associated with the condition of general
bad health that has been brought about, and often yields
to the ordinary laxatives.
Unless the patient is completely cured, and especially
if he continues to be exposed to the influence of the
poison, chronic symptoms appear sooner or later. He-
sides a condition of general bad health there is now
paralysis of the extensor muscles of the forearm, causing
what is commonly called drop-wrist In some cases, as
among miners, inside painters, and others who are ex-
1 Read before the Northwestern Medical and Surgical Society, New York,
Novemlier a6» 1884.
3 L. Tanquerel des Planches : Lead Diseases, by Dana, p. 34. 1848.
* Wilson : Monthly Journal of Medical Science, Edinburgh, May, 1852.
622
THE MEDICAL RECORD.
[December 6, 1884,
posed to the vapors of lead, tremors are developed
resembling paralysis agitans. In other cases arthralgia
occurs, so that the patient imagines that he has rheu-
matism of the joints. These cases appear to be com-
paratively rare, however, since of twenty-six cases that
applied to me for treatment at the Northwestern Dis-
pensary, in this city, only two had tremor, and that of the
upper extremities, and one had arthralgia. In all three
cases the lead cachexia was well marked. I have had as
yet but little experience with lead encephalopathy. The
so-called blue line along the gums was ^rst mentioned by
Dr. Henry Burton, of London, in 1840.* Since then
this sign has been insisted upon by nearly all authors on
the subject as diagnostic. It is said to be due to the
chemical action on lead of sulphuretted hydrogen gener-
ated about unclean teeth. For although the sulphide
(sulphuret) of lead is black, under certain conditions it
may, so far as I know, appear blue. Nieraeyer, how-
ever, does not mention any blue line at all, but says '
that "the gums are dark, almost slate-gray, the teeth
themselves being discolored," a condition that may
evidently exist without lead-poisoning. Flint ' says truth-
fully that the blue line is not constant, and does not
occur where the teeth are missing. Taylor * says that
mercury and the salts of silver produce this blue line,
and that in certain cases of chronic lead- poisoning
it may be absent. All the blue line I ever found existed
as frequently without lead-poisoning as with it. Bad
and unclean teeth, I am inclined to think, will produce
this so-called blue line along the gums independently of
lead-poisoning. Even if it can be due to this cause, it
would probably be absent in cases so slightly affected as
to give rise to any doubt in the diagnosis. Beyond bieing
an occasional clinical curiosity, therefore, even if it be
that, it appears to be of little or no importance.
The duration of an attack of lead colic varies in dif-
ferent cases and the way in which it is treated. Thus
under proper treatment it may last only a few hours or
days at most, whereas if let alone, or in those cases
where the patient seeks the advice of a druggist and
undertakes his own treatment, an attack may last in
varying degree of intensity for a week, or even in-
definitely. The symptoms of chronic lead-poisoning, on
the contrary, even under the best treatment, may con-
tinue for weeks and sometimes months. I once treated
a patient with drop-wrist steadily for five months before
he was dured. In other cases, undoubtedly, the dura-
tion is much longer, especially if the patient continues to
be exposed to the poison.
The prognosis is nearly always favorable except in
those chronic cases where general tremor has resulted,
or where some grave complication has arisen. Thus it
is said that a patient may die of apoplexy, or in an epi-
leptic convulsion, during an attack of lead colic, or from
supervening inflammation in some of the abdominal
viscera, although I have never seen any of these cases.
As the disease becomes chronic, defective nutrition, gen-
eral emaciation, and chronic nephritis with a fatal result
may occur.
The pathology of lead-poisoning may be said to be yet
a subject for dispute. It is quite probable, however,
that the motor cells of the anterior horns of the gray
substance of the spinal cord are primarily affected.* We
know that strychnine exalts the functions of these cells,
and it appears that lead, on the contrary, in poisonous
doses, depresses them. The muscles become affected
accordingly. Thus in certain cases there is paralysis of
the extensor muscles of the forearm, causing the charac-
teristif drop-wrist. They naturally yield first, being
weaker than the flexors. Subsequently, however, the
paralysis may extend to other muscles of the body, in-
> Medicsd Gazette, London, vol. xxv., p. 687.
3 Practice, seventh American, from the eighth German edition, vol. i., p. 619.
x88o.
* Ibid., fifth edition, p. 543. 1884. * Poisons, p. 400. 1JB75.
* Functions of the Spinal Cord, by M. Allen Starr, A.M., M.I). : American Jour-
nal of Neurology and Psychiatry for August and November, 1884.
eluding flexors also. Hence in some chronic cases we
not only find drop-wrist, but also atrophy of the flexor
muscles of the thenar eminences. There is reason to
believe that all the voluntary muscles may become more
or less affected as the disease progresses, only it is more
noticeable in the extensors. However this may be, I
believe with Romberg that the paroxysms of abdominal
pain are neuralgic in character. Constipation cannot
account for it, since a patient may be as regular in his
bowels up to the time of an attack of lead colic as could
be expected in one who was already in a state of general
bad health, and whose intestinal mucous membrane was
under the astringent influence of lead, if it had any. The
attack once commenced, however, the bowels become
markedly constipated, and as the pain increases in se-
verity the more obstinate is the constipation. The
reason of this is obvious. For as in pleurodynia, sciatica,
and similar painful aflfections muscular movements be-
come limited, so does intestinal neuralgia lessen peris-
taltic action. If the pain be very severe, as in some
cases, peristaltic action is lost altogether, so that the
bowels become absolutely motionless. Hence the ob-
stinate constipation. To give drastic cathartics in such
cases, therefore, without some anodyne, either in combi-
nation or previously administered, under the idea that
moving the bowels will cure the pain, only aggravates
the latter, and is unscientific practice. Just the reverse
of this is the truth. Allay the pain and the bowels will
often move without a cathartic. I usually give the two
combined, however, as will presently be described.
It is clear that this temporary condition of obstinate
constipation is not due to lead paralysis and atrophy of
the muscular coat of the intestines, otherwise it would be
more permanent. On the contrary there are cases with
complete drop-wrist whose bowels are perfectly regular.
Neither can pain be due to inflammation of the intes-
tinal mucous membrane, or to spasm of the muscular
coat of the bowels, otherwise, instead of obstinate consti-
pation there should be diarrhoea or dysentery. Moreover,
in those cases where post-mortem examination has been
made, no trace of inflammation was usually found, and.it
is hardly possible for muscular spasm to continue without
interruption for a week, as lead colic sometimes does.
Collections of gas in the intestines cannot account for
the pain, since they are not always noticeably present,
nor is relief usually accompanied by marked escape of
flatus, as in wind colic.
In regard to treatment, prophylaxis by avoiding ex-
posure to the cause as far as practicable is of the first
importance. Milk, as recommended by some, is a pro-
phylactic so far as it is an article of nourishment. For
that reason it is better than dilute sulphuric acid, which
is of no value and is fit only for washing the hands. It was
first introduced by Gendrin, in imitation somewhat of the
alum treatment originated by Grashuis, on the theory
that it would produce in the system the insoluble sul-
phate of lead, which was supposed to be inert. Clinical
observation, however, disproves this theory. The judi-
cious use of iodide of potassium, producing in the system
the soluble iodide of lead, which is readily eliminated,
would, I think, be a much better plan. Should lead
colic occur, however, the immediate indications are, ob-
viously, to allay pain and, on general principles, to
evacuate the bowels. Perhaps the best and simplest
method of treating lead colic is to give a hypodermic in-
jection of morphine, repeating it if necessary, and let the
bowels take care of themselves. " The employment of
cathartics," says Professor Flings* "maybe useful in re-
moving lead contained in the contents of the alimentary
canal. Aside from this object, and avoiding incon-
veniences from constipation, cathartics are not indicated.*'
A free stool, however, would have a good moral effect
on the patient, who is apt to regard the constipation as
the sole cause of his trouble. And as it will be necessary
» Op. cit., p. 543.
December 6, 1884.]
THE MEDICAL RECORD.
623
to regulate the bowels in order to facilitate the elimina-
tion of the poison from the system while improving the
patient's general condition, it is just as well to begin at
once.
Many so-called remedies have been used in the treat-
ment of this disease, including, of course, mercury and
even general blood-letting. In 1752 Grashuis, a Dutch
physician, conceived the idea that alum (sulphate of alum
and potash, or ammonia) would be a good remedy in this
disease on account of the sulphuric acid in it, which he
supposed would combine with the lead and render the
latter inert. This plan has since been followed by
various physicians, and even at this time it is mentioned
by some authors as a specific in this disease. For in-
stance, Bartholow * says : ** For the treatment of the colic
of some cachexide the appropriate remedy for the cachexia
will be necessary : for example, quinia in intermittent
colic, iodide of potassium in nocturnal colic, and alum in
lead colic." Usually about a drachm is given four times
daily in water, and in about one week or more the pa-
tient may get better or not, which he generally does any-
how. A more preposterous plan of treatment cannot
well be imagined. The same may be said of Epsom salts
(sulphate of magnesia), which is undoubtedly an imita-
tion of the alum treatment. The fact that Epsom salts
contain sulphuric acid does not make it preferable as a
sah'ne cathartic in this disease to Rochelle salts. Both
alum and salts frequently irritate the stomach, and the
former not infrequently produces vomiting.
Instead of losing time with such doubtful, if not in-
jurious means, I have used, with nearly invariable suc-
cess, a combination of croton-oil and morphine in pill
form, as has been suggested by various authors. I have
usually ordered one to two drops of croton oil and one
grain of morphine rubbed up with a sufficient quantity of
extract hyoscyamus (or some inert extract), to be divided
into three pills, one of which is to be taken eveiy two
hours until pain is allayed and the bowels move. Loomis '
uses, in addition to croton oil and morphine, one-sixth
grain extract belladonna in each pill The croton oil is
ready to act about the time that the patient is getting re-
lief from pain by the influence of the morphine, and both
indications are thus met at the same time. There are
other cathartics that might answer the same purpose if
given with opium, but I have always found these pills to
be of a very convenient form for administration, and they
do not irritate the stomach. They are as certain a rem-
edy for lead colic as quinine is for intermittent fever, and
should be freshly made up. One or two are generally
sufficient, and rarely have I found it necessary to give
the third. Of course if the case requires it a hypodermic
injection of morphine may be given at once, as has already
been said. I have never had occasion to use it. I do
not think that it would interfere with the early movement
of the bowels, and if it did I do not believe that it would
make any difference. Niemeyer ' says that ** there is no
remedy more successful than opium in relieving the con-
stipation of lead colic." A painter once informed me that
whenever he found obstinate constipation and colicky
pains coming on he would take thirty drops of laudanum.
In this way he not only allayed pain, but soon had a
copious evacuation from the bowels. By leaving off
work for a couple of weeks he was ready to begin again.
In that way he said he ''kept out of the hands of the
doctors."
The treatment should not end with curing an attack
of lead colic, however, especially if the patient goes back
to his occupation. The poison must be eliminated from
the system, otherwise symptoms of chronic lead-poison-
ing will appear in time, if indeed they have not already
commenced.
For eliminating the poison the only proper remedy is
the iodide of potassium. This drug was recommended
for the first time in this disease by Melsens, of Paris, in
> Pmctice, fifUi edition, p. xo8. 1883. * Ibid., first edition, p. 320.
' Op. cit., p. 691.
1884.
1849. ^y chemical action it produces the soluble iodide
of lead in the system, as already stated, and its undoubted
efficacy is proved by the well-known fact that it causes
lead to appear in the patient's urine.* I always give the
iodide in ten-grain doses three times daily, and have
never found it necessary to give it in larger doses. The
question arises. How long should this remedy be con-
tinued ? Where the case is not of long standing, and
where paralysis has not occurred, I believe that six weeks
is enough — it being understood that meantime the general
health must be attended to, and that the patient does not
continue to be exposed to the poison. For this reason
he should at once leave off work and endeavor to find
some other employment for the time. But where drop-
wrist has occurred, I have kept up this treatment steadily
for three months. Even in the worst cases I have never
had occasion to use the iodide any longer than that if
the patient obeyed instructions and took it steadily. I
prefer to discontinue it then and put the patient on bark
and iron. If necessary, however, the iodide may be con-
tinued for a longer period and in larger doses. I have
never tried the sulphur baths and have never found them
necessary.
Iodide of potassium eliminates lead from the system,
but it does not restore the paralyzed and atrophied mus-
cles to their normal condition. For this purpose elec-
tricity is the proper remedy, although dry-rubbing and
otherwise stimulating the muscles meantime should be
practised. At no time during treatment is the induced
(faradic, which is subdivided into primary and secondary)
current to be preferred to the constant (galvanic, contin-
uous) current. At first the former is usually of no bene-
fit, since in many cases it fails to cause the affected mus-
cles to contract. In marked cases, where all other
methods of applying electricity fail, the interrupted con-
stant current should be used^ and if necessary the poles
should be changed. After considerable improvement has
taken place the constant current without the interruptions
may be used. The strength of the current should be
about fifteen to twenty cells, according to circumstances.*
If the interrupted constant current be used, the number
of interruptions should be about six times a minute.
Placing the negative pole over the musculo-spiral nerve
in the arm (middle cervical vertebra — De Watteville) and
the positive pole successively over the motor points
(bellies) of the affected muscles of the forearm, the con-
stant current, interrupted or not as the case requires,
should be used for about two minutes for each muscle.
As the case improves sufficiently the induced may be
substituted for the constant current, although I have
never seen any benefit derived from the change. The
applications of electricity should be repeated tliree times
a week (every other day) until a complete cure is effected.
If the interrupted constant current fails to cause the
affected muscles to contract at first, even though the poles
be changed, the prognosis is less favorable. Such cases
appear to be rare, but even then a complete cure is not
to be despaired of without further trial. The applications
of electricity should be repeated. At the same time the
iodide of potassium should be systematically administered
with a view to eliminating the poison, and the general
health should be attended to. If then the interrupted
constant current failed to cause the muscles to contract,
the case might be regarded as hopeless.
Of the twenty-six cases mentioned, only four had any-
thing like a blue line along the gums. Dr. J. C. Mac-
kenzie, of this city, saw most of these cases with me. I
do not attribute the discoloration in those four cases
to the sulphide of lead. One had lead tremor of the
upper extremities. I only saw him once. There were
seven who applied while they had lead colic, and they all
recovered without difficulty. There were eighteen with
lead paralysis to a greater or less extent Of these
two were affected only in the left hand, five in the right.
1 Flint : op. cit., p. 544*
* De Watteville : Medical Electricity, second edition, p. 187.
1884.
624
THE MEDICAL RECORD.
[December 6, 1884.
and eleven had complete double drop- wrist. In those
cases where one hand only was affected the paralysis
was not so marked as in the cases of double drop-wrist,
and in one case the index and middle fingers of the right
hand were only affected, the former much more marked-
ly. Of the eleven that had complete double drop-wrist,
two were sent to hospital, not having sufficient means to
be treated outside. One of these had tremor of the
hands and atrophy of the thenar eminences. Of the re-
maining nine with double drop-wrist, eight were cured
without difficulty, but in one case the interrupted con-
stant current failed at first to cause the affected muscles
of the right hand to contract. After three weeks' sys-
tematic administration of iodide of potassium and re-
peated applications of electricity they began to respond.
The muscles of the left hand responded from the first.
There was marked double drop-wrist and the muscles of
the thenar and hypothenar eminences were much atro-
phied. This patient completely recovered after five
months' treatment. Eight of the eleven cases having
double drop-wrist stated that they noticed that the right
hand began to weaken first, and generally attributed it
to getting turpentine on that hand, while three did not
remember which hand was affected first. Of seventeen
cases of lead-poisoning during the past year reported to
me by Dr. Edwin E. Swift, through the courtesy of Pro-
fessor E. C. Seguin, of the Department for Nervous
Diseases, Manhattan Eye and Ear Hospital, in this city,
six had the so-called blue line along the gums; none
were affected in the right or left hand alone ; seven were
not affected with paralysis ; and ten were affected in
both hands. Oi' these, four are reported as having had
paralysis to commence first in the right hand and six
doubtful. Adding these ten to my eighteen, we have
twenty- eight cases of lead paralysis. Of these, seventeen
were first affected in the right hand, two in the left, and
nine were doubtful. Twenty-one cases were affected in
both hands, and the remaining seven would doubtless
have become so in time if they had not applied for
treatment. In a total of forty-three cases there was a
so-called blue line along the gums in ten, and none in
thirty-three ; a result likely to be found in an equal num-
ber of laboring people who had never been exposed to
the influence of lead-poisoning.
I do not believe that there was any local effect of the
poison on one hand in preference to the other. It may
have been accidental that more were affected in the right
hand than the left in the above-mentioned cases. Or it
may be that most of them, being right-handed, merely
noticed it in the right hand first, though it may have ex-
isted to some degree in the left hand also. For the same
reason, left-handed people might be likely to notice it
first in the left hand.
31 West Thirty-third Strkbt, November a6, 1884.
A Reminiscence of the Iniernational Medical
Congress. — On the first day of the great gathering, while
the different nationalities were flockmg into the Univer-
sity porch, they encountered on the steps a porter dis-
tributing small rectangular cards, the size and shape of
book-markers. These were received by the English and
Americans with an amount of laughter and merriment
utterly unintelligible to their colleagues of the European
continent. On these cards were printed the following :
W. C. Stinck's,
Bog Papir og Kunsthandel,
Amagertow 33,
Kjobenhavn.
Translated into what Mark Twain calls " a language a
Christian can understand," this announcement is a very
prosaic one. The first line is the respectable shop-
keeper's name, which in Danish has not its English mean-
ing. The remainder is simply " Dealer in Books, Sta-
tionery, and Art, 33 Amager Market, Copenhagen." —
M^d, Press,
VOMITING IN PREGNANCY.
By W. gill WYLIE, M.D.,
professor of gynecology in the new YORK POLYCLINIC, AND CVNSCOLOGIIT
TO BBLLSVUB HOSPITAL, NEW YORK.
In the spring of 1879 I was studying diseases of the
cervix uteri in preparing a paper upon " Laceration of
the Cervix Uteri," and I came across Dr. Edward Cope-
man's paper in the British Medical Journal of May 15,
1878, on " Dilatation of the Os Uteri for Vomiting in
Pregnancy.*' About this time I had two cases of vomit-
ing with pregnancy, and had tried many drugs with poor
success. One of these was a multipara, and I had very
little trouble in introducing the index finger of my left
hand into the os uteri up to the first joint, and it gave
complete relief. The other patient was a primapara thai
1 had treated for retroversion, and had become pregnant
while wearing the pessary. Notwithstanding that the
uterus was held in good position, the vomiting was very
severe. The cervix was pointed, hard, and had a slight
erosion of mucous membrane around the os. Without
using great force I found that I could not pass my
finger. I put her in Sims' position and with a uterine
dilator opened the cervix by gradually dilating it for a
half inch or more. There was slight pain and a little
bleeding, but no real disturbance. The vomiting was
somewhat relieved, but not cured. After an inter\'al of
four days I dilated the cervix again, going pretty well up
to the OS internum with the point of the dilator. After
this the vomiting ceased. In the fall of the same year a
case very similar to the latter came under my care ; when
I examined it I found the uterus completely retroverted
and the fundus fixed under the ilio-synchondrosis ; 1 re-
placed the uterus and kept it in position by a pessary ;
the backache and local pain were completely relieved,
but the vomiting grew worse. After trying various reme-
dies without material benefit, I dilated the cervix, and
after the second dilatation the vomiting completely
ceased. Since then, I have had many cases, some of
them extreme cases ; one where the patient was so ill
that I was sent for to bring on abortion as the last resort,
and in all relieved the vomiting by dilatation and local
treatment, except in two instances, one a patient that
left town after one dilatation, and the other was a hospi-
tal case, where the whole vulva and vagina were com-
pletely covered with inflamed and sensitive venereal
warts.
Although vomiting in pregnancy is so common that it
is one of the most reliable of all the early symptoms of
pregnancy, after a close study of many cases I am con-
vinced that marked vomiting m pregnancy is, in the ma-
jority of instances, due to an abnormal condition of the
cervix uteri. The cervix may be the seat of acute dis-
ease, or the tissues are abnormal from previous disease
or imperfect development of the cervix, and in the
majority of cases the cause of the vomiting will be found
in the cervix. Not long since a handsome, healthy young
woman came to my clinic in great distress about her
abdomen growing large — she had been married four or
five months. She said she had not had her menses, but she
could not be pregnant, for she had not had any morning
sickness, and all her friends said it must be a tumor. Oa
examination I found the cervix perfectly healthy, and the
uterus enlarged as it should be in pregnancy at the fifth
month.
Many women do not have nausea with pregnancy, and
the absence of that symptom indicates a healthy cervix,
and its presence I believe nearly always indicates local
disease or an abnormal state, the result of disease or im-
perfect development.
In looking over the literature, it is surprising how little
has been done in the way of local treatment, and how
much women have been dosed with almost every kind of
drug for it. To-day, in our best text-books on obstetrics
it is not treated as a symptom indicating disease, but
merely as one of the symptoms of pregnancy, and local
December 6, 1884.]
THE MEDICAL RECORD.
625
treatment may be referred to, but it is not advised. No
one denies how serious it often is, and that now and then
it causes death. In 1873 ^^* Alfred H. McClintock, in
a paper read before the Dublin Obstetrical Society, in
which he advocated induction of abortion as the only
thing to do in extreme cases, says that without much
trouble he had collected the record of fifty deaths
from vomiting in pregnancy, and he reports thirty-six
cases in which abortion was induced as a last resort, with
twenty-seven recoveries and nine deaths ; but he had
nothing to say about local treatment.
In a paper before the London Obstetrical Society, in
1871, on " Vomiting in Pregnancy: Its Cause and Treat-
ment," Dr. Graily Hewitt claims that the severe forms
are due to local disease, but makes the mistake of attrib-
uting it all to his hobby — displacements, flexions, and
versions.
In the London Lancet of February, 1878, Dr. M. O.
Jones, of Chicago, 111., wrote a paper on ** Vomiting in
Pregnancy," and advocated in certain cases the local ap-
plication of nitrate of silver to the os uteri as a cure.
In some cases this will undoubtedly stop the vomiting.
Dr. Copeman's paper came out in the same year. May,
1878, in the British Medical Journal^ and was followed
by a number of articles and reports of cases confirming
Dr. Copeman's views. In 1879, whep Dr. Sims returned
fi'om Europe, I had two or three cases which I had him
see as typical ones treated by Dr. Copeman's method
of dilatation. In 1880 he wrote a paper on the subject,
and it appeared in the Archives of Medicine, In tny
paper on " Laceration of the Cervix," read before the
County Medical Society, i88r, under the head of Pre-
vention, I said : " When a woman becomes pregnant it
must not be taken for granted that the neck of the uterus
is perfectly healthy, or if it is in good condition at this
time, that it will remain so throughout pregnancy."
Morning sickness to a moderate extent may occur
without any perceptible disease of the cervix, but, as a
rule, it is a pretty certain indication that there is an un-
healthy condition of the neck of the uterus. For two
years past, I have not seen a single case of this distress-
ing condition that did not yield in a few
days to local treatment, while several of my
cases were not helped by the usual reme-
dies.
If, during pregnancy, there is nausea, leu-
corrhea, or any indication of disease of the
cervix, an examination should be made and
the case treated, not only to relieve the
S3m[iptoms, but in order to get the neck
o{ the uterus in a healthy condition before
labor.
The danger of inducing an abortion by
treatment is by no means as great as I at
first supposed it would be, and I think that
with reasonable care many more cases of
abortion and premature birth could be ob-
viated than would be caused by the treat-
ment. Applications can be made to the
cervix, and for at least three-fifths of an inch |
within the canal, and tepid vaginal injec- \
tions can be safely used during pregnancy.
For the relief of nausea, I have found
dilatation of the canal for three-fifths of an I
inch to be, so far, perfectly successful in re- |
lieving this syniptom and in softening the
hardened condition of the cervix so com-f
monly associated with it, and perhaps caus-j J
ing the vomiting. Sometimes the index fin-;>
ger introduced to the first joint will answer,' but in
many cases, especially in primaparae, it is very diffi-
cult to get. even the point of the finger into the cer-
vix. I nov^ use a modified uterine dilator bent nearly
at right angles, so that not more than three-fifths of an
inch can enter the canal ; it is opened by a screw ad-
justment w^hich enables you to regulate the extent of
\i
dilatation, and its shape makes it easy to introduce it
even when the cervix is, as it often is, very high and far
back in the pelvis.* In some cases, there will be slight
hemorrhage after even moderate dilatation, and usually
one dilatation completely relieves all vomiting. After
dilatation, the neck soon becomes shorter and much softer.
I caution my patients, when pregnant, to be careful at
the time that they would expect to have their menses if
not pregnant, and to be especially careful if any of the
usual premonitory symptoms should become manifest ;
for I am satisfied that at this time abortion or premature
labor is most likely to occur.
If not successful in correcting any trouble of the cervix,
and there is any discharge, vaginal injections are to be
used, and for some days before labor is expected anti-
septic injections are used once a day. In all cases I
have the nurse come early, and if these carbolized injec-
tions are not used before, one is given at the first indica-
tions of labor beginning, and everything must be in readi-
ness for the carrying out of a somewhat modified form of
Listerism during and after labor, until the discharge
ceases. An examination is carefully made of the cer-
vix and uterus before the patient is allowed to sit up.
If obstetricians would take as much pains to prevent
laceration of the cervix uteri as they do to prevent lacera-
tion of the perineum, much would be done toward obviat-
ing this accident. They should avoid rupturing the
membranes until it is absolutely necessary. In a rigid
OS, carefully and slowly assist dilatation with elastic di-
lators. In dryness of the parts, freely use lubricants.
When the pains are very powerful, and the voluntary
efforts at expulsion violent, the latter should be con-
trolled, if necessary, by chloroform at the time of the
head passing the cervix, and one or more fingers be kept
against the head, and an effort made to regulate and
modify the more violent efforts at expulsion. Sometimes
an opportunity will be found to help the cervix over a
part of the head, where it is retarded more than atjother
points.
It is true that many cases of lacerated cervix give the
history of forceps being used, but this may be due to the
fact that those conditions which necessitate the use of
forceps are often the same in which a laceration of the
cervix would take place whether the forceps are used or
not To avoid lacerating the cervix by the use of for-
ceps, it is well to dilate the cervix as much as can safely
be done before they are applied, to decide as early as
possible that forceps are necessary, and to handle them
skilfully, adjusting them accurately, and pulling steadily
and in the right direction and at the right time. Forceps,
timely and skilfully applied in retarded labor, often pre-
vent sloughing and some of the worst forms of lacerated
cervix.
Anyone who has watched carefully the changes that
take place during pregnancy, can readily understand that
any condition of the tissues of the cervix which prevented
its softening might cause reflex vomiting. A few weeks
after impregnation the cervix becomes congested, is
longer than normal, and bluish in color; by the second
month the congestion is at its height, and the mucous
membrane may be much softer than normal, but under-
neath it hard tissues may be felt, and the cervix is not
completely softened until after the fourth month. In the
later months it may be so soft as to make it somewhat
difficult to define its outlines, and the os internum seems
to be the only thing which prevents an escape of the
contents of the uterus. A week or so before labor the
cervix may be stretched and flattened to such an extent
that it cannot be defined at alL
Infiltration, congestion, and swelling always precede this
softening process, and if the tissues are imperfectly de-
veloped, or if they are indurated by disease, or left in-
durated after the disease has subsided, it is plain that the
softening process cannot take place normally. If there is
' la my last instnunene represented by the wood-cu^ die sanew is left out, as I
find the hand a better guide as to dqpree of force needed to dilate.
626
THE MEDICAL RECORD.
[December 6. 1884,
cystic disease of the glands or follicles the softening can-
not take place normally. If there is granular erosion, or
hard cicatrices from laceration, or diseased everted tissue,
it cannot take place normally. In cases of subacute ca-
tarrh, there is often hyperaesthesia of the mucous lining,
and deeper tissues may be hardened and changed, and
thus the softening process preparatory to enormous ex-
pansion cannot normally take place, and reflex vomiting
is the result.
I admit that without further proof the above would not
be convincing, but if the following plan of treatment is
adopted, I am certain that nearly every case of vomiting,
no matter how severe, can be cured without any special
medicine being used by the mouth, except what may be
needed to regulate the bowels and keep the general
health good.
If a patient comes to me suffering from nausea and
vomiting, and there are other symptoms of pregnancy,
instead of dosing her, I make a local examination and
give local treatment for any disease of the cervix that I
may find. If there is no active disease I would dilate
the cervix, knowing from experience how frequently it
will give relief. The dilatation should not be made
when the menses would be due, nor when any of the
usual premonitory symptoms of the menses existed.
The vulva and vagina are carefully washed with a i to
3,000 solution mercuric bichloride, I then dip the blades
of my dilator in pure carbolic acid and shake off the free
acid and introduce the points into the cervix for about
half an inch, and slowly dilate until the blades separate
from one-third to one-half an inch. If there is an eroded
or everted diseased tissue present, I touch it lightly with
an applicator that has been dipped in pure carbolic acid.
I then, with a powder-blower, cover the cervix with a
thin layer of iodoform, and place against the cervix a flat
pledget of borated absorbent cotton soaked in pure
glycerine, which is to be removed in twenty-four hours
by means of a short string attached to it In some cases
there is slight pain, but in most cases no pain or real
disturbance whatever is produced. As a rule, this will
relieve nausea ; but after four or five days, if there is still
nausea, I repeat the dilatation and may pass the dilator
three -fourths of an inch, and in some cases where the
cervix is long, even more. Very rarely will more than
two dilatations be needed. In some cases the cervix is
so patulous that dilatation may seem to be useless, but
well up in the cervix tight bands may be found, and when
stretched complete relief is effected. Even where the
cervix is lacerated and apparently open, bands may be
found, and when stretched relief is obtained. It is easy
in such cases to recognize when the end of the dilator
comes against the os internum, for it is firmly closed, and
by passing the instrument until the os is felt and then
slightly withdrawing it, dilatation can be done without
much risk. In severe cases the cervix may be of a very
bluish-black color. The glycerine application causes a
free watery discharge and relieves this congestion. P or-
merly I used nitrate of silver for granular erosion, but I
found that the carbolic acid and glycerine has an equally
good effect
If there is a doubt about the amount of dilatation, the
best test is to put the patient on her back, and when the
index finger, up to- the first joint, can be easily passed
into the cervix, the dilatation is sufficient. Before resort-
ing to abortion in any case where dilatation up to the os
internum failed, I would first dilate the os internum and
wait long enough to see if it would stop the vomiting,
for this can be done in some cases without abortion nec-
essarily following.
Conclusions. — i. That nausea and vomiting, or morn-
ing sickness in pregnancy, should not be considered and
treated as merely one of the symptoms of pregnancy,
but, as a rule, as indicating an abnormal condition of the
tissues of the cervix uteri, due to imperfect develop-
ment, disease, or the effect of disease on the tissues of the
cervix.
2. That any pathological state which interferes with
the softening and other changes which the cervix un-
dergoes during pregnancy, may cause nauseal vomiting.
3. That in most cases relief is obtained by freely di-
lating the cervix uteri below the os internum, and in
many instances it is the only means by which relief can
be had. It is true that inducing abortion will give relief
but to accomplish this the cervix must be dilated.
4. That in many cases specific medicines given by the
mouth are useless, and, as a rule, should not be used
until a local examination is made and the indications for
local treatment ascertained.
THE LAW GOVERNING THE COMPENSATION
OF PHYSICIANS.
By henry a. RILEY, ESQ.,
NSW VOKK CITY.
The usual and proper performance of the duties of a
physician requires him to answer calls for medical ser-
vices at times and under conditions when it will be im-
possible, unfeeling, or at least indelicate for him to stop to
inquire who is to pay him for such services. This being
the case, it often happens that the physician runs a great
risk of losing all compensation whatever, owing to the
lack of there being any person at once legally responsible
and pecuniarily able to pay.
The legal questions at issue, and the cases decided in
the courts on this subject, will be of general interest
It will, however, be convenient to discuss only the
question of the responsibility of a private person who re-
quests medical services for some one else, and reserve
until another time the consideration of the case where
some public official requests the medical service, and the
point is whether his request binds the town or county.
It may in general be stated, that a person who calls a
physician to attend some one else is not liable for the
physician's bills. The point in the cases almost invari-
ably turns upon the question whether the person order-
ing the services acted for himself, or as agent for the
sick person, and the view the physician took of the rela-
tion between them, by seemingly holding the one or the
other liable.
The gist of the law of agency is well stated by Judge
Daly, of the New York Common Pleas Court, as follows :
" It is a general principle of the law of agency that one
who procures services to be done for another, is not him-
self chargeable as the debtor, unless he omits to make
known his principal, or erroneously supposes that he
has authority, or exceeds his authority, or expressly or
implicitly engages to be answerable either by directly
promising to pay for them if rendered ; or by doing or
saying something which justifies the person who is to
perform them in supposing that the one who applies to
him engages to pay for them." Buck vs. Amidon, Hov
Pr. Rep., 378.
An apparent exception to this rule, making the person
receiving the services liable for them, is that of a person
who requests the services for those whom he is under
some legal obligation to support or care for, such as a
husband or the father of minor children. The cases
illustrative of these points will be instructive. In Eng-
land, at least until recently, a physician could not col-
lect by law from any one for his services, they being con-
sidered as rendered gratuitously without there was an
express agreement to render compensation. A curious
case showing this, is Vertch vs. Russel, 3 Q. B., 928, tried
in 1842. The defendant here was a lady of moderate
fortune, who requested a physician to attend her brother,
who was ill and in indigent circumstances. It did not
appear by the evidence that any agreement was made in
advance in regard to the matter, but after a* time she
wrote him a number of letters in which are these ex-
pressions : " As your account against me for aiiendancc
upon my brother must be formidable, you will cWigeme
December 6, 1884.]
THE MEDICAL RECORD.
627
by letting me have it." " My wish is to present you with
some such a sum as. you would call upon me to pay you."
« I do not know what you would deem, under the cir-
cumstances, a suitable acknowledgment." *' I hope you
will at once tell me what sum will be agreeable to you to
accept from me." The physician named ;^i5o, which
the lady thought too much, and oflfered ;^^o in settle-
ment. This amount was declined and suit brought for
the larger sum. On the trial a verdict was given for the
defendant, which was afterward affirmed. The ground of
the decision was apparently that there was no original
contract and the letters were not sufficient to take the
place of such contract. From the rule preventing the
physician from bringing suit without some agreement, it
is clear that he would have had no cause of action
against the lady's brother.
In Sellen vs, Norman, 4 Carr. & Payne, 80, another
English case, where the services were rendered to a ser-
vant, it was said : '' It seems that a master is not bound
to provide a menial servant with medical attendance and
medicines during sickness, but if a servant fall ill and the
master calls in his own medical man to attend such ser-
vant, the master will not be allowed to deduct the charge
for such medical attendance out of the servant's wages,
unless there be a special contract between the master
and servant that he should do so."
- This case is an apparent exception to the general rule,
owing to the relation of master and servant. This rela-
tion in this country is not regarded in quite the same light
as in England, and it is a question how the courts here
would decide the point : there do not seem to be any
cases bringing it up.
In Boyd vs, Sappington, 4 Watts, 247, a Pennsylvania
case tried in 1835, there was a request by a father to a
physician to attend hts son, the words used being : '* Doc-
tor, you must come, I am afraid my son will die."
It appeared by the testimony that the son was thirty-
two years of age, and in business for himself. The court
held that this request raised no implied promise on the
part of the father to pay for the physician's services. If
a stranger had called the doctor it would have been a
parallel case with that of an inn-keeper, who might sum-
mon a physician hastily to attend a sick guest, and such
a person would not be liable. Under the circumstances
the court held the rule to be the same as if the father had
been a stranger. It was said '' a dififerent principle would
be very pernicious, as but very few would be willing to
run the risk of calling in the aid of a physician where the
patient was a stranger, or of doubtful ability to pay."
In Smith vs. Reddick, 5 Jones L., 342 (North Caro-
lina), the plaintiff brought suit for services as a physician,
rendered at defendant's request to a third person, under
these circumstances : Reddick was not related, it would
seem, to the sick person, but was sent by him for a Dr.
Pettis, but not finding him, called upon Dr. Smith, and
said : '* I have come after you to go and see a sick man."
Reddick did not return to the patient's house. The
court said ** the evidence tended to show that the plain-
tiff was aware of the fact that the defendant acted merely
as a messenger, and did not intend or expect to make
himself personally liable for the services which were to
be rendered to the sick man. The doctor who was in
attendance explained to the sick man, in the presence of
the plaintiff, what had occurred, that the defendant, who
had been sent for Dr. Pettis, not finding him, as the case
was urgent, had applied to the plaintiff to come in his
place, and the plaintiff would assist him in performing
the operation, which was assented to. If the plaintiff
was not willing to assist at the instance and on the credit
jf the sick man, it was his duty to have made known his
>bjections. To hold the defendant liable under these
rircumstances, would deter every one from doing the chari-
able office of going after a doctor for a sick neighbor.''
In Buck z/s. Amidon, 41 How. Pr. Rep. (New York),
;7o, we find an instructive case. The plaintiff was a dis-
inguished surgeon of New York City, and the defendant
a well-known business man^ also of the same city. The
latter received a telegram from his brother at Groton,
Conn. , saying that a surgeon must at once be sent up, as
a dangerous operation had to be performed, and request-
ing Dr. Buck's services. He then went to see Dr. Buck,
showed him the telegram, urged him to go, secured his
consent, met him at the railway depot, and accompanied
him. The operation was very skilfully and successfully
performed, and when asked for his bill Dr. Buck pre-
sented his charge of $400, in the name of the sick man.
The patient expressed his surprise at the amount, and a
short time afterward payment not being made. Dr. Buck
wrote to him as follows :
**Mr. J. C. Amidon, Groton^ Conn.:
" Dear Sir : After waiting a reasonable time without
hearing from you^ I beg leave to remind you that it is
customary to settle such accounts as mine, for professional
services rendered at a distance, promptly. Hoping it
will receive your early attention, I remain," etc.
The bill remaining unpaid. Dr. Buck brought suit not
against J. C. Amidon, but against his brother, who had
called at his office and requested the services. Dr. Buck
testified on the trial that on his arrival at Groton, he had
noticed the plain way of living shown by J. C. Amidon,
and said he felt surprised that persons in such circum-
stances should think of sending to New York for a sur-
geon. These circumstances were introduced to show
that the patient was originally regarded by Dr. Buck as
his debtor. Suit was nevertheless brought against his
brother, and the jury gave a verdict to the plaintiff for
the full amount claimed. This verdict was, however, re-
versed on appeal, the court holding that it would be
** preposterous to say, that a person who brings a mes-
sage to a surgeon from the attending physician of a pa-
tient, requesting him to come and perform an operation
upon the patient, is by the mere delivery of such a mes-
sage, chargeable with the obligation of paying the sur-
geon for his services. He is a mere agent and nothing
more, unless he communicates the message in such a
way, or does or says something that fairly warrants the -
surgeon, before he undertakes the service, in supposing
that he is the person who is to pay for it, and in this re-
spect it can make no difference that the bearer of the
message happens to be a brother of the patient." The
case of Crane vs, Baudouine, 55 N. Y., 256, occurring
in 1873, ^s a case in the New York Court of Appeals, and
is the most authoritative statement of the law as it is in
the State. The circumstances were as follows: Mrs.
Martine, the defendant's grown-up daughter, was removed
from her own house to be under her mother's personal care.
Shortly afterward, as the plaintiff testifies, Mr. Martine
called and said that the defendant (Mr. Baudouine)
wished him to call and see his daughter. Dr. Crane did
so, and saw the defendant each day during his visits, left
directions as to the proper treatment with the defendant,
and told him what to do. He further testified that he
did not know that Mrs. Martine was married until a con-
siderable time after he began his visits, and that he
charged the defendant on his books and sent him a bill.
The defendant denied that he had ever employed the
plaintiff or requested any person to call on him. The
referee before whom the case was first tried, decided in
favor of the defendant. This judgment was reversed on
appeal, but on a second appeal the original judgment was
affirmed. It was held, that the daughter being married
and with a home of her own, had no claim upon the
father, and that the fact of removal to his house for bet-
ter care did not cast any obligation of support upon him.
The father would, moreover, be naturally interested in
the condition of his daughter, be ready to receive direc-
tions as to treatment, and would be likely to repeat to
others what the physician might have said ; but none of
these things would warrant the implication of a promise
to pay for the medical services, unless the defendant was
under some legal obligation to care for the patient. It
is said that the " acquiescence of one in the rendering of
628
THE MEDICAL RECORD.
[December 6, 1884.
service or benefit to another, not entitled to call upon hira
therefor, is not equivalent to an acknowledgment that
it is rendered at his request. So far as a legal responsi-
bility was concerned, the defendant, though the father of
the patient, was a stranger to her and her necessities. "
Perhaps the only case sustaining the opposite view
here presented is Bradley vs. Dodge, 45 How. Pr. Rep., 57
(New York), where the following principle is enunciated :
" Where a person calls at the office of a physician, and
in the absence of the latter leaves his business card,
written on it, * Call on Mrs. Day, at No. 769 Broadway,'
and leaves the card with a clerk in the office with a re-
quest to hand it to the physician and to tell him to
• conae as soon as possible,' he becomes liable to pay the
physician's bill in attending upon Mrs. Day in pursuance
of such message." This case was decided before that of
Crane vs. Baudouine, 55 New York, 256, and in an
inferior court, so it can hardly be considered the law in
New York State. The case, moreover, enjoys the very
unusual distinction of being assailed by the court re-
porter as bad law in a vigorous note, from which we take
the following extract : ** Let us see how this thing works :
we will take as an illustration an almost every-day
occurrence arising in the country.
** A. B. is taken suddenly and seriously ill in the night-time
and sends to his neighbor, C. D., living in the next house
to his, to have him go after the doctor as soon as he can,
for he is in great pain and distress. C. D. jumps out of
bed without hesitation and hastily dresses himself, and
goes out to his barn and takes a horse from the stable,
and not waiting to put on a saddle or bridle, jumps on to
the horse with the halter only, puts him at full speed for
the doctor's office, some two or three miles distant. On
arriving there he finds the doctor absent from home, but
his clerk is there, and C. D. at once says, * Tell the doctor
to call on A. B., who has been taken suddenly sick ; tell
him to come as soon as possible.'
** In accordance with this message the doctor calls
upon A. B., and prescribes for and attends him profes-
sionally for several days. After a reasonable time the
doctor sends in his bill to A. B., and it not bemg paid as
soon as the doctor desires, he calls on C. D. and requests
him to pay the bill. C. D., with perfect astonishment
asks why he is to pay it. The doctor informs him that
he made himself liable to pay the bill because, when he
delivered the message, he did not tell the clerk that he
came for the doctor by the request of A. B., nor that he
acted as agent of A. B. in delivering his message. * Well,'
says C. D., * the fact was I did go at the request of A. B.,
and merely acted as his agent in delivering the message,
and I will swear to these facts if necessary.' The doctor
insists that it will do him no good if he should give such
testimony, for the law is settled on that point, as just
such a case has recently been decided in New York
under just such a state of facts, where the jury in the
Justice's Court found a verdict for the doctor for the
amount of his bill, and on appeal by the defendant to the
General Term of the New York Common Pleas, that
court unanimously sustained the verdict of the jury and
affirmed the judgment of the court below. 'Well,' says
C. D., 'if that is the law, I think I will wait a while before
I go after a doctor again as an act of neighborly kind-
ness.' "
In recapitulation it may be said, that the nearly unan-
imous testimony of the law-books is to the effect that a
person who requests a physician to render medical
services to another does not himself become liable for
the physician's compensation, unless he promises to make
such compensation before the services are rendered, or
unless he is under some legal obligation to care for the
person in whose behalf the services are rendered.
Hydrochlorate of Cocaine. — Want of space has
crowded out several interesting items concerning the use
of this drug in dentistry, minor surgery, and laryngology.
gtrogress fst plcdical Science*
Changes of Hemoglobin. — In a memoir on the sub-
stances which change haemoglobin, and especially those
which convert it into methsemoglobin, Dr. Hayem ar-
rives at the following conclusions : Haemoglobin gives
the blood its characteristic redness, preserves its re-
spiratory capacity, or, in other words, its property of
absorbing oxygen, so long as it is not chemically changed.
The most complete chemical change it can undergo is
conversion into methaemoglobin. This substance is of
a brownish color. When shaken in contact with air
it does not absorb oxygen. Potassium-ferrocyanide and
potassium-chloride both convert haemoglobin into meth».
moglobin; these substances have been used for many
years therapeutically.; recently nitrite of amyl and nitrite
of soda, which have also this property, have been em-
ployed. Hayem proposed to ascertain how it is that
considerable doses of these medicines can be adminis-
tered without leading to a change in the haemoglobin ;
also, when it does undergo an alteration, and death does
not result, by what process the blood is freed from
the methaemoglobin. Although haemoglobin dissolved
or rendered soluble by the coagulation of blood has the
same respiratory capacity as the haemoglobin of blood-
corpuscles, there is an important difference in behavior
between these two varieties in presence of the substances
which provoke the formation of methaemoglobin. The
haemoglobin of red blood-corpuscles is indifferent to the
action of those substances which convert dissolved haemo-
globin into methaemoglobin. Submitted to the influence
of nitrite of amyl vapor, the haemoglobin of blood-cor-
puscles is rapidly converted into methaemoglobin, which
reabsorbs oxygen ; whereas dissolved haemoglobin, con-
verted into methaemoglobin, is permanent, and persists
until the blood putrefies.
Weigert's Method of Staining the Brain and
Cord. — A solution of haematoxylin is prepared with water
and alcohol. The sections are kept immersed in it dur-
ing an hour, and the temperature is maintained between
104° and 122° F. They are then removed from the so-
lution, washed, and placed for three hours in a two per
cent, alkaline solution, or in one of potassium ferrocyar
nide. Afterward they are submitted to the influence of
alcohol, xylol, and Canada balsam as in the ustial method.
In sections thus prepared, nerve-fibres with a myeline
sheath are stained blue, the neuroglia pale yellow, and
the ganglia cells brown. This method throws into relief
the nerve-fibres with a myeline sheath. In preparations
of tabes dorsalis, Clarke's columns appear as light rings
against a dark background; microscopic examination
shows that a large quantity of nerve-fibres with a my-
eline sheath have disappeared.
The Treatment of Acne in the Male by ^he
Cold Urethral Sound. — Dr. Sherwell, of Brooklyn,
believes that acne and rosacea, either alone or combined,
depend in almost every instance upon conditions reflected
from the sexual or digestive apparatus, and in the rela-
tive order as given ; and that even the red face and nose
of the coachman, of whom Hebra speaks, are only inten-
sified, not created, by the external irritation of biting
winds, etc. His theory of the etiology of the more pro-
nounced forms of acne, as the tubercular variety, and rosa-
cea, is that nine out of ten cases are caused by congestioD
of the mucous membranes of some of the viscera spoken
of, probably passive in character. Why they should be
reflected upon the face he does not know, and can iom
no opinion, any more than he ,can in urticaria, which
arises, in his belief, from a more' active and ephemeral
but similar condition of the gastro-intesrinal mucous
membrane in the same relative number of cases. He
thinks it probable, however, that the mucous irritation
arid consequent congestion is situate higher up in the
alimentary canal in urticaria. In these cases, too, it
December 6, 1884.]
THE MEDICAL RECORD.
629
might be difficult to explain why the efflorescences are
almost always situate on the trunk and limbs. It will be
seen in the foregoing how far he is removed from the
Marsyan-like dogma of the Viennese school, and not
alone in respect to these diseases, but in regard to others,
as, for instance, eczemas of the infant, or child ; in those
cases he pays quite as much attention to the prima viae
as to the skin, considering the trouble as springing very
often, if not generally, from gastro-intestinal irritations.
In short, he believes in the complete analogy between
the skin and mucous membranes, and thinks their re-
flected action is much more common and important than
many authors would have us believe. He recommends
in persistent cases of acne and rosacea in the male sub-
ject, the use of the cold urethral sound, and that too with
some degree of diligence. He does not, of course, mean
by this that proper topical measures to the parts affected
are not to be used in conjunction therewith ; or that tonic,
cathartic, dietetic, and hygienic measures and principles
to meet common-sense indications should be omitted. —
Journal Cutaneous and Venereal Diseases^ November,
1884.
Elephantiasis Scroti. — ^A tumor of the scrotum,
weighing forty-two pounds, was successfully removed at
the Prince Alfred Hospital, Sydney. The patient was
a white man, twenty-four years of age, with a good family
history. He had resided where elephantiasis is unknown.
At the age of six years, an enormously hypertrophied
prepuce was removed. At the age of twelve years he re-
ceived a blow on the scrotum, followed by a painless en-
largement, and at the same time he had an attack of
chyluria. From this time on there were frequent febrile
attacks, chyluria, and gradual increase of the tumor,
until the penis was lost to view. Urinary sinuses were
also formed. Repeated examination of the blood
showed absence of filarise. Leucocytes, however, were
in excess, and the red corpuscles appeared swollen and
did not form rouleaux. The operation left both penis
and testicles, and was accomplished with little loss of
blood by the use of Esmarch's roller and india-rubber
compressor. The tumor was composed of dense white
fibrous tissues, interspersed with patches of adenoid
growth* It contained numerous enlarged blood-vessels,
and dilated lymph channels. There were patches of
thickened homy epidermis, excessive deposit of pigment
in the rete, and the stratum granulosum was increased in
thickness. — Australasian Medical Gazette, June 15, 1884.
Thk Relations of Hysteria with Scrofula and
Tuberculosis. — Professor Grosset, of the Montpellier
School of Medicine, concludes a series of articles on this
subject (^Brainy part xxvi., 1884) by the following sum-
mary : " Tuberculosis, like all other diatheses, is an es-
sentially general and constitutional disorder ; pulmonary
phthisis is but one of its manifestations. It may show
itself as a neurosis, and more particularly as hysteria.
Just as chorea is often a rheumatic disease, angina pec-
toris a gouty disease, thus hysteria may be a tubercular
disease, taking the word tubercular in its nosological, not
in its anatomical sense. In speaking of hysteria as a tu-
bercular disease, therefore, we do not assume the exist-
ence of tubercular matter in the nerve-centres, for we do
not look upon tubercles as pathognomonic of the dia-
thesiSy which exists without them, as they may exist with-
out it. The tubercular diathesis is essentially hereditary,
but may be understood only if it be followed up in fami-
lies under its various manifestations from generation to
generation. We then see how hysteria may represent
<liathesis in one of the members of the family as meningi-
tis may do in another, or Pott's disease in a third. Be-
-sides such cases, in which hysteria is the sole manifesta-
tion of the diathesis, there are others where the same
individual presents, simultaneously or successively, the
two orders of manifestations, pulmonary and neurotic.
We then witness the typical phenomena which character-
ize other Protean diseases ; the two orders of symptoms
alternate and replace one another ; or if they be simul-
taneous, influence and modify one another, until one of
them gets the upper hand. In other words, the mutual
relations between the phthisis and hysteria of the tuber-
cular diathesis are like those between the cerebral and
abdominal symptoms of typhoid fever, or between the
visceral and articular manifestations of gout. These re-
marks concerning hysteria and phthisis form but a frag-
ment of a great and true chapter concerning the relation-
ship of all neuroses, and even of all nervous diseases, to
the diatheses and general diseases. If we cannot under-
stand the neuroses without peceiving their mutual rela-
tions, if the consideration of the ^ neuropathic family^ is
indispensable for securing a clear grasp of the phenomena
of neuropathology, it is yet necessary to go still further
and complete all this by the conception of the * diathesic
family^ outside of which we shall find nothing but isola-
ted, scattered, meaningless units. Hitherto the neurotic
element of hysteria has much too exclusively attracted
attention; the diathesic element has not been met by
treatment. Though we have no specifics against diatheses
(except in the case of syphilis), we nevertheless have va-
rious rational means to deal with them. The treatment
of rheumatism is not that of scrofula, nor that of tubercu-
losis. Hence, it is not indifferent to know whether a
neurosis depends upon the one or the other constitutional
state. Three categories of indications will have to be
fulfilled in the full treatment of hysteria. First, the ac-
tual symptoms are to be met with appropriate measures,
such as ovarian compression, ether inhalations, sesthesioge-
nous applications, etc. Second, the state of the nervous
system, which is to be modified at any cost : hydrother-
apy is often useful ; change of surroundings ; electric-
ity, galvanic, but more especially static. We have little
faith in the bromides. Third, the diathesis forms the fun-
damental ground for a chronic exhibition of arsenic, sul-
phur, alkalies, chloride of gold, mineral waters, etc. Un-
less these three orders of indications be duly taken into
account, our measures, based upon a superficial diagnosis,
must necessarily remain sterile."
Rational Treatment of Typhoid. — Dr. Rial, under
the above title, describes in L Union M/dicale^ Septem-
ber 28, 1884, a method of treating typhoid fever, which
consists principally in the administration of lar^e doses of
subnitrate of bismuth. He claims that it dismfects the
intestinal canal, and prevents putrefactive changes by
fixing the sulphuric acid, free or nascent, and changing it
into an insoluble, inoffensive, black sulphate. Any sub-
stance employed to prevent or destroy putrefaction in the
intestinal canal must be a powder insoluble in the digest-
ive tract, inoffensive in itself, but having a real chemical
action on the putrid matter. The subnitrate of bismuth
he has found to fulfil these conditions better than any
other agent. He administers it as follows : The first day
he gives a starch clyster containing two and a half
drachms of the bismuth, and by the mouth, from five to
six drachms within an hour in divided doses. The second
day this same quantity is given by the mouth, but the
doses are extended through the twenty-four hours. This
is continued daily until toward the end of the treatment,
the dejections, becoming less and less black, contain
particles of the white bismuth, when the daily dose can
be gradually decreased. The diarrhoea is usually arrested.
If constipation exists, sulphate of soda in doses of 3 ij* to
3 iv., by the mouth or rectum, may be given. He cites
three successful cases in children where he has employed
this treatment.
PsYCHE-OLOGY. — One day last summer two boys were
rowing past the Riverside Hospital, on Blackwell's Isl-
and. As they passed close to the Board of Health boat
lying at the wharf, one of them rested on his oars, and
spelling out her name, P-s-y-c-h-e, pronounced it " fish.''
** That don't spell * fish,' you great idiot,*' shouted the
other, " that spells * Physic ;' it's the doctor's boat."
630
THE MEDICAL RECORD.
[December 6, 1884.
The Medical Record:
A Weekly yournal of Medicine and Surgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD & Co.. Nos. 56 and 58 Ufayette Place.
New York, December 6, 1884.
RECENT CONTRIBUTIONS TO GASTRIC
PATHOLOGY.
A NUMBER of contributions have of late been made to
the subject of gastric disturbances. It was in 1878 that
Leube first (after Beard) called attention to the subject
of nervous dyspepsia, so-called ; and a little later Julius
Glax and R. Burkart wrote monographs regarding it.
Leyden and Krafft-Ebing have also called attention to
certain gastric neuroses found in spinal irritation and as
the result of onanism. Quite recently Leube, at the
meeting of the Congress of Internal Medicine, brought
up the subject of nervous dyspepsia again, and both he
and Edinger have made important contributions to the
methods of diagnosis. Clifford Allbutt's Gulstonian
lectures are most suggestive as regards the subject of
gastric neuroses, while very recently Bouchard, S6e, and
Mathieu have written upon gastric dilatation, and
Glazinski and Jaworski have made an interesting pre-
liminary communication upon the physical methods of
diagnosticating stomach disease.
A perusal of the various communications above re-
ferred to leads to the impression that great strides have
been taken in gastric pathology during the last five
years. But it is equally certain that almost no definite
and fixed results have yet been obtained. It would be
useless to attempt any generalization, therefore, as regards
the present state of our knowledge of the pathology of
the subject We shall, however, present to our readers
an analysis of some of these later contributions since
they show that certain lines have been laid down,
working along which, pathology will in no long period
of time reach something positive as well as practi-
cal
Professor Leube's paper {Centralblatt fur Klinischt
Medicin^ January 5, 1884), in which he lays down rules
for the examination of the stomach contents, has already
been given in substance in this journal.'
A preliminary contribution covering similar ground,
by Drs. A. Glazinski and W. Jaworski, of Cracow, has
appeared in the Berliner Klinischer Wochenschrift of
August 18, 1884. These authors have made examina-
tions of the action of the gastric juice in two hundred
cases of health and disease. Their method was as fol-
lows : the person experimented upon, having fasted till
the stomach was empty, is given the white of a hard-
> The Mkdicai. Record. April xa, 1884, pw 405.
boiled egg and loo c.cm. of distilled water. He then
remains quiet for an hour and a quarter.
At the end of this time, by means of a soft syphon
tube, 100 ccm. of water are introduced into the stomach,
and the whole contents syphoned out and preserved for
examination. More water is then introduced and re:
moved in order to be sure that nothing remains in the
stomach cavity. If the digestion was healthy the follow-
ing conditions were found :
1. No pieces of albumen were returned through the
syphon.
2. The stomach juice is clear or opalescent. It is
neutral or feebly acid in reaction, and contains, as shown
by methyl-violet, no hydrochloric acid.
3. The filtrate gives none of the reactions for synto-
nin or peptone. On the addition of a little hydrochlo-
ric acid it digests, in less than seven hours, a very small
piece of albumen.
4. Under the microscope the fluid withdrawn shows
no ferment-organisms or free nuclei.
If, despite the fact that the foregoing conditions are
found, some dyspeptic trouble is complained of, a second
examination is to be made, but in this case, only half
an hour after the ingestion of the albumen. In healthy
stomachs at this time the following ought, according to
our authors, to be found :
1. About half of the albumen comes away with the
fluid, and the pieces will be found swollen and their bor-
ders frayed.
2. The filtrate is strongly acid and shows the presence
of HCl. It also shows the presence of syntonin and
gives a moderately strong reaction for peptone.
3. The filtrate digests albumen without the addition <A
any acid.
4. Under the microscope no ferment-organisms or
free nuclei are visible.
On the other hand, in pathological conditions it is
found :
• I. That the albumen ingested remains in the stomach
much longer than an hour and a quarter, and this is what
most frequently occurs. Sometimes the albumen is
swollen and partly digested; at other times, when the
gastric juice is absent, there is hardly any change.
2. The stomach contents are cloudy, of a yellowish-
green or bluish color, and mixed with greenish-yellow
flocculL
At the end of half an hour the stomach contents are
sometimes much more strongly acid, sometimes less acid
than normal. After an hour and a quarter, the filtrate, if
any albumen is present, is usually more acid than normaL
After half an hour the filtrate may or may not contain
peptone. After an hour and a quarter the fluid contains
peptone. Microscopic examination shows the presence
of mucous corpuscles colored with bile-pigment and fer-
ment-organisms, or free nuclei.
The authors advise that after examinations have been
made in the manner laid down by them, tests of the vital
capacity and contractility of the stomach according to
the method of Jaworski should be made* If no physical
signs of disturbed digestion exist, then the gastric symp-
toms must be referred to a nervous basis.
The article of Leube upon nervous dyspepsia, read at
the Congress of Internal Medicine, has been given in de-
December 6, 1884.]
THE MEDICAL RECORD.
631
tail in The Record (May 31, 1884, P* 621). The attempt
to giv^e to nervous dyspepsia a distinct nosological status
was not received with favor, and it may be stated that
German writers generally show an inclination to abandon
the term nervous dyspepsia for a broader one.
The article by Professor Bouchard is in the form of a
lecture delivered before the Hospitals Medical Society
of Paris on June 13th, and is most suggestive. He
claims that gastric dilatation is of very frequent occur-
rence. Indeed he finds it in one case out of three. But
the main part of his paper is devoted to an attempt to
explain the so-called reflex phenomena of dyspepsia as
well as many of the concomitant symptoms, by assuming
that the fermenting food generates poisons and causes a
true toxaemia.
In dyspepsia then we must look out for a toxaemic
condition, just as in renal disease we must watch for
uraemia. This view, which was suggested first, we believe,
\>ySer\2Ltox{Beriiner Klinischer Wochenschrifi^ 1868, No.
4), is based by its author on a study of two hundred and
twenty cases. It is in harmony with the present ten-
dency of pathologists to reduce to the minimum the re-
flex and sympathetic processes as causes of disease.
An important contribution to gastric pathology has
been made by Professor Germain S^e, and Dr. Albert
Mathieu in the Revue de Mtdecine, Nos. 8 and 9, 1884.
These writers treat of atonic dilatation of the stomach,
which they consider as does Bouchard, to be a very com-
mon condition. They believe also that many of the
cases of ** nervous dyspepsia," as described by I^eube,
should really come under this head. Atonic dilatation
is not produced by mechanical detention, as is usually
stated, but rather it is the result of an adynamic state of
the general system. The pathology of gastric dilatation
\& thus comparable to that of certain forms of cardiac
dilatation. Both are expressions of myasthenia. During
and after adynamic fevers, or as the restdt of profound
anaemia, or in conditions of mental depression, gastric
dilatation occurs. Psychical causes are quite prominent'
in this affection, ranking only second in frequency.
MM. S^e and Mathieu give an elaborate array of cases,
and discuss the symptomatology and diagnosis.
The chief symptoms are flatulence, pains, vomiting,
constipation, dyspepsia, and reactive efifects upon the
general system.
In the matter of diagnosis the authors are inclined to
treat with derision some of the " fantastic " methods of
physical exploration suggested by the Germans. Careful
comparative examinations by percussion, after the intro-
duction of eiOfervescing powders, and then of pure water,
are specially recommended. Percussion without these
measures cannot of itself decide the diagnosis. Auscul-
tation and succussion furnish also some corroborative
signs. For the many details of this valuable paper, how-
ever, we must refer our readers to the originals.
TETANUS INFANTUM.
In considering the comparative frequency and great fatal-
ity of the first kinesio-neurosis of life, it seems strange
that we have not more definite and satisfactory knowl-
edge of its etiology. The mere fact that many very '
diverse causes have been given by good observers shows
pretty conclusively that no one of them is always opera-
tive. The most satisfactory way to reach a correct con-
ception of this peculiar condition is first to consider the
nervous status of the infant in general, and then in each
case to carefully seek out the immediate irritant. What,
then, constitutes the physiological predisposition to this
severe and fatal tonic spasm of early infancy? The
peculiar anatomical arrangement of the nervous system
at the beginning of life is well known, and explains the
physiological phenomena seen at this time. Although
the brain is comparatively large in size in proportion to
other organs, its condition is immature. It is soft from
the imniense amount of water it contains, light in color,
with the gray substance and convolutions undeveloped.
As a result the functions of the cerebrum are largely in
abeyance. The spinal cord, on the other hand, the first
formed nervous structure of the foetus, has at birth a
large development and a marked functional activity. As
reflex action is one of the principal characteristics of the
cord, it follows that in early life this kind of activity must
overshadow all voluntary forms of motion. Moreover, at
this time reflex action is not strongly held in check by
cerebral inhibition. As the infant grows and the gray
matter and convolutions become more developed, its
nervous system reaches a condition of more stable
equilibrium ; but during the first days of life, with active,
readily irritated spinal centres, and a watery brain incapa^
ble of much controlling energy, the only wonder is that
reflex motor disturbances are not more frequently seen.
There are many ways in which irritants may act on the
unstable nervous S3rstem and produce a tetanus. In this
affection, as in eclampsia, the source of disturbance must
be carefully sought out and, if possible, removed. Irrita^
tion and inflammation of the umbilical vessels or um-
bilicus have frequently been noted by different observers.
Sometimes retained meconium in the intestines appears
to be the source of trouble. A condition of personal and
domestic filth, the infant being allowed to remain sur-
rounded by its fermenting excreta, or even impure air
and various atmospheric disturbances, have seemed to be
sufiicient to upset the impressible nervous system of the
young infant and bring on a tetanic spasm. Sometimes
violence to the cerebro-spinal axis during parturition is
the starting-point of trouble ; in other cases meningitis
may be found. One of the late ideas is that an adherent
prepuce may be a factor in causing the disease. There
are thus many general and local agencies that, under
favorable conditions, are capable of acting on the easily
excited spinal cord and motor nerves, to the production
of general or partial tetanus. Perhaps the most remark-
able contribution to the literature of this subject appeared
in 1846, in an article by Dr. J. Marion Sims in the
American Journal of the Medical Sciences. This distin-^
guished writer then first advanced the idea that tetanus
was caused by a centric disturbance due to pressure from
an inward displacement of the occipital bone. This dis^
placement may at times be very considerable ; again it
may bd so slight as to require careful examination for its
detection. The pressure exerted by the occipital or
parietal bones extends itself on the pons, medulla ob-
longata, and cord, with a resultant spasm. This explana^
tion of the phenomena of infantile tetanus did not at the
time meet with a favorable reception by the profession^
and has since been almost forgotten. There has lately
t
632
THE MEDICAL RECORD.
[December 6, 1884.
appeared a monograph by Dr. J, F. Hartigan, in which
the original views of Dr. Sims are again advanced and
fortified by cases and autopsies. Histories are given of
forty-nine cases in all, some seen before and some after
death. Six of these cases that were seen early recovered
under postural treatment. In twenty-five cases autopsies
were made, in which a generally uniform post-mortem
condition of congestion and extravasation of the brain
and cord was found. No other internal lesion was ob-
served except at times an engorgement of the lungs.
Finally, eighteen cases are given in which a history was
obtained after death, although some were seen before the
fatal result, but where post-mortem examination was not
allowed. One factor in connection with all these cases
that the author especially brings out is that there was
very generally found a depression of the occipital bone.
The relation between the arrangement of the bones ex-
ternally and the extravasation found internally at the
autopsies, has afforded occasion for generalizing as to
trause and effect, also to confirm the idea advanced so
long ago by Dr. Sims. If we have here the only true
pathology of tetanus infantum, the treatment of this fatal
malady will be simple and frequently successful. Although
a depressed occipital bone is physiological . during the
parturient state, if it persists after birth it soon becomes
pathological, and must be relieved by reducing the dis-
placement and thus saving the cerebro-spinal axis from
injurious pressure. Unfortunately, however, while literary
medicine is often so beautifully exact and satisfactory,
clinical medicine is full of doubt and perplexity. Many
excellent observers have not been able to discover any
noticeable displacement of the occipital bone at the be-
ginning of the disease, and if seen later it may sometimes
be simply the result of brain shrinkage accompanying the
rapid general atrophy. The tetanic spasm, by greatly in-
terfering with respiration and circulation, would naturally
produce the congestions and ecchymoses found on post-
mortem examination in the cerebro-spinal axis and lungs.
Doubtless a primary inward displacement of the occipital
bone may at times be the first source of trouble. We
think, however, that in tetanus infantum different cases
may have widely different causes. When wc remember
the favorable development of the infant's nervous economy
toward such an accident, varying doubtless in different
individuals within wide limits of susceptibility, it seems
scarcely probable that only one universal cause is always
operative. Any injury or trauma should rather be looked
upon as a possible exciting cause and endeavor be made
to remove it. Certainly the medical treatment of this
disorder is extremely unsatisfactory.
ARTIFICIAL HYPNOTISM IN PHYSIOLOGY AND THERA-
PEUTICS.
The so-called mesmeric sleep — artificial or induced hyp-
notism— although it can scarcely be said as yet to have
found a well-recognized place in the domain of either
physiology or practical medicine, and though still looked
upon with disfavor and contempt by very many in the
profession, is being made the subject of earnest study —
as it was by the late Dr. Beard in this country — by sev-
eral eminent physiologists in England^and on the Conti-
nent.
Dr. Laugley, of London, has written a very enter-
taining and scientific article on the subject in the Pop^
ular Science Monthly (October, 1884); the late Pro-
fessor Las^gue, of Paris, was an accomplished hypnotist,
devoted much attention to the subject, and used to tuni
it to account in the treatment of his hysterical patients;
Emile Yung, who has lately written a very entertaining
book on " Normal and Pathological Sleep," has a long
chapter on mesmerism, in which he details the advan-
tages which may be derived from it in hysteria ; Charles
Richer, in his "Clinical Studies in Hystero-Epilepsy,"
speaks highly, as a means of treatment, of " Braidism"
(so named because Braid, of England, in 1843, was the
first to give this artificial sleep a scientific exposition);
and Heidenhain, of Breslau, has experimented much in
hypnotism and written much about it
At a recent meeting of the French Association for the
Advancement of Sciences, Dr. Bernheim, of Nancy, well-
known as a clinician and the author of a work on prac-
tical medicine, read a report of three cases of chorea
cured by what he calls "the hypnotic suggestion." He
remarks that f* suggestion " in the hypnotic state may
" realize " (cause) paralysis, contraction, anaesthesia, and
divers functional troubles, and that it is natural to dfr
mand if this same " suggestion " may not in certain cases
cause such functional troubles to disappear. Dr. Bera-
heim affirms that for many years he has obtained a great
variety of excellent therapeutic effects, and often sub-
stantial cures by the " suggestive " method, " which
consists, during the provoked sleep, in affirming the dis-
appearance of the different subjective symptoms experi-
enced by the patient."
Drs. Heurot and Voisin, at the same meeting, related
cases in their practice where they had derived benefit
from "suggestion." Voisin's patient was a female, "de-
bauched, coarse, and lazy." He utilized the hypnotic sleep
"to calm this hyper-excitation, mental and sensorial!"
During the mesmeric sleep — which he kept up for ftom
ten to twelve hours a day — he improved the opportunity
' to suggest to the patient " ideas of obedience, of submis
sion, of decency, and exhorted her to useful labor." He
also encouraged her to learn by heart entire pages from
some moral book. " A complete transformation was ef-
fected in several months ! "
Whether or no, in accordance with the above example*
it shall yet be found that the best way to reform the im-
moral and criminal class is to hypnotize them and " sug-
gest*' morality, subordination, and decency, remains for
future sociological experimenters to decide.
Dr. J. N. Langley, in the Popular Science Monthly^'
who thinks that " there is no doubt that mesmerism may
help and sometimes cure persons suffering from certain
diseases of the nervous system," ably treats the subject
from a physiological standpoint. He thinks that "as
disease may be the result of either over-activity or of
under-activity of any part of the central nervous system,
it is reasonable to suppose that a beneficial effect will
follow the employment of a method which allows us to
diminish or increase this activity at will.** This is, he
thinks, a side of the question " which is of the greatest
interest both to physicians and to physiologists, since it
bears directly upon the problem of the influence of the
1 Popular Science Monthly, October, 1884: Tbe Phyiiolo«ical Aspect of Met
December 6, 1884.]
THE MEDICAL RECORD.
633
nervous system on nutrition. " There is good reason to
believe that, by directing attention strongly to any par-
ticular part of the body, the nutritive state of that part
of the body naay be altered. The determination of the
actual way in which this is brought about is full of difficul-
ties, but the following way is, at least, theoretically pos-
sible. It may be that the nerve-centres connected with
the tissue in question are made unusually active, and
that they send out nerve-impulses of a trophic nature,
that is, impulses which directly control the nutrition of
the tissues. The alteration in the tissue caused by
its changed nutritive state — its changed metabolism —
raay conceivably be beneficial or detrimental to the whole
organism ; it may give rise to a diseased state, or get rid
of an existing one."
This writer's explanations of the phenomena of hypnot-
ism are summed up in the following propositions : " The
primary condition of mesmerism is an inhibition of a par-
ticular mode of activity of the cortex of the brain, in
consequence of which the will can no longer be effective.
This inhibition may be brought about by nervous im-
pulses coming from certain sensory nerves, as those of
sight, touch, and hearing. It may also be brought about
by impulses or changes arising in the cortex itself. The
inhibited cortex, and probably also inhibited lower centres
of the brain, send out inhibitory impulses to all other
parts of the central nervous system, so that the mes-
merized male or female gradually passes into a state of
torpor or even of complete anaesthesia. The phenomena
of the excitable stage of mesmerism are proximately de-
termined by the possibility of exciting any particular
centre alone, without exciting at the same time other
centres, by which its activity is normally controlled. In
lower animals this stage is less marked, in consequence
• of a greater interdependence of the various parts of the
central nervous system.
^eiws at tlije WSizzU.
M. Pasteur is going to Rio Janeiro to study yellow
fever.
Our National Sanitary Patrol. — ^The Revenue
Marine, consisting of 38 vessels and 950 officers and men,
covers the entire coast of our country and acts when
needed as a sanitary patrol.
Epidemic of Hybrophobia in Vienna. — A cable re-
port, under date of November 26th, states that a veritable
epidemic of hydrophobia is prevailing in Vienna, Already
eighty cases have been reported.
Epii>kmic Dysentery. — The daily papers have had
much to say regarding a fatal epidemic disease which has
been attacking the inhabitants of Eastern Kentucky and
Western Virginia. We are informed that the disease is a
dysentery caused by drought, filth, and bad food. The
stories regarding it have been much exaggerated.
A Hermaphrodite. — A person calling herself by the
ambiguous name of Madame Duplex de Balzac, informs
the profession that she (or he) Jhas just arrived from
Europe and ** intends to exhibit herself (or himself) before
any person who is anxious to enlighten himself on natural
science." Dr. William T. Lusk certifies that Mrs.
Duplex de Balzac is an example of hypospadias. The
generation organs are those of a male, but the general
habit of the individual (and it is this which makes the
case an interesting one), is of the feminine type. The
bones are small, the wrists and ankles are slender, the
breasts, the hair, the complexion, and the voice are those
of a female. Dr. William M. Polk states that it is a case
of true hermaphroditism.
Money for Physicians' Widows. — The forty-second
annual meeting of the Society for the Relief of Widows
and Orphans of Medical Men, was held last week, and
the following officers were elected by ballot : President
—Dr. S. S. Purple ; Vice-Presidents— Drs. J. L. Vander-
voort, J. W. Warner, T. F. Coch ; Treasurer— Dx, John
H. Hinton ; Board of Managers — Drs. G. M. Smith,
T. C. Finnell, Afred C. Post, John J. Mulhan, Willard
Parker, Isaac E. Taylor, and W. T. White. The report
for the year ending September 12 th, showed that the
actual expenses of maintaining the Society were but
$47.85, while the total receipts from various sources were
$50,016.33. There was paid for annuities to 14 widows '
and 8 orphan children $4,252.50, and invested in bonds
and mortgages $37,000. The total assets of the Society
on September 19th, were $143,447.96.
Suicide of an Insane Physician. — A Danish adven-
turer calling himself Dr. F. De Castro, committed sui-
cide in Newark last week. His last will, dated February
12, 1883, read as follows : ** After death I request that
my body shall be given to the Chicago Medical College,
or any medical college in the city of Chicago, upon the
following conditions : After the body has been serving its
medical purpose for science, the entire skeleton be placed
in the museum with the following inscription on the brow
of the skull : * This is the skeleton of F. De Castro, the
great traveller and linguist, who died a martyr for those
he loved so well.* If the Chicago colleges will not ac-
cept the body, any medical college in the city of New
York which will comply with my request may take charge
of it."
The President's Message. — In his annual message,
referring to the subject of cholera President Arthur
states that, pursuant to his proclamation, the Secretary of
the Treasury prohibited the importation of rags and the
admission of baggfige of immigrants and of travellers ar-
riving from infected quarters. '^ Lest this course may
have been without strict warrant of law, I approve the
recommendation of the present Secretary, that Con-
gress take action in the premises, and I also recommend
the immediate adoption of such measures as will be likely
to ward off the dreaded epidemic and to mitigate its
severity in case it shall, unhappily, extend to our
shores."
Regarding the Army Medical Museum, he says : " Dur-
ing the past session of Congress a bill to provide a suita-
ble fireproof building for the Army Medical Museum and
the library of the Surgeon- General's office received the
approval of the Senate. A similar bill, reported favor-
ably to the House of Representatives by one of its com-
mittees, is still pending before that body. It is hoped
that during the coming session the measure may become
a law, and that thereafter immediate steps may be taken
to secure a place of safe deposit for these valuable col-
lections, now in a state of insecurity."
634
THE MEDICAL RECORD.
[December 6, 1884
NEW YORK NEUROLOGICAL SOCIETY.
Stated Meeting y November 11, 1884.
W. J. Morton, M.D., President, in the Chair.
SPINAL CONCUSSION AND THE NATURE OF ITS SEQUELiG.
Dr. C. L. Dana read a paper on this subject (see p. 617).
Dr. W. a. Hammond said : I agree with Dr. Dana in
the view that there is such a thing as concussion of the
spinal cord. I agree with him further in the doctrine
that it is difficult for us to tell by the symptoms what the
exact nature of the injury is that the patient has suffered.
But this fact, I think, remains, that there is some injury
which the spinal cord is capable of suffering, which is not
of such a serious character as to cause death, and which
is not accompanied by any injury to the bones, or to the
muscles or ligaments. That after all is the practical point.
Dr. Hammond then related the history of two cases of
spinal concussion in which he had been called as an expert.
The first patient suffered from muscular weakness, spinal
pains, severe general nervous symptoms, and walked
with a peculiar paralytic gait. There was no positive
evidence of organic disease of the spinal cord. He rc-
'ceived large damages, but he still, twenty years later,
suffers from his trouble. The second case, of a somewhat
similar character, made a better recovery, but still walks
with a cane. Dr. Hammond thought that this patient
suffered from some organic disease of the cord.
The speaker referred to the first case which occurred
in this country in which a post-mortem was made. The
patient was a physician, who fell on the ice and suffered
from the symptoms of antero-lateral sclerosis. On post-
mortem, sclerotic patches were found throughout the
spinal cord. I think traumatism may give rise to spinal
affections without there being any palpable lesion of the
soft parts, or of the bony structures, or the ligaments.
Only a few days ago I was called to the upper part of
the city to see the case of a woman who had fallen
through a dumb-waiter, a fire-escape, or something of
that sort, which barely allowed her to pass in a doubled-
up form. She fell a distance of thirty-five feet, by meas-
urement, into ihe cellar, striking on her buttocks upon
the hard ground. There was no fracture. Three months
after the occurrence of the injury I saw her. She was
still suffering from paraplegia and incontinence of urine,
and paralysis. Hypochondriasis and hysteria had also
developed to an extreme degree. Yet she is rapidly re-
covering. I do not think there was any hemorrhage in
her case, because I do not think hemorrhages of the
spinal cord are recovered from. She suffered not only
from motor troubles, but from sensory disturbances like-
wise ; also from atrophy of her limbs, showing that the
injury involved the whole segment of the cord, both the
sensory and motor parts. Yet she has recovered, and I do
not believe, therefore, that in her case there was any de-
struction of the cord. I cannot conceive that there
could have been anything else than a concussion.
Now, I would like to know what it is that happens
sometimes when patients lift heavy weights and they feel
something give way in the back, and after that they lose
the use of their limbs, gradually waste away, and become
paralyzed. I have seen such cases. I remember one
which came under my observation some years ago, where
the patient, endeavoring to lift a heavy window, got his
hand in place and lifted with all his might, and suddenly
felt something give way in his side. There was tio in-
jury there that could be detected by an examination ;
there was no fracture ; no dislocation. And yet that pa-
tient gradually lost the use of his legs. What was that ?
Probably a rupture of some of the fibres of the cord or
of the membranes of the cord ; certainly an injury to the
cord and not of -the bony structures about it.
I cannot conceive of the possibility of getting rid of
these facts, that the spinal cord is capable of suffering
injury, without there being any detectable lesion of the
soft parts, or of the bones, or of the ligaments, or inter-
vertebral substance, and that the trouble inside of the
spinal canal involves the spinal cord.
Dr. Corning related the history of a case in which
partial impotency persisted long after the accident, and
in which there were marked suicidal tendencies. There
was not a trace of external injury.
Dr. Rockwell considered that organic or structural
conditions seldom followed concussion of the spinal
cord. Notwithstanding the fact that at the present time
he had under his care a young person who was suffering
from typical myelitis, ascribed to a severe fall followed
at once by incomplete paraplegia, which had gone on to
complete paraplegia, it seemed almost incredible to
him that a person could have severe concussion of the
spine without the cerebro-spinal system in its entirety
being involved. In concussion there seldom could be a
rupture of the vessels or nerve-fibres without causing
death. The majority of cases of concussion that had
come under his observation had presented symptoms as
manifold almost as those of neurasthenia. The progno-
sis was generally good, and the best remedy time. The
concussion that follows the blow of a bullet was fre-
quently observed during our war.
Dr. Hammond added a case of railway injury, in which
there was no lesion whatever of the external parts appar-
ent; but there were ocular disturbances (which he thinb
are rare, as Dr. Dana says). The patient had double
vision ; congestive disks ; bird vision ; and suffered from
the symptoms of neuro-retinitis, but they eventually dis-
appeared. He had marked paralysis of the nerve on one
side. He was injured in the upper part of the cord ;
suffered from loss of power in his arms and legs. Had
head symptoms, was hypochondriacal and hysterical He
recovered a very large sum from the railway company.
Dr. Weber remarked that from what he had seen and
read upon the subject, it seemed to him that Page was
certainly stealing a march upon Erichsen with regard to
the views which Erichsen entertains. As I said in a
paper read before this Society upon another subject, the
more we shall get into the habit of including a thorough
examination of the cord and its meninges in post-morteno,
the more our knowledge upon the demonstrable lesions
will increase, and the less we shall hear in the course of
time of concussion of the spine. I do not mean to say
that there is no such thing as concussion of the spine, but
I believe that a good many cases which are considered
as such are not (in spite of the symptoms pointing that
way) dependent upon concussion of the spine, bat
upon concussion of the brain. Now, the case which has
been related by Dr. Hammond, of the woman falling
down a dumb-waiter, thirty-five feet, and striking upon
her buttocks — taking it for granted that there was a com-
plete absence of all injury to the soft parts and to the
ligaments and bones, as Dr. Hammond stated — is a case
more of concussion of the brain than of concussion of
the spine.
Dr. Hammond : To this I can only say, that there
was no cerebral symptom — that was my understanding-^
in the early part of the disease.
Dr. Weber : There may have been, though. .'
Dr. Hammond : I understand not She never lost
consciousness for a moment. I cannot conceive of con-
cussion of the brain without loss of consciousness.
Dr. Weber : In an abstract of a large number of
papers that I read recently, in a volume of Virchow-
Hirsch's /ahresberUht, I found that most of the lead-
ing physicians abroad believe that many cases of so-called
concussion of the spine, without any injury to the soft
parts or the bones, really depend upon concussion of the
brain. Some years ago 1 saw, at the St. Francis Hospi-
tal, a case precisely like the one related by Dr. Ham-
mond. It concerned a young man who had been trying,
on a wager with some other man, to lift heavier and
heavier weights. While still straining he suddenly felt
something give way in his back. He fell down and lost
the use of his limbs. When I saw him, two weeks after the
December 6, 1884.J
THE MEDICAL RECORD.
63:
accident, there was paraplegia of the lower limbs and a
paralytic condition of his bladder. He remained in the
hospital for some time, and failing to improve, he was at
. leDgth discharged. I look upon this case as one of apo-
plexy of the spinal cord.
Dr. Roberts viewed the diversity of opinions as show-
ing a manifest want of conception of fundamental ideas
in regard to the subject. He considered the problem
one ot physics ; dealing with a material object, and the
forces acting upon it Among the queries propounded
occurs this one : Is it possible for the spinal cord to be-
come concussed without injuring any of the hard parts
of the vertebrae ? Now, what is a traumatism ? What is
concussion ? The effect of blows upon hard, and upon
soft or elastic substances, is very different. And we have
every reason for believing that this eflfect differs upon the
hard and soft parts of the human body ; for the effects
considered from the physical standpoint are the same, so
far as the mechanical effects are concerned. Vibratory
impulses, we find, are conveyed with much greater facility
along a hard wooden beam than they are through the at-
mosphere. Now, if we saw the beam in two and inter-
pose an elastic buffer, it will be found that the sound will
not be transmitted ; a physical barrier to the transmission
of these impulses has been interposed. I may summarize
two or three principles which underlie this problem by
stating that the harder the substance and the more direct
its continuity the greater is its conductivity to jars, to vi-
bratory impulses, to injuries. When a human being is
thrown from a vehicle and strikes upon the ground, the
force with which he is carried is represented by the
rapidity with which the body is moving and its bulk.
Now, it took a certain amount of force to set his body in
motion, and it would take an equivalent amount of force
to arrest that motion. When he strikes against the
ground this motion is arrested; he must meet with a
force equivalent to that which is represented by his mo-
mentum. The force is thus annihilated and is expended
upon the jarring. How can these vibratory impulses
affect the individual? We must examine the hard and
soft parts, and the attitude of tl\e individual, and from
our examination of inert physical substances, we have
reason to go at once to the bones for the channel through
which these vibratory impulses can most readily be con-
veyed. The attitude of the patient at the time the blow
is received is an important factor in determining the
probable amount of injury. If the skeleton is erect and
the patient is thrown forcibly upon his feet in the erect
attitude, the resulting injury will be much greater than it
would if he were in a crouched position. But then, in
this steoping attitude, the limits of the elasticity of his
muscles, and the limits of the elasticity of the flexure,
may be exceeded when the blow is so severe as to over-
come /the power of the muscles to maintain this protect
tive attitude. Another important factor to be consid-
ered is : whether the patient be fat or lean, for we are
dealing with a physical problem. Elastic substances are
always the materials with which we annihilate or absorb
vibratory impulses. Strike a living skeleton, such as
you see in our museums, forcibly upon the breast, and
you produce a shock that may result disastrously ;
whereas a blow upon a well-developed pectoral muscle
is received with impunity.
Dr. ORi«ME Hammond did not think that there was
any question at all that cases of congestion of the spine
and symptoms referable to the cord alone did appear after
the spine had been in receipt of an injury. He thought
the question of the greatest importance was : What is the
nature of the trouble with the spine ? whether it is a
morbid change which goes on progressively, or whether
it is simply functional.
Dr. W, O. Moore stated that there were two classes
of cases met with in ophthalmic practice. The first is
that which me meet with merely upon the receipt of an
injury to the spinal cord, viz., ca<ies in which there was
an increase in the circulation of the optic papillae, and
cases where there was decided neuro-retinitis. In one
case there was atrophy of the optic nerve. Whether
concussion took place as claimed by the history of the
patient he could not decide, but two cases in his history
book give decided evidence that concussion of the spine
did occur. In one case the patient fell from the second
story, striking mostly upon his feet and buttocks. His
general health was at once affected, and he Aras not able
to attend to business thereafter. He had more or less
neurasthenic symptoms. Two years later failure of vision
was noticed, from ordinary atrophy of the optic nerve.
Color-blindness then appeared, first for red, then for
green, then for yellow and blue, and then it was entirely
gone. After ten years' failure of vision he is now totally
blind, and has no symptoms of locomotor ataxia or any-
thing of that sort. In the other case, the patient was
thrown from his seat on a wagon and fell in a heap, with-
out striking any particular part of the head. Atrophy of
the optic nerve took place on one side. The case was
under observation about two years, until finally the
atrophy was complete and there was total blindness of
that eye. In the other eye he did have for several days,
two or three weeks after the injury, a flushing of the optic ,
disk. At one time it was feared that it would likewise
become atrophied. The last case was considered by
some eye men rather a case of concussion of the optic
nerve. That there is a connection between the symptoms
of the spinal disease and the eye, there is no doubt. We
see it causing atrophy of the pupil, and later on contrac-
tion of the pupil. He thinks there is no doubt a connec-
tion between the sympathetic and medullary fibres which
go to the pupil. In these cases there was no direct blow to
the eye nor head, and no laceration or contusion of any
soft parts.
Dr. Dana considered Dr. Moore's cases extremely
interesting, because they contradict entirely the very
positive statements of Mr. Page in his work on " Injuries
to the Spine." He then read the following letter from
Dr. Allan McLane Hamilton regarding this subject :
"While I have been satisfied, from a very varied experi-
eitce in court and elsewhere, that the vast majority of
those who claim compensation for railway injuries are
malingerers and impostors, I still find that nervous shock
is quite apt to develop a * railway hysteria' in some,
which is in every sense a real disease, and is due to actual
physical disease, and in others to the development of a
morbid expectant attention. It is unnecessary to adopt
the extreme opinion of either Erichsen or Page. There
is in sixty per cent, of the cases an intermediate condition
in which subjective symptoms are the only ones. In
some of these cases the hemiansesthesia, lately described
by Putnam, may be detected by abstract tests. In others
we are furnished with vague yet unmistakable disorders
of a functional yet serious nature. I strongly disprove of
the injustice of juries who manifest an assinine disregard
of scientific proof, and award enormous damages because
of prejudice against corporations, simply upon the story
of the plaintiff. On the other hand, there are cases turned
out of court when some award should be made. I do
believe that in the great number of well-established cases
of railway hysteria, that moderate verdicts should be ren-
dered, just as they are in punitive libel cases when the
peace of mind has been hurt. In the majority of cases
no speculative damages should be allowed upon a simple
personal relation of symptom."
Dr. J. G. Johnson, of Brooklyn, asked Dr. Moore
whether, in the case he mentioned, there was a connect-
ing train of symptoms that showed that the blow did the
injury.
Dr. Moore replied that the man who fell from the
wagon was seen thirty-six hours after the injury. He
had failure of vision from the very beginning; in that case
he had flushing of the optic nerve, and decided symptoms
of neuro-retinitis. This gave way after a period of two
years, and atrophy developed. In the other case, where
the patient fell from one story to the other, the patient
636
THE MEDICAL RECORD.
[December 6, 1X84.
had double optic atrophy, which of course may have
arisen from other causes. As far as I can get the evi-
dence from Dublin, it was a decided case of concussion.
As he remembered the case it began some years after the
accident
Dr, Johnson asked if there was an early history of the
case?
Dr. Moore said there was not. It came on some
years after this trouble. He had no evidence of locomotor
ataxia.
Dr. Harwood remarked that, out of a number of
sufferers from railway accidents, he recalled two cases
of spinal concussion. He advised the patients and the
corporation to settle amicably. But his advice was not
taken in either of the two cases, and they finally went to
trial. His view was sustained by the jury, and a ver-
dict was secured for the plaintiff ; but what is very un-
usual in these cases, as he had observed them in suits that
had been brought, these patients ultimately died from
the results of their injuries.
Dr. Adams observed that most of the cases that showed
any injury after a concussion generally showed it in the
lower extremities. Many cases of Pott's disease were
recognized by most authorities to be caused by concus-
sion. It would appear that the milder injuries caused
ordinary concussion of the spine, and more severe ones
Pott's disease.
Dr. J. G. Johnson : I only wish to say that a fact which
would militate against any such hypothesis as that is, that
in the case of vertebral caries, which, according to this
theory, is supposed to result from more severe injuries,
we have none of the symptoms of spinal concussion.
I merely want to ask the neurologists one question, and
that is, if they have ever seen a case of spinal concussion
in a railway employee (who takes the risk of the convey-
ance) without the physical symptoms showing either
meningitis or myelitis? These anomalous symptoms,
which are laid down by Erichsen with such fluency of
language, I have never seen in my twenty-five years' ex-
perience as a railroad surgeon. I have never seen a
single railway employee have them. And for this reasons
Dollars and cents do not enter into the consideration of
the railway employee. He has every inducement to get
well ; he has his family to support ; if he does not get well
in a reasonable time he goes out, and somebody else takes
his place. On the other hand, the man who has been on
a railway train, who has a good shaking up and a terrific
scare, has no object in getting well. The company has
got to pay him roundly ; it has to pay him for his loss of
time ; it has to pay him for his suffering, both mental and
physical ; it has to pay his surgeon also ; his surgeon has
an unknown quantity to handle ; he has something to
treat that the patient does not understand. If the patient
has a broken leg he knows what he has got, and the doctor
cannot come in and discuss spmal concussion symptoms,
and all that. He has seen broken legs before ; has had
cold extremities, vomiting, exhaustion, and so on ; but
he has not had the scare of a doctor coming in, feeling
up and down his back to see whether it pains him, and
asking him whether he can stand on his legs, and going
through all those symptoms, that unknown quantity which
they J know so well to do. He has not had some
confrere to come in and suggest some more doubts. The
doctor, in a good many cases, is hungry, and the big cor-
poration may pay his bill. He has to examine that back
often ; he has to find out just what these doubtful things
mean ; and the patient, having it iterated, and reiterated,
and reiterated again, begins to believe himself that there
is something terrible the matter with him. He does not
dare to go out and take a little fresh air and exercise
(which, as my friend, Dr. Hammond, says, is the best
thing to restore the nerves), because a railway man might
be around and spy him using his limbs. He gets morose,
and has no object to get well, because that suit is not
settled. He begins to have some motor disturbances ;
he has these profuse sweats, etc. When you come to
take that kind of disturbance — of expecting to recover
from the company — out of the question, they get well
very frequently with indecent haste.
In regard to the claim of destruction of the virile
power, which has been alluded to here by one of the
speakers this evening, that is one of the most common
allegations that have been made in these cases. I re-
viewed that point in a paper on " Railroad Injuries," read
before the Medico-Legal Society.
I think there is no doubt that serious lesions of the
spine and spinal cord do occur as the result of railway
concussions. We have also mingled with it a large
variety of other symptoms. When a train is suddenly
stopped, the patient is violently thrown backward and
forward, shaking up all the viscera, and the whole sym-
pathetic nervous system, and the other organs suffer.
Added to that this terrific fright and the utter helpless-
ness of their condition and the effect upon the mind is
something which is severe. But with all that, when you
come to consider the fact of compensation, we find these
cases so much aggravated that I do not think any physi-
cian is right to go into court and swear that the patient
has disease of the spine unless he has the physical symp.
toms, and he should not simply rely upon the statement
of the patient, who is interested to make matters as bad
as he can.
I saw an extremely interesting case some years ago,
which was the result of a railroad disaster on the New
York Central Railroad. The patient, a lawyer in this
city, was in a sleeping-car when it was derailed. He was
thrown down an embankment, and I saw him the next
day but one. He was in such a condition that he was put
on a return train and came to Brooklyn. There were
marked contusions of his shoulders, abdomen, breast,
back, and hips, showing that he had received a violent
rolling over. Some thirty-six hours from the time of his
injury his limbs began to fail him. He could walk if he
was watching whejre he placed his foot. If he walked,
and you would speak to him, he would tumble over.
That increased, and paralysis of sensation followed, un-
til it extended up as far as the ninth dorsal vertebra.
There was no shamming' about it. I tried electricity ; I
burned his legs with matches, and things of that kind,
which he would not have been able to stand if it had
been felt Dr. Ranney saw the patient on behalf of the
New York Central Railroad Company. The case was
settled at about twenty thousand dollars. Dr. Ranney
based his claim that he would recover on the fact of there
being no wasting of the hmbs. I at that time held the
opinion that it was an extravasation of the blood around
the substance of the cord ; I did not think it could be in
the pith, from the fact of its being limited to the nerves
of sensation and not of motion. After that he recovered
entirely and thoroughly, and his own ph}'sician and my-
self, who examined him subsequently, failed to find any
indication of any physical pain whatever. He recovered
in about six months.
There is a point of interest in regard to these spinal
cases alluded to by Erb, that I would like to hear about
from the neurologists. Men long connected with railway
trains, as engineers, after a while lose their snap ; they
don't get in on time. Finally they show a complete
nervous break-down. Erb alluded to this particularly.
What change has probably taken place in the old railway
employees where there is this nervous break-down, which
shows itself by a lack of courage and nerve-power, and
by gradual failure ? These cases are becoming extremely
interesting in Germany, where the railway employees are
allowed damages, just the same as passengers on trains,
and this old, worn-out railway nervous system is being
put in as a spinal concussion.
Dr. Birdsall thought that these cases were a good
deal rarer than the general impression would lead one to
conclude. The prominence which the work of Erichsen |
had been given, had led people to look for effects of
spinal concussion, and to talk about them a good deal
December 6, 1884.]
THE MEDICAL RECORD.
637
more than was really admissible from the facts of obser-
vation.
He had been led to conclude that many patients
had, previous to their concussion, what was ordinarily
termed neurotic or neuropathic constitution.
It had been stated by Dr. Weber that many of these
symptoms were cerebral. He thought they were devel-
oped, probably, as much from fright as from concussion
of the spinal cord. On the other hand, he would not be
understood as denying the existence of functional, and
perhaps something more than mere functional, disturb-
ances of the cord from concussion. There was a good
deal of difference between a single shock, a severe shock
due to railroad accident, and the continual jarring which
went on in a man in the cab of an engine. It seemed
to him that in a healthy person, while the former might
be readily recovered from, the latter, even of a more
moderate character, would prove more injurious, and he
should certainly be very careful about classing them in
the same group.
Dr. Johnson said the length of time, doubt, and un
certainty of the cases are important elements to consider.
As far as a surgeon for a railroad company being affected
in his evidence by outside influences is concerned, he
would find that truth was the first essential; he would
not hold his appointment for twenty-four hours when his
company was satisfied that he was not truthful. When
we are sent to investigate a case on behalf of the cor-
poration, we make as thorough and as exhaustive an ex-
amination as it is possible with the knowledge that we
have, and our report is made in writing and goes to the
company's office, with everything bearing against us as
well as bearing for us. If we misrepresented that case,
and ^his is shown in evidence in court when the case
comes to trial, it shows that we are ignorant or dishonest,
and our walking tickets are prepared. No man can
hold his position as a surgeon for a company who is not
honest, because they pay by dollars and cents on an
opinion, and if it is not truthful they do not want it.
Luther R. Marsh, Esq., said he was bewildered by
the medical phraseology, which transcended that of the
legal guild in the magnitude of its technology. If he
were to ask the doctors the difference between "the
whole of an undivided moiety, and the moiety of an un-
divided whole *' they would understand his meaning, but
they could hardly use a neurological sentence that would
not send him to his dictionary. When quite a young
man he had written an article for a local newspaper,
without regard to sense, but simply for the cadence of
the sentences. The beginning of that article, which the
good people of the town puzzled over with their glasses,
ran as follows : "Pedaneous are the gorgeous geoponics
of saginated hoplites." But while his big words were
without meaning, theirs were not. He had gleaned from
them that the spinal cord was certainly capable of in-
jury, without any necessary harm to its bony or other
coverings. The paper haid seemed to him eminently
impartial, steering a midway course between what the
transportation companies might call the extravagances of
Erichsen, and what suitors for personal injuries might
class as the perversions of Page. He had also learned
that when a man had been concussed, as the doctors
called it, in the nerve-centres, he was never thereafter
fully himself again. He did not, however, consider the
word " concussed " felicitous. He was pleased to learn
from Dr. Roberts that it was a good thing to be fat, and
have a shield between one's self and harm. He con-
sidered this well shown in Dr. Hammond's case, where
the woman was saved by landing on the voluminous
natural cushion of her seating apparatus. The insinua-
tion which had been made, that the consideration of the
fee could swerve the testimony of the physician, he repu-
diated, and said that he stood up for the honor of that
sacred calling which deals with the mysteries of human
life, and which he had always held in reverential regard.
From Dr. Dana's paper he had seen that he agreed with
Charles Sumner, that what a man most needed was back-
bone ; that wonderful combination which enabled a man
to stand erect, and firm, and unbending, in all emer-
gencies.
Dr. Dana : I only wish to say with regard to one or
two points that Dr. Johnson raised, first, with regard to
employees not suffering from this concussion of the spine ;
I think he will find the symptoms of concussion of the
spine, as delineated by Dr. Erichsen, were described by
Dr. Abercrombie twenty-five years before Erichsen
wrote, and his classification of spinal injuries would hold
good now.
He was ver}' glad that Dr. Johnson brought out the great
importance of the malingering element, because it is an
important one. Every one knows there is a prejudice in
juries against corporations. There are certain courts
where a corporation cannot get a verdict any way, at least
so the lawyers say. Therefore, I think that in justice we
ought to keep that fact of malingering before us as being
a very important one indeed.
As regards the trouble brought on in locomotive engi-
neers, he thought that Dr. Johnson would find that Dr.
Rigler, whom he quoted in his work on " Injuries of the
Spinal Cord,'* has devoted a good deal of attention to this
disease, which he calls sideromorphophobia, or fear of
railways. He did not think that it was due to continu-
ous concussion alone, because it occurred in locomotive
engineers more often than in the other employees. It
seemed to the speaker that the constant strain and anxi-
ety which these engineers suffered were very important
elements in producing it.
In conclusion, he said that there was a class of cases
that had not been much referred to in the discussion.
Nervous and hysterical women, when frightened or in-
jured on a railroad, were very liable to go to bed, and, un-
der the sympathizing influence of friends and the prospect
of large damages, develop a functional paraplegia with
symptoms of spinal irritation. It was often hard to tell
the exact amount of real injury for which the company
was responsible. As a rule the companies were unjustly
mulcted, though sometimes the trouble became a real
one.
NORTHWESTERN MEDICAL AND SURGICAL
SOCIETY.
Stated Meetings November 26, 1884.
E. C Harwood, M.D., President, in the Chair.
lead-poisoning.
Dr. R. C. M. Page read a paper on the above subject
(see p. 62 1 ), the discussion on which was as follows :
Dr. Flint : In a meeting of this kind it is more pleas-
ant for me to listen to others than to occupy time by my
own speaking, but I will with pleasure make a few re-
marks on the paper. In the first place, as to the name : it
seems to me to be a misnomer to call it colic at all, as the
colon is not specially involved. It has nothing to do with
a spasmodic affection. I consider that it is a neuralgic
affection. One curious fact in connection with it is the
different way in which it manifests itself in different per-
sons as regards their susceptibility. Out of any given
number of persons who are exposed to it, a certain num-
ber only are affected by it. I cannot explain this, and
do not know that any one has ever been able to do so.
Another curious fact in connection with it is its limitation
to the extensor muscles. I do not know that that has
ever been satisfactorily explained. In many cases the
flexors remain unaffected. I think Dr. Page will recol-
lect a hospital case, many years ago, which well illus-
trated that fact. It was before the elevators had been
introduced, and as it was necessary to take the patients
firom the lower wards up to the amphitheatre, it was
sometimes a puzzle as to the manner in which we could
do this. I had a patient who had the drop-wrist to a re-
markable degree, and he had no power over the exten-
638
THE MEDICAL RECORD,
[December 6, 1884
sors. We wanted to take another patient up-stairs, and
we took this patient, who was a very muscular man, and
raised his hands and gave him a good grasp, which was
necessary. Having done this, he took hold of the pa-
tient and carried mm up three or four flights of stairs
easily enough. That case illustrated to a remarkable
degree, I think, the fact that the paralysis was limited to
the extensors, and that the flexors were exempt. We
And sometimes the same paralytic effect on the toes, as
connected with their extensor muscles. I can hardly
agree with the writer of this paper as to the importance
of the diagnosis of the blue line. I cannot cite statistics,
but I am accustomed to find it more often than in the
data which he has mentioned. It seems to me that in a
large number of cases we can distinguish the blue line
readily from the discoloration mentioned, and it is often
a very useful point in diagnosis. I have been led to
think that we neglect the examination of the urine too
much. I was led to think so by a case which I saw sev-
eral years ago with the late Dr. Stoner of this city. It was
a case in a child, seven years of age, who had complete
paralysis of the flexor muscles of the forearm. I told Dr.
Stoner that it was a case of lead-poisoning. He said :
" It looks like it, it is true, but it cannot be, for the rea-
son that it is impossible. This child has not been ex-
posed to the causes which produce lead-poisoning. There
is no possibiUty of the child having be6n exposed to lead."
The child at that time did not show the blue line. It
occurred to me to have the urine examined. We did so,
and sent a specimen of it to Dr. Doremus, and the ex-
amination showed conclusively the presence of lead. My
impression is that it is now a common practice to examine
the urine. It is not a difficult one, surely. The question
that arose after we had found out this much was. How did
this lead get into the child? After a great deal of in-
quiry the facts in the case seemed to be these : The child
had been accustomed to play with leaden soldiers, and
it was recollected that he was accustomed to have them
in his mouth. With respect to treatment, I am very
glad to be able to concur with the writer of this paper.
It seems to be a fact that the treatment formerly con-
sisted of the stereotyped drastic remedies. The writers of
some years ago followed a course of treatment that con-
sisted in the administration of cathartics. The French
writers on the practice of medicine seem to observe that
method of treatment. I think it is also followed by the
English practitioners more than by us. I cannot think
that it is a rational method It is injurious to a greater
or less extent. I believe the plan that has been indicated
in the paper is to relieve the pain by opium, and pay no
attention to the bowels, except so far as the moral effect
is concerned, or to obviate too prolonged a siege of con-
stipation, and then to eliminate the lead from the sys-
tem by the iodide of potassium. I cannot, however, but
be somewhat skeptical as to its eflficiency. I have given
it in a great many cases without any good effect appar-
ently, and have been ready to think sometimes that we
overestimated its value. In a large number of cases
where the iodide of potassium has not been used, they
have ended about as well as if it had been used. I
simply throw out that idea, however, and do not give it
as an opinion.
Dr. Little : In what way is the lead rendered vola-
tile by turpentine ? I believe that Dr. Page in his paper
said that the use of so much turpentine rendered the
paint volatile, and consequently led to its inhalation by
the painter. I did not know that any of the paint that
was commonly used was volatile enough to be thrown oflf
with the turpentine and inhaled by the patient. It has
often occurred to me that lead-poisoning is produced
by the use of lead as an astringent. I have never
yet seen a case, however, in which lead-poisoning was
produced by the use of lead in this connection. Maybe
its use, however, is not continued long enough. I have
never seen any bad efifects from the use of the iodide of
potassium.
Dr. Blumenthal : I think Dr. Page has pretty thor-
oughly covered the whole field. The recognized treat-
ment certainly is that which he has just outlined. It
consists, in the first instance, in the relief of pain by an
opiate treatment in conjunction or not, as the case may
seem to demand, with croton oil, and after that the
elimination of the lead from the system by the iodide of *
potassium. If I am not very much mistaken there often
remains a good deal of atrophy after all traces of lead
have been eliminated from the system. I have often got
a great deal of encouragement by the use of nux vomica
and strychnine while using electricity. The tonic treat-
ment that has been pointed out is certainly one in which
we all agree. There is a vast amount of difference in
the systems that absorb the poisons — that is, some will
absorb more poison than others before they present synp.
toms — and consequently there must be a great deal of
difference in the treatment that may be necessary to pro-
duce relief. The most probable reason, to my mind, why
the right hand is affected oftener than the left is that it is
used more by the workman than the other. His right
hand is very frequently covered by the paint, and cons^
quently there is more opportunity given for the absorp-
tion of the lead than in the case of the left hand. Before
the patient feels the effect on his system his limb is
likely to be affected. Of course where he is left-handed
the reverse would be the case. The point which Dr.
Flint raised is a very important one, and that is that we
are too likely to look after other symptoins and not pay
enough attention to the urine.
Dr. Baruch : I have used very frequently an appli-
cation of white paint to burns, just as the painters do,
quite as thick as I could use it — ^just thick enough so
that I could handle it properly. I employ it in connection
with about two per cent, of carbolic acid. I have used
this in connection with dilute sulphuric acid lemonade,
and I would like to have the question settled here
whether there is any necessity of giving a patient !his
sulphuric acid lemonade while h« is being treated with
applications of white paint.
Dr. Wood : One idea has struck me in Dr. Baruch's
address, and that is whether we do not run a great risk,
when we use white paint for several days over a large
surface, of producing lead-poisoning ; and yet I must say
that I have never come across such a case. I have, how-
ever, seen the symptoms of lead-poisoning from the use
of lead internally. I once saw a case that was called
chronic diarrhoea in one of our soldiers of the late war.
He had been taking the acetate of lead, and when he
came North he continued it for some time ; how long I
am not able to say. When he returned he had symptoms
of lead-poisoning. I believe it is generally conceded
that the drastic purgative treatment of this disease is not
cariied out to the extent that is recommended in foreign
works. There is no question but what the soothirg
opium treatment conduces more to the recovery and
convalescence of the patient than a cathartic treatment
Dr. Dessau : I was quite surprised to hear the writer
of the paper speak so disparagingly of the treatment
which consisted of the use of alum and sulphate of mag-
nesia. I have used hypodermic injections of morphine
to relieve pain also, but the constipation was relieved by
the use of sulphate of magnesia and alum, and it was
used in very large doses. I used about a drachm of the
sulphate of magnesia every three hours. Soon afterward
the bowels were relieved. After this the patient is put
upon the iodide of potassium treatment, but the consti-
pation in my case was certainly relieved by the use of
alum and the sulphate of ma^esia, because no other
treatment was resorted to. This particular patient had
been constipated for a week.
Dr. Fuller : I cannot say anything with regard to
the treatment of the case, but the other day I had the
opportunity of observing the disease in children of very
tender years. The author of the paper did not mention
particularly the occurrence of the aiffection in children,
December 6, 1884.]
THE MEDICAL RECORD
639
but only spoke of adults. The cases I saw were the
youngest I had ever taken notice of — they were only
three or four years of age ; they were undoubted cases
of lead-poisoning. The history of each case could be
traced exactly: Their father was a painter, and the
closet in his house contained paint; they contracted
the disease from this. They had a great many forms
of treatment applied to them without any appreciable
results. They were afifected both in the upper and lower
extremities.
Dr. Leonard : I saw an unusual case while in the
Adirondacks, which was diagnosed as lead-poisoning.
After the case had existed for some months it was cured
by the use of the iodide of potassium treatment. The
patient was a hunter who had tried to stop chewing
tobacco, and to accomplish this he had put a bullet into
his mouth, and the disease was attributed to this cause.
Dr. Little : I would like to ask concerning the use
of sulphuric acid as a prophylactic. Dr. Bsuiich has
said that it should be used as a lemonade. I have not
had any experience, but I have noticed that it has been
recommended by the authorities.
Dr. Flint : There has been one topic which has not
been referred to, and that is the relation of lead-poison-
ing to gout. It has been asserted that gout has followed
where lead has been introduced into the system. I would
like to ask those present if they have ever known of a
case where they could attribute gout to lead-poisoning.
Dr. Chamberlain : Somethmg has been said about
hair-washes as productive of lead-poisoning. I recollect
a case twenty-five years ago where the disease was pro-
duced by this influence. I think it was published in
Wood's New Remedies, All of the preparations men-
tioned contained lead, and evidence was brought forth
to show that lead-poisoning was produced by the use of
these preparations.
Dr. Fruitnight : It has been emphatically stated that
other muscles besides the extensors are affected. Last
summer a patient presented himself at my office. He
worked in Western Pennsylvania. I asked him to strip
himself, and on removing his clothing I observed that
the muscles of the upper extremities were all more or
less atrophied. He had to be assisted in taking off his
clothing. He had worked a year in the establishment in
which he was at that time employed. I endeavored to
find out every possible cause for his condition, but was
forced to the conclusion that lead was the cause. I
questioned him with regard to other men working in the
same establishment, and he told me that a great many of
them had suffered from the drop-wrist. Another patient
was a printer who had been a very adept workman, but
It last he became unable to fulfil his duties any longer as
readily as he could before. His muscles became weak,
ind he had pains and was beginning to waste away. I
iaw him about two months afterward and noticed that
here was no reaction to the electric current either farad-
c or galvanic. I kept him under the usual remedies
or about six months without any effect.
Dr. Page, in closing, said : I have very few remarks to
uake. In regard to Dr. Flint's cases, where the iodide of
otassium failed, it is very likely that the patients did not
ake it regularly and continued to be exposed to the in-
action of the poison. In that case they were hardly fair
ests. With respect to the blue line, I have nothing
lore to add. With regard to the remarks of Dr. Little
n the volatilizing of the paints by turpentine, I would say
lat I do not know that such is the case, but believe it
) be so. With regard to Dr. BlumenthaVs remarks con-
eming nux vomica, I would say that of course it may be
[ven. J thought that I had included it in my remarks
n the general treatment. With regard to the remarks
f Drs. Baruch and Wood about painting burns with
unt, I do not think that any burn will last long enough
\ cause the patient to be poisoned with applications of
ad, but if it does, I do not think the sulphuric acid will
revent it. I have known painters to take it regularly
three times a day and yet be the worst poisoned men of
the lot. In reply to Dr. Dessau^ I believe that the mor-
phine cured the patient. My point in regard to Epsom
salts and alum was that the theory of sulphuric acid acting
on the lead in the system is of no value. Concerning
Dr. Fuller's remarks about children, I must say that I
never came in contact with children that had lead- poison-
ing, but that all my cases were adults. Drs. Chamberlain
and Harwood spoke of hair-washes as a cause of lead-
poisoning. I would say that they are said to be a frequent
source of lead-poisoning with ladies. There is no way
to stop it that I know of except for yie ladies not to use
them. You cannot make people stop manufacturing
them. Consequently if ladies will use cosmetic slops and
greases they must expect to suffer the consequences.
With regard to what Dr. Fruitnight has said about the
flexors, there is no dbubt in my mind but what the flexors
become affected in time. The reason I think why it does
not become more marked in the flexors is because the
patient stops work in time. He is not exposed to the
poison any longer and is undergoing treatment. I know
of no case of gout traceable to lead- poisoning.
Dr. Wylie read a paper (see p. 624) on " Vomiting in
Pregnancy," the discussion on which was as follows :
Dr. Baruch had seen one death, in consultation,
resulting from vomiting in pregnancy. He had, however,
seen death imminent in three different cases of pregnan-
cy, in which he had been forced to produce abortion.
He had noticed at that time, after introducing a bougie
into the uterus overnight, and allowing the remainder to
coil up in the vagina, that there was no vomiting. On such
occasions there would be no vomiting, and labor would
not come on for two or three days. Two or three hours
after the bougie was introduced the vomiting would
cease. He attributed this to the fact that the connection
between the foetus and the uterus was disturbed. This
dilatation of the cervix was a dangerous precedent, and
should be resorted to only in desperate cases. He had used
it in one case successfully ! When producing abortion
he would first dilate the cervix before going on. The
pathology was not at all clear. He had two cases of
sterility. In both he had succeeded in curing the sterility
by dilatation. In one of these cases he had a very bad
case of vomiting, in fact as bad as he had ever seen not
to be dangerous.
Dr. Powell would like to add one case in support
of Dr. Wylie's view. It happened three of four years
ago. He met Dr. Wylie on the street, and told him that
he had been called in to see a woman suffering from
vomiting, and gave the history of this case. It was the
fourth pregnancy, and she had never reached full term,
and premature labor had to be brought on every time to
save her life. At Dr Wylie's suggestion the cervix was
dilated at once. Dr. Powell went by no especial rule,
simply dilating it until the woman said that it pained her
a little. His finger passed in for about half an inch.
The result was marvellous. She went to sleep within
half an hour afterward, and never had the least trouble
with her stomach. She has been pregnant and delivered
at full term a second time since.
Dr. Fruitnight said that his brother, the late Dr.
William Fruitnight, had a case in which the obstinate
vomiting was overcome by means of dilatation of the
cervix.
Dr. B. F. Dawson had no experience in it. He had
not dilated a cervix in five years, except for the purpose
of curetting the uterus. He would like to ask Dr. Wylie
how one dilatation will correct disease of the cervix.
It seemed to him a dangerous proceeding.
Dr. Wylie did not claim that it necessarily cured the
disease, but that it took off the tension and served to re-
lieve any hardening that prevented the tissues from swell-
ing. Dilatation counteracts the disease. He had some
doubts, the same as Dr. Dawson, years ago, when he first
tried dilatation. These had been dispelled, however, and
six weeks ago he was bold enough to dilate here, in his of-
640
THE MEDICAL RECORD.
[December 6, 1884.
fice, the wife of one of the ministers from Washington, and
relieved her vomiting almost at once, which had resisted
much dosing by the mouth.
Dr. Dawson thought that cases had been heard from
where vomiting occurred simultaneously with pregnancy,
and continued right along through it. We all know the
effects of warm water, glycerine, and iodoform, and as
Dr. Wylie uses these in making his applications, may not
they be" the means of giving relief ?
Dr. Wylie : Hardly ; for Dr. Copeman and many
others cured by dilatation, pure and simple. As a rule,
if you examine woipen that are pregnant you will find
that they have a healthy cervix when they have no vom-
iting, and when they have vomiting you will find that
they have a contracted or an indurated cervix.
Dr. Little said that a friend of his had tried dilatation
and found it very good.
Dr. Dawson asked what was the psychological effect
that was produced by this act ?
Dr. Wylie could not say.
Dr. Copeman : In dilating, intending to induce abor-
tion, there was an accidental delay, and he found that
nausea stopped. It happened in a second case, and
then he believed that dilatation had prevented it. Quite
a number have followed him since then, and established
the fact that it can be done safely and satisfactorily.
Dr. a. S. Hunter had no experience with the dila-
tation of the cervix, but he was very glad of the oppor-
tunity of listening to Dr. Wylie's paper, for it encouraged
him in the use of that means in the event of the failure
of medication. He had lost one case in his professional
career from severe vomiting alone. The patient was
forty-three years of age, and had vomited a great deal.
If labor had been induced she would have died without
any loss of blood. He had been successful in many
cases by the use of oxalate of cerium and ingurim ; five-
grain doses of each. It has given prompt relief. He
once knew of a woman who the morning after mar-
riage was seized with vomiting, which continued for three
months. When delivery came on it was evident that
conception had occurred at that time. • The patient that
he lost died just before he read the paper of Dr. Cope-
man, and he was very sorry that he had not known of it
in time.
Dr. Harrison agreed in most of the conclusions of
Dr. Wylie. His only objection to his etiology was that
it was not quite comprehensive enough. He had seen
one case of obstinate vomiting. He included every case
of vomiting, as, for example, any disease of the kidneys
or disease of the stomach, and he came to the conclusion
that there must be some local cause, and in the case he
had in mind he thought he would have to pioduce an
abortion, as the patient was so very much exhausted.
Dr. Thomas was added to the list of consulting ph3'si-
cians, and he insisted upon it, said that it was absolutely
necessary to induce an abortion, which he did with the
effect of curing the patient. In this case the cause of
the vomiting was due to peritoneal irritation from pre-
vious peritonitis. The uterus was bound down by false
adhesions, and afterward she became pregnant He
thought it was the peritoneal irritation produced by
the expanding uterus that caused the vomiting. In
another case of severe vomiting the patient had taken
some pills to bring on an abortion. It produced gastro-
intestinal catarrh, and subsequently she had an attack of
acute atrophy of the liver, which caused her death. He
never saw a worse case of vomiting than that.
Dr. Dawson asked how Dr. Wylie would explain the
fact that most women stop vomiting after a few weeks
without dilatation.
Dr. Wylie : After a few weeks the cervix may soften
to such an extent that the pathological condition which
may have existed has been really changed by the soften-
ing process which takes place. My experience has been
that the dilatation does not necessarily remove the ab-
normal pathological conditions of the cervix, but relieves
the tension that seems to be the cause of the vomiting.
That is, according to the experience that I have had.
Dr. Dessau had a case once where a woman called in
to see him on account of persistent vomiting. She was
then about in the commencement of the ninth month of
pregnancy, and she told him that the vomiting had not
commenced until about the month before. About foiu^ or
five years ago a case happened where vomiting terminated
with the birth of the child. Here the vomiting came on
at the end of pregnancy.
Dr. Wylie said that pregnant women might contract
diseases that might affect the cervix, such as venereal
disease. He haS known of one or two cases where the
irritation of the vulva from venereal warts seemed to cause
the vomiting.
Dr. Jacobus : In a case at his clinic one of the patients
had lacerated her cervix, which had been treated by am^
putation with galvanic cautery. She did not want to
become pregnant, and said that if she did become so she
would in all probability miscarry. Later she became
pregnant, and was quite put out about it, and was some-
what disposed to blame the treatment for getting her in
that condition. It amused her husband considerably. She
had practically no cervix, only an internal os. If dilatar
tion would be likely to do harm I should think it would
have done so in this instance. Dr. Wylie ought to recol-
lect her, for he sent her to him. She did not succeed in
producing miscarriage, and Dr. Wylie dilated her os, and
the next day she had some symptoms of miscarriage.
After the dilatation she walked home and took aloes pills,
ajid had a flow. Then the husband came around and
said that the flowing had ceased. Dr. J. sent back by
him some morphine pills. About a month afterward she
came around for some pills, and I found that she was
still pregnant. She went on, and in about seven or eight
months had a child. If dilatation was dangerous and pro-
duced miscarriage, it should have done so in that case.
He thought that she would have gone the full time if she
had had a cervix. She had a flow of water there for two
weeks on account of a rupture, yet she was delivered of
a child which lived.
Dr. McLaurey had seen some very severe cases, but
never a fatal one. The most successfiil remedy that he
could use was morphine and bismuth and caffeine. He
had found that to be a very excellent remedy. He had
never tried dilatation. In speaking of psychological influ-
ences he would like to state .this. Occasionally he found
a lady complaining that as soon as she becomes pregnant
her husband becomes sick. A few weeks ago a lady
came to him and said she was pregnant. I said to her :
" How do you know you are ? " She said, " Oh, as soon
as I am pregnant my husband always becomes sick.
This is the third pregnancy I have had, and my husband
is sick every day." He had heard of this fact before,
but he could not explain it, and would like to know if
there was any one in this room that could.
Dr. Chamberlain was familiar with the paper of Dr.
Copeman, and had employed his methods with satisfac-
tion. He would remind the gentlemen of Dr. Engleman's
paper that was published. He was inclined to regard
the interpretation of this nausea as a neurotic phenome-
non. The cervix is the most important portion of the
uterus. Up to the time of birth the cervix is in volume
as great as all the rest of the uterus, and up to the time
of puberty there is a portion of the uterus that is between
the reflection of the peritoneum on the bladder and on
the rectum and th6 vault of the vagina ; a portion be-
tween those is of the same volume as the uterus. The
lower portion of the uterus is thrown down, and the
upper portion is thrown off. The cervix is the active
portion of the uterus. It is through that portion that
the nerve supply reaches the uterus, and it has been ob-
served that the neurosies (?) of the uterus are connected
with the cervical portion. He had dilated the uterus
repeatedly where he had attempted to bring on deliveiy
in cases of convulsions, and as often as he had done that
December 6, 1884.]
THE MEDICAL RECORD.
641
thing he had found that the convulsions had ceased. Re-
peatedlyi and he thought constantly, in every case where
he had employed this dilatation of the cervix to suppress
vomiting in pregnancy, it had been successful. He
recollected a case in which a lady had a small fibroma
on the posterior wall of the cervix. It acted like a kind
of a ball-valve over the os internum. In that case he
dilated the cervix and the vomiting stopped and did not
return. He was convinced from experience that while
undoubtedly such cases as Dr. Harrison has cited, where
there is a palpable structural change, and this may be-
come the cause of vomiting, and also in Dr. Wy lie's
cases, where he describes disease of mucous membrane,
the treatment should be that of the mucous membrane.
He was confident, nevertheless, that the kind of spasm
which was remedied by the process of dilatation was the
cause of a great many cases of severe vomiting in preg-
nancy.
Dr. Wylie had nothing to say, but admitted the paper
was not as broad as it might be, as Dr. Harrison said,
and it was drawn strongly in one direction so as to bring
this point out : that local treatment can be given without
great risk, and is in most cases the best, and in some the
only, means of giving relief.
The Society then adjourned.
OUR LONDON LETTER.
(From our Special Correspondent.)
PULMONARY SURGERY — ^A NEW UNIVERSITY FOR LONDON —
SMALL-POX AND CHOLERA — SURGICAL SCARLET FEVER.
Tx>NDON, November 15, X884.
At the last meeting of the Medico-Chirurgical Society a
brief but interesting discussion took place on pulmonary
surgery. Dr. Cayley showed a specimen of cancer of
the oesophagus associated with a pulmonary cavity. The
cavity was tapped during life by means of a trocar
and canula. It was found at post-mortem that the pul-
monary cavity was in communication with the cancerous
tract in the oesophagus and stomach, and that the fluids
from the diseased area passed into the cavity. The
case was obviously one in which a cure could not be ex-
pected ; but the operation afforded the patient great re-
lief by obviating the fetid expectoration from which he
had been suffering. The case also shows that the lung
can be tapped without much danger. In this case sev-
eral punctures were made, without success, in various di-
rections before the cavity was reached, and the patient
had not suffered therefrom.
A proposition is on the carpet to found a new univer-
sity for London. London's present university occupies
the anomalous position of being merely an *' examining
board," though in this respect it performs its functions
so hypercritically as to rather deserve the name dura —
than a/ma — mater. It also stands in an isolated position
without any very direct relation with medical and other
colleges, and with practically no control over the teach-
ing its alumni receive before presenting themselves to
receive its official stamp. It is now proposed to found
a new organization, with several faculties, with complete
university teaching, supervised by the university authori-
ties, and to bring it into close relation with existing
institutions. An attempt will be made to merge the
present in the new university. Active support is al-
ready promised from influential quarters. The Council
of Legal Education will, it is believed, support the
scheme. Earnest support may be expected from the
medical schools and corporations. The Normal School
of Science at South Kensington may also not improba-
bly throw in its fortunes with the new scheme.
There is reason to fear an increase in the small-pox
epidemic as the winter comes on. The number of cases
under treatment in the hospitals, etc., of the Metropoli-
tan Asylums Board has again increased. The number of
new cases admitted last week was more than double that
of those admitted the previous week, viz., two hundred
and thirty- three, as compared with one hundred and one.
The outbreak of cholera in Paris suggests the possi-
bility of one here ; but we can as yet show a clean bill of
health.
At the last meeting of the ivTedical Society of London
an interesting paper was read by Dr. De Haviland Hall
on the subject of "Surgical Scarlet Fever,*' and was fol-
lowed by a lively discussion. Several speakers doubted
whether such cases were really scarlet fever, and it was
suggested that the eruption might be really a rash due
either to the shock of the operation or resulting from the
anaesthetic used. No speaker ventured to defend the
view that the performance of a surgical operation can
originate such a disease as scarlet fever. Dr. Hall
thought the poison had been absorbed before the opera-
tion, but that it would not have manifested itself so soon
(in this case on the day following the operation) unless,
as Sir J. Paget says, the health had been disturbed. Sir
J. Fayrer, Mr. R. W. Parker, and Mr. Durham all re-
garded the case as one of scarlet fever. Mr. Parker
remarked that his experience at a children's hospital had
taught him that the occurrence was by no means rare in
surgical cases which had recent wounds, and the scarlet
fever might be very severe and the wound take on fresh
action.
ON LARGE DOSES OF THE POTASSIUM IO-
DIDE IN THE TREATMENT OF THE LATE
LESIONS OF SYPHILIS.
To TUB Editor op Tub Mbdical Rbcosd.
Sir : In The Record of the 2 2d ult, p. 584, Dr. J. S.
Crawcour, M.R.C.S. Eng., refers to an editorial on Dr.
Seguin's article in the Archives of Medicine^ on what
is claimed to be the American mode of using the iodide
of potassium in the late lesions of syphilis. In this ar-
ticle Dr. Seguin is quoted as claiming that the practice
of giving very large doses of potassium iodide in certain
cases has been in vogue for over fifteen years. "By
large doses is meant such as make up a total of two and
a half to ten grammes in twenty-four hours." Dr. Se-
guin is shown to have claimed that this practice originated
with theJate Dr. Wm. H. Van Buren, about fifteen years
since, and that "it has received slight or no adequate
notice in text-books," and that "it is only in the works of
Loomis, Bartholow, and of Van Buren and Keyes, and
Bumstead and Taylor, and of Buzzard, abroad, that any
recognition of it is found."
Dr. Crawcour objects to the claim made by Dr. Se-
guin, that the administration of large doses of potassium
iodide in the late lesions of syphilis originated with the
late Dr. Van Buren, and thus was of American origin,
and quotes a prescription made by himself in 1859,
which calls for one drachm of the potassium iodide to be
given four times in the twenty-four hours. He says : "It
will thus be seen that the method of giving the iodide of
potassium in large doses is by no means a New York
method, but was used in New Orleans twenty-five years
ago, and as," he says, "I had only been in this country
five years, it might be more correctly termed an Eng-
lish method." It appears to me that Dr. Crawcour is quite
justified in assuming this as far as any statements made
by Dr. Seguin are concerned. Dr. Seguin was in error
not only in attributing to Dr. Van Buren the credit of
originating the plan of treatment of late syphilis by the
iodide of potassium in large doses, but in his statements
as to the comparative ignorance of the profession at large
in regard to it, and also that " it is only in the works of
Loomis, Bartholow, and Van Buren and Keyes, Bumstead
and Taylor in this country, and of Buzzard abroad, that any
recognition of it is found." According to the definition
previously given of large doses^ anything above two and a
642
THE MEDICAL RECORD.
[December 6» 1884.
half graaimes, 1.^., about forty grains^ may be considered
as coining within the meaning of the term.
Ricord, in 1835, says of the treatment of the late lesions
of syphilis by large doses of the iodide of potassium : " Two
scruples may be given at first, in three doses, in the course
of a day ; fifteen grains should be added every five days
until one and a half drachm (about five grammes) are
taken a day, which I have rarely gone beyond." This
passage occurs in the work of Hunter and Ricord (on
Venereal), of 1835, and may be found in an American
edition of the same edited by Dr. Bumstead, in 1853, p.
470. Acton, of London (i860), quotes the above with
approval. Lancereaux, of Paris (Sydenham edition, p.
320), says : " The doses in which iodide of potassium is
given vary from seven and a half and fifteen grains to
forty-five, sixty, seventy-five, and ninety grains in twenty-
four hours. Some practitioners carry the dose to one
hundred and fifty ^ one hundred and eighty^ and two hun-
dred and twenty-five grains or even more'' Beaumler on
syphilis, in "Ziemssen's Cyclopaedia," vol. iii., p. 297, says
of the use of iodide of potassium in the treatment of late
syphilitic lesions, ** even thirty or forty-five grains several
times a day must be given to attain a cure."
Mr. Coulson in his treatise on "Syphilis" (London,
1869, p. 242), says : **Many of the severer forms of late
and visceral syphilis will require one drachm, or even
larger doses, three times daily."
Hill and Cooper (London, 1881), in their work on
'* Syphilis and Local Contagious Disorders," p. 414, say, of
the iodide of potassium : "Forty to sixty grains three times
a day will sometimes quell an obstinate syphilide which
has resisted smaller quantities, but larger doses than these
may be required." I would also refer to my own book,
published in 1883, P- i43» where the use of iodide of
potassium in drachm doses in certain cases, and its con-
tinuance for a long period, is advised in the same con-
nection; the method of its administration is distinctly
indicated. At p. 199 et seq., a case of^ cerebral syphi-
lis is cited in illustration, where drachm doses of io-
dide of potassium were administered for several months
with apparent cure, and when the withdrawal of the
remedy under other care, apparently, resulted in the death
of the patient.
Inasmuch as, besides this, I have for the past twenty-
five years taught this plan of treatment for the late lesions
of syphilis in my clinic at the College of Physicians and
Surgeons, and also for the past ten years in my wards
in Charity Hospital, I would like to be included among
those who were credited with having aided to some ex-
tent in spreading the knowledge of its great value in
this country. I would like also to say that while there
seems to me to be some question as to the good taste in
claiming the plan of the administration of large doses of
the potassium in cases of the late lesions of syphilis as
an ** American plan," there can be no question that it
has found its earliest and warmest advocates and teachers
among American physicians.
Dr. Seguin claims from personal inquiry that Dr.
Draper recognized its value as early as 1865 — nineteen
years ago. In the same way, he states that Dr. Keyes
recollects Dr. Van Buren as teaching it as far back as
1863 — twenty-one years ago.
Dr. Taylor tells Dr. Seguin that he has accepted it
ever since he heard it taught by Dr. Draper and Dr. Van
Buren in 1866. This brings Dr. Seguin to the con vie-
tion that the plan is a purely American one, and was in-
stituted by Dr. Van Buren. Dr. Seguin is in error.
Dr. William Kelly was Physician-in-Chief in Charity
Hospital, Blackwell's Island, N. Y., from 1848 to 1853.
He was a man of marked ability and thoroughly inter-
ested in all advances in medical science ; and was an
especial admirer of M. Ricord, and in harmony with his
views on the treatment of syphilis.
In 185 1 and 1852 I was an interne in that hospital,
together with Professor Loomis (who is cited as approv-
ing the potass, iodide plan), also Dr. William Chamber-
lain, now one of the Visiting Physicians to Charity Hos-
pital, Dr. J. W. Barstow, of Sanford HaU, Flushing, amd
others. The plan of treating the late lesions of syphilis
with large doses of potassium was then in vogue in Char-
ity Hospital, thus thirty-three years ago. Dr. Kelly, then
Physician-in-Chief to Charity Hospital, was also a lect-
urer on Venereal Diseases at the College of Physidans
and Surgeons, New York, at that early period, and
taught the foregoing plan in the college and in the wards
of Charity Hospital
After Dr. Kelly's death his private case-books came as
a valued legacy to me. Among the cases in book E.,
1852, on page 6, I find the following : " Ulcers, syph.
phagedenic, by large doses of iod. pot Mary N was
.admitted to hospital February 14, 185 1 ; had secondaiy
eruption and enlarged glands and falling of hair in 184^
. . . At time of admission body was covered with
ulcers, some rupetic and some ecthymatous. . • . Was
put on generous diet, morphine, and iodide of potassimn.
This latter was carried up to two drachms per diem. Un-
der this patient got apparently well, and was discharged
September i, 185 1. Was readmitted to hospital one
month after with ulcers on ankles. Periostitis of tibia
occurred ; surface over it ulcerated ; treated with poultices
and iodid. potass. Local applications— creasote ung.,
tabaci, nit. arg., etc. — failed to relieve pain. Iodide of
arsenic was tried until its inefficiency was proved
Mercury in small doses. Patient all the time on ale and
good diet.
"April 26, 1851. — Determined to try iod. pot in large
doses. The ordinary doses up to 3j-3ij. had failed.
The dose was then gradually increased, so that she took
5 ss. of the salt each day. She began at once to im-
prove. Pain ceased in two days, and healthy action of
ulcers set in. She sat up for half a day on May 5th for
the first time in four months. Now — May nth — can sit
sit up all day. Has taken six ounces of the iod. pot to
this date,"
There are in the same book several other cases reported
in full, which are in complete accord with the one quoted
above, showing that this was the accepted practice in
Charity Hospital at that time. I would then claim for
Dr. Kelly the priority in systematically and successfully
treating the late lesions of syphilis by means of large
doses of the iodide of potassium and of teaching this
method in public
There seems to me an important difference of opinion
between the editor of The Record and Dr. Seguin,
whose paper on the ** Dosage of Potassium Iodide " was
the original subject of comment, in regard to the best
mode of administering the drug. Dr. Seguin states that
a singular unanimity prevails among autliorities in advising
that the iodide of potassium should be taken after meals
— he states that no good physiological reason can be
^iven for this rule, and he says, '' I strongly suspect that
It is nothing more than the blind following after example."
He therefore advises that it be always given upon an
empty stomach. The editor of The Record disagrees
with him, and advises pursuance of the rule advised by
authorities. The reason why the drug is usually given
after meals is, I think, because it is less likely to produce
irritation of the mucous membrane of the stomach.' It
occasionally happens that, even when every possible care
is taken, such disturbance of the stomach results that the
use of the drug has to be discontinued. The life of a
patient may depend upon his ability to bear a certain
amount of the iodide. A very moderate experience with
' I have at present under my care a worthy and very intelUgeat member ofovr
profession suflfering with ^ve ulcerations on the throat from late syjrfiOn. Tbe
original trouble was acquired in attending a syphilitic woman durini( oonfinemcm
The ulceration continued to prosress until dracnm doses of the iodide of pocaissiaB
were taken every six hourn. This amount C 3 j.) was administered after tmemh
in an ounce of water, and followed quickly by a tumbler of milk. On beinc ques-
tioned yesterday as to the effect of these Urge doses on his digestive appaxacat.
he said, " My appetite and digestion are excellenL My stomach bears oie iodide
much better when taken after food. I do not feel the effisct of sixty grains nz a
dose as much as I formerly did Ji/tten grains, well diluted, but on an cmpcr
stomach. The only time I feel any tendency to nausea is just after die dose 1
take at one o'clock a.m., when I follow it with a tumbler of nulk, but on aa odter
wise empty stomach."
V
December 6, 1884.]
THE MEDICAL RECORD.
643
the use of the iodide of potassium in large doses will be
sufficient to prove the increased tolerance to the drug
when administered largely diluted with some bland fljuid
as milk, or some mucilaginous decoction ; especially
when administered after a meal. Beginning with eight or
ten grains, the gradual increase, say by a grain or two (or
even three in an emergency) at each dose, and taken
with, or immediately followed by a tumbler of milk or
gruel, preferably after a meal, has proved in my experi-
ence the most free from danger of irritating the stom-
ach. I have recently had a case under my care where
3 xij. were thus administered in twenty-four hours, for
three months, without disturbance of the stomach, and
with the effect of relieving almost completely a serious
paralysis of the bladder and rectum, following constitu-
tional or active syphilis. This is the largest amount I
have ever administered in a case during the same time
The assertion made by Dr. Seguin, that ** iodism is in
nowise dangerous^ and is only an inconvenience and a
drawback to treatment,*' is scarcely justifiable when a
moderate amount of iodide of potassium will sometimes
cause such irritation and swelling of the mucous membrane
of the fauces and air-passages as to place a patient's life
in peril. Such a case is quoted in Hill and Cooper, page
425, when tracheotomy was required to save life. I have
myself seen the same accident, threatening death from
oedema of the glottis, when only twenty grains of potass.,
thrice daily, were being administered.
F. N. Otis, M.D.
108 Wbst Thirty-fourth Strbst, New York, November 23, 18&4.
MR.
LAWSON TAIT AND LISTERISM IN
OVARIOTOMY.
To THB Editor op The Medical Record.
Sir : I have just seen in the columns of your valuable
paper a paragraph headed ** Another War over Listerism
and Ovariotomy,*' in which you extract from Mr. Thorn-
ton's letter in the American Journal of Obstetrics certain
figures which Mr. Thornton supplies on behalf of Dr.
Bantock and myself. I can safely leave Dr. Bantock to
deal with his part of the question. Concerning my part
I can only say that I am not responsible in any way for
any figures which Mr. Thornton may credit me with. So
far as I can make out, Mr. Thornton's present figures are
those which he manufactured for me on a previous occa-
sion, and which require to be corrected as follows :
Cases. Deaths.
Clamp (non-Listerian) ... 36 9
Clamp (Listerian) 26 7
Ligature (non-Listerian).. 209 6
Ligature (Listerian) 30 2
301
24
Mort. per cent.
25.0
27.0
3.0
6.6
8.0
From this statement it will be seen by any one who can
reason on the subject at all that so far as my practice is
concerned Listerism has no effect one way or the other,
and that the heavy mortality in the early part of my
practice was due mainly to the clamp, assisted of course
by the factor of want of experience, which always tells.
Mr. Thornton lumps my non-antiseptic cases together,
and ignores the fact that they contain this heavy clamp
mortality. This he does, of course, because the question
between us is as to whether it is the clamp or not which
has been the root of all our evil. The suppression of the
further dissection of my statistics which I gave is not
honesty particularly after the discussions which have
already taken place on this subject The concluding
sentence of your paragraph says that '' it is known that
Mr. Tait, when still a rising variotomist, was hardly
treated with fairness by the London gentlemen whom he
now in his triumph too rancorously assails." I am soiTy
that I am too rancorous on the subject, -and for the
future 1 shall endeavor to modify my expressions within
limits which I trust may seem to you to exclude rancor ;
but if you knew in what manner I have been assailed,
what vile charges have been made against me behind my
back by Mr. Thornton and others, which they never dare
even to hint at in public, you would, I think, agree with
me that no kind of language could be too rancorous in
dealing with such men.
Your obedient servant,
Lawson Tait.
P. S. — I am just closing my first thousand cases of
abdominal section, and as soon as I can I shall send
you a summary of conclusions, and after that I shall
trouble myself not a brass farthing about Listerism or its
advocates. L. T.
Birmingham, Enc. November 14, 1884.
TRACHEOTOMY IN CROUP.
To THE Editor of The Msdical RscoRn.
Sir: In The Record of November 15th there ap-
peared an interesting and forcible article by Dr. Simon
Baruch, advocating an early operation in membranous
croup, and giving as a basis for his argument the clinical
histories of three cases. I cannot but dissent from the
conclusions of the author, because I believe that, if tra-
cheotomy were ginerally performed early in croup, many
children would be unnecessarily subjected to it, and
cures which would have been either spontaneous or the
result of medical treatment attributed to it. To do the
operation early one must often do it almost at the onset
of the symptoms, for frequently only a few hours find the
patient in great danger from asphyxia ; while often the
symptoms which have seemed so threatening as to war-
rant an operation may yield and the patient recover.
From choice or necessity, most operators do tracheot-
omy in cases of imminent danger, and are actuated, I
think, more by the desire to relieve the patient, if only
temporarily, from the fearful suffering which even they
cannot witness with equanimity, rather than inspired by
any great hope of saving life. I do not think that clini-
cal experience bears out the belief that a late operation
prejudices its success, for the patients seldom, if ever, die
of exhaustion. The almost invariable history of those
who die is that they succumb to an extension of the dis
ease below the tube, or to the general efifects of the dis-
ease, or worst of all, to the accidental stopping of the
tube.
I believe, therefore, that while he who operates as a
last resort occasionally saves a life, the early operator
does the operation, in some cases at least, which would
have recovered without it. I am greatly strengthened in
this opinion by having observed several cases of mem-
branous croup recover without tracheotomy, whose con-
dition seemed most desperate. One expelled the mem-
brane in a large cast, while in a hot bath into which it
had been placed while almost completely asphyxiated,
and two recovered under a plan of treatment which 1
will now describe, while giving the clinical history of the
most recent case. I will premise by saying that the other
case alluded to only differed from the one detailed in that
the patient was a year older. Both were in a condition
which would have justified an operation, and in both
cases I am sure their cure, had it been done, would have
been attributed to it. I was called to see the patient, a
little girl, W , two years of age, on the evening of
November 15 th, and found that she had been ill all the
week, and croupy for two or three days. The parents
had not considered her condition dangerous, however,
until a few hours before I saw her, nor had any treatment
been used. I found her breathing with the greatest dif-
ficulty, 50 to 60 a minute ; the pulse, 140 ; and epister-
nal and abdominal retraction well marked. Inspection
showed diphtheritic patches upon the tonsils, and every-
thing indicated a speedy asphyxia unless relief could be
644
THE MEDICAL RECORD.
[December 6, 1884,
obtained. I was deterred from advising an immediate
operation by the fact that at two years the prospect of
success is not flattering, and by a lingering hope inspired
by the previous case, that the relief might perhaps be ob-
tained by other means. I must confess, too, that, having
done tracheotomy for croup seven tjmes, with only one
successful result, I am not as enthusiastic in its advocacy
as I would be had I saved one in three.
To return to the case in hand :
I ordered equal parts of powdered alum and sulphur
to be blown into ^e throat at the moment of deep in-
spiration (from an insect powder blower) as often as
asphyxia threatened.
This was done, and the child struggled through the
next thirty-six hours, expelling shreds of membrane after
the insufflations at frequent intervals, until at length, on
the fourth day, the respiration, though somewhat difficult,
was much deeper and freer, and all membrane had van-
ished from the throat in view. The child has now been
quite well for several days. I am not an enthusiastic
therapeutist, and hardly thought of this as an efficient
treatment for true croup, until this last and desperate case
yielded to it.
What convinces me, or at least leads me to hope, that
it may really be a means of combating the disease, is
the fact that its use leads palpably and obviously to the
expulsion of the membrane, and this makes the cure
seem a logical sequence, rather than a |ucky chance.
I desire expressly to disclaim any idea of originality in
calling attention to this mode of treatment for croup, my
only desire being to secure for it a fair trial. Let it be
used, when used at all, freely and energetically.
S. S. Jones, M.D.
809 Lexington Avenue, November 35th.
Official List of Changes in the Stations and Duties of Officers
serving in the Medical Department^ United States Army^
from November 23 to November 29, 1884.
LoRiNG, L. Y., Captain and Assistant Surgeon. As-
signed to duty as Post Surgeon, San Diego Barracks,
San Diego, Cal. S. O. 135, Depai»'nent of California,
November 19, 1884.
Wilson, George F., First Lieutenant and Assistant
Surgeon. Granted one month's leave of absence, from
November 20th. (Vancouver Barracks, Washington
Territory.) S. O. 180, Department of California, No-
vember 18, 1884.
Wales, Philip G., First Lieutenant and Assistant
Surgeon, now at Fort Coeur d*Alene, Idaho Territory.
Ordered for temporary duty at Vancouver Barracks,
Washington Territory. S. O. 179, Department of Cal-
ifornia, November 17, 1884.
plcdicaX Itjems.
Contagious Diseases — ^Weekly Statement. — Re-
port of cases and deaths from contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the week ending November 29, 1884 :
Week Ending
9
%
1
£
1
1
s
1
1
November 22, 1884
November 29, 1884I
0
0
29
42
54
52
6
2
115
90
55
55
0
0
1
0
Deaths,
November 22, 1884
November 29, 1884 .
0
0
9
15
15
H
6
2
14
23
28
26
0
0
I
0
The Value of Human Life. — At the International
Congress of Hygiene, at the Hague, Dr. Jules Rochard
of Paris, gave an address on this subject He called at-
tention to the commercial value of human life and to the
loss occasioned by sickness and death ; and then pro-
ceeded to consider the question, whether hygiene was
capable of producing improvement. In doing so, he re-
ferred to the disappearance of diseases which once devas-
tated countries. The black death, which destroyed a
.fourth part of the inhabitants of the world, forty millions in
Europe alone, had become almost unknown ; and many
other diseases, to which our forefathers gave most for-
midable names, only remained in memory. In the same
way, diseases of modern days ought to disappear. A^.
ready the occurrence of the plague was only sporadic •
ague had still a few victims ; but cholera still threatened
Small-pox, measles, and scarlet fever were all diseases
against which protection could be afforded. This vas
best known in the case of small-pox ; and he was con
vinced that the time would come when a father would be
punished for having unvaccinated children in his house as
much as for having dynamite or gunpowder in his cellar.
The value of vaccination was beyond all doubt ; and in
Amenca and England precautions had long been taken
against measles and scarlet fever. By adopting proper
methods, disease would be made to disappear. The
speaker referred also to the researches of Villemin and
Koch, in their bearing on the reduction of the mortality
from pulmonary consumption. Severe legislation was
not admissible ; but care should be taken to prevent the
marriage of phthisical subjects ; to separate the phthisical
from other persons in hospitals, dormitories, etc. ; and to
prevent the use of tuberculous meat. Endeavors should
also be made to cause the disappearance of malaria by
the drainage of marshes. In Holland, however, it was
scarcely necessary to say this, for the whole country was
a marsh, which through the courage and energy of the
people had been dried and converted into beautiful val-
leys. He would not absolutely assert that all the germs
of death and disease could be removed by sanitary meas-
ures. Hygiene could not entirely displace medicine.
For, even when hereditary diseases disappeared, new
diseases took their place ; anaemia, diseases of the ner-
vous system, alcoholism, morphinism, and many othen
which were the results of the vices of mankind.
Iodide op Silver. — Dr. Sedan advocates the use of
iodide of silver, especially in purulent affections of the
eye. The salt is said to exceed in antiseptic power even
the bichloride of mercury. The dosage is not given.
— Recueil ct Ophthalmologies November 8, 1884,
Inhalation ofthe Vapor of Glycerine. — Dr. Castle,
of this city, writes concerning the abstract of an article in
the Revue Medicale (Medical Record, October 1 1, 1884),
which refers to the benefit to be derived from the inhala-
tion of vapor of glycerine by patients suffering from a
fatiguing or painful cough. He thinks there must be
some mistake about this, for glycerine is not volatile at
ordinary temperatures, and when vaporized in the manner
described, without the presence of vapor of water, it is
very apt to be decomposed and give off acreolin, which
would prove anything but comforting to the respiratory
organs of the person subjected to the experiment.
Jews as Physicians..— Dr. C. H. Von Klein says in
the Journal of the American Medical AssocicUion^ that
sixty-seven per cent, of Jewish physicians maintain pro-
fessorships in medical colleges ; thirty-six per cent arc
medical authors. Medicine appears to be the favorite
study, and, as a rule, they always maintain a high stand-
ing. There have been many Jewish physicians in a
professional capacity at the courts of famous kings. The
celebrated Maimonides was physician to King Salahed-
din, of Egypt; Rabbi Meir to the King of Castile;
Zedekiad, physician to Louis the Pious of France, and
Montalto to Queen Marie of Medicis.
The Medical Record
A Weekly yournal of Medicine and Surgery
Vol. 26, No. 24
New York, December 13, 1884
Whole No. 736
<3^0itmX ^xXitltB.
IS THE OPERATION OF TRACHEOTOMY IN
DIPHTHERITIC CROUP DANGEROUS?'
When Should the Operation be Performed?
By JOSEPH E. WINTERS. M.D.,
CUNICAL PROPKSSOK OP DISBASSS OP CHILDREK, MBmCAL DEPAXTMENT UNI-
VERSITY OF CITY OP NEW YORK.
At the March meeting of the Obstetrical Section of this
Academy it was stated ^ that "tracheotomy is an opera-
tion attended with great immediate danger to the life of
the patient/' ' This statement was so startling to me and
so at variance with my impressions from reading, and from
Boy own personal experience, that I believed it to be er-
roneous. The opinion that tracheotomy is a dangerous
surgical operation I believe has no valid foundation, nor
will it bear the test of a close examination, and should
not be accepted with the confidence with which it seemed
to be received in this hall last March.
The speaker, in the closing discussion, in corrobora-
tion of his opinion, quoted Mr. Timothy Holmes, of
London, as saying that the operation is the most danger-
ous of any in surgery. On page 303 of Mr. Holmes'
work on the "Surgical Treatment on Diseases of Chil-
dren " will be found the following : " I think that, of all
the operations which we are commonly called upon to
perform on children, tracheotomy is the most dangerous,
both in its immediate performance and in its secondary
complications." And further, " I would not recommend
tracheotomy while any prospect of recovery existed other-
wise." If this suggestion of Mr. Holmes is followed, de-
lay \n the performance of the operation should be
ascribed as the cause of both the secondary complica-
tions, and of death, rather than the operation itself. On
page 302 he says : "In thirty-one cases the causes of
death have been noted ; and in very few of these cases
was the cause of death connected in any way with the
operation." , . . The original disease caused death in
fourteen cases, " pneumonia and catarrh in twelve, scar-
let fever in three, collapse of the lung in one, secondary
hemorrhage (fifth day) in one," making the total number
thirty-one, in none of which was the cause of death in
any way connected with the performance of the operation,
^OT Mr. Holmes states on page 326 that the ulceration
which caused the secondary hemorrhage was produced
by the tube. On page 316 he says : "Considering the
risk of operating below the thyroid isthmus, and the
largQ size and vascularity of that body at an early age, I
would urge the propriety of making the opening above
the isthmus. . . . After the age of five, or there-
abouts, the surgeon can. if he prefer it, open the trachea
below the thyroid isthmus. But I do not myself recom-
mend this operation, at any rate before puberty.'* On
page 318 it is stated : "To cut through the isthmus of the
thyroid is, in early life at least, a dangerous proceeding."
Speaking of hemorrhage, Mr. Holmes, on page 317,
says : '* I have three times seen death on the table during
tracheotomy ; and twice from this cause. In one case,
in which I w^as myself the operator, the child was very
' Read before the Section of Obstetrics and Diseases oi Women and Chil-
dren, October 33d> and by invitation was reread before the Academy at large,
necember 4tb.
* jyr, Ripley, Mbdical Rrcord, April 5, 1884, ^age 360.
' ''The operratlon of tracheotomy in young children ror croup, in its imminent
peril to life^ is one of the most dangerous operations in surgery." (Dr. Ripley,
Mkoicai, Record, July, 31, 1880, page zi8.)
youn^ (age not given). On exposing the parts, I dared
not divide the centre of the thyroid body, on account of
its thickness, and the large size of the vessels visible in
it. On the other hand, to open the trachea below I had
Xo plunge my knife almost beneath the sternum. . . .
In the incision a vein was cut very near to its opening into
the left innominate, and the bleeding proved fatal before
I could get the tube in."
In the first volume of Trousseau, page 423, he says : " I
have often witnessed the difficulties and dangers of a too
nimble tracheotomy, even when performed by an able
operator.*'
Marsh * says : " It would be nearly as reasonable to
cut straight down upon the subclavian artery as to at-
tempt tracheotomy as it is very often performed, and it
would be scarcely more dangerous. The amount of hemor-
rhage during tracheotomy will depend almost entirely on
the method of operating."
Mr. Durham " says that of one hundred and eight cases
of tracheotomy at Guy's Hospital, performed during a
period of twelve years, there was not a single case of
serious hemorrhage, and the operations were performed
by the house surgeons in a very large proportion of the
cases, and that, too, very often under circumstances of
peculiar emergency and difficulty.
Of eighty-seven cases reported in vol. ix. of The Medical
Times and Gazette^ collected from various London and pro-
vincial hospitals, there was but one case of hemorrhage,
and in this Marshall Hall's tracheotome was used, and a
vessel cut, ending in fatal hemorrhage. Durham says of
this, that it is ** an instrument which to mention is to con-
demn."
Regarding the thyroid isthmus, Trousseau * says : " If
the isthmus of the thyroid body presents itself under your
bistoury, never hesitate to divide it in the mesial line ;
there is usually an arterial jet as large as a thread, which
ceases after some seconds, and by this section you have
signally facilitated the operation." Of one hundred and
nine tracheotomies for croup in children, Trousseau never
found it necessary to have recourse to the ligature or tor-
sion for a single vessel ; the hemorrhage always ceased
as the canula was introduced.
Holmes, on page 323, says the operator in trj'ing to
insert the tube into the trachea sometimes " pushes the
canula down the cellular tissue in front of the windpipe,
causing pressure on the trachea, and obstructing respira-
tion still further." . . . "The third (case) in which
I have seen death during the operation, the fatal event
seemed to me due mainly to this error."
One of the three fatal cases of Mr. Holmes, then, was
due to what Trousseau would have termed a " too nimble
tracheotomy;" and in another, death was caused by
pushing the canula into the cellular tissue outside of the
trachea, and thus adding to the original difficulty. Com-
ments on Mr. Holmes' tracheotomies are unnecessary.
The speaker then quoted Professor S. D. Gross as
saying " the same thing" as Mr. Holmes. In Professor
Gross' "Treatise on Foreign Bodies in the Air-Pas-
sages," on page 231, regarding tracheotomy in children,
he says : " I know hardly an operation in all surgery
that I would not rather undertake than this. . . »
The amputation of a limb, the extirpation of a glandular
tumor, lithotomy, and even the perineal section are
trifling matters in comparison with tracheotomy in a
' St. Bartholomew's Hospital Reports, vol. iii., p. 334.
'The Practitioner, 1869, vol. ii., p. 212. * Trousseau in the Union M^icale.
646
THE MEDICAL RECORD.
[December 13, 1884.
short, thick-necked, and restive child." On pages 232,
233 he says: "The isthmus of the thyroid gland, even
when it descends considerably lower than usual, will
seldom embarrass our progress ; should it do so, it nmst
be held out of the way, although it has sometimes been
divided with impunity/'
He adds : " Professor Van Buren, of New York, in-
forms me that he has completely divided this process on
several occasions without the slightest loss of blood, mis-
chief, or inconvenience." Even after this Professor
Gross says : " Generally, however, it will be well enough
to avoid it by holding it out of harm's way ; should this,
however, be impracticable, any bleeding that may be ap-
prehended can be effectually avoided by embracing the
part in two ligatures, the knife being afterwards carried
between them." Here Professor Gross's directions cer-
tainly complicate the operation and prolong it unneces-
sarily.
He next directs that the trachea be held by a tenaculum.
The operation is performed with much more ease
and safety when the trachea is grasped between the
thumb and index-finger of the left hand than when held
by the tenaculum. The trachea should never be entered
without our being guided by the touch. If the windpipe
is veiy deeply placed, and is not readily brought into
view, it may be taken hold of with the double hook below
where it is to be opened, and drawn upward and forward
until brought into sight. The hook must, however, be
held by an assistant, and the operator should keep his
thumb and finger on the trachea.
On page 237 Dr. Gross says: "Great care is to be
taken not to permit any blood to enter at the artificial
opening, as the smallest quantity of this fluid may not
pnly induce violent cough and spasm, but instant suf-
focation." Further: "The best plan to avoid this oc-
currence is not to injure any vessels, but to hold them
carefully out of harm's way; or, where this is imprac-
ticable, to wait until all hemorrhage has ceased before we
penetrate the windpipe,'^
With reference to the first of these statements, it is
known that the entrance into the trachea of a small
quantity of blood is not dangerous, and many operators
purposely introduce a quantity of fluid into it to excite
cough in order to expel mucus and membrane. Bret-
tonneau even recommended washing out the tube with a
solution of nitrate of silver. Next to the hissing sound
with which the air enters the opening in the trachea, one
of the most striking things in connection with tracheot-
omy is the violence with which anything entering the
trachea is ejected. To wait until all hemorrhage has
ceased before opening the windpipe, would, in many
cases, be to wait until the patient is dead. The surest
way of arresting hemorrhage is to admit air freely to the
lungs, so as to relieve the embarrassed venous circula-
tion, and thus allow the blood to return to the heart
Time spent in trying to stanch the bleeding before open-
ing the windpipe is generally to the injury of the patient.
With reference to this Professor Gross himself says on
page 279 : " It is worthy of remark that, when the hem-
orrhage is venous, it generally instantly ceases, even
when it is copious^ the moment the knife penetrates the
windpipe." And again on page 266 he says : " I have
never experienced the slightest inconvenience from any
occurrence of this kind. Several of my operations, in
fact, have been nearly bloodless,"
Allow me to turn back and repeat a former quotation
from Professor Gross, page 231, in order to make a com-
parison : " I know hardly an operation in all surgery I
would not rather undertake than this. . . . The am-
putation of a limb, the extirpation of a glandular tumor,
lithotomy, and even the perineal section, are trifling mat-
ters in comparison with tracheotomy." On page 373 he
says : " I am satisfied, from the facts before the profes-
sion, that bronchotomy, properly performed, is, in general,
a perfectly safe procedure, . . . and rarely fol-
lowed by fatal results. "
Dr. Gross in his book does not report a case of
tracheotomy for croup. After making a careful analysis
of Dr. Gross' work, I am unwilling to accept his first
statement regarding the dangerous character of trache-
otomy, particularly when it is made to apply to the oper-
ation in croup.
Dr. A. Jacobi was quoted as saying that he never went
to a tracheotomy operation without a feeling of fear and
trembling. In the extensive writings of Dr. Jacobi on
the subjects of diphtheria, croup, and tracheotomy, I
fail to find any statements which would diow that he con-
siders the operation dangerous.
Now let us review the opinions of other authors :
Bretonneau, to whom we are indebted for the re-
vival of tracheotomy in the nineteenth century, does not
speak in any of his five memoirs of the operation as being
a dangerous one, nor of skill in its performance being a
necessity to insure success ; his whole stress is upon the
size of the canula, the temperature of the air the patient
breathes, and the after-treatment and care. Bretonncan
was so clear and decided in his convictions, which were
always stated definitely, that had' he felt the operation lo
be a dangerous one, he certainly would have mentioned
it in one of his several communications.
Trousseau, whose contributions on tracheotomy have
never yet been surpassed, said : " Tracheotomy in itself
is an operation which is more delicate than diflBcult ; it
requires only care and presence of mind." He then says
that he has performed the operation "more than two
hundred times," and adds, " I have never had immediate
accidents to deplore, except in an adult, who died of
syncope at the moment I made the section of the skin.'
And again he says, " I have finished these operations,
apparently so perilous, without fear and without acci-
dent.'*
M. Emangard * says : " The performance of this opetar
tion is exempt from all danger.''
Rilliet and Barthez • say : " The operation in itsdf
is not dangerous."
Bouchut, in 1852, said: "This operation is of easy
execution — it presents no danger in itself, and if it docs
not succeed more frequently, it is because the cases in
which it is employed are truly beyond the resources of
art — the physician ought always to be ready to operate.'"
West says : " It is admitted on all hands that in itself
the operation is not attended by serious hazard ; and the
uncertainty as to its issue depends not on any defect in
the proceeding.'*
Meigs and Pepper speak in these terms : "7? m the
uniform testimony of those experienced in the matter,
that the operation is in itself alone but slightly dangerous
to life."
Vogel tells us that "the operation itself is not at-
tended by any danger to life."
Dr. R. M. Edwards said : ' " The operation itself is so
simple to a man accustomed to handle a scalpel and for-
ceps, that it is surprising so much has been written aboot
it, and so many instruments devised to simplify its per-
formance."
Dr. W. H. Day, of the Samaritan Hospital for Chil-
dren, says: "Tracheotomy in itself is not a dangerous
operation."
Mr. Lawrence * says : " We are fully justified in repre-
senting the operation of bronchotomy as attended with
little pain and no danger." ** The operation itself is so
simple and so easy that there is very little to be said on
the mode of executing it."
Conway Evans' says: "That tracheotomy is in itself
a very dangerous operation, the tendency of all evidence
on the subject tends to disprove." He quotes fiXMo
Professor Gross' work to show that the operation is not
dangerous !
J. H, Pooley, M.D., Professor of Surgery, Starlii^
> Les Annales de la Mtfd. et Phys. Sep., x8a7. * Dts. of Children, voL L, jSu
* In the Edinburgh Med. Journal, October, 1856, toL iL, part x, p. 3x4-
* Med. ChinuT. Trans,, vol. vL 1815.
* Edinbuirgh Med. Journal, January, x86o, voL v., part a, p. 613.
December 13, 1884.]
THE MEDICAL RECORp.
647
Medical College,' says: "The operation itself involves
very little danger to life."
\Vm. M. Mastin,* in an article in which he gives an
analysis of eight hundred and sixty-three tracheotomies
ivhich he collected with much care, says: **I cannot
see . . . how any one will venture to say that trache-
otomy is/^r se of particular danger."
Mr. Howard Marsh,* in an article entitled "Trache-
otomy in Children, its Method, its Dangers, and its
Difficulties," says: "I am convinced that tracheotomy
should be regarded as a delicate operation, which re-
quires coolness and caution in its performance, rather
than as one that is necessarily either very difficult or very
dangerous."
Robert Wm. Parker, Assistant Surgeon of East Lon-
don Hospital for Children, says : " By common consent
the operation itself is not dangerous, and it hardly, if at
all, complicates the primary disease which calls for It."
Thomas King Chambers said : " Tracheotomy is an
alarming operation to hear of or to look at, but in reality
it is not a dangerous one. ... Do not, therefore,
alarm the patient's friends by speaking of it as a * last
hope,*. *a final resource,' or by any similar weak, expres-
sion."
Let us see what was the verdict of the older authors
on this operation. They always spoke from the force of
their convictions, and in definite, unmistakable terms.
According to Galen, Asclepiades first invented and
performed tracheotomy in cases of quins}', about 100
B.C. Here the term "quinsy" relates to croup of the
present day, for it is described as an affection which
" presents no visible appearance either in the swallow or
in the throat, which, while narrowing the glottis, renders
the voice acute, and quickly manifests symptoms of
strangulation."
Coelius Aurelanius says : "In this manner he (As-
clepiades) saved a great many persons who were in
danger of perishing from suffocation."
Fabricus, in the sixteenth century, said : ** The opera-
tion is absolutely free from danger. . . . There is no
part of the least consequence exposed to injury in this
operation. ^ Fabricus is the first who speaks of the canula.
Casserius said : " Those are both ignorant and timor-
ous who rashly neglect this safe, easy, and often salutary
operation. It is easily performed, and cannot give rise
to danger. . . , We have nothing to fear from the slight
hemorrhage caused by opening the trachea." Casserius,
who introduced the curved canula, is the first who men-
tions the thyroid gland in speaking of the operation.
In 1586 Sanctorius proposed puncture of the trachea
with the trocar, which he had invented for performing
abdominal paracentesis.
Bartholini entertained doubts respecting the use of^the
operation in quinsy, especially in infants.
Ren^ Moreau, in his reply, March i, 1646, declared
that the operation was neither difficult nor dangerous,
and through his sound reasoning he served to convert
Bartholin! to the use of the operation.
In 1695 Dekker proposed to perform the operation
with a cutting trocar.
Boerhaave,* in the first part of the eighteenth century,
said : ** The windpipe may be divided without any danger
to the patient's life."
Detharding, in 1714, wrote, with reference to tracheot-
omy : ** The skin only is divided, and a small portion of
membrane. There is no ground for fear, even from the
least dexterous operator. No blood-vessel from which
one need fear hemorrhage, no nerve of which the divis-
ion can produce any inconvenience."
Juncker, in treating of this operation, said : " It does
not require great dexterity.*' The first vertical incision
through the cartilages of the trachea was made by him.
1 Richmond and Louisville Med. Journal, June, 1877, p. 5x7.
> Gaillard's Med. Toumal, January, 1880, vol. xxix., p. 15.
> St. Bartholomew's Hospital Reports, vol. iii.
^Van Swieten's Commentaries upon] Boerhaave's Aphorisms, vd. viiL, p.
Z33. JSdinburKh. 1776.
In 1750 Dr. Lawrence Heister,* Professor of Physic
and Surgery in the University of Helmstadt, wrote :
" This is a safe, easy, and often salutary operation.*'
Heister was the first to use the word tracheotomy.
Louis, in the early part of this century, said : " A little
consideration as to the parts to be divided and the mode
of doing it suffices to show that the operation could not
be attended with the least danger."
Mr. Holmes' obvious misconception regarding the
pierformance of tracheotomy, and the contradictory state-
ments made by Gross, show sources of fallacy on their
part ; and this, with the vast preponderance of authori-
ties against their opinion, wholly overthrows it.
The operation of tracheotomy not being dangerous in
itself, nothing connected with its mere performance should
influence the time when it is to be resorted to.
How does diphtheria tend to cause death when left to
itself? In a very large proportion of the fatal cases, the
disease, in young children, ultimalety causes death by me-
chanically obstructing the passage of air into the lungs.
The object of tracheotomy is to supply a provisional air-
passage in the place of the obstructed rima-glottidis, so
as to allow the disease to run its full course, and to gain
time for the administration of remedies ; and if it ac-
complish this, it should be acknowledged, even though
the patient should die afterward from 3ie persistence of
the original disease, or some of its complications. That
it does accomplish this will be seen by the mode of
death after the operation. This depends very much
upon what time in the course of the disease the opera-
tion has been performed ; the type of the disease, the
condition of the patient, and the care with which the
after-treatment has been carried into eflfect When the
operation has failed to save life, it has been generally
either because it was postponed until it was too late,
until secondary complications in the bronchi and lungs
have arisen, to sudden collapse, to the persistence and
extension of the original disease, causing death by as-
thenia or acute nephritis and uraemia, or because effi-
cient after-management and care were wanting. Sup-
puration in the anterior mediastinum (this generally may
be obviated by not extending the superficial incision too
near the top of the sternum), erysipelas and gangrene
around the wound, and the slipping of the canula from
the tracheal opening have been experienced.
I wish you to mark that none of these causes of death
are instances of failure of the operation when properly
performed, or of its not removing the main source of
danger when the disease is left to itself.
The only lesion that causes death, which is directly due
to the operation when properly performed, is ulceration
of the trachea from the mechanical irritation of the tube.
Vidand, in 1854, and Goupil, in 1856, exhibited before
the Anatomical Society of Paris two specimens of ulcer-
ation of the trachea after tracheotomy, produced by ir-
ritation of the canula.
In 1859 Barthez called attention to this point, still
almost unknown.
Roger, in the same year, in a monograph, published an
analysis of twenty-one cases of ulceration of the trachea.
Sanne ' in his work reports seventeen cases, collected
in the service of Barthez. He says : " More or less red-
ness of the trachea and bronchi have been noted in eleven
of seventeen cases, out of which seven were accompanied
with broncho-pneumonia. In one case there was ab-
scess of the mediastinum, consecutive to a perforation
of the posterior wall of the trachea, and one of oedema
of the glottis."
In the Trans. Path. Soc, London, vol. xviii., p. 32, is
recorded a case of death from pyaemia after tracheotomy,
from ulceration caused by the tube. Two cases have hap-
pened in Guy's Hospital, in which ulceration extended
through the anterior wall of the trachea into the innomi-
nate artery, and fatal hemorrhage of course resulted.
> General System of Sui|:ery; fourth edition.
3 Sanu^ : £tude sur le Croup, apris la Trach^otomie.
648
THE MEDICAL RECORD.
[December 13, 1884.
Mr. Marsh reports two instances of ulceration of the
trachea out of thirteen operations in his own experience,
and makes allusion to three others he has been told of.
There are many cases scattered through the literature
on tracheotomy, but these are sufficient for us to recog-
nize its importance, its frequency, and the different ways
in which it tends to cause death.
The causes are the shape, the size, and the length of
the tracheal tube, so that it presses against the walls of
the trachea to the extent of producing mechanical irrita-
tion and ulceration.
Roger thinks that a small canula, by allowing of its
too free movability and the consequent friction which
results from it, can cause ulceration.
The symptoms are expectoration of more or less pure
blood, along with the sanguinolent expectoration com-
mon to every case of tracheotomy for the first few days,
in some cases pain referred to the point where the tube
impinges against the wall of the trachea, and dark dis-
coloration of the end of the canula.
The accident can almost always be prevented by hav-
ing the canula short, curved at nearly a right angle, and
of proper size, so as to fit quite accurately the calibre of
the trachea, but without making undue pressure, and hav-
ing it freely movable on its shield, so that it shifts with the
varying attitudes of the child. The tube should be care-
fully watched and the trachea daily examined for indi-
cations of irritation, and if detected, the tube must be
removed and the opening in the trachea kept open by
means of silver or hard-rubber or gutta-percha hooks,
which are held in place by a tape going around the
neck.
Tracheotomy, then, perfectly accomplishes its primary
object — that is, to overcome a positive mechanical ob-
struction in the larynx, and to prevent that njode of
death by which nearly all fatal cases of diphtheritic croup,
in which it is not resorted to, terminate, namely, death
by asphyxia.
We will now consider
The influence of the operation on the original disease,
— Sir James Paget * says : "1 have never seen the wound
become diphtheritic after tracheotomy." Further on he
says " : " I have collected the particulars of upward of
one hundred and twenty cases in which tracheotomy was
performed in children suffering with diphtheria, and in
none of them was the wound attacked by the disease."
Mr. Spence, in a letter to Sir James Paget, wrote : " I
have, on several occasions, seen the wound affected, and
have known the child die from that, after the breathing
was free and the tube removed.*' He does not in this
communication state, however, whether or not the dis-
ease had disappeared from the fauces ; in other words,
that death was not due to the persistence of the original
disease, at its original site.
Mr. Parker, of London, says : "In my own practice
it has only occurred twice, and on each occasion it was
very slight. In one case, on removing the tube, I found
the wound patched over with little islands of false mem-
brane. ... In another case a similar condition of the
wound was found."
Mr. Howard Marsh says : " Diphtheria of the wound
is rare.'*
Trousseau says he has seen leech-bites, slight cuts,
blisters, and excoriations and different wounds in various
parts of the body became diphtheritic, but he does not
speak of its c^ccurrence on the tracheal wound, which,
from his usual careful minute way he surely would have
done IkmI he ever observed it.
Saniic," who was a pupil of Trousseau, and who bases
his c»bscrvati()iis on six hundred and sixty-two operations
on croup by tracheotomy, says in his excellent work :
** Diphiiuria of the wound is not so frequent as you
might at fiist suppose. It seems that the false membrane
> Second edition of his Clinical Lectures, p. 34.
• < )p. cit.. p. 463.
* EcuJe sur le Croup apr^s la Trach^otomie, par le Dr. Sann^. Paris, 1869.
appears more readily on the cutaneous ulcerated surface,
or that only deprived of its epidermis, than in a wound
which involves the profound parts. This is so commonly
the case that in diphtheria of the wound the lesion is first
to be seen on the superficial parts, or edges of the wound,
where the skin has been cut. It then extends to the
neighboring parts." ...'*! will not advance, how-
ever, that diphtheria never attacks the edges of the wound,
. . . but I do insist on this point, that very often the
pellicles of the wound have been confounded with plastic
exudations." ..." Diphtheria of the wound by it-
self is not very grave ; of all the complications which
belong to the wound it is the most natural, since it is but
the propagation to the exterior of the lesion which char-
acterizes anatomically the malady ; it has then in a great
many cases but a local importance."
I had expected in examining the German authorities
to find frequent mention made of diphtheria of the wound,
on account of their proneness to call every wound on
which there is an exudation diphtheritic. I find, how-
ever, that their references to it are very infrequent, that
it is always found to be very slight, and does not com-
plicate the original disease or the operation, and that it is
readily controlled by simple treatment.
Dr. O. Pinner,* in a report of one hundred and thirty-
seven cases of diphtheria and tracheotomy says : " In a
few cases diphtheria of the wound occurred."
Dr. Max Schiiller" says in his work : "As a rule diph-
theria of the wound may be prevented entirely by the
early employment of damp carbolic dressings." . -
"At any rate it seldom becomes necessary to employ
energetic remedies, as diphtheria of the tracheal wound
does well under carbolic treatment."
Dr. H. Lindner * says : " Diphtheria of the wound oc-
curred in but three of one hundred and one cases operated
on. Gauze compresses of carbolic acid was the only
measure taken to prevent its occurrence."
We now come to
The influence of the operation on the cure of croup.
— The admission of air into the lungs through an artificial
opening in the windpipe secures for the diseased larynx
entire rest, and this leads to a suspension of diseased
action there. Even if the patient die after the operation,
and we ^n^^ post-mortem^ that the diseased action has not
ceased in the larynx, it is generally either because the
operation has been too long delayed, and, as a result,
death followed too soon for any reparative process to
take place, or to the character of the original disease.
Mr. Spence's communication to Sir James Paget
shows that the cure of croup may be accomplished by
tracheotomy during the persistence of the orginal dis-
ease, and which afterward may destroy life.
The following cases from Sann6's interesting work are
most instructive, and confirm the statement that tracheot-
omy tends to the cure of this very fatal complication :
Case IX., page 202. — Aged four years ; operated on
in second stage of croup. Died third day from exhaust-
ion. Autopsy showed that the larynx contained no false
membrane.
Case XL, page 208. — Aged five years ; operated on in
third period. Died sixteenth day. Larynx swollen and
cedematous, but contained no false membrane. Died of
Bright' s and pulmonary complications.
Case XIL, page 213. — Aged eighteen months ; operated
on in third period. Died fourth day. No fsdse mem-
brane in the larynx. Bronchi contained a quantity of
detritus and false membrane. Marked congestion of pos-
terior part of the lungs.
Case XI IL, page 214. — Aged five years. Tracheot-
omy third period. Died eleventh day. No false mem-
brane in larynx ; right lung healthy ; left lung seat of
pneumonia.
Case XXVIL, page 252. — Aged twenty- three months ;
' Deutsche Zeitachnft fiir Chiruzg., B. »▼., P- 304-
3 Deutsche Chirurg. : Prof. Dr. Billroth und Prof. Dr. Leuclce, L. 37. Dr-
Max SchtiUer : Die Tracheotomie, etc., p. 96. Stuttgart, 1880.
■ Deut. Zeil. fiir Chir., November 8, 1882, p. 453.
December 13, 1884.]
THE MEDICAL RECORD,
649
operated on in extremis. Death eleventh day after op-
eration. No false membrane in larynx.
Case XXVIII., page 256. — Aged two years; operated
second stage of croup. Died one hundred and fifty-
fourth day. Nothing in larynx.
In every recorded case in which death occurred within
twenty-four or forty-eight hours after the operation, false
membrane was found in the larynx on autopsy.
In " Guy's Hospital Reports," Third Series, volume
xxii., the autopsies in cases of croup show the same re-
sults as those given above.
Some interesting cases bearing on this are found in
The Medical Times and Gazeite^^ in an article entitled
<< Comments on Tracheotomy for Scald of the Glottis."
There were three cases which ended in recovery. The
ages of the patients were one year, two and a half years,
and three years, respectively. "It would appear that
when cases do well after tracheotomy for this accident,
that the restoration of a healthy condition of the laryngeal
mucous membrane is rapid. In one case the canula was
kept in place for six days, in another for five, and in a
third for three."
The following case from " Guy's Hospital Reports," ^
with remarks by Mr. Howse, shows still more strongly
the value of tracheotomy in the cure of laryngeal disease :
A child aged twenty-six months, with chronic laryngitis.
Breathing stridulous. Tracheotomy performed by the
house surgeon October 8th, died on the night of the 12th.
Autopsy showed the larynx and epiglottis to be normal
in appearance.
Remarks by Mr. H. G. Howse, one of the editors of
the " Reports : '' " The normal appearance of the
larynx is of great interest, as it tends to show that when
the part is put in a state of perfect rest after a trache-
otomy operation, all signs of inflammation may subside
within five days — the period which elapsed between the
operation and death."
The cure of many cases of ulceration of the larynx
by tracheotomy, occurring in the course of pulmonary
phthisis, and which return after the tracheal opening is
allowed to close, but again subside when the functions
of the organ are once more suspended, might be quoted
if time and space permitted.
The influence of tracheotomy in arresting diseased ac-
tion in the larynx, leads us quite naturally to contem-
plate the relation of laryngeal to laryngo-tracheal diphthe-
ria. The diphtheritic process stops at the level of the
vocal cords much more commonly than is generally sup-
posed. That this is true of a large percentage of the
cases is shown by some valuable autopsies recorded by
Kronlein." Of 200 autopsies reported by Kronlein,
in 46 there was false membrane in the larynx and
trachea; and there were 164 with membrane in the
larynx and on the parts above, and no membrane in the
trachea.
When the disease involves the trachea it is by propa-
gation from the larynx^ and not by a simultaneous attack
on the larynxy trachea^ and bronchi. In many cases this
extension downward may be prevented by early making
a way for sublaryngeal respiration, so that the inflamed
larynx may be allowed to rest and be saved from irrita-
tion by the passing breath, and thus cause the arrest of
diseased action there.
If tracheotomy per se is not dangerous, if it meet the
complication of obstruction of the glottis, and is promo-
tive of the cure of this complication ; if the specific dis-
ease is in no way aggravated by it, and very rarely in-
deed appear on the wound, it certainly brings with it no
element of added danger.
Influence of delay, — The next consideration in de-
ciding when to operate would be the result to the patient
of delay in the performance of the operation. When
we see that medicinal remedies fail to influence the arrest
1 October aa, 1850, page 404.
■ Guy's Hospital Reports, 1875, vol. xx., I^ees 507-8.
* Krdnlein ia Langenbeck's Archives for Cfiiucal Surgery, page 353. Bertin,
«77.
of croup, to relieve, or even to alleviate its symptoms,
shall we trust to the occurrence of that rare accident, the
expulsion of the membrane, or shall we operate without
delay ?
As to expectoration of the membrane and cure of the
disease without operation, Professor J. Lewis Smith
stated at the March or April meeting that about one in
eight recovered when medicinal treatment only was used.
Statistics of croup (membranous), taken collectively,
show that the disease is fatal in about ninety per cent, ot
the total cases.
After tracheotomy the recoveries are from one-fourth
to one-half. Trousseau gives one-third in hospital, and
one-half in private practice. Collected statistics from
English and Scotch hospitals and private practice show
that two-fifths recover after the operation.* Sannd '
gives 89 operations by eleven different operators in vari-
ous parts of France, with 39 cures : one cure in 2.28
operations. In another table, 39 operations by five oper-
ators with 17 cures : one cure in 2.29 operations. These
figures at once decide clearly the only course to pursue.
Does delay in the performance of tracheotomy com-
promise its success ? I cannot conceive a case where
delay would be more dangerous ; there is constant risk
of suffocation, which sometimes comes on very suddenly.
We gain nothing by delay, while the success of the op-
eration is interfered with to a great extent. When the
rima glottidis is obstructed less air enters the lungs with
every inspiration, and the lungs are less expanded, and
in proportion as the circulation of air through these or:
gans becomes diminished, the circulation of the blood
will be embarrassed, and this soon causes this fluid to be-
come vitiated by defective oxygenation. When the op-
eration is long delayed the impeded state of respiration
and circulation produce a violent constitutional disturb-
ance ; venous congestion has become general, the veins
of the head and neck are turgid, the entire body cyanosed,
cold, and bathed in clammy perspiration, the pulse at
the wrist imperceptible, the face livid and ghastly, the
child tossing in agony from one position to another, hop-
ing to find relief, the inspiratory muscles, especially the
auxiliaries, making violent, but fruitless efforts to get
more air through the contracted glottis. The vessels of
the bronchial mucous membrane and the lungs become
passively distended, and a little later serum infiltrates
into the parenchyma of these organs, and the bronchi
become choked up with mucus, thus impeding respira-
tion still further. The weakened and overtaxed heart,
with the brain, being supplied only with venous blood —
the patient, in fact, poisoned by his own vital fluid — be-
comes comatose or convulsed, and the sensorial func-
tions blunted and nearly destroyed. Yet it is advised that
the patient be allowed to reach this stage, that the im-
mediate precursors of death appear, before making an
opening in the windpipe to allow the passage of air to
the lungs !
If under these circumstances the operation fails to save
life, it is spoken of as being dangerous and perilous, of
inducing secondary complications, and similar absurd ex-
pressions !
It would be as rational to persist with taxis in a stran-
gulated hernia until gangrene has set in, before relieving
the constriction with the knife, as to continue medicinal
treatment in a case of obstruction of the glottis until the
patient has arrived at the stage described, before making
an opening for sublaryngeal respiration. And in the
same proportion that delay in strangulated hernia is dan-
gerous, so it is in a case of membranous obstruction of
the glottis.'
He who has made autopsies in cases of croup where
tracheotomy has not been resorted to, and death has oc-
» Medical Times and Gazette, November 25, 1876, page 600.
s Sann^ : Diphtherie, page 467. Paris, 1877.
* Justice to my patient, justice to myself, fidelity to die profession I represent,
all unite in demanding that m^tv, early, before the development of conditions which
will make any interference but a forlorn hope, tracheotomy should be done I (L. S.
Pilcher, Proceedings Kings County Society, Brooklyn, May, 1877, p. 8a.)
650
THE MEDICAL RECORD.
[December 13, 1884,
curred from asphyxia, has seen that the lungs and bronchi
are in a state of venous congestion.
My own records show this invariably. I have examined
the records of a large number of autopsies and have found
that, where carefully made and recorded, the appearances
were quite uniformly the following :
First, /Where tracheotomy had not been performed,
the lungs and bronchi were congested, and there was al-
ways an excessive quantity of mucus on the bronchial
mucous membrane. In a smaller number of cases, oede-
ma of the lungs and pneumonic changes.
Second, where tracheotomy had been performed in
the third stage of croup, and death had followed soon
after, the post-mortem appearances were much the same
as in the cases not operated on.
Third, where death had taken place from several
days to two or three weeks after the operation, the mu-
cous membrane of the bronchi and the pulmonary vessels
was quite normal.
Showing how quickly obstruction to respiration may
induce changes in the bronchi, Mr, Thomas Bryant * re-
lates the case of a child three years old, in whom trache-
otomy was performed for foreign body, and it could not
be removed. The operation was performed one hour af-
ter the accident. The respiration remained unaltered,
and nine hours after the operation, and ten after the acci-
dent, the child died. On autopsy, the bronchial tubes
were found filled with tenacious mucus — in some parts
completely obstructing the passage of air to the lungs,
which were airless. A piece of nutshell was found in the
rima between the cords.
The condition of the pulmonary and bronchial vessels,
found so constantly after death from croup, results from
obstruction in the larynx and impeded respiration, for
wh^n diphtheria exists in the throat only, and there is no
implication of the larynx, the disease tends to destroy life
by exhaustion and blood-poisoning, and rarely do any of
the secondary bronchial or pulmonary complications occur.
Where these complications are found on post-mortem
examination, after tracheotomy, they are not the result
of the operation, for they seldom occur when tracheotomy
has been performed on healthy organs, or in cases of
syphilitic, and even tubercular laryngeal disease, with
chronic pulmonary disease, and the tube is worn for
months, and in some instances for many years. The re-
peated performance of the operation on the same patient
within a short period, without accident or complication,
and with ultimate recovery, shows the utter harmlessness
of tracheotomy, both in its immediate effects and in its
remote consequences.
Mr. Greenfield' relates that tracheotomy on a child
ten months old, with croup, was repeated nine days after
the first operation, and seven days after the removal of
the tube by the nurse. During the latter part of this
operation the child appeared to be dead. Artificial res-
piration was performed and the child revived. Recovery
was perfect. Dr. H. Z. Gill ' performed two operations
of tracheotomy on a boy, aged three years and one month,
with croup, at an interval of fifty-one days, with ultimate
recovery. No bronchial or pulmonary complications af-
ter either operation. Pugin Thornton * performed trache-
otomy four times in five years on a man sixty-seven
years old, with syphilitic laryngitis, without accident or
subsequent complication, and the case ended in complete
recovery.
The great reason why bronchial and pulmonary com-
plications follow tracheotomy where it is performed for
croup is, that where obstruction has continued a long
time the lungs are in a state of congestion, and in this
condition any slight irritating cause, such as would act
harmlessly on healthy lungs, will hasten on into a dan-
gerous inflammation. When it has been decided that a
positive mechanical obstruction to the entrance of air
* British Medical Journal, Februarj" ^7, 1877, p. 205.
into the lungs exists, do not wait until lividity sets in,
before making a way for free and easy respiration. Let
the operation be done before secondary complications
have arisen, or the accession of those symptoms which
are in themselves extremely dangerous to life, which
often render all treatment unavailing, and make the re-
moval of the mechanical obstruction of less importance.
While estimating the effect of protracted obstruction
to respiration with the devitalizing influence on the
blood of the rapidly accumulating carbonic acid gas, its
depressing action on the organic nervous system and on
the heart, we should keep in view that these combined
influences are promotive of the spread of that depressing
disease, diphtheria.
We must also take into consideration the life-giving
and disease-destroying power of oxygen. Oxygen is the
most potent of all tonics, and pure, warm air is the
most valuable remedial agent that we possess for diph-
theria. Let a child with severe diphtheria be kept liter-
ally out of doors, in warm, dry, sunny, summer weather,
and an almost immediate and uninterrupted improve-
ment in all the symptoms will be observed, both in the
general condition and in the local manifestations. In
the majority of cases of croup the patient dies from
want of oxygen and exhaustion of the organic nervous
system ; and the object of the tracheotomy is to render
oxygen accessible to the child ; and it should be remem-
bered that every draught of fresh air assists in the pro-
cess of cure. Do not wait, therefore, until the patient's
strength is worn out with gasping and fighting for breath
before granting him nature's sovereign restorative, f
Who can watch a child struggling for breath with all the
agony which in consequence ensues without feeling im-
pelled to have recourse without delay to the simple proced-
ure of tracheotomy ? Let those who counsel that tracheot-
omy be the last resort witness the extraordinary relief which
follows it, how the breathing becomes tranquil, easy, and
regular, the countenance natural, the cold sweat ceases,
the pulse is again felt at the wrist, and perhaps the child
sits up and takes nourishment, or falls into a quiet,
peaceful sleep ; and I think they will regret not having
granted the child access to air sooner, and lifted in one
instant an agony of suspense from the parents !
Guersant ascertained that the resolution of pneumonia
is facilitated by the greater freedom with which the re-
spiratory functions are accomplished after tracheotomy.
But while the symptoms of suffocation and of pneumonic
changes may be relieved by the late performance of
tracheotomy, they may often be prevented by the early
introduction of air into the lungs. It is said that if we
advise early operation we may operate on many who
would have recovered without resource to this proceed-
ing ; and that we may see our patient recover after the
operation has been rejected by the parents, but this will
happen very rarely indeed, and it is better to err on the
safe side, as the operation can never increase the danger,
while delay has many times deprived the patient of that
chance of life which the operation can offer.
Though there are, undoubtedly, isolated cases of recov-
ery from diphtheritic croup, the proportion of these is so
small after we are positive that membranous exudation
has invaded the larynx, that we ought to have early re-
course to the only mode of arresting death in the major-
ity of cases.
It is a far weightier responsibility to decide when to
operate than merely to open the windpipe. We must
first determine the existence of false membrane in the
larynx.
Though recession of the soft parts of the chest-walls
with every inspiration is a valuable test of the amount
of interference with that act, it does not necessarily indi-
cate the presence of a pseudo-membrane in the larynx,
and it is not a reliable guide if the expiration is free
and easy, for these symptoms may be due in great
part to spasm. The dyspnoea due to spasm alone is
intermittent or remittent, never continuous. But if
December 13, 1884.]
THE MEDICAL RECORD.
651
there i» suppression of the voice, and expiration is la-
bored, prolonged, and audible, there is no longer doubt
about the presence of membrane, for nothing but me-
chanical obstruction could produce these symptoms.
As soon as they appear, and there are no longer remis-
sions between the croupal paroxysms, but the dyspnoea
is continuous ; if insufflations of alum, or of alum and
sulphur, with ipecacuanha cease to afford relief, or emesis
can no longer be produced, and if ipecac only purges,
and poultices and steam have been fairly tried, it may be
said that all remedial measures have failed to control the
disease, and the operation should at once be performed.
There is nothing in the operation itself incompatible with
recovery, even at the early age of six and nine weeks.
In 1830, Dr. Scoutetten, Professor of' Surgery, Military
Hospital, Strasburg, operated successfully on his own
child, six weeks old.
The diagnosis of croup in this case has been ques-
tioned, but it b stated in the original report that there
was expectoration of membrane for two days after the
operation.
In 1880, Dr. Steinmeyer* performed a successful tra-
cheotomy on a child nine weeks old. I have during this
research found recorded an astonishing number of recov-
eries from tracheotomy in infants from a few months to
two years old, which shows that the tender age of the
patient should not be allowed to contra- indicate trache-
otomy ; and the recollection of these may induce many
to perform the operation who now oppose it on the
ground of the early age at which we are frequently called
upon to have recourse to it in many cases of diphtheritic
aoup.
In very young children the disease advances much
more rapidly, and the liability to bronchial and pneu-
monic complications is greater, and they come on ear-
lier in the disease than they do in older children,
therefore we should operate earlier in the younger.
In young children the trachea is deeply imbedded in
cellular tissue and fat ; it is small -and freely movable,
and the other structures of the neck are closely con-
nected with it. Thus the operation presents difficult-
Us which are not met with in older children.
Progn4fsis,'^Y^dj\y age, previous ill health, especially
chronic catarrh, scrofula, bronchial and chronic pneu-
monic changes, all make the prognosis more serious.
If scarlet fever or measles are prevailing at the time of
the operation, and the patient has not had them, he con-
tracts them with increased facility, and the prognosis is
rendered very grave by this added danger. Nasal diph-
theria makes the prognosis worse and severe epistaxis
before or after the operation is of bad prognostic omen.
When croup comes on very early in the disease, and
makes its appearance very suddenly, and the obstruction
is at once extreme, the prognosis is far more serious, for
in such a case the membranous exudation early tends to
spread into the bronchi, and even to the alveoli. When
the lymphatics of the neck are much enlarged, and the
neck greatly swollen, the operation has less chance of
success. The presence in the urine of albumen and
casts make the case more unfavorable. When the
breathing is very laborious in character, and the supra-
sternal, supra-clavicular, infra-clavicular, and the scro-
biculus cordis depressions are not marked, the prognosis
is less favorable than when recession at these places is
very considerable.
When the bronchi and lungs are free, and the obstruc-
tion to inspiration is only in the larynx, the recession of
the soft parts is very great. Less marked depression
denotes obstruction below the larynx and the existence
of secondary complications.
It is an unfavorable sign if the breathing does not
become perfectly free and regular after the operation,
and indicates either the existence of false membrane
below the tracheal opening, or a large quantity of mucus
* Berlin. Idinisch. Wochen., No. 46, 1880. Operation f<ir retro- pharyngeal
abscess.
in the tubes, or pneumonic changes. Difficulty in swal-
lowing after the operation is a bad symptom. This arises
from fluids passing through the glottis, where they excite
convulsive coughing and escape through the canula.
After-management. — Success after tracheotomy is to be
obtained more by careful nursing than from the perfec-
tion of the operation itself. From careful observation I
am convinced that the two main causes of failure of
tracheotomy in saving life are the late performance of
the operation, and inefficient after-care, and among the
last-named want of proper attention to the canula. Olxi
struction at the inner end of the tube from false membrane
or mucus, causes more deaths after tracheotomy, than
either pulmonary diseases or the original malady which
rendered the operation needful.* The physician should
not forget that his whole duty is not performed when the
operation is completed ; that tracheotomy does not tend
to cure the disease, but that it allows time for the applica-
tion of the treatment found to be most successful in
controlling it.
The sustaining of the patient, the administration of the
remedies for the arrest of the disease, attention to meas-
ures for subduing the local process and reducing inflam-
mation, the temperature, quality, and amount of moist-
ure in the air that the patient breathes, the care of the
canula, and the condition of the trachea and bronchi
are not generally carried out with enough thoroughness to
give the patient all the advantages which the operation is
capable of affording.
I must again revert to the most important of all the ques-
tions just now in connection with our subject — the danger
of the operation itself. The quotations from so many emi-
nent authorities of vast experience in the perfor?rance of
tracheotomy prove beyond all peradventure that the opinion
that it is a dangerous operation is erroneous — and it is not
only erroneous, but dangerous. To the majority of people
in this city the proposal of tracheotomy seems equivalent
to pronouncing sentence of death ; and from the opera-
tion being represented as formidable comes the unwilling-
ness of parents to consent to it until the child is about to
expire, and of physicians to undertake its performance.
In many cases where tracheotomy is required it is as
much a case of emergency as that of a bleeding artery.
When danger is imminent, an operation is often needed
even without a consultation, and a delay of a few minutes
might cost the life of the patient ; but owing to the prac-
titioner being afraid to operate, he often leaves his
patient struggling for breath and rushes after a tracheoto-
mist J and returns, perhaps, to find that his patient has
died strangulated.
At the March meeting one of the speakers said that
he had been summoned to half a dozen such cases, and
then, in alluding to the danger of tracheotomy, he stated
that he " was willing to go upon record as saying that
there have been more deaths upon the table in tracheot-
omy than from any other operation which is performed." *
From this he inferred its danger ! It would have been
as logical to have said that tracheotomy is dangerous
because more patients have died during the delay at-
tendant on the bringing of a tracheotomist to the patient.
An eminent physician in the early part of this century
was allowed to perish from this very neglect. Dr.
Matthew Baillie in the third volume of the " Transactions
of the Society for the Improvement of Medical and Sur-
gical Knowledge," records the fatal illness of Sir John
Macnamara Hayes. He was taken ill on July i6, 1809.
His disease was croup. On the night of the i8th trache-
otomy was proposed. Mr. Home and Mr. Wilson were
sent for to perform bronchotomy. Mr. Wilson was out
of town, and Mr. Home did not come until four in the
morning, but the patient was then in a dying state ; he
expired at six. Autopsy, 20th : ** The cavity of the
glottis was found to be almost obliterated by the thick-
^ Seventy-eight per cent, die in the first four days (Wanscher). Seventy-nine
and one-half per cent, die in the fiist tour days, and nearly sixty-three per ceni.
during the first two days (Kronlein, in T anfzenbeck's Archives).
3 Dr. Ripley, Medical Record, April 5, 1884, p. 388.
652
THE MEDICAL RECORD.
[December 13, 1884,
ening of the inner membrane of the larynx at that part."
A prominent practitioner in this city left a case of
diphtheritic croup in the care of a young surgeon, who
had been on the surgical staff of Bellevue Hospital for
eighteen months, with the instruction that he should go
for Dr. X. if he thought tracheotomy necessary. It did
become so and he obeyed instructions. Dr. X. not being
at home, another surgeon was sought and found. The
trachea was opened immediately, but the child died soon
after from exhaustion, owing to the late performance of
the operation.
Contrast this absurd proceeding with the custom in the
hospitals in England, where nearly all the tracheotomies
are performed by the house-surgeons.
In this connection the action of Professor J. G. Ehr-
hardt,* in the light of a single experience of the kind, is
interesting and instructive : "Case of diphtheritic croup,
summoned at 2 p.m., December 12th, and found child
much worse. Tracheotomy only thing that offered benefit.
Time was lost while waiting for my father to assist me,
when he arrived the boy was nearly dead. There were
two or three respirations after the tube was inserted. I do
not believe that the operation hastened death." " Decem-
ber 15th, called to a boy of five years. Time was too
precious to send for a surgical assistant ; operated at
once. Child recovered."
The physician who leaves his patient in a state of
rapidly advancing asphyxia and goes in quest, perhaps
in vain, of a surgeon merely to make an opening in the
windpipe, is as culpable of neglect as he would be if
he left a spurting artery and went for a surgeon to arrest
the bleeding. Another reason why an exaggeration of the
danger of tracheotomy should not prevail is that in coun-
try districts it almost entirely prevents recourse to it. A
physician but eighty miles from this city, who is in the habit
of doing capital operations, has told me that he would
not dare to undertake tracheotomy, because there is a
universal impression that the operation is extremely
dangerous to life.
I hope, as a result of the proper appreciation of this
life-saving measure, and a thorough understanding of its
harmlessness, that when diphtheritic croup is epidemic in
the country, tracheotomy will be as frequently performed
by the "family physician '* as common bleeding used to be.
This misrepresentation of the danger of tracheotomy
has caused its abandonment several times in its history.
After its proving successful in the hands of Asclepiades,
100 B.C., from its being scorned and being spoken of as a
crime by Caelius Aurelanius, it was lost sight of for more than
two hundred years, when it was revived by Antyllus about
340 A.D. After this the writings of Rhazes, Avicenna, and
others caused its suspension until the time of Paulis -^^ge-
naeta in the seventh century, who seems to have repeatedly
opened the windpipe. From that date until the attempted
reintroduction by Guieto de Cauliaco, in the fourteenth
century, we hear nothing of the operation. Brasavola,
in the middle of the sixteenth century," asserts in his
" Commentaries " that he himself opened the trachea in
a case of a patient laboring under quinsy, and on the
point of death, and thus saved his life, the surgeon not
daring to perform the operation. Dr. Geo. Martyn in
1730 performed a successful tracheotomy on a young lad
with croup.*
Dr. Michaelis * in a letter from New York, dated 1 780,
advised early operation in these words : " It is unpardon-
able if it is not resorted to in time."
In 1807 Napoleon offered a prize for the best essay on
diphtheria. The men between whom the prize was
divided, and all who were gathered at the great medical
concourse in Paris when it was awarded in 1808, were,
with one exception, opposed to tracheotomy. Caron
upheld the operation with great energy and indefatigable
perseverance. So strong were his convictions, and so
1 American Journal of the Medical Sciences, April, 1873, ?• 43i« ' 1546* '
* Philosophical Trans., 1^30. Ix>ndon, 1809.
* Richtcr's Chimrg. Biblioth., vol. vi., p. 120. \oss : N. Y. Joum. Med., Jan-
uary, z86o, p. 31.
great his ardor, that he oflfered a prize of a thousand
francs to the man who would cure croup with the aid of
this operation. But the opinion of the judges and the
writers of the prize essays so influenced men that there
was no advance made in tracheotomy until Bretonneau.
It was given to Bretonneau to restore a supreme resource
so unjustly condemned. Four consecutive reverses did
not discourage him, and in 1825 he had the happiness of
saving the daughter of his best friend by the operation.
In 1814 Thomas Chevalier,' of London, made a sue-
cessful tracheotomy in diphtheritic croup in a boy seven
years old. Such, however, was the opposition to and
dread of the operation, that' **in 1820 a medical gentk-
man of high standing in this city (Edinburgh) who was
anxious to afford relief to two of his children affected by
croup could not prevail upon any of the principal surgeons
to perform tracheotomy. At his urgent request Dr. Bryce,
a gentleman in general practice, operated on one of the
children without ultimate success, as both of them died."
Though we need not apprehend the abandonment of
the operation to-day, an exaggeration of its dangers
might be the means of its being withheld from many who
could be saved by it, or of its not being resorted to until
it is too late to accomplish any good. Let not the erro-
neous and dangerous opinion go forth from this Academy
that tracheotomy is the most dangerous of all surgical
operations! The diffusion of this dictum emanating
from such a representative body of medical men, will be
the means of destroying far more lives in a compara.
tively short period, than the operation itself or anything
directly connected with its performance has from the
time that it was first instituted, more than two thousand
years ago. .
Conclusions. — Tracheotomy of itself, performed with
care, involves little if any danger to life.
Accidents during the operation generally result from
want of care.
It prevents asphyxia, and thus gives more time for the
administration of remedies, and for the system ultimately
to throw off the disease.
It prevents laborious and rapid breathing and lessens
exhaustion.
It allows a free supply of air, and thus assists in the
cure of the original malady.
It is the supreme resource, and as the patient cannot
be made worse by it, do not postpone it until there is but
a forlorn hope even from it.
Persistence of the original disease, delay in the per-
formance of the operation, and neglect after, are the
causes of its failure.
Operate early, very slowly, deliberately,' carefully, and
without hurry.
It is never too late to operate : even though the child
has stopped breathing, if life is not extinct, open the
windpipe and perform artificial respiration— many chil-
dren have been saved under just such conditions. C,
If strangulation is the main symptom neither age, con-
stitutional condition, nor complications can furnish a
contraindication to its performance.
It alleviates suffering.
It mitigates all the symptoms.
It obviates secondary complications.
It never adds one element of dangerjo the original
disease.
Statistics taken collectively show that nine-tenths of
the cases which render the operation needful will suffotaie
without it.
Performed early it snatches from certain death fully
two-fifths of all the cases.
No patient that dies after the operation would have
lived if it had not been performed.
When it fails to save life the relief afforded and tjie sub-
stitution for the most agonizing mode of death — strangular
» Med. Chimrg. Trans., 1815, vol. vi., p. 150. This operation, though attributed
to Mr. Chevalier, was done by Mr. Lighifoot, the house surgeon.
* James Spence at the Forty-third meeting of the British Medical Asflodation.
December 13, 1884.]
THE MEDICAL RECORD.
653
tion — one of the least, by asthenia, are sufficient reasons
to justify its performance.
The dictates of science, facts, and common humanity,
unite in demanding it.
Sevcrinus must have been inspired when in the seven-
teenth century he said of it : " It is a divine invention."
Allow me one nure quotation, gentlemen. In The
Medical Recoud of June 28, 1884, Professor Letamendi
says : " In the days of more knowledge and less nonsense,
tracheotomy will be ranked among the minor surgical
operations."
Successful Tracheotomies for Croup in Children One
Year of Age and Under,
% >Age.| Disease.
,Wki
J 6 Croup.
.Mos.i
2 I 3 Croup.
I
3 6>^ Croup.
^ ' 7 Croup.
5
Operator.
iScoutetten (1830),
;Annandale.>
ijos. Ben.
Tait
7 Croup.
7 Croup.
I > Lindner.
7 Croup. iWegner.
Authority.
7 Croup.
L
7>^Croup.
Kronlein.
Jos. Bell.«
8 Croup. lElias.
10
zi
14 10 DiphUieria.
xo Croup. "•,!
10 ICroup.
10 Croup.
23
10 Croup.
11 iCroisp.
n Crotip.
I
II 'Croup.
II Croup.
n Croup.
12 ,*Croup.
Croup.
Croup.
Day.
Baizeau,
V. Winiwarter.*
Elias.
Bourdillat.
Geo. F. Shrady.*
Trousseau.
Rauchfuss.
J. Cooper Forster.
Derby.
Lindner.
Tr endelenbu rg.
A. T. Woodward.
Soc. Med. des Hdp. de
Paris, 1867.
Ed. Med. Jour., vol vii.,
part 2, June, 1862, p.
iiai.
Bell : Letter to Brit. Med.
Jour., April 8, 1871.
Brit Med. Jour., April 15,
1871. p. 391-
Deutsche Zeitschrift f,
Chir, Band xvii., Heft
S und 6. .,
Kronlein: Archiv f. klin.
Chir, vol. xxi., 1877.
Rauchfuss in Gerhardt's
Handb. Kind., vol. iij.,
p. ao2.
Syme : Ed. Med. Jour.,
vol. vl, part 2, April,
1 861, p. 9561
Deutsche Med. Wochen.,
November 9, 1878.
Greenfield in St. Thomas'
Hosp. Rep., vol. viii., p.
263.
Gaz. des Hdpitauz, 1867,
P-397.
ahrl "
24 |i2 .Croup. .Dujardin.
From One to Two
25 13 Croup.
I i
26 13 Croup.
27 13 Croup.
28 |i3 'Croup.
Wardner.
Barthez.
Trousseau.*
Archambault.
Jahrbuch £ Kind., 3 u. 4,
p. 337. 1876.
Deutsche Med. Woch..
November 9, 1878.
L* Union M^d, 1872, vol
xiii., 3d series, p. 826.
N. Y. Med. Record, vol.
xxii.. Nov. 4, 1882, p. 512.
Paris Theses, 1834, vol. x..
No. 289, p. 13, Aussan-
don's Thesis.
Gerhardt's Handb. Kind.,
vol. iii. , p. 202.
Brit. Med. Jour., March
25, 1871, p. 309.
Stevens : Boston Med. &
Surg. Jour., vol. Ixxi.,
October, 1869, p. 167.
Deutsche Zeit. £ Chir..
Band xvii., Heft $ u. 6.
Gerhardt's Hand. Kind.,
voL vi., p. 262.
Mastin: Gaillard's Med.
Jour., January 1880, p,
L'union M6d., 1872, 3d
series, voL xiv., p. 46.
Years of Age, ^
fiLounsbury and Gill: IlL
State Med. Soc. Trans.,
1878, p. 164.
Mastin: Gaillard Jour.,
January, 1880, p. 3a
Gaz. Hebdom., 1862, p.
806.
Jour, des Conn. Med.-
Chirurg. .September 3d,
t. ii., p. I.
Gaz. des H6pitaux, 1867,
p. 397.
* Qiild lived seven weeki after the operation. On autopsy lungs were found to
be perfectly healthy.
^Communication to Med. Chirurj?. Society, Edinburgh. Professor Syme
I ttooght that the operation would not do any good in this case, but yielded to Bell,
Ifae house-surgeon, who did the tracheotomy, which was followed by instant relief
; tothechild. y» J
' Respiration stopped and artificial respiration was performed for ten minutes,
Ud haul to be resorted to three times within the first hour.
;: * Thb is the youngest successful case operated upon in this country. This
2>peration was perfom^ed between the tenth and eleventh month. Child is still
u^^g. • Operation same year as reported.
I Age. Disease.
Operator.
Authority.
jMos.
29 '14 Croup.
30 14
31
32
Croup.
14 Croup.
14K Croup.
33 IS
34 IS
35 lis
36|iS
37;i6
38!i6
39 117
40 17
41 '18
42 18
43 ^18
44 18
45 18
46 18
47;i8
48 18
49 ii8
50 ;i8
51 ji8
S3 J19
S4|I9
55 19
56 19
57|i9
I
58 '19
'Croup.
Croup.
Croup.
I Croup.
Croup.
Croup.
Croup*.
Croup.
!Cabot.»
I
'V. Langenbeclc
I
Rapin.
: Millard et H^mey.
I
I
I Cabot.
miie.
Baizeau.
Isambert.
Lindner.
I
,Wegner.
I Nathan Jacobson.
Vigla.
Diphtheria. Bartscher.
Croup.
Croup.
Croup.
^C. Withusen.'
Diphtheria. I Josef Pauley.
I
Croup. George Rachel.
Croup. Collins.
; ]
Diphtheria. I Voigt
Croup.
Croup.
Croup.
Croup.
Croup.
Croup.
Croup.
Croup.
Croup.
' Moutard-Martin.
I
I Potain.
I Archambault.
I Roger. ,
iPancoast.
I
Bose.
Weber.
59
60 ;ao
61
62 21
64 J22
65 I22
66 22
67 |2a
Croup.
Croup.
Croup.
i
Croup.
Croup.
Croup.
Croup.
Croup.
Croup.
68 1 22 I Croup.
I I
69 22 Croup.
lCr<Mip.
Croup.
70 23
71 '2a
72 22
73 22
74 23
75,23
76 23
I Croup.
I Croup.
Croup.
Croup.
Croup.
,Wegner.
[Trendelenburg.
Jennings.
!Busch.
Bose.
Fitzau.
I
, Kronlein.
It. Sendler.
[ Dower. <
I Isambert.
Gushing.
I Laborde.
Maslieurat-Lag^mard.
Ferraux.
Ijohnson.
I
'Wegner.
'Laborde.
Trousseau.
Bose.
Burland.
Haywood: Boston Med.
I and Surg. Jour., voL
Ixii., p. 273, i86o.
KrSnlein : Archiv f. kKo.
I Chir.. vol. xxi., 1877.
Sann6 : Trait6 de la Diph-
theric, p. 481, Paris, 1877.
Sann4 : op. cit., p. 481.
Jour. deTherapeutique^
1874.
Boston Med. Jind Surg.
Jour., vol. Ixx., p. 61.
:Gaz. des H6pitaux, 1867^
p. 397.
I Gaz. des H6pitaux, p. 397,
i 1867.
Clinique Med., vol. i., p.
I 452.
Deutsche Zeit f. Chir.^
I Band xvii., Heft 5 u. 6.
'Kronlein: Archiv f. klin.
Chir., vol. xxi., 1877.
N. Y. Med. Record, June
30, 1883, p. 705.
Gaz. des H6pitaux, 1867;
p. 397-
Deutsche Med. WocRwn-,
I 1880, p. 29.
1 Dub. Med. Press, April 5,
1865, p. 320, from Uges-
, krift for Larger, March.
! 16, 1865.
I Berlin, klin. Wochen-
I schrift, February 25^
I 1878, p. 105-6.
Amer. Jour. Med. Sci-
I ences, July, 1877, P- 95-
.Mastin: Gaillard's Med.
I Jour., voL xxix., p. 30^
I January, 1880.
I Jahrbuch f. Kind., voL
j viii., p. 121, 1882.
Gaz. des H6p., 1867, p..
I 397.
Gaz. des Hi6p... 1867. p.
! 397
jGaz. des H5p., 1867, p.
I 397.
;Gaz. des H6p., 1867, p.
Meigs r Amer. J our. Med.
Sciences, April, 1849^
Kronlein : Op. cit.
Zeitschrift f. Ration. Med.
Neue Folgei,Band iii-^
I Heft I, p. 8, 1852.
I Kronlein : Op. cit.
■Vaneschi: Berliner klin.
j Woch., April, 1872, p.
i 163-
'Archives of Pediatrics,
I vol. i. , No. 9, Sept 1$^
I 1884, p. 546.
Vaneschi : Berliner klin.
Woch., April, 1872, p.
163.
Vaneschi : Berliner klin.
Woch.» April, 1872, p.
16^.
Berliner klm. WGcheB<-
schrift, April 25, 1879, p.
223.
Krdnlein : Op. cit
Vierteljahrschrift f. Prak.
I Heil., vol iv., p. 71.
'Brandt: N. Y. Med. Rec-
, ord. January 13, 1883,.
I P« 54*
Sann6 : Diph. , p. 481.
Pacific Med. and Surg.
Jour. , vol. vii. , p. 14.
Gaz. Hebdonv, 1862, p^
807.
Gaz. Med. de Paris, 1841^
p. 380 ; 1842, p. 170.
Gaz. Hebdom., 1862, p.807'
mi. State Med. Soc.
I Trans., 1879, P- 120 ; re-
ported by Gill.
I Kronlein : Op. cit
Sann6 : Diph. , p. 481.
|Sann6: Diph., p. 481.
Kronlein : Op. cit.
Gaz. Hebd.. 1862, p. 808.
Yrs.
771 -2
78:
79 I 1-2
80.
Cases Exact Ages not Given,
Croup.
j- Croup.
Krackowizer.
Korte (three cases).
Jacobi: Am. Jour. Ob.,.
May, 1868.
Arch, fur klin. Chir.,.
Band xxv., p. 820.
1 Child had double pneumonia and recovered.
* One case died on'eighly-first day of exhaustion from diarrhoea.
654
THE MEDICAL RECORD.
[December 13, 1884.
COCAINE IN INTRA-NASAL SURGERY.
By WILLIAM CHAPMAN JARVIS, M.D.,
LRCraRBK ON LARYNGOLOGY IN THE NKW YORK UNIVERSITY MEDICAL COLLEGE.
On the receipt of the intelligence of KoUer*s experi-
ments * with cocaine, through Dr. Noyes* communication
to The Medical Record, the first thought was naturally
one suggestive of startling possibilities corresponding in
direction with the reader's line of inquiry. In response
to this impulse I have conducted a series of experiments
with the new anaesthetic in operations upon the nares,
and in view of the remarkable and positive character of
the results obtained feel encouraged to relate my experi-
ence, with certain additional corroborative testimony.
My first experiments, conducted several weeks since
with a two per cent, solution of the salt, were not ex-
tended on account of the unfavorable impression received.
Though sceptical regarding the action of this solution
for my purposes, I was nevertheless inclined to expect
better results from a stronger preparation. A four per
cent, solution of the crystalline hydrochlorate of cocaine
was afterward obtained from a diflfereut source. My
method of applying the salt consisted in placing pledgets
of absorbent cotton in contact with the structures requir-
ing removal, and projecting upon them, by means of a glass
lube, from five to ten drops of the cocaine fluid. The
cotton once moistened can be used several times at a
single silting ; indeed cotton saturated with the fluid and
afterward dried will remain cocainized for many hours. I
employ an exceedingly fine home-made spray to produce
more extensive effects.
The cases reported have been selected on account of
the exaggerated sensibility of the structures involved, and
as such offer excellent evidence of the powerful analgesic
action of cocaine.
Mr. , banker, consulted me on account of an an-
noying nasal catarrh. Examination revealed, among
other things, a deviated septum pressing against a con-
gestive hypertrophy of the left antero-inferior turbinated
tissues. The deviated cartilage extended as a narrow
horizontal ledge to the osseous edge of the septum, and
obstructed nasal respiration through the left nostril.
While employing a probe to point out the site of the af-
fection, it happened to lightly touch the septum. The
patient started as if severely injured, and invariably ex-
hibited signs of intense discomfort. When the manipu-
lation was repeated, intense sensitiveness was exhibited,
and my prospects of assistance from the patient in a delib-
erate operation could hardly have been less favorable. A
pledget of absorbent cotton was inserted in the nostril,
against the abnormal structures, and a few drops of the co-
caine fluid placed upon it by means of a camel's hair bmsh.
At the expiration of twenty minutes the cotton was re-
moved. The first effect observed was the retreat of the
lower turbinated tissue from contact with the septum,
thus aflbrding more room for operative manipulation.
This peculiar action of the cocaine has already been de-
scribed by Dr. Bosworth. I tentatively nipped off a
piece of the septum with my fenestrated cartilage forceps ;
the procedure, according to the patient's statement, was
perfectly painless. Emboldened by this I commenced
work in earnest, the slight amount of bleeding enabling
me to continue operating uninterruptedly for five min-
utes. During this interval the patient declarq^ there
was an entire absence of sensation. The parts were
then cleansed of tissue debris. In five minutes sensation
had returned. I reapplied the cocainized cotton, and
after leaving it in five minutes, proceeded with the op-
eration. In this interval I removed the whole length of
the remaining deviated cartilage. The patient could
with difficulty find words to express his profound sense of
satisfaction.
Amanda D , aged sixteen, referred to me by Dr. S.
Hemingway. Congenital occlusion of the nares from
malformation of nasal and turbinated bones. Bridge of the
nose almost entirely wanting. Interocular space very
broad, falling of the lower jaws, with associated signs of
habitual mouth-breathing. Both nostrils impacted with
flesh-like masses, having almost the firmness and elasticity
of rubber. The structures were jammed so tightly against
the wall of the septum as to give at first sight the impres-
sion of its fusion with the cartilage. The turbinated tis-
sues present none of the usual signs of hypertrophied
membrane, having the appearance of slightly congested
turbinated tissues, and having only a trifling tendency to
retract when touched with cocaine. The tissues still
possessed a sensibility evidently equalling that of the
normal erectile structures. The posterior nares were
obstructed. A case of congenital stenosis succcssfuily
treated by me several years since presented many feat-
ures in common with this one.*
I had operated upon Amanda D on a previous
occasion, employing my transfixion needle and ^crascur.
The child did not possess a particle of fortitude, causing
me a great deal of trouble by her persistent crying, and
in spite of every precaution for her comfort she proved her-
self to be one of the most intractable patients I ever had to
contend with. This state of hyperaesthesia was probably
due to the prolonged contact of these delicate tissues
with the septum narium. The case seemed an excellent
one for the employment of cocaine. I therefore placed
a pledget of absorbent cotton in the left nares, and
moistened it with a few drops of the solution, carried into
the nostril upon a camel's-hair brush. After the expira-
tion of fifteen minutes I removed the cotton, and delib-
erately transfixed the pale tissues, the passage of the
needle, as stated by the patient, causing absolutely no
pain. The loop was likewise painlessly introduced, and
the operation satisfactorily completed.
After an interval of five days I continued operating, re-
plenishing my cocaine bottle from a neighboring druggist.
The solution, though applied as in the first instance, did
not have the desired effect. I then procured a fresh solu-
tion from still another druggist. This fluid likewise failed.
I^ater in the day I procured some of the original prepa-
ratioUf and found it as effective as in the first instance.
Small portions of the turbinated bodies were successfully
removed by means of the fenestrated cartilage forceps,
an expeditious but more painful and bloody method than
excision with the wire, and therefore never employed
by me for this purpose. The controlling influence of the
cocaine over the blood supply removed this objectionable
feature, and furnished a clear field for operation. As
the incisions gradually included the deeper-lying tissues
they became sensitive, requiring fresh applications of the
cocainized cotton.
Mr. P , merchant, thirty-two years of age, was seen
by me in consultation with Dr. Bellows, of Brooklyn. The
patient had been unable to breathe through the nose for
fourteen months. The nostrils closed gradually, the
right being the first to become involved.
Dr. Bellows informed me that he had already been in
the hands of a physician, who employed the galvano-cau-
tery for several weeks. A surgical procedure of a more
formidable character was next employed, the patient
emerging from etherization only to be confined to the
house for three weeks on account of the severity of the
operation, and an otitis media acuta set up by the trau-
matism. After recovering from these unfortunate sequela
his condition was worse than before the operation. An
examination showed the right nostril to be entirely oc-
cluded by a combined deviation of the septum and tur-
binated hypertrophy. A very narrow chink in the left
nostril permitted the occasional entrance of a feeble cur-
rent of air, enabling the patient to partially remove
pent-up nasal secretions. It possessed, however, very
little respiratory value.
I have been gradually clearing the nostrils for several
* Wiener Medizmische^ochenschrlft, No. 44, 1884.
1 Archives of Laryngology, voL uL, x888 .
December 13, 1884.]
THE MEDICAL RECORD.
655
weeks, removing small portions of the tissues in such
way as not to interfere with th.e patient's business. Al-
though the careful excision of small portions of bone and
cartilage greatly diminished his suffering, there were,
nevertheless, moments when he complained severely of
the pain inflicted by the rongeur and cutting forceps. I
employed cocaine by placing small bits of absorbent
cotton in contact with the already wounded and tender
surfaces, and dropping the solution upon it by means of
a pipette. In thirty minutes the pledgets were removed
and a tentative test made. Although the forceps inflicted
pain, superficial sensation was reduced to a degree per-
mitting the stripping off of membranes partly divided in
a previous operation. Another application of cocaine
was made, the cotton being again removed after an inter-
val of fifteen minutes, I then commenced to divide the
tissues, and was told to continue the operation, as no
pain was inflicted. I continued operating for three min-
utes, when the patient interrupted me while cutting away
the deeper structures over the vomer. In this interval
bone and cartilage were alike divided without causing
the slightest pain. This method of alternately benumb-
fng and cutting was continued for more than two hours
and a half, the patient being in the best of spirits during
the entire interval. He left the office breathing through
a free opening into the posterior nares, and thoroughly
convinced of the pain-relieving properties of cocaine.
The following history, reported through the courtesy of
Dr. William Vanderpoel, offers additional evidence in a
case in -which my dcraseur was recommended : Mrs.
Annie M , aged twenty-nine years and six months,
pregnant, presented herself at my office, November 3d,
suffering from a growth in the left nostril which pro-
truded three-fourths of an inch, was about three-fourths
of an inch in diameter, of a dark red color, firm upon
pressure, and insensible to ordinary manipulation. Two
months previous she had come to me, presenting a small
growth in the left nostril, which had all the characteristics
of an ordinary gelatinous polypus. Under ordinary cir-
cumstances I should have removed it at once ; but con-
sidering the fact that she was then four months pregnant,
and had previously miscarried three times, in each in-
stance with profuse flooding, I feared the shock of an
operation and ordered a spray of carbolic solution (y^),
under ^rhich treatment the growth seemed to disappear,
but a month later returned.
Still fearing an operation, on November 9th I injected
the tumor with a few drops of glacial acetic acid, and also
gave the patient a powder, composed of tannin, to be
snuffed up the nostril as best she could. On November
15th, there was little improvement, so I decided upon an
operation. To lessen the pain and shock of the operation,
I employed the muriate of cocaine, two per cent, solu-
tion, applied with a camel* s-hair brush, to inside of the
nostril, as well a& the tumor would permit the insertion
of the brush.
I made three applications at intervals of ten minutes,
using in all 3 ss. of the solution, or about one grain of co-
caine muriate. The first application was rather painful
from the contact of the brush, but the subsequent caused
no uneasiness. The Jarvis' snare was then applied without
any discomfort, and passed well up to the root of the
tumor, which seemed to have origin from the middle tur-
binated bone. No pain was experienced during the opera-
tion, and after an hour and a half the tumor came away,
the patient not losing more than a few drops of blood
during the entire operation, and no hemorrhage fol-
lowed it.
In addition to the foregoing cases I have employed
cocaine to remove polypi and hypertrophied turbinated
tissues, and have found it useful to facilitate the prac-
tice of posterior rhinoscopy and to alleviate pain in
the larynx and pharynx. I do not consider its em-
ployment urgent in the removal of polypi and tur-
binated hypertrophies, since these growths, especially
the former, can be in most instances removed with little
or no pain by means of my nasal 6craseur. The time
required to make the operation painless with the snare
is necessary also to prevent the occurrence of annoy-
ing hemorrhage. Although cocaine at times restrains
bleeding, its action in this respect is not necessarily per-
manent. I have observed tissues pale and bloodless
when divided under the influence of cocaine, bleed pro-
fusely as soon as the effect wore oflf. The employment
of cocaine in the nostril has been referred to in this
country by Bosworth, Bettman, Ingals, Knapp, Gruen-
ing, and Claiborne.
It is curious to note that while Professor W5hler and
Dr. Niemann mention its effects upon the tongue, they
claimed it possessed no action upon the eye.* Von
Anrep {Archives fur Physiologie^ p. 56, 1880) experi-
mented upon himself by pencilling the tongue with a
weak solution of cocaine, and observed a loss of sensa-
tion. The blood-vessels were first constricted, then di-
lated, and eventually resumed their normal condition. It
was probably this discovery that induced Fauvel and other
European laryngologists to employ cocaine in examina-
tions of the throat. Although I have only employed a
four per cent, preparation of the salt, the experiments of
Jelenek' indicate an advantage to be obtained by the
employment of stronger solutions (twenty and thirty per
cent, alcoholic) of the salt. The difference will prob-
ably show itself in a deeper and more rapid effect. My
remarks upon cocaine analgesia would be incomplete
without reference to another agent of this kind. I al-
lude to rhigolene. Although no record of its use in
intra-nasal surgery has come under my notice, rhigolene
has yielded excellent results in my hands. For the pres-
ent I must content myself with a brief account of the
method, since a detailed description would be foreign to
the subject of my paper.
This petroleum naphtha, proposed by Dr. H. J. Bige-
low, of Boston, as a local anaesthetic, boils at 70® F.,
and, in the form of a spray, is capable of reducing the
temperature 15® below zero. Rhigolene, when applied
with a suitable atomizing apparatus, will effectually
freeze the tissues in less than a minute.
I make use of a special contrivance for this purpose.
Its action is more prompt and deeper, but of shorter
duration than that of cocaine. Cartilage and mucous
membrane can be deeply and freely divided without
pain or hemorrhage. The rapid disappearance of the
artificial congelation makes it necessary for the operator
to act with promptness and energy. In cases requiring
extensive operative interference, frequently repeated ap-
plications of the rhigolene spray are necessary. This,
however, does not apply to the practice of 6crasement.
Tissues properly snared with the wire loop of my nasal
^raseur can be continuously frozen and divided. I
have utilized partial cocaine anaesthesia to facilitate
transfixion and snaring of the turbinated tissues, rapidly
completing the operation with the rhigolene spray. It
is hardly necessary to add that daylight must be em-
ployed for illumination, on account of the inflammability
of the naphtha fumes.
Rhigolene acts more rapidly than ether, and for this
and other reasons is to be preferred.'
Conclusions. — i. Cocaine is useful in intra-nasal sur-
gery, as a local anaesthetic, for the removal of deep as
well as superficial tissue abnormalities.
2. Repeated applications are required for the re-
moval of the deeper structures, the time requisite for
anaesthesia always being shorter after the first effect has
been obtained.
3. By promoting quiet and preventing secretion, hem-
orrhage, and sneezing, it facilitates the employment of
cutting instruments within the nasal cavity.
4. The action of cocaine for profound anaesthesia de-
pends upon the quality and quantity of the salt.
» American Journal of Pharmacy, i860, vol. xxxit., p. 450.
< Wienex Medizinische Wochenschrift, No. 45, 1884.
* Dictionnaire de M^decine, etc., Littr^ and Kobtn.
656
THE MEDICAL RECORD.
[December 13, 1884.
5. In rhigolene we possess a most valuable local an-
aesthetic for intra-nasal operations, the effects produced
being more rapid and complete but of shorter duration
than those of cocaine.
6. Rhigolene is advantageously employed in conjunc-
tion with cocaine.
25 East Thirty-fikst Street.
FURTHER OBSERVATIONS ON THE USE OF
COCAINE.
. By H. KNAPP, M.D.,
NEW YORK.
Since my communication on cocaine and its application.
Medical RecoRD, October 25th of this year, I have used
the new anaesthetic in a considerable number of cases, of
which the following may be of interest even after the gal-
axy of cocaine papers that have appeared in the Ameri-
can and foreign press since October i8th.
Case I. — Enucleation of an eyeball under anasthesia
from injecting cocaine into the post-ocular cellular tissue,
— To-day, at my clinic at the University Medical College,
I presented a patient, aged twenty-five years, in whose left
eye I had diagnosticated a choroidal sarcoma. I stated
before the class that it would be quite an interesting ex-
periment to inject cocaine into the orbit, behind the globe,
and afterward test the sensibility of the anterior parts of
the eye, supplied by the ciliary nerves. The hour, however,
drawing to a close, the practical indications of the case
were the only ones we had time to attend to. I instilled two
drops of a four per cent, solution of Merck's hydrochlorate
of cocaine into the conjunctival sac. Five minutes later
another five drops were instilled, and about six minims of
the same solution injected behind the globe. This was
easily done and not felt at all by the patient. The eye-
ball had been forcibly drawn toward the nose with a pair of
fixing forceps, the point of the hypodermic syringe thrust
into the orbital tissue as far as the posterior pole of the
globe. Five minutes later the eye was enucleated in the
usual way. The patient indicated slight pain at the di-
vision of the tendons of the recti muscles. The division
of the optic nerve and the dissection of the posterior
segment of the globe caused almost no pain. When the
eyeball was removed, I thrust the end of the forceps an
inch deep into the wQund of the orbital cellular tissue.
The patient did not move, and said she felt nothing.
The bleeding was very scant. The eyeball was opened
at once, and a typical melanotic sarcoma of the choroid,
the size of a cherry pit, covered by detached retina, was
exhibited to the class. Ten minutes later, when the
hemorrhage had completely ceased, I united the con-
junctival wound with a continuous suture. By this time
the sensibility had returned, and the patient screamed at
every stitch, saying that this hurt her very much, whereas
during the operation she had felt almost no pain.
This observation has convinced me that even the re-
moval of the eyeball does not lie outside the field of ap-
plication of the new local anaesthetic.
Case II. — Ptosis operation after subcutaneous injection
of cocaine ; anasthetic effect not very satisfactory. — A
boy aged about ten years, with double congenital ptosis,
was operated on at the clinic of the University, Novem-
ber 25th. I injected a few drops of a four per cent, solu-
tion of cocaine under the skin of the right upper eyelid,
introducing the point of the syringe 3 mm. above the
edge of the lid, near the outer commissure, and advancing
it horizontally nearly to the inner commissure. In with-
drawing the needle, I injected the liquid. The lid swelled
slightly, was suff'used with blood, and in ten minutes
only partially insensible. I held it compressed between
a clamp, removed an elliptical piece of skin and muscle,
and stitched the lower lip of the wound to the upper,
passing the sutures high up through the skin. The tissue
which I removed was infiltrated with blood. The patient
had pain during the whole operation, not great in the
centre, but quite keen at the peripheiy of the wound.
He was restless and uneasy. I etherized him, which
took about one minute, and performed the same opera-
tion on the other eye under perfect anaesthesia. The
four black silk-sutures which loosely closed each wound
• were removed to-day, a week later, before the class.
There was no trace of suppuration ; primary union had
taken place in both lids, though the wounds had been
protected by nothing more than a clean handkerchief, and
the boy had gone home to Harlem immediately after the
operation. The result in both eyes is perfect.
Case III. — Perforation of drumhead ; cocaine anes-
thetizes the inner wall of the drum-cavity^ but not the
drumhead, — Mr. ^, aged twenty-one, a student of
medicine, presented himself on October 23d at my of-
fice, with a middle-sized, clean-cut perforation in cad
drumhead. The drumheads, as well as the inner walls
of the drum-cavity were quite sensitive to the touch of
a probe. Fifteen minutes after the instillation of coca-
ine, the drumheads had lost nothing of their sensibil-
ity, but the inner walls of the drum-cavity were com-
pletely anaesthetic. The patient felt a bitter taste in his
throat.
Case IV. — Cocaine in cataract operations pre-emi-
nently useful, — Division of primary and secondary cata-
ract is entirely without pain — a great advantage, for it re-
moves also the reflex contraction of the globe, which
favors too great a capsular opening in soft cataract, and
prolapse of vitreous or of shreds of capsule in secondary
cataract. The perfect rest of the eyeball is highly favor-
able for an exact technique.
In extraction of senile cataract under cocaine, there is
only one step connected with pain, viz., the excision of
the iris. This pain is commonly not great, and easily
borne. The perfect insensibility of the conjunctiva and
cornea insures the steadiness of the eyeball, and the cor-
rect location of puncture, counter-puncture, and track of
the section. The absence of pressure makes accidents,
such as falling of iris before the knife, and prolapse of
vitreous, less likely to occur. Without going into de-
tails, I may «ay that it assists the operator in every step,
but particularly in the so-called toilet of the wound, 1.^.,
its cleansing and final adjustment.
The property of cocaine to contract the blood-vessels,
which is of great advantage in operating, has been sus-
pected of having bad after-effects. Dr. G. J. Ball, in the
New York Medical Journal^ November 22, 1884, i)age
587, makes the following remark : **It became a ques-
tion whether the new anaesthetic might not impair nutri-
tion in certain operations in which the slightest impair-
ment might afifect the result injuriously. In two cases of
cataract extraction in which cocaine was employed, the
operations had been followed by sloughing of the flap.
It might be well to consider whether this was more than
a mere coincidence." I think it was not. Since the in-
troduction of cocaine, fifteen successive extractions have
been performed under the influence of cocaine at the
New York Ophthalmic and Aural Institute. Only one
operation was followed by some reaction — it was a com-
plicated operation. The recovery was protracted, but
good. The other cases were free from any disturbance
both during the operation and the course of healing, and
the results were good in all.
I feel sure that in this, the most important operation
in ophthalmic surgery, therate of success will be increased
by the introduction of the new anaesthetic, through I>r.
C. Koller.
Dbcbmbbs 9. 1884.
The Shortest Clinical Report on Record.--A
correspondent from Warren, O., would like to hear from
the profession on the following case : " Man — after swal-
lowing glass of whiskey, chewed and swallowed part of
the glass." Correspondent would like to know how it
should have been treated.
December 13, 1884.]
THE MEDICAL RECORD.
657
[^Xinic^l gjeparttttjent
MURIATE OF COCAINE IN DENTISTRY.
G. W. Weld, M.D., D.T).S., of New York, believes
that the best method of application of muriate of cocaine
in the operation of removing tartar from the teeth, in
Rigg's disease, is as follows : Wash the gums with a little
dilute alcohol, then apply, by means of a cameFs-hair
brush, a small quantity of a ten per cent, solution of the
cocaine. Renew this once or twice, when in the course
of five minutes it will be found that there is a marked
numbness and diminution in the sensibility of the gums
corresponding to the sides of the teeth on which the ap-
plication was made. The following formula is recom-
mended :
Cocainas chloridi (Merck) gr« vj.
Spiritus menthae piperita 3 j.
An exposed nerve pulp was treated with the above
solution, and partially extirpated, without causing any pain
to the patient. In the preparation of an extremely
sensitive tooth for filling, a glycerite, ninety per cent, in
strength (made by dissolving Merck*s crystals in glyce-
rine) was allowed to remain in the cavity for a period of
thirty minutes. On renewing the operation the patient
stated that the pain was materially deadened. The same
experiment was tried with the borate of cocaine fFoucar's
crystals), and similar results apparently obtainea, but the
paste was permitted to remain in the cavity of the tooth
for twenty-four hours.
Dr. C. H.[Shears writes : " I have used cocaine twice
in the extraction of teeth, and in each case the operation
was for a single tooth. The preparation used was a two
per cent, solution. In the first case the tooth was ex-
quisitely tender and the gum inflamed, and so closely ad-
herent to the tooth that it was necessary to incise it.
After carefully drying the gum, a small camel's hair-bmsh
was dipped into the solution, and the gum on either side
of the tooth brushed across a few times. This was re-
peated twice at intervals of about three minutes, making
three applications in all. A few minutes later the gum
lancet iwpas used, with almost no pain at all. The tooth
was then extracted with a little less pain than it could
have been without the anaesthetic. The second case was
similar to the first, and the solution was applied in the
same manner, with two additional 'applications. After
cleansing the incision from blood a few drops of the solu-
tion were instilled into it, and repeated once after about
three minutes. No pain attended the incision, and the
tooth was extracted with considerably less pain than in
the first case.*' •
W. P. HoRTON, Jr., of Cleveland, O., sends us word
that he inserted a few drops of the four per cent, solution
into the cavity of a sensitive tooth, and that ^a few
minutes afterward he used the dental engine without
pain.
Dr. J. R. Uhler, of Baltimore, Md., says that on
November ist, he published some experiences with
muriate of cocaine in general surgery. In all cases it
produced more or less superficial anaesthesia, but acted
better on thin mucous membranes than on the unbroken
skin. Upon the rectum, when freely used, beside be-
numbing the parts, it produced in two cases a rigid tonic
contraction of the sphincter ani, which had previously
been relaxed, and contraction of the longitudinal fibres
of the gut, pulling up the mucous membrane, which before
ha I protruded. So firm was the contraction that the
sphincter stood out like a ring, and the finger could
with diflSculty be made to enter it. For vaccination and
small operations upon the skin, the following plan was
tried in two cases and found satisfactory. First, a few
drops of a strong solution of the dnig were painted on the
skin where it was intended to be cut, and after the lapse
of a few moments the knife, dipped in some of the solu-
tion, was passed gently over the part, so as to denude
only a few of the outer cells of the skin/ but not penetrat-
ing;deeply enough to cause hemorrhage or pain. Over
this minute abrasion or cut, which was made to allow the
drug to get nearer to the nerves, and be absorbed, some
more of the solution was painted, and after a short inter-
val the operation was proceeded with, the patients mak-
ing no complaints. Where mucous membranes are hard
and very thick it will act slowly or imperfectly, unless
used by hypodermic injection, and anaesthesia is most
plainly perceived where nerves are most thickly dis-
tributed. In a case of labor reported in the Maryland
Medical Journal I purposely avoided appl)dng cocaine
to the mouth of the uterus, as I feared that'^tetanic
rigidity of the organ might be produced.
MURIATE OF COCAINE IN GENERAL
SURGERY,
Dr. J. W. Stickler, of Orange, N. J., wishing to know
the effect of cocaine hydrochlorate upon the skin and
underlying tissues, had the following experiment tried
upon himself by Dr. T. Y. Simpson : Dr. S injected
with an ordinary hypodermic syringe, four and one-half
minims of a four per cent, solution of the alkaloid under
the skin of the fore-arm. After the lapse of five minutes,
the point of a knife was applied to different parts of the
skin, immediately over, and adjacent to, the point of
puncture, with the following result : partial anaesthesia
of the skin along the line of the injection^ most marked at
the point where the fluid was deposited in the tissues,
that is, at the precise point where the cocaine was forced
from the point of the hypodermic needle. On either
side of this line, the partial anaesthesia extended about one-
eighth inch. As the anaesthesia did not become more pro-
nounced after waiting another five minutes, a second
injection of five minims was made. The needle was
inserted at a point just beside, and parallel with, the first,
but forced deeper into the tissues (one inch). At the end
of five minutes, the same superficial test was applied as
in the first instance, the face being turned aside so as
not to see the application of the knife. Sensation seemed
about normal, except in a band of integument, nearly
one inch long, and half an inch wide, the maximum
superficial anaesthesia existing along the line of the open-
ing made in the tissues by the hypodermic needle. The
hyperaesthetic line bounding the anaesthetic area (referred
to by Dr. Hepburn in Medical Record, November 15,
1884) I could not define in my own case, and there did
not seem to be increased sensitiveness at any point within
the limits of that portion of the skin slightly congested
by the action of the drug. After thirteen minutes had
elapsed from the time of puncture, the doctor transfixed
with a surgeon's needle the anaesthetic skin, without
producing the slightest pain. The needle being with-
drawn, an incision was slowly made with a scalpel through
the entire thickness of the skin and cellular tissue, pro-
ducing so little sensation of any kind that, had my atten-
tion been otherwise engaged, I doubt if I would have
known that the doctor was cutting me. This cut was made
along the line of the injection, and about corresponded
in extent with the length of the hypodermic needle. The
wound was left open about four minutes, when a needle
was slowly introduced, at a point midway between the
two extremes of the cut, into the deeper tissues. Abso-
lutely no sensation was experienced till the point of the
needle entered the sheath of one of the extensor muscles.
That the muscle was penetrated was evident from the
motion given the needle when the muscle was exercised.
The pain occasioned by contact of the needle with the
muscular tissue was very slight. About five minutes
later, sutures were introduced without pain, but produced
a sense of pressure such as Dr. Wright said he felt when
a needle was thrust into the skin of his forehead (Medi-
658
THE MEDICAL RECORD.
[December 13, 1884*
CAL Record, November 22, 1884). The anaesthesia
remained well pronounced half an hour. Twenty minutes
after the second injection, there were slight muscular
tremors ; other than these, there were no evidences of
systemic disturbance. It is interesting to observe that
when tke hypodermic needle is made to traverse a direct
course through the skin and cellular tissue, the hydro-
chlorate of cocaine does not diffuse itself equally in every
direction, but follows quite definitely the channel made
for it by the needle, producing anaesthesia along this line,
but to a very limited extent on either side of it. In
opening an abscess, or in making any straight incision,
this circumstance would find a practical application. A
much larger area of skin could be rendered anaesthetic
by one injection, if the cellular tissue were made more
permeable by moving the point of the injecting needle
from side to side after its introduction.
MURIATE OF COCAINE IN OPERATIVE GYNE-
COLOGY— VESICO-VAGINAL FISTULA.
Dr. W. H. Doughty, Jr., of Augusta, Ga., writes : **The
peculiar interest which attaches to all reports upon the
use of the hydrochlorate of cocaine leads me to report
the following observations, made November 18, 1884, upon
its effects during an operation for vesico-vaginal fistula.
" The fistula was a small one, barely admitting a silver
probe of ordinary size. The patient having been placed
in the *knee and breast' posture, after thoroughly
cleansing the vaginal surface and roughly testing its
sensitiveness, two applications (two drops each) of a two
per cent, solution of the hydrochlorate of cocaine were
made, three minutes apart. Two minutes later the sensi-
tiveness was decidedly lessened, but not enough for my
purpose. The solution was now freely applied with a
brush, and five minutes later the application was re-
peated. After three minutes more the anaesthesia seemed
to be complete.
** The paring was made during sixteen minutes without
the slightest evidence of pain, but at the expiration of
this time the patient complained and the solution was
again applied. In thirteen minutes more the paring was
finished without pain.
" The patient having been in the * knee and breast '
posture for more than a half-hour, and being now fatigued,
was placed in Sims' position and allowed to rest for a
few minutes. Upon resuming the operation, the intro-
duction of the first two sutures was attended with con-
siderable pain ; the solution was therefore again applied,
and the remaining sutures, four in number, were intro-
duced without pain.
"The apparent effect of the drug upon the hemorrhage
was worthy of note. During the first sixteen minutes of
the paring there was very slight oozing, but when the
sensitiveness returned the loss of blood was decidedly
increased ; it diminished very much after the solution
was reapplied.
** The sponge was not carefully used before making
the application during the introduction of the sutures,
and the coagula which formed were seemingly firmer than
usual and rather difllicult of removal by sponging.
"Drs. T. R. Wright and J. M. Hull, of this city, were
present and assisted me."
MURIATE OF COCAINE IN IRIDECTOMY— IN-
JECTION INTO THE ANTERIOR CHAMBER.
Dr. Eugene Smith, of Detroit, Mich., writes : ** Hav-
ing, during the past three weeks, proved the value of the
muriate of cocaine as a local anaesthetic, in strabismus by
six operations, in congenital and cortical cataract by four
operations, and in iridectomy by three operation-, besides
several minor operations on the cornea, I wish to lay
before the readers of The Medical Record two points
in its use which seem to render it more efficient. I apply
it in the form of spray with a hand atomizer and get a
inoro rapid effect, as the movements of the lids and the
lachrymal secretion do not carry off the solution as
quickly as when dropped into the conjunctival sac
"In my first case of iridectomy with cocaine, while the
cornea was insensitive, the iris was unaffected by the
external application, and its seizure with the forceps was,
as usual, quite painful. In two cases of iridectomy,
both nervous females, five minutes after spraying the
cornea a«^d conjunctiva, I made the corneal incision with-
out pain, then injected^ by means of a small lachrymal
syringe^ two (2) drops of the two per cent, solution inh
the anterior chamber^ and three minutes later seized the
iris with the forceps, drew it out, and completed the
operation without causing pain to the patient.
" No reaction followed its intraocular use J*
FAILURES WITH COCAINE.
Dr. F. C. Riley, of this city, makes a report of two
cases in op'.ithalmic practice which demonstrate that the
much lauded new remedy is not always as reliable as
might be wished.
Case 1. — Granular lids with intense pannus occurring
in a girl of ten years. The photophobia in this case was
so marked that, upon facing the patient toward the win-
dow in an ordinarily well-lighted room, the eyeball rolled
upward and inward to such a degree as to completely hide
the w^ole corneal expanse from vie w, unless the superior
palpebral covering was lifted.
Two drops of a two per cent, solution of Merck's co-
caine was instilled, at intervals of ten minutes, for a period
of half an hour, or three instillations in all, with no per*
ceptible effect either as regarded dinrinution of sensibility
to light or touch. Neither was there any appreciable
effect produced upon the size of the pupil, nor did the drug
affect the circulation so far as it was possible to observe it.
Three days subsequent to the preceding trial, I de-
termined upon operating to relieve the pannus, and again
tried the same solution, instilling four drops every five
minutes for a period of three-quarters of an hour, or in
all nine instillations. Careful efforts to touch the con-
junctiva or cornea at any part thereof, between each in-
stillation, failed to elicit the slightest evidence of anything
even approximating a condition of anaesthesia. Feeling
that a fair trial had been given the dnig in this case, I
proceeded to the use of ether and performed syndectoniy.
Case II. — A lad about twelve years of age, who had a
perforating ulcer of the cornea about six months since,
with prolapsus of iris into the perforation, etc. Cornea
almost completely cloudy or pearly. To the outer* and
upper segment yet remained a small spot of transparent
tissue, at which point I deemed it advisable to perfonn
an iridectomv in order to free the entrapped iris, which
seemed to produce a constant irritability of the eye.
Vision-perception of light only. Using the same solution
of cocaine as in the former case, four drops every ten
minutes for forty minutes, with absolutely no effect of
any kind, either to cornea or conjunctiva, led me to the
opinion that the solution was not what it should be.
Subsequent results with the same solution have, however,
dispelled my suspicion as to the sample used, as I have
since obtained all the physiological effects so far noted
by other observers. The two cases recorded, however,
seem to me to prove beyond the suspicion of a doubt that
there are certain conditions, pathological maybe, or in-
dividual idiosyncracies, possibly both, that tend to mili-
tate against the verdict so generally expressed thus Car
in favor of the anaesthetic effects of the drug. It seems
to me that in the use of this substance, the cases of failure
to obtain the desired end should be placed before your
readers as well as the brilliant results obtained by so many
of us. That it has been a great blessing to many during
its short career there is no doubt, and that it will con-
tinue to prevent the attendant pain of many operations
in the future I am confident. Even if it gives as universal
satisfaction in time to come as it has in my hands thus
far, it is indeed a friend to the suffering and distressed.
December 13, 1884.]
THE MEDICAL RECORD.
659
The Medical Record:
A Weekly yournal of Medicine and Surgery.
6EORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD & Co.. Nos. 56 and 58 Ufayette Place.
New York| December is, 2884.
THE EARLIER EMPLOYMENT OF COCAINE.
While the enthusiasm for cocaine continues but slightly
abated in its intensity, a brief reference to some of the
results recently obtained, as compared with the earlier
records of its employment, r^iay prove interesting.
In 1859 Mantegazza ("Sulle virtCl igieniche e medici-
nal! della Coca,'* pp. 76, Milano) noted the soothing
influence exercised by the leaves of erythroxylon coca,
when broOght in contact with mucous membranes. Lit-
erature^ however, seems almost unanimous in conceding
to Niemann (i860) the credit of being among the first
to isolate cocaine and give it a certain amount of phys-
iological individuality.
This investigator is mentioned as having observed sev-
eral of the now recognized properties of cocaine ; but,
singular to relate, he stated it possessed no action upon
the eye. The postponement of the discovery of its an-
aesthetic action upon the eye was probably owing to this
misleading remark. Its employment in the throat, sub-
sequent to Niemann's observation of its action upon the
tongue, furnishes some grounds for such an inference. In
1877 Ch. Fauvel, of Paris [Gazette des Ildpitaux, \>2ig<t
427), is reported by Dr. Scaglia as having utilized the an-
aesthetic property of cocaine to afford relief in painful
anginae. Jelinek (Wiener Medizinische Wochenschrift^
No. 46, 1884) claims to have successfully employed co-
caine to relieve painful deglutition in ulcerative laryn-
geal phthisis.
Equally interesting are the experiments of Thomas
Moreno y MaTz (1868), detailed in his monograph **Re-
cherches cliniques et physiologiques sur FErythroxylum
Coca et la Cocaine," pp. 90. The acetate of cocaine
was employed in his experiments. Particularly interest-
ing are his observations upon the hypodermic employ-
ment of cocaine. He injected a solution of the acetate
of cocaine into the leg of a frog, and observed after the
expiration of ten minutes distinct loss of superficial sen-
sibility over a circumscribed area ; the most powerful
irritants failed to provoke motion. In a quarter of an
hour the sciatic nerve was laid bare, and sensation was
observed to be completely abolished. The conclusion
he arrived at, " Pourrait-on Temployer (cocaine) comme
anesth6sique local,'* though slowly accepted, has been
remarkably well verified.
The employment of the hypodermic method for the
painless removal of tumors has been recently followed by
excellent results in hospital practice. A body of gentle-
men, in this city, composed of willing medical students
and intelligent surgeons, have been experimenting with,
a view to determine the hypodermic effects of co-
caine when applied directly to the sensory cutaneous,
nerves. In twenty minutes after the introducticwi of fif-
teen minims of a four per cent, solution, all the parts sup-
plied by the anaesthetized nerve were rendered analgesic
The constitutional effects (vertigo, nausea, etc.)^ were-
mild and transient in character. If the infierences de-
divced from these observations are correct, this property
of cocaine to affect all the nerve-terminak whea applied
to a particular radical must prove of great service for the
performance of many major as well as minor surgical op-
erations.
In 1880 Von Aurep ("Archives fiir Physiologie")
elaborated a series of experiments with cocaine, care-
fully conducted upon warm- and cold-blooded animals
and upon himself. Prominent among the results re-
corded is its action on the pupil.
The value of cocaine for the relief of pain in many-
acute and chronic affections is no»w well recognized. I*
has been employed for this purpose in diseases of the-
eye, ear, throat, urethra, etc. Inj.ected into the urethra it
has converted internal urethrotomy into a painless pro-
cedure. The combined employment of cocaine and
rhigolene in operations on the nose is recorded in the
present issue of this journal.
On account of the high price of the imported article
an attempt has been made to produce a domestic prep-
aration of the salt. Aside from those preparations,
claimed as proprietary, but really consisting of an im-
ported alkaloid combined with a domestic acid, a large
proportion of the home-made cocaine has proved unre-
liable.
DEAD TEETH IN THE JAWS.
We are in receipt of numerous communications on the-
above subject, mostly covering ground that has already
been gone over, and we have not space to give the mat-
ter further attention at this time than to allude to some
points in a letter on this subject from Dr* G. V. Black, ai
dentist of Jacksonville, 111., who regards this as ** simply
a question in pathology," and objects to the term " dead,
teeth," since dentists hold that in death or intentional de-
struction of the pulp the dentine only loses its vitality;
and that while •* the tooth is retained in heahhy connec-
tion with the alveolar process," the cementum and peri-
osteal membrane remain " unaffected " so far as the
death of the pulp is concerned. We can but regard this,
assertion as much too sweeping, since when the greater
part of the tooth is in a pathological condition it cannot
ever afterward be considered as sound unless it were-
known that a reparative process began after so great an.
injury rather than one of a destructive character. The
progress of disease in these parts is pretty well under-^
stood ; it consists, first, in disturbances in the cementum^
which immediately overlies and is continuous with the
lifeless dentine of pulpless teeth ; and, second, in the in--
flammation of the periosteal covering of the cementum..
The acute, subacute, or chronic pericementitis thus estab-
lished extends itself very often until the nutrition of the-
cementum is seriously interfered with and destructive in-
flammation of portions of the cementum follows. This
66o
THE MEDICAL RECORD.
[December 13, 1884,
is finally attended by contaminating secretions which may
be absorbed after entering the tissues, or swallowed.
But even more danger to the patient may arise fromjthe
nervous irritation propagated by these diseased teeth^;
important regions are often thus affected. Morbific in-
fluences of this kind may continue on almost indefinitely
without perceptible disturbance in the tooth, and being
thus unsuspected, health may be undcrmined^before the
cause is discovered. To advise that such teeth are
harmless because the local irritation is scarcely percegti-
ble is, in many cases, to bring about irreparableXinjury
to health. While instances of harm from^retention'of
such defective teeth are so frequently occurring in prac-
tice, and persons with dental skill are unable to realize
the mischief being done, the safer course is to advise that
all dead teeth be removed, at least until such time ar-
rives when medical specialists can determine with cer-
tainty that teeth are not the seat of any trouble that can
possibly injure the patient.
THE REPORT OF THE SURGEON-GENERAL OF THE
UNITED STATES ARMY.
The annual report of the Surgeon-General of the Army
for 1884 has been received, and, like previous reports,
touches upon subjects of general interest. Our army
now consists of 20,230 white, 2,309 colored troops, and
210 Indian scouts. Among the white troops there were
on the average 1,003, or 5° per 1,000, constantly sick,
being a slight increase over the previous year. Of the
sick, eighty per cent, were under treatment for disease,
and twenty per cent, for wounds, accidents, and injuries.
The total number of deaths was 250, or 12 per 1,000, a
slight increase over last year, despite the fact_[that we
had no Indian fights during 1883-84.
It is interesting to note that for the first time on record
the mortality of the colored soldiers was less than that of
the white, it being only 10 per 1,000. The ratio of
sickness was very slightly greater among the colored
troops. These latter suffered more from venereal dis-
eases and less from intemperance than the white troops.
From which it may be provisionally inferred that while
the white man takes to wine, the black man prefers the
woman.
Comparative statistics show that the white troops are
more susceptible to malarial disease than the black, the
difference being about 76 per 1,000 of mean strength in
favor of the negro.
It is further stated that typhoid fever attacks the whites
one-third oftener than the negroes, but that the mortality-
rate from this disease is twice as great in the latter as in
the former.
Typhoid fever prevailed among the troops more ex-
tensively than it has done since the war. It is gratifying
to note, however, that the mortality from this disease
among the white troops has fallen from twenty-one per
cent, to sixteen per cent.
Regarding the Army Medical Museum, the Surgeon-
General states that during the year there have been 144
accessions, making a total, June 30, 1884, of 9, 1 14 speci-
mens.
As to the Library, we learn that the additions during
the past year include about 4,000 volumes and 5,500
pamphlets. By actual count at the end of the fiscal year
the Library contained 65,738 volumes and 86,503 pam-
phlets.
The need of a new*fire-proof building is again insisted
upon.
The publication of the third and last medical volume
of the " Medical and Surgical History of the War" was 1
delayed by the untimely death of Dr. Woodward. The
completion of this volume, however, has been placed in '
the hands of Surgeon Charles Smart, and it will probably |
appear soon.
One year ago there were fourteen vacancies in tbe
grade of Assistant Surgeon ; since then five officers
have died or resigned. Daring the year, however, twenty-
two candidates have been found qualified, and there are
now no vacancies in the medical corps of the army.
THE LAST REPORT OF THE NATIONAL BOARD OF
HEALTH.
The " Annual Report of the National Board of Health for
1883" reaches us somewhat over a year after its first
presentation to Congress. The contents of the report
itself in consequence are already in large measure known.
The more active work of the Board as regards quaran-
tine and scientific investigation was suspended by action
of law in June, 1883, consequently occasion is taken in
the present report to review the history of the four yean
of the Board's existence.
We learn that in that time there were appropriated for
its use $767,500, of which $639,446.19 were expended
The largest sums were employed ill sustaining a floating
quarantine on the Mississippi. About $36,000 was given
to aid the State Board of Health of Tennessee, while
sums of from three to eleven thousand dollars were given
to help other localities. About $35,000 was spent in
special scientific investigations.
The sum appropriated for the Board in 1882 was but
$50,000, while in 1883 the annual appropriation was cut
down to $10,000.
The work of the Board has consisted mainly in assist-
ing, by advice and money, local health authorities, in
establishing maritimel quarantine stations, in inaugurating
an interstate and immigrant inspection service, in secur-
ing the co-operation of the United States consuls, and in
prosecuting certain scientific investigations. Owing to
the lack of funds, the immigrant inspection service has
now been discontinued, the Mississippi Valley inspection
service has been transferred to the Sanitary Council of
the Mississippi Valley, the maritime quarantine stations
have passed to the care of the Marine Hospital service,
while the scientific work has been entirely abandoned.
The Board requests that the powers originally con-
ferred upon it be restored ; meanwhile it asks that the
sum of $37,700 be appropriated for actual expenses and
to enable it to perform the duties required of it by the
second section of the Act of March 3, 1879.
Appended to the report are several scientific com-
munications and special reports. The articles on "Beri-
beri in Ceylon," on "Leprosy in Maracaibo," on "The
Filaria Disease," and the reports on cholera in Japan
and in China, are of especial interest
December 13, 1884.]
THE MEDICAL RECORD.
661
SOME FACTS ABOUT ADULTERATED DRUGS.
Pr. Bennett F. Davenport, Food Inspector of Massa-
chusetts, makes a brief report in The Sanitarian of some
of the results which he has obtained in examining for
adulterations in drugs under the excellent law of his
State.
Under this act the last version of the United States
Pharmacopoeia is made the standard.
Dr. Davenport during his first year examined about
three hundred sample^ of pharraacopoeial drugs, and
found that about forty per cent, did not conform to the
requirements. Among the drugs examined were one
hundred samples of tincture of opium. Of these four
only exceeded the maximum allowable strength of 1.60
per cent, morphine according to the 1880 Revision of
the United Stales Pharmacopoeia ; while eighty-two fell
below the minimum allowed of 1.20 per cent., forty-
dirce only fell below the about 0.90 per cent, morphine
which, according to the Revision of 1880, was the quan-
tity required by the Revision of 1870. Their average
strength was 0.965 per cent, morphine, the extreme
being 0.336 and 1.87 per cent.
It is thus shown that some samples of laudanum are
nearly six times stronger than others. Dr. Davenport
also concludes that there is much greater apparent than
real change in the strength of laudanum made according
to the 1880 Revision of the United States Pharmacopoeia.
Of the simple cinchona alkaloid salts about twenty-five
per cent, were found to contain an excess of the cheaper
alkaloids.
About two hundred samples of powdered pharmaco-
poeial drugs were examined microscopically, and about
twenty per cent, were found to contain foreign ingredi-
ent, or rather appeared so, for it is not common now
as formerly that totally foreign substances are introduced,
but it is the closely allied and inferior varieties, or
damaged samples and trimmings of the very same
drug, that are used. Millers now, says Dr. Davenport,
study structural botany, and are becoming as expert as
those whose duty it is to expose their improper practices.
The excellent suggestion is made that there be organ-
ized in this country a Society of Public Analysts similar
to that which has done so much good work in England.
The results, on the whole, of Dr. Davenport's exami-
nations are not calculated to excite alarm. They show
that druggists are slow in adopting the changes of the
last Pharmacopoeia, and that manufacturing pharmacists
are inclined to make their preparations a little weaker
than the standard,
i THE CLINICAL DEPARTMENT OF THE RECORD.
i The very large number of short clinical communications
sent to us by our readers in all parts of the country has
been a source both of gratification and perplexity. While
conscious of their practical value it has often been im>-
possible to give them either the space or the prominence
they deserve. We have resolved, therefore, to remedy the
matter in a measure by establishing a Clinical Depart-
ment in which the choicest and most original articles re-
ceived will be placed, and published in such a way as to
call to thena proper attention. The present issue of The
Record contains the first instalment of these clinical
notes, and we feel sure that now and hereafter they will
form a most attractive and instructive feature in our
pages. It is hardly necessary to say to our contributors
that communications for this department should be brief,
practical, and to the point, and should express some ac-
tual lesson taught by the Writer's own experience. For
the rest, clinical notes may cover the whole range of
practical medicine, surgery, obstetrics, and therapeutics*
THE ABUSE OF SUBSCRIPTION CLUBS.
It may be charged that we are writing with a bias^
nevertheless we cannot refrain from making a little
protest against the abuse of subscription clubs. It is a
very widespread practice among the physicians of towns
and cities to club together and take a number of medical
journals. This is a wise and economical plan, up to a
certain extent ; but every physician ought to have one
or two journals as his own personal property, and the
subscription club not infrequently prevents this. It is
not the hasty week-to-week reading of numerous medical
journals which is helpful to a doctor. He must have the
volumes on his shelf to refer to in studying his cases or
preparing his papers. It is an essential now in medical*
writing that the author know what has been said already
on his subject. Still more important to the practitioner
is it that he prescribe no therapeutical measure that has
already been shown to be useless, and that he leave his
patient with no remedy untried. To a practitioner the
bound volumes of his standard medical journal are more
valuable than text-books. We speak what is only the
ordinary teaching of good sense, therefore, when we say*
that it is neither wise nor economical for a doctor to
depend alone upon a weekly visitation of a few journals
for his scientific culture, or to keep him really abreast <rf
the medical progress of the day.
FURTHER DISCOVERIES IN CHOLERA, AND CONFIRMA^
TIONS OF KOCH'S VIEWS.
We learn that Dr. Rudolph Emmerich, of Munich, who
has been studying the cholera in Naples, has discovered
a peculiar micro-organism in the blood and tissues of
persons affected with that disease. This organism already
goes by the name of the '' Emmerich Bacillus." It wa&
found in the internal organs and blood in nine autopsies,
and in the blood from the arm of one living cholera pa-
tient.
Dr. E. Van Ermengen has communicated to the Mi*
croscopical Society of Belgium the results of his patho-
logical studies of cholera. He has made eight autopsies
and thirty-four examinations of stools. The comma*
bacilli have been cultivated, and successfully inoculated
in dogs, rabbits, and guinea-pigs. His conclusions are
almost identical with those of Koch. He says :
**The pathogenic action of these products of cultiva^
tion is very likely due to a zymosis, to an unstable albu-
minoid compound. Corpuscles of fresh human blood
placed on Ranvier's heated platinum, and brought into
contact with a drop of a serum-culture, present charac-
teristic changes wholly comparable with those described
by MM. Nicati and Rietsch in their observations on the
blood of chpleraic cases.
'* The discovery of the comma-bacillus is of the great-
est importance in the diagnosis of choleriform attacks of
662
THE MEDICAL RECORD.
[December 13,
doubtful nature which occur at the commencement of
epidemics, and for the resort to more effective prophy-
lactic measures which this early diagnosis allows.
- " The employment of bacterioscopic methods in the
/diagnosis of cholera does not offer any great difficulty in
) practice, and it would be very desirable, in view of the
serious threats of an invasion of Belgium by cholera,
that a sufficient number of physicians employed in the
sanitary services should be initiated therein with the least
possible delay."
.^ , ■■ ., — ■
Ninth International Congress. — The committee
^n organization has elected the following officers : Presi-
jdeni-^Dr, Austin Flint, Sr., New York ; Vice-Presidents
— Drs. Alfred Stills, Philadelphia; Henry I. Bowditch,
Boston ; R. P. Howard, Montreal ; Secretary- General —
Dr. J. S. Billings, U.S. Army; Treasurer— Vix.]. M.
Brown, U. S. Navy ; Members of Executive Committee
.y(in addition to President, Secretary-General, and Treas-
urer)— Dr. I. Minis Hays, Philadelphia; Dr. A. Jacobi,
New York ; Dr. Christopher Johnston, Baltimore ; and
Dr. C. Busey, Washington. The meeting is to be held in
Washington, D. C, in 1887. The membership will be
.composed of delegates from each of the regularly organ-
ized general, State, and local medical societies. The of-
ficial languages will be English, French, and German.
"The published discussions will be in English; and the pa-
.pers in the languages in which they are delivered. The
work of the Congress will be divided into eighteen sec-
tions. The detail of organization is to be entrusted to
tthe Executive Committee.
Dr. Livingston S. H inkle v, of New|York City,' has
.been appointed Medical Superintendent of the Essex
"County Asylum for the Insane, Newark, N. J.
In Case of Cholera. — The Board of Estimates and
Apportionment of this city has added $50,000 to the
estimate for the Health Department, to be used in case
of cholera. This is very well, but an additional sum
.ought to be given at once for the purpose of preventing
the cholera's entrance.
Politics and Sanitation. — There can be little doubt
.that the New York City Health Board is seriously crip-
.^led by bad x^olitical influences. It is an open secret
now that the Board has not suppressed the manure
.dump nuisances because the owners of them were of too
great political importance. The slums and unhealthful
tenements of the city cannot be cleaned or improved in
many cases because their owners possess too much
4)ower in the wards. The President of the Board of
Health was ajjpointed as the result of a "deal" be-
tween Tammany Hall and the Republican machine.
Caution in the use of Cocaine. — Since the paper
of Dr. Knapp^vide page 656) was in type we have re-
.ceived the following note from that gentleman : " Will
you allow me to add a word of caution to the communi-
. cation on * Cocaine' which I sent you a week ago. I
.injected 6 minims of a four per cent, solution into the
.orbit, close to the posterior segment of the eyeball.
'The anaesthesia in Ikatipart was complete, and the oper-
ation and recovery of the patient were without any dis-
turbance. During the operation I noticed that the pa-
tient's face became quite pale. I omitted to mention
this in my communication, as the patient did not com-
plain. To-day, likewise, at the University College CH-
nic, I injected 5 minims of a three per cent, solution
underneath a sebaceous tumor, the size of a small wal-
nut, situated in the centre of the upper lid. The anaes-
thesia was almost complete, and the somewhat laborious
operation passed satisfactorily, but during it the patient
became as pale as a corpse, felt ' somewhat faint, asked
repeatedly for drink, and was covered with cold perspi-
ration. In about fifteen minutes this condition of dis-
tress, which was, however, in no way alarming, dvsap.
peared. Though much larger doses — Hepburn, HaB,
etc. — have been hypodermically injected before gencnd
symptoms manifested themselves, I think that five or
six minims of a three per cent, solution may be too
much for the orbit. The orbital cellular tissue is so vas-
cular that it resembles cavernous tissue. Liquids in-
jected into it may enter the general circulation more
readily than from other parts. In further operations
I shall inject no more than one or two minims, and grad-
ually feel my way. I beg you, dear doctor, to grant this
note a place in your columns, for I would deeply regret
if my previous communication should be the cause of an
unpleasant accident by inducing somebody to inject too
large a dose of cocaine into the orbit."
New York Academy of Medicine. — At the stated
meeting held December 4, 1884, the following nomina-
tions were made for officers. For President: Drs.
Samuel T. Hubbard, A. Jacobi, William T. Lusk, T.
Gaillard Thomas, and C. R. Agnew. For Vice^PresUtid:
Drs. C. C. I*ee and T. Addis Emmet. For Correspond-
ing Secretary: Drs. Paul F. Mund^, H. Knapp, and L
Elsberg. For Trustee : Drs. H. T. Hanks, A. L. Loomis,
J. Williston Wright, E. Eliot, and Frank H. Hamilton.
For Member of Committee on Admissions : Drs. William
M. McLaury, Seneca D, Powell, A. S, Hunter, C. A.
Leale, L. Elsberg, and J. A. Wyeth, For Member of
Committee on Medical Education : Drs. Joseph D. Bryant,
F. R. Sturgis, and Stephen Smith. For Member of Com-
mittee on Ethics : Drs. A. Hadden, A. S. Hunter, T. G.
Thomas, T. E. Salter thwaite, and Andrew H. Smith.
For Member of Committee on Library : Drs. E. Darwin
Hudson, Jr., and George M. Lefferts.
Cocaine Ointment for Piles. — Dr. F. A. Bunall
writes : " Please mention in your coca literature that the
coca leaves treated with heated lard and an alkali, form
an ointment resembling stramonium ointment, which
seems to possess soothing properties. Applied to the
tongue it leaves an impression similar to that produced
by a solution of muriate of cocaine. This ointment, pre-
pared at my request by a leading pharmacist of this
city, has been used in three cases of hemorrhoids with
the effect of alleviating pain. The muriate of cocaine
will, I think, be found of service in such cases, and
this alkaline ointment is also worthy of further trial as a
local anodyne."
Dr. W. B. De Garmo has been appointed Assistant
to the Chair of Orthopaedic Surgery in the New York
Polyclinic.
December 13, 1884.]
THE MEDICAL RECORD.
663
Dr. R. VV. Wilcox has been appointed one of the As-
sistants to the Chair of Neurology at the New York Post-
graduate Medical School.
The Discoverer of the An/esthetic Powers of
Cocaine. — Dr. W. Oliver Moore writes that, in a letter
received last week from Dr. Koller, it appears that he '
not only first used it on the eye, but suggested its use on
the throat to his laryngological friends in Vienna, instead
of getting his idea /r(7/» them^ as has been inaccurately
reported in many of the journals. Dr. Koller is second
physician to the Vienna General Hospital.
Insane Asylum Reform. — Much disturbance has
been excited in the Cook County Insane Asylum re-
cently over the revelations in the past management of
the institution recently brought out. The asylum, al-
though built for only 300 patients, has been made to
hold 558. It has been managed by local politicians,
and the officers and attendants have been more skilled
in politics than in the care of the sick. Dr. Clevinger,
special pathologist, recently made specific charges against
the warden, matron, and other employees. An investi-
gation has followed. We learn, however, that the Com-
missioners, after a recent visit, decided that everything
was in good condition, and ended their reformatory toil
with a champagne supper. The trouble excites renewed
interest i n the subject of the prostitution of medical char-
ities to p^olitics. We call to it the attention of that use-
ful but polynomial organization, the National Associa-
tion for the Protection of the Insane and the Prevention
of Insanity.
Insusceptibility to Vaccination. — English statistics
show that about one infant in every thousand is insus-
ceptible to vaccination.
Tracheotomy Aspirators. — One result of the sad
death of Dr. Rabbette has been the invention of several
forms oi apparatus for sucking secretions from the trache-
al wound. One of the simplest of these is made on the
principle of a drjj-cup with a rubber ball.
'Proffered Contribution to the Edinburgh Med-
ical School. — Mr. William McEwan has offered to give
$25,000 to the Edinburgh Medical School, provided
$50,000 is raised from other sources. The sum of
$75,000 is needed to complete and furnish the building.
Charges against Russian Hospitals. — At a recent
meeting of the St. Petersburg Health Committee, some
statements were made which throw a sinister light on
some of the Russian hospitals and nurses. Professor
Botkin, speaking of the large death-rate in the St. Peters-
burg hospitals, said: '*I have come to the conclusion
that the patients die mostly from weakness, for, with their
daily allowance of thirteen or fourteen copecks, they can-
not even buy a pound of beef for broth. In addition to
this, the nurses, who are very badly paid, steal the food
of the patients whenever they can.' ' Considerable sur-
prise is also sometimes expressed in St. Petersburg society
at the rapid growth of wealth among hospital authorities.
The Ingestion of Cholera Bacilli and Cholera
Dejecta. — While Dr. Klein has swallowed cholera ba-
cilli in pure cultures. Dr. Bochefontaine, chief of Vul pianos
laboratory y has swallowed pills composed of a drachm
of diarrhceic fluid from a cholera patient. Dr. B. was a
little ill the next day, but had no choleraic symptoms
whatever. We observe that attempts are made to dis-
credit the value of the above experiments. This is unjust,
however. If Dr. Klein swallowed the true bacilli without
harm, while in a cholera country, he added to the cholera
question some negative evidence at any rate. Dr. Boche-
fontaine's experiment tends to show also that some pecul-
iar individual factor is necessary for the development of
the disease.
Death of M. Fauvel. — The death of M. Fauvel, the
celebrated French sanitarian, is announced.
Then and Now. — Fifty years ago there were hardly
any such things as dispensaries or out-patient depart-
ments. Now in every large city a fourth of the inhabi-
tants (if we go by reports) are annually treated for noth-
ing. The effect has been to make the early attainment
of professional skill more easy, but the early attainment
of paying professional practice more difficult.
The most Powerful Antiseptics. — Studied by their
power to prevent the development of micro-organisms in
sterilized broth, the biniodid of mercury stands at the
head of the list of antiseptics. It is three times as strong
as the bichloride. A solution of a ttj^ttd' strength ren-
ders life impossible to any form of microbe, says M.
Miguel, while of bichloride the strength must be y^^^*
Iodide of silver is also more powerful than the bichloride
of mercury.
Board of Medical Examiners of the State of Vir-
ginia.— ^The Governor of Virginia, William E. Cameron,
has approved of each of the nominations of the Medical
Society of Virginia made during its last session. Of the
thirty-two members, only one is "not regular."
Subcutaneous Vaccination. — Bourgeois, in the Bul-
letin g^nhral de Thtrapeutique^ recommends the sub-
cutaneous injection of vaccine lymph in place of the
endermic method. He has employed the new method
with success.
A Bust of Dr. J. Marion Sims. — A bronze bust of
Dr. J. Marion Sims by Dubois, of Paris, has been placed
in the rooms of the Medical Library Association in Bos«
ton. It is the gift of a lady who was successfully treated
by Dr. Sims.
The Rugby Game op Foot-ball. — The decision of the
Athletic Committee of the Harvard College Faculty, that
the game of foot-ball, as at present played, is ** brutal,"
** demoralizing," and ** extremely dangerous," is no more
than should be expected. For our part, we can only re-
peat what we have said, that the Rugby game is fitted
only for small boys and trained pugilists. It utterly fails
as an athletic sport.
Meaning of the Word Pharmacology. — A corre-
spondent writes : '' Of late the word pharmacology is be-
ing used. I would like to know its meaning. Webster de-
fines pharmacology as ' the science or knowledge of drugs,
or the art of preparing medicines.* The Lancet of August
16, 1884, speaks of pharmacology, or the physiological
action of drugs. Dunglison's Medical Dictionary (1874)
gives no definition for the word whatever." The term
pharmacology means the science of drugs and drug ac-
664
THE MEDICAL RECORD.
[December 13, 1884,
tion from all possible points of view. The word has
lately been much used for "experimental pharmacology,"
or the study of the physiological action of drugs.
The United States Marine Hospital Service af-
forded relief to 44,751 patients during the year 1883-84,
of whom 13,078 were treated in hospitals, and 31,673
at the dispensaries. The receipts from all sources were
$421,348.59, and the expenditures $465,387.45.
The United States I.ife-Saving Service was in-
strumental in saving 4,237 lives last year.
^jewiexcTB atxd Notices.
The Visceral Neuroses ; being the Gulstonian ^Lec-
tures on Neuralgia of the Stomach and Allied Dis-
orders, delivered at the Royal College of Physicians
in March, 1884. By T. Clifford Allbutt, M.A.,
M.D., Cantab., F.R.S. 8vo, pp. 103. Philadelphia:
P. Blakiston, Son & Co. 1884.
The publishers of this little volume have done a service
in giving Dr. Allbutt' s lectures to the American public.
The writer is an original thinker and vigorous and charm-
ing writer. In his too infrequent contributions to med-
ical literature he has shown that he touches no subject
which he does not adorn. Nor has he failed in the pres-
ent case. Attention is called to a class of ailments that
are not sufficiently recognized and understood by the
profession in general. We need not go into any analysis
of these lectures, since proper reference was made to them
in The Record when they first appeared. We simply
commend them most heartily to American readers.
Transactions of the Louisiana State Medical So-
ciety at its Sixth Annual Session, held at Baton
Rouge, La., May 21, 22, and 23, 1884.
Proceedings of the Connecticut Medical Society,
1884. Ninety-third Annual Convention, held at New
Haven, May 28th and a9th. New Series, Vol. iii.. No.
I. Hartford, Conn. : S. B. St, John, M.D., Secretary,
Hartford.
Transactions of the Medical Society of the State
OF California, during the years 1883 ^^^ ^1884.
Sacramento: 1884.
Transactions of the Medical Society of the State
OF West Virginia* Session of 1884, May 21st and
22d.
Transactions of the Medical and Chirurgical
Faculty of the State of Maryland. Eighty-sixth
Annual Session, April, 1884.
These volumes contain many excellent reports and pa-
pers. We note, however, that most, if not all of these
have appeared in various medical journals, and they do
not require comment here.
&ovKzsvan^i^nc!^.
THE VOMITING OF PREGNANCY— DILATA-
TION OF THE CERVIX UTERL
To THB Editor of Thb Medical Rbcoko.
Sir : The report in your last issue of the discussion at a
late meeting of the Northwestern Society has been noted
as incorrect and incomplete by several of the gentlemen
who took part in it. My own remarks on the treatment
of the vomiting of pregnancy by dilatation of the cervix
were made late in the evening, and, as they stand, are
simply unintelligible.
I ask your leave to correct them and to add mention
of another case in point. The report should be as fol-
lows :
Dr. Chamberlain said that he read the paper of Dr.
Copeman when it first appeared, and had since cm-
ployed its methods with satisfaction. He would also re-
mind the gentleman (Dr. Wylie) of a paper by Dr. Engle-
man, published in the " Gynecological Transactions."
I am accustomed to regard the nausea of pregnancy as,
•for the most part, a neurotic phenomenon. The reflex
actions arising from the uterus seem to start mostly from
its cervical portion. This is the most important portion
of the organ. At birth, and even up to the approach of
puberty, that portion of the womb which is between the
vault of the vagina and the peritoneal reflection over the
bladder and the rectum, equals in volume all the rest of
the uterus.
As the long bones develop upward and downward
from the diaphyses, so from this centre the vaginal pot.
tion develops downward and thefundal portion develops
upward. Through this area the uterine arteries and the
spinal nerves enter the womb, and here, in the cervical
portion, is the centre of neurotic activity. I have re-
peatedly dilated the cervix to bring on delivery in cases
of convulsions, and have almost uniformly seen the con-
vulsions cease as soon as the dilatation was well ad-
vanced.
Repeatedly, if not constantly, when I have dilated the
cervix to suppress the vomiting of pregnancy, the proceed-
ing has been successful. I recall the case of a lady hav-
ing a small fibroma in the posterior wall, which acted like
a ball-valve over the os internum. She became pregnant
and suffered from a nausea so intense and persistent that
she was dependent entirely upon rectal alimentation. I
dilated the cervix, the vomiting ceased and did not re-
turn.
Undoubtedly there are cascs, such as Dr. Harrison has
cited, where a structural change may be the cause of the
vomiting, and when, as Dr. Wylie has said, there is dis-
ease of the cervical mucous membrane, the treatment
should be of the mucous membrane ; but I am confident,
nevertheless, that there is a kind of spasm at the os in-
ternum which may be remedied by the process of dilata-
tion, and which is the cause of a great many cases of
severe vomiting in pregnant women.
Rectal tenesmus is cured often by forcible dilatation of
the anus, and tenesmus of the neck of the bladder is
often cured by dilatation of urethral stricture.
The case in point mentioned is as follows :
About three hours after the above remarks were made
I saw in consultation a case of puerperal convulsions.
The woman, a multipara, was expecting confinement in
about a month, but had not notified her physician until
a few hours previously, and then on account of intense
cephalalgia suddenly developed. There was some cedema
partial suppression of urine, which was heavily loaded
with albumen, and embarrassed respiration. There was
frequent grumous vomiting. There had been one severe
and prolonged convulsion, and lesser spasms.
She was hardly semi-conscious, apparently not'recog-
nizing what was going on about her, and moaning con-
tinuously with the intense pain in the head.
We wished to bleed, but were not allowed to do so. Two
drops of croton-oil were administered, and dilatation was
begun with the fingers, and continued with Barnes* bags.
In half an hour it was so far advanced that the largest
bag was distended with nearly a pint of warm water. No
anaesthetic was given. The convulsive movements ceased,
she lay quiet, and no longer moaned. Three hours later
she was naturally delivered and at last accounts was do-
ing fairly well. I have not personally seen her since the
day of delivery.
This was the third time within little more than one
year that I had met the same gentleman in such a case
of uraemic coma and convulsions. In all three cases the
eclamptic phenomena ceased when full dilatation was
secured, and did not return.
W. M. Chamberlain, M.D.
€8 West Fortieth Street, December 6, 18P4.
December 13, 1884.]
THE MEDICAL RECORD.
665
il^otrtB 0t ^ocutUs.
NEW YORK ACADEMY OF MEDICINE.
Stated Mteting^ December 4, 1884.
FoRDYCE Barker, M.D., LL.D., President, in the
Chair.
The Statistical Secretary reported the death of Allen
S. Church, M.D.
T>K, Joseph E. Winters read a paper (see p. 645) with
the following title :
IS THE operation OF TRACHEOTOMY IN DIPHTHERITIC
CROUP DANGEROUS ? — WHEN SHOULD THE OPERATION
BE PERFORMED.
Dr. J. WiLLiSTON Wright opened the discussion, and
said that he did not regard tracheotomy as an especially
difficult operation. He was well aware that when un-
dertaken, as it frequently was, in the middle of the night,
perhaps in a tenement-house, by the light of a tallow
candle or a dirty kerosene lamp, with such assistants as
one could under those circumstances obtain, it was an
operation which almost every surgeon approached with
some sense of misgiving, and especially as it usually oc-
curred in such cases in young children with a short neck
and a deep trachea. These difficulties, however, were not
so great but that they might all be surmounted by one
who pretended to understand anything of surgery, coupled
with a cool head and a steady hand.
The incision for the operation was a simple one, in-
volving the skin and fascia chiefly. Then came the
separating of the space between the muscles which were
in front of the neck, and, in doing this, the operator
reached a mass of connective tissue and veins which, if
wounded, frequently bled profusely. If the operator at
that time was impressed with the hemorrhage which was
going on, and undertook to arrest it before opening the
trachea, he would probably consume the remainder of
the night in so doing. However, if the case was not
urgent, it nn'ght be proper to arrest some of the hemor-
rhage, even supposing it to be simply venous. Arterial
hemorrhage, if the incision was made properly, was seldom
troublesome.
On the other hand, if the case was an urgent one, one
demanding immediate relief, the child dying with as-
phyxia, his custom was to ignore this venous hemorrhage
and go on into the trachea, feeling very certain that, as
the author of the paper had stated, this venous hemorrhage
would usually stop as soon as the knife entered the trachea,
or at least as soon as the tube was introduced.
Concerning the entrance of blood into the trachea,
he had usually regarded it as a matter of no special im-
portance. On the contrary, it had seemed to him to be
•the very thing needed to stimulate violent expulsive ef-
forts which rid the trachea of mucus as well as of blood.
In that sense, therefore, he did not regard tracheotomy
as either an especially difficult or dangerous operation.
He regarded tracheotomy in the adult as one of the
simplest operations in surgery. In the young child the
operation was facilitated by placing under the neck a
common wine bottle wrapped in a napkin, and allowing
the head to hang over it.
With regard to the isthmus of the thyroid body, in
operating in urgent cases he .would be inclined to cut
through it with the knife ; but, on the other hand, in
cases where securing of time was not so much the ob-
ject, he would surround the two sides of it with a ligature
and divide the tissues between the ligatures, as stated by
Dr. Winters. If, however, the child was practically dead
when placed upon the table, he would not stop for this
mode of procedure.
As to the time at which tracheotomy should be resorted
to, he was of the opinion that it should be performed '
early — that is, as soon as severe symptoms made their
appearance which were not relieved by ordinary medical
measures ; in that respect he agreed with the author of
the paper. If the diagnosis of membranous croup, or of
diphtheritic laryngitis was well made out, he believed that
the sooner the patient had the opening made into the
trachea the better were his chances of getting well.
The operation, in his judgment, was not in any sense
the cause of death, except, possibly, it might lead to
secondary affections, but not more so than a simple in-
cision made elsewhere.
His fueling with reference to early operation was so
strong that, if the diagnosis was reasonably correct and
he was unable to get anyone to perform the operation
on one of his own children or a near friend, he would
perform tracheotomy himself. Still further, he would
perform the operation upon himself under the same cir-
cumstances were he unable to get a surgeon to perform it.
He had performed the operation once with an ordinary
pocket-knife in a case of foreign body in the larynx.
Dr. a. Jacobi thought that the discussion should not
be so much upon the general subject as upon the elab-
orate paper of the evening. The subject had claimed
the attention of almost numberless writers for the last
two generations, a fact which was proved by Dr. Win-
ters' paper, which teemed with quotations gathered for
the purpose of proving that there was no danger from
tracheotomy. The author of the paper had quoted fropi
writers on both sides of the question, but had rested
upon the side of those who considered that tracheotomy
was not a dangerous operation, and at this point Dr.
Jacobi entered a criticism, in that the author had not
stated why he did not consider tracheotomy as a danger-
ous operation. We should know first what the dangers
were and then see if they could not be overcome. Dr.
Winters had searched the literature of old Europe appar-
ently from beginning to end, but had made mention of
only one American operator, namely, Professor Gross,
and in that instance almost only for the purpose of show-
ing that Professor Gross was guilty of contradictions in
his own writings, so much so that it was scarcely possible
to say whether Gross really regarded the operation as
dangerous or simple and easily performed.
Dr. Jacobi would have been pleased to have had more
extended reference made to American operators ; for ex-
ample, Dr. Gay, of Boston, who published an excellent
paper on this subject not many months ago, and in our
own midst he could recall excellent papers by Hadden
and Ripley, each of which contained a vast amount of
knowledge and solid experience. More than this, there
were other men in other cities who had performed the
operation, and had reported a large number of cases.
He thought we could have learned something from the
experience of these surgeons.
With regard to the dangers of tracheotomy, the prin-
cipal one was that it was usually a bungling operation,
and by bungling operation he meant a bloody operation,
which is not infrequent in unskilful hands. The prin-
cipal thing in performing the operation was to be as con«
siderate and slow as possible, for by so doing hemorrhage
could be avoided. If the tracheal cartilages which were
to be cut could be seen distinctly the dangers from hem-
orrhage would be avoided. If it was not desirable to
operate below the isthmus, if there was not sufficient
room to perform the operation there, Bose's operation
might be performed, which consisted in pulling oflf a part
of the isthmus. Cutting through the isthmus would give
rise to some hemorrhage, and to cut through it was a
mistake. Nevertheless, it must be done when the case
was an urgent one, and, under those circumstances, it
might be forgiven \ but if there are two or three minutes
to spare the isthmus should not be cut.
Dr. Jacobi was not of the opinion expressed by Professor
Wright, that is, to cut directly through the isthmus when it
bleeds. He had seen such operations, and he had not been
able to find the trachea on account of the blood, and
666
THE MEDICAL RECORD.
[December 13, igg^.
had lost a patient under such circumstances. He did
not regard it as an indifferent matter whether blood was
drawn into the trachea or not It was true the child
coughed afterward, and threw out a good deal of the
blood, but would the child throw out everything ? No.
Even when the child was healthy it would throw out
some blood as late as ten or twenty minutes after the
operation, if all of it ever came up. When blood had
entered the smallest bronchi it had the same influence
which a small amount of viscid mucus would have in the
same position. Broncho-pneumonia in children was
usually a consequence of simple bronchial catarrh. In
those cases the smallest bronchi were filled with mucus,
and behind them the air-cells contracted, the blood-ves-
sels in their immediate neighborhood dilated, congestion
followed, and finally broncho-pneumonia developed.
Therefore, if blood entered into the srtallest ramifica-
tions of the bronchi, a very frequent result was broncho-
pneumonia and death, and that result could be averted
by avoiding hemorrhage, and hemorrhage could be
prevented by taking a little time before the trachea was
opened, which in the large majority of cases could be
accomplished. First see the trachea, and then cut into it.
There was another cause of danger. From the resume
of the literature given by the author of the paper it
seemed that a large number of the old authors were op-
posed to the operation, and a large number of modem
authors were not opposed to it, and why ? The old sur-
geons operated before chloroform was discovered, or
were afraid to use it, and the discovery of chloroform was
only about thirty years of age. Billroth published his
experience in the University of Zurich twelve or fourteen
years ago, in which he declared that tracheotomy was
the most formidable operation which he had ever been
called upon to perform. He had not used chloroform,
and that it was which made the operation so serious. Dr.
Jacobi was decidedly of the opinion that anaesthetics
should be used, as the occurrence of death during the
operation was much more rare than when they were omit-
ted. He then referred to cases in which children had
died, struggling against nurses who took them out of bed
for the purpose of making a simple nasal injection, and
if babies were operated upon without the aid of an
anaesthetic many would be killed who would have been
saved had an anaesthetic been administered. He pre-
ferred chloroform decidedly to ether, because it took too
long to bring the patient under the influence of ether.
Here, then, were the principal dangers : first, in not
using chloroform, and, second, from hemorrhage.
At what stage of croup should the operation be per-
formed ? The author of the paper had stated that if the
diagnosis was correct we should not wait. Dr. Jacobi
was of the opinion that we should not wait until we were
sure that it was a case of membranous croup ; for there
were some cases of croup which were not membranous.
He would say that whenever there was laryngeal stenosis
which would positively lead to death, operate, even if
the diagnosis of the presence of membrane had not been
made.
Dr. Jacobi objected to dividing croup into several
stages, especially with reference to the operation ; for,
in some cases the symptoms demanded tracheotomy im-
mediately. He would operate when he knew that there
was laryngeal stenosis, a considerable amount of reces-
sion in the supra- and infra-clavicular regions and in the
region of the ensiform process, and when he knew that
these symptoms had had a duration of several hours, or
sometimes several days, and that dyspnoea had been in-
creasing rapidly, particularly in the morning only ; for
in the evening the symptoms are as a rule aggravated ;
when there was cyanosis and frequent pulse, then he
would operate at once by all means. Under such cir-
cumstances we should not ask whether or not there was
a membrane or some other obstruction.
It was true that diagnosis should be clear to a certain
extent. There must be, of course, laryngeal stenosis^
or the long-drawn-in inspiration which alone justified us
in assuming that the stenosis was not in the larynx
alone. Pneumonia was not a contra-indication of trache-
otomy.
What could be done in cases in which there was a general
constitutional diphtheritic sepsis? Decidedly much
could be done under those circumstances. In such
cases there was a strong indication for the operation, for
this reason : as soon as the windpipe was opened the
fetid inhalations from the nose and throat were removed
from the lungs, which was an immense advantage. A
large number of children died in consequence of these
fetid inhalations. While formerly constitutional diph.
theria, complicating diphtheritic croup, was considerda
contra-indication to tracheotomy. Dr. Jacobi was npon
the opposite side, and believed that this was one d the
principal indications for the performance of the opera-
tion. In other cases we might wait a little, because of
the benefit which might accrue from the use of internal
remedies, and he was still of the opinion expressed in
his paper read in May last, that benefit could be derived
from the use of mercurial preparations. In cases of
membranous croup these preparations should be tried
in addition to the measures which have already been in
general use. Since he had resorted to the mercurial
treatment he was positive that he had saved a large num-
ber of patients, and that his percentage of recoveries
without tracheotomy was much larger than it had ever
been before.
Of what did the children die when tracheotomy was
performed ? They might die of diphtheria, but they
would die of diphtheritic sepsis whether the trachea was
opened or not. They might die of paralysis, of nephritis, of
hemorrhage, and they might die in consequence of ade-
nitis with gangrene occurring, perhaps, in such enlarged
glands, with hemorrhage from rupture of blood-vessels
by the gangrenous process. Croupous pneumonia was
not so infrequent simply as a complication of diphtheria,
and very probably due to the same cause.
But the principal causes of death after tracheotomy
were broncho-pneumonia, or oedema of the lungs, or de-
scending diphtheritic membranous process. Children
were apt to die of broncho-pneumonia two or three days
after the operanon. Pulmonary oedema might occur and
kill within a few hours after the operation. Within the
last ten or fifteen years he had seen a large number of
patients die of descending diphtheritic process. The
process would descend into the trachea and bronchi
sometimes to the third bifurcation. These childi«n
would die almost at a certain hour ; that is, between
fifty and seventy hours after the operation. But the
descending process could be relieved in many cases by
the introduction of oxygen into the circulation.
In saying what he had in the way of criticism he
had also meant to say that he appreciated the value
and importance of the paper, one which was well worthy
of close attention, for the purpose not only of gathering
material for criticism but also valuable information.
Dr. J. Lewis Smith said : " All who have seen much
of .tracheotomy are for the most part agreed as to the
dangers which attend it. The younger the child the
greater the danger, so that in infancy the operation is
more difficult and dangerous than in childhood. I have
observed two conditions which greatly enhance the dan-
gers in opening the windpipe. One is the late perform-
ance of the operation, when the patient is nearly moribund
and the operator is impelled to operate in the quickest
possible time in the fear that the patient will die on the
table. He does not have time to pick his way cautiously
between the blood-vessels, consequently, there is greater
hemorrhage, and the trachea is opened before the bleeding J
entirely ceases. The second condition is when the op-
erator does not fully appreciate the difficulties in the way,
and undertakes the operation when poorly prepared
with instruments, and in other ways. Such a case was
the first tracheotomy which I witnessed. Soon after my
December 13, 1884.]
THE MEDICAL RECORD.
667
^aduatioD a young physician, full of confidence, met me
in the street, and wished me to hold a child while he
operated. Unfortunately the patient was an infant, with
short neck and fleshy. He was restless during the cut-
ting, and died from the abundant hemorrhage before the
trachea was reached. Inexperience and the lack of
proper appreciation of the difficulties attending trache-
otomy therefore increased greatly the dangers of the ope-
ration. From the tenor of the paper to which we have
listened, the young physician might be led to suppose
that tracheotomy is a simple procedure and attended by
little risk or difficulty, but I would strongly advise one
who operates for the first half dozen times to have with
him a physician or surgeon who is familiar with trache-
otomy, for he is apt to be confronted in the operation by
unexpected difficulties, as the presence and abnormal
distribution of large blood-vessels. In the city such help
is readily obtained, but in the country it might be more
difficult.
" In considering the time when tracheotomy should be
performed, it seems to me convenient to recognize two
classes of cases. When croup commences in the begin-
ning of diphtheria the inflammation is active, the exuda-
tion occurs rapidly, and a thick pseudo-membrane soon
forms, causing a laryngeal stenosis which is apt to increase
from hour to hour in spite of our inhalations and medi-
cines. In such cases I think we all agree that the earlier
tracheotomy is performed the better. In other instances
diphtheria has continued a few days and the acute stage
has passed when croup begins, the exudation is poured
out less rapidly and less abundantly, the stenosis is not
so urgent, and the patient not infrequently, in the type of
diphtheria now prevailing, recovers by inhalations and
medicinal treatment. While, therefore, in the one class
of cases the rapidly increasing stenosis is such as to ren-
der recovery almost impossible without surgical interfe-
rence, in the other class of cases the subacute character
of the inflammation and the slowness of the exudative
process give more time for the action of medicines,
so that perhaps tracheotomy may be avoided. During
the last few months I have seen two patients recover from
marked larnygeal stenosis due to croup commencing at
the close of the first week, or in the second week of diph-
theria. In both there was membranous exudation on the
fauces, and such dyspnoea that the post-clavicular and
infra-mammary regions were depressed on inspiration,
but the dyspncea was not progressive, the suffering was
not marked, and time was allowed for the action of alka-
line inhalations and medicinal measures, and tracheotomy
was fortunately avoided.
" If, therefore, there is marked and increasing laryngeal
stenosis, notwithstanding well-directed and energetic
treatment, and the patient begins to suffer from lack of
air, all of us, I think, would advise early tracheotomy, but
in the other class of cases it is proper to wait and trache-
otomy may not be necessary.
" The position taken by the writer that we must be sure.
of the presence of a pseudo-membrane in the larynx be-
fore deci^ng to operate, I agree with Dr. Jacobi, does
not seem to me well taken. It is difficult to inspect the
larynx with the laryngoscope when the fauces are much
swollen, and the stenosis may be such as to require
tracheotomy when there is no pseudo-membrane in the
air-passages. Trousseau has pointed out that there may
be even a faucial pseudo-membrane while the obstruc-
tion in the larynx is due to the infiltration and thickening
of the mucous membrane. In at least two cases in the
New York Foundling A-sylum in which death occurred
from croup, no pseudo-membrane was found in the air-
passages, but thickening of the mucous and submucous
tissues sufficient to cause fatal stenosis. The indication
for tracheotomy is the amount of obstruction and dysp-
noea, rather, than the presence or absence of a pseudo-
membrane. Those who believe that there is no remedy
for croup except tracheotomy, would be likely to advise
the operation in all cases, when there is marked dyspnoea,
but I am . sure that a considerable number may be re-
lieved without tracheotomy by the judicious use of calomel
in a few doses at the commencement, perhaps by one or
two doses of the turpeth mineral to which our esteemed
President called attention several years since, by the use
of the bichloride of mercury, and especially by the persist-
ent use of alkaline inhalations."
Dr. John H. Ripley had been interested in the pa-
per of the evening, especially as the author had taken
a position quite antagonistic to that which he himself
occupied. Dr. Winters' position with regard to the dan-
gers, the difficulties, and the consequences of late opera-
tion were opposed to Dr. Ripley's views. In sup-
port of his own views with regard to the dangers of the
operation, Dr. Winters had marshalled a large number of
ancient and modern men of foreign countries, some of
whom had performed tracheotomy, and some of whom
had never done so ; some of whom had performed trache-
otomy for croup, and some of whom for other causes ;
some of whom had performed the operation in children,
and others who had performed it in adults. As Dr. Rip-
ley understood the question, it was not whether the opera-
tion of tracheotomy in general was a difficult or a dan-
gerous surgical procedure, but it was whether tracheot-
omy in children for croup was a difficult and dangerous
operation. So far as tracheotomy generally was con-
cerned, he should be willing to put in a demurrer to the
position taken by Dr. Winters, as it was well known that
it was neither very difficult nor very dangerous.
The danger in cases of croup consisted, first, in the
condition of the child ; second, in the necessity for per-
forming the operation within a given length of time. Dr.
Winters had considered one danger, and, so far as Dr.
Ripley had been able to discover, he had touched upon
only one, or at least but very little upon any other, namely,
hemorrhage. Dr. Ripley did not understand that hemor-
rhage was the most common cause of death during the
operation of tracheotomy. The operator had to deal
with children who were suffering from systemic poisoning,
from stenosis of the larynx, often from infiltration of the
cellular tissue of the neck, which was sometimes im-
mensely swollen. In order to reach the trachea under
these circumstances the surgeon must go down for per-
haps two inches, which necessitated a good deal of time
and a good deal of care, and these little children were so
paralyzed with the poison of diphtheria that, before the
surgeon reached the trachea, the patients were liable to
die from syncope^ and not from hemorrhage.
If, when the stenosis was very great, chloroform was ad-
ministered, the child was liable to die of apnoea ; but if
chloroform were not administered, as Dr. Jacobi has prop-
erly said, the child would die from paralysis of the heart
and respiratory muscles incident to struggling.
With reference, then, to tracheotomy being a dangerous
operation, he was willing to go with the small majority
made up of such gentlemen as Professor Gross, Mr.
Holmes, and Professor Billroth, and should feel satis-
fied if he maintained the position which those men had
taken. He thought it was fair to presume that their
opinions were based upon an extensive clinical experi-
ence.
Dr. Ripley had performed tracheotomy one hundred
and ten times, and had seen it performed at least fifty
times more. He had also seen nearly every form of com-
plication which could exist, and had seen all sorts of
operators make a trial of it. He had assisted several
operators at their first operation, and believed that he
had been the means of saving several lives by being
present at operations performed by inexperienced oper-
ators. He had known a large number of deaths to occur
upon the table.
He did not say, as had been indicated by the author of
the paper, that tracheotomy was the most dangerous of
all operations. He simply said that tracheotomy for
croup in young children was one of the most dangerous
operations in surgery. He also said that his opinion was
668
THE MEDICAL RECORD.
[December 13, 1884.
supported by Gross, Holmes, and Jacobi. He also was
familiar with the opinions of most of the surgeons in this
city, and knew that those who operated a great deal con-
sidered it as a general rule a very dangerous operation.
With regard to ten deaths occurring upon the table
during tracheotomy, the operations were performed by
seven men, and four of those were gentlemen of remark-
able surgical experience, ability, and coolness. He knew
of one death which occurred from puncturing the internal
jugular vein, and the patient died from hemorrhage, the
operation being performed by one of the best surgeons
in New York City.
He also knew of (juick operations, of two or three
plunges ; in one the plunge was into the spinal column,
in another the operator plunged into the oesophagus, and
in the third the plunge was into the side of the trachea,
and the scalpel went completely through it. Dr. Ripley
regarded such work as rather reckless surgery. He
thought it was sufficiently dangerous when the tissues
were carefully dissected down to the trachea, and the
trachea was seen before it was opened. The trachea was
liable to be displaced by an enlarged gland, or other
condition, and he regarded it as exceedingly dangerous
to endeavor to cut mto the trachea by striking it with
the scalpel in the median line.
As regarded early operations, Dr. Winters had advo-
cated strongly the performance of the operation early.
As Dr. Ripley had often said, the man who oper-
ated early would have the greatest success, not for the
reasons which Dr. Winters had given, ho^vever, but for
the reason that unnecessary operations, as a rule, were
those which were performed early. He had within the
last few months watched ten cases of diphtheritic croup
in which it became a question whether or not tracheot-
omy would be required, and in all the patients had re-
covered without an operation. As a matter of necessity
there was great danger of making a mistake in diagnosis.
It was often impossible to differentiate until the cases
had been watched for two or three days, but in such
cases the patients almost always get well without the
operation. It was true that the operation might be de-
manded for inflammatory stenosis of the larynx, as Dr.
Jacobi had said, but those cases were very rare ; they
would answer very well to the picture which the author
of the paper had given as diagnostic of membranous
croup. Cases of catarrhal laryngitis were, as a rule, not
accompanied by a great amount of difficulty in expira-
tion, but in certain cases there would be difficulty in both
inspiration and expiration, and in these cases the patient
would get well without the operation. Besides, there
was a certain number of cases of diphtheritic croup in
which the patients would recover without either remedies
or operation. Hence it was that there were so many
specifics for croup, because in a certain proportion of
cases of croup the patients would recover without any
treatment, especially if the air of the room was kept
moist with steam.
Concerning the effects of delaying the operation,
he had been complimented by Dr. Winters with the
statement that his argument was illogical because he had
advocated a late operation, and then went on to say that
he had been called to operate for croup and found the
children dead when he reached the place. Dr. Ripley
was unable to see anything specially illogical in the
statement which he made, and thought that if the gentle-
men who read his paper would follow the course that he
there advocated, they would come out all right. With
reference to these cases, in one instance the doctor had
not seen the patient for a number of hours, and in one
case for twelve hours. If Dr. Ripley had advocated any-
thing in his paper, it was that all such ca^es should be
watched very closely.
If Dr. Winters' causes of death after late operations
were really such, then they must be those which he
stated, such as pneumonia and extensive bronchitis. Dr.
Ripley thought that if there was any fact in scientific
medicine easily demonstrated, it was that stenosis of the
larynx, or stenosis of any part of the respiratory organs
before the air- vesicles were reached, which was not com-
plete, gave rise, not to congestion of the lungs, but to
ancemia of the lungs, which can be easily ascertained by
physical signs. Broncho-pneumonia, as claimed by both
Dr. Jacobi and Dr. Winters, was not found, but anairaia *
of the lungs and certain areas of collapse \^hich had
been produced by plugging up the bronchi leading to
these collapsed portions of lung tissue. If that was true,
then prolonged stenosis of the Jarynx did not give rise to
congestion of the lungs, and hence delayed operations
were not dangerous on account of broncho-pneumonia
which might follow. Dr. Ripley then referred to anaa-
topsy recently made by Dr. Maxwell, in a case of diph-
theritic croup, in which were found membrane cxten&g
downward as far as the third bifurcation of the brondn,
with two or three large areas of collapse, and no broncho-
pneumonia whatever. Dr. Ripley then stated, as he had
done previously, and he now has the records of about
twenty autopsies, that in not a single instance had there
been found sufficient pneumonia to produce death. The
most common cause of death, whether in the early or
late stage, was bronchial croup. Trace the bronchi out
and it would be found that the membrane extended
sometimes as far as the fourth or fifth bifurcation, but
before the membrane lined the tubes throughout the
child must die of suffocation.
There were also other causes ' of death, such as ne-
phritis, which killed in quite a number of cases; also
respiratory or cardiac paralysis, or both. These were
the three principal causes of death after tracheotomy.
Carbonic acid poisoning had no tendency to increase
the formation of membrane.
When the child did not have retraction of the chest-
walls in respiration he did not perform tracheotomy.
In conclusion he simply wished to impress what he
had stated with regard to the causes of death upon the
table, namely, that hemorrhage was one of the most in-
frequent, and further, that he regarded it as eminently
proper for an inexperienced man to call to bis aid, if pos-
sible, an experienced man when the operation was per-
formed.
Dr. Winters, in closing the discussion, remarked,
with reference to Dr. Jacobi's criticism, that he had
quoted many American writers as well as Professor Gross.
Regarding the entrance of blood into the trachea,
there had been a great misconception concerning the
performance of tracheotomy. Tracheotomy properly
performed was almost bloodless. He had seen the
operation performed for the first time very often, and
had seen it done better than it was usually executed by
specialists, for the reason that the operators usually pro-
ceeded with more care, and secondly, that the specialist
was not accustomed to watching the disease day by day,
was terrified by the appearance of the patient, and
thought that preservation of life depended upon making
an opening into the trachea quickly. Dr. Winters
thought the operation should be performed by the man
accustomed to sit by the bedside and watch the progress
of the disease, and who therefore knows that it matters not
if he complete the operation in one or twenty minutes.
How should tracheotomy be performed in order to be
bloodless ? After the incision through the integument
was made the scalpel should be put aside and not taken
up again until the trachea was laid bare. The separation
of the tissues might be made with two pairs of forceps,
or it could be done readily with the end of a pair of or-
dinary scissors. If any portion of the fascia could not
be torn it could be raised on a director and divided,
preferably by a pair of dull scissors, after being carefully
inspected. When the operation was performed in this
manner care was not required with reference to the en-
trance of blood into the trachea.
Dr. Jacobi had said that, when blood entered the
trachea and the bronchi, it might cause bronchitis and
December 13, 1884.]
THE MEDICAL RECORD.
669
broncho-pneumonia. Dr. Winters regarded this as the
view formerly advocated by Niemeyer in treating of
bronchial hemorrhage, and thought that it had been
almost entirely exploded; mdeed, Niemeyer retracted
it before his death. It was not possible foi blood to
get into the small bronchi, and produce broncho-pneu-
monia. If a small quantity of blood got into the trachea
and was left there, the operation was not completed.
The operation was incomplete until every portion of
blood had been expelled from the trachea by titillation
with a feather or other means.
Dr. Jacob! had also stated that the older writers were
opposed to the operation of tracheotomy because it was
before the discovery of chloroform, but Dr. Winters
thought that the quotations which he had made were suf-
ficient answer to that statement. Billroth had been re-
ferred to as opposing the operation, more especially be-
cause he had performed it without chloroform. On this
point Dr; Winters stated that Billroth had performed
the operation only twelve times so far as he had been
able to find on record. Concerning chloroform, he had
not supposed there was any question concerning the
propriety of using it ordinarily in tracheotomy, nor did
he suppose there was any marked difference of opinion
as to which was preferable, chloroform or ether. Ether
produced irritation and congestion of the air-passages
sometimes amounting to acute inflammation.
With reference to membranous croup having stages.
Dr. Winters did not use the word stages with reference
to croup, except as quoted from Sann6, of Paris. He
agreed with 'Dr. Jacobi, that these stages could not be
always recognized.
Dr. Jacobi had also alluded to the use of mercury in
the cure of croup. That bichloride of mercury was a
germicide or an anti-fermentative in the cure of diph-
Sieria Dr. Winters did not believe. It was not possible
for bichloride of mercury to be introduced into the blood
in sufficient quantity to act in either way. In the first
place, it was given in small quantities frequently re-
peated, and it was rapidly eliminated, and if elimination
was interfered with it induced one of two things, either
vomiting or purging. Therefore there was not sufficient
of the remedy accumulated in the blood to act as either
a germicide or an anti-fermentative. Was it possible to
get the jgermicidal effect of the remedy by its internal
administration? Positively, no. It had no other action
than that of a simple tonic, and its action in the cure of
croup was precisely the same as that of iron, a remedy
which it would never supersede. As to bichloride of
mercury having any influence in producing resolution
of the membranous exudate, it had no more action than
any other mercurial salt.
With reference to the extension of diphtheria to the
bronchiy if diphtheria extended into the trachea and
bronchi it almost always did so before the performance
of tracheotomy. Dr. Winters did not think that a post-
mortem record couJd be found which would tend to show
that the membranous exudation of diphtheria appeared
in the trachea and bronchi offer the performance of tra-
cheotomy, when it did not exist previous to the operation.
The extension of the disease was by its propagation
downward, and in those cases in which it was found
death occurred within a comparatively short period,
before sufficient time had elapsed for the disease to ex-
tend there after the performance of the operation.
As regarded Dr. Smith's statement concerning the
necessity of assistance to one inexperienced in the per-
formance of tracheotomy, Dr. Winters could not feel
that it was essential, and Dr. Smith himself had admitted
that under certain circumstances in the country it was
not necessary. What can be done in the country can
be done in the city.
Tubage of the larynx dates from Hippocrates, although
Dr. Winters was not able to state that it was then ap-
plied. It had been practised in France a great deal, but
it wa^ entirely out of use, and no one in France, experi-
enced in the treatment of membranous croup, would
think, at the present time, of tubing the larynx.
Dr. Ripley had stated that many of the gentlemen
whom he had quoted had never performed tracheotomy.
In answer to this, Dr. Winters said he had quoted
one, possibly two, gentlemen who had never performed
tracheotomy, but almost all the quotations had been
made from men who had performed the operation hun-
dreds of times, and almost all of them had performed
the operation in diphtheritic croup. In regard to Dr.
Gross, his book, at least, did not show that he had ever
performed tracheotomy for diphtheritic croup. Dr. Rip-
ley apparently confounded the dangers of the operation
with the dangers of the disease^ and said that the condi-
tions which render the operation needful made it dan-
gerous. Dr. Winters said that the operation itself, per-
formed with care, was not dangerous. Any man who was
competent to practise medicine could, in a time of emer-
gency, without a single surgical instrument, perform
tracheotomy in diphtheritic croup in a young child with
a short, thick, swollen neck, with absolutely no danger
to the patient. Such a man generally has a knife with
which he can make an incision through the integument,
and with an ordinary pair of scissors he can work his way
to the trachea with the loss of less than a drachm of blood.
When the trachea has been clearly exposed he can open it
with a penknife, and he can then hold the trachea open with
two bent pins and a tape going round the neck, as one sur-
geon did, and saved the child^s life. Any man who was
prepared to undertake tracheotomy in that way was far
superior to the specialist who used a large array of instru-
ments, and with one incision laid bare the trachea.
Concerning deaths upon the table. Dr. Ripley still
insisted upon that occurrence as being an indication
of the danger of the operaton. When death occurred
upon the operating-table it was not due to the operation,
unless performed with haste and carelessness. It was
always due to either carelessness or late performance of
the operation. Again, Dr. Ripley said that by resorting
to the operation early we should operate in cases where
it was not necessary. To that point Dr. Winters had al-
luded in his paper, and it was there that the question of
diagnosis was introduced. That was the reason why
the operation should be in the hands of the general prac-
titioner, because he was a better diagnostician in croup
than the surgeon, who was not accustomed to watch the
progress of the disease. A man who had watched many
cases of croup could be very sure of his diagnosis.
With reference to catarrhal laryngitis, spasm, and
oedema. Dr. Winters impressed the fact spoken of by Dr.
Ripley, that where expiration was free there was no
membrane in the larynx ; but the moment you have ob-
struction, prolonged audible expiration, voice suppressed
to a whisper, there was membrane in the larynx ; nothing
else would produce that symptom.
Regarding prolonged obstruction to inspiration. Dr.
Ripley had said that it did not produce congestion of
the lungs. That view would not bear close examination.
Any one familiar with the physiology of respiration
knew that as soon as interference with the inspiratory
act occurred embarrassment of the pulmonary circula-
tion followed, and with this damming back of blood upon
the heart, a final result was a weakened heart-force, de-
layed circulation, diminished aspiration force, and passive
congestion of the pulmonary vessels, and to this there was
no exception in protracted stenosis of the larynx. No
man could prove by autopsies upon record that it did
not occur in every case of protracted croup where
tracheotomy had not been performed. Dr. Winters had
examined the records of hundreds of cases, and had found
passive congestion, accumulation of mucus in the bron-
chi, pulmonary collapse, and when the condition had ex-
isted a little longer he had found congestion of the lungs
and pulmonary oedema, all the changes which exist in a
case of ordinary broncho-pneumonia. Dr. Ripley had
also spoken of the analogy existing between astiima and
670
THE MEDICAL RECORD.
[December 13, li^^
croup so far as the lungs were concerned. Dr. Winters
said there was no analogy whatever existing between the
two conditions.
Dr. L. Elsberg wished to say a word in defence of
the memory of his old teacher, Professor Gross, who had
taught that, although the general operation of tracheotomy
was perfectly simple and not difficult to perform, there
were circumstances which rendered it one of the most
serious and formidable operations in surgery. It was not
true, as Dr. Winters had stated, that Professor Gross had
not performed the operation for diphtheritic croup. Dr.
Elsberg heartily sympathized with the general drift of Dr.
Winters' paper, and said that he had previously placed
himself upon record with the statement that any medical
man worthy of the name of physician should be table to
perform tracheotomy.
Dr. Winters remarked that no one would bow lower
or more reverently than he to the memory of the late
Professor Gross, but he believed it to be eminently
proper to criticise some of the statements which this
justly distinguished author had made in his work on
** Foreign Bodies in the Air-passages," and, so far as his
book was concerned, there did not exist in it any evi-
dence that Professor Gross had ever performed tracheot-
omy for diphtheritic croup.
. The Academy then adjourned.
NEW YORIC PATHOLOGICAL SOCIETY.
Stated Meeting, November 12, 1884.
R. E. Van Gieson, M.D., Vice-President, in the
Chair.
Dr. R. W. Wilcox presented a specimen of
cancer of the breast — SCIRRHOUS MAMMA —
which he removed October 16, 1884.
Mrs. W , fifty years of age, with excellent family
history, and the mother of three children, had had pain
in the left side of her chest for the last three years. As
the pain was increased on deep inspiration she inferred
that it was due to some respiratory or rheumatic affection,
and applied a plaster. When she removed this plaster she
noticed a small lump, about the size of the end of her in-
dex-finger, in the left breast, below the nipple. Within
the next six months she began to have stinging, itching,
and drawing pains at intervals, but more especially dur-
ing the few days previous to the menstrual period. Dur-
ing the last year retraction of the nipple has been noticed.
The pain gradually increased until it became constant
and severe, interrupting the sleep. Had no symptoms
during lactation. Has not yet reached the menopause.
Axillary glands not affected.
The report of the examination of the specimen, by Dr.
H. C. Coe, is as follows :
Gross appearance, — Specimen includes the entire mam-
ma, which is of nearly normal appearance, though the
nipple is small, fixed, and slightly retracted. Below the
nipple is a hard mass about the size of a hazel-nut. On
section the gland is found to be overgrown by adipose
tissue. In the centre of the mass, just beneath the nipple,
is a firm, hard, fibrous mass, which is attached to and in-
volves the base of the nipple. Strong bands of fibrous
tissue extend from the periphery of the gland to this nod-
ule.
Microscopic examination. — The central mass is found
to be largely made up of fibrous tissue. Some sections
show an entire absence of cellular elements, others are
filled with scattered groups of epithelial cells, having a
distinct alveolar arrangement. No signs of degenerative
changes throughout the growth.
Dr. Garrish asked if any member had known a pa-
tient to live ten years after removal of a breast for scir-
rhus. The late Dr. Valentine Mott had made the asser-
tion that no patient could live more than six years after
removal of the breast for cancer.
Dr. Wveth referred to one case in which the padcnt
had lived seven years after removal of the cancerous
breast. In his case there had been a number of opera,
tions.
Dr Carpenter referred to a case in which, eight years
ago, he assisted in removing a tumor of the breast, which
microscopical examination, made by Dr. Delafield and
himself, determined to be cancer. There had beenn)
recurrence of the disease.
Dr. George A. Dixon presented specimens of
pachymeningitis interna hemorrhagica, with cfre.
BRAL hemorrhage,
accompanied by the following history :
J. C , thirty-three years of age ; Ireland ; fireman,
admitted to Charity Hospital, October 27, 1884, Family
history : Negative \ previous history : Patient has been a
hard drinker for some years, his work has been fireman
on board ship. Gives no history of any trouble up to
six months ago. Then, while at Madagascar, was attacked
with what he called " chills and fever." Would have a
chill v^hich was quite severe, followed by headaclie and
fever, lasting until evening ; these symptoms returned
each day. He complains of some epigastric pain, and
has vomited some blood. Had a small hard sore on penis
three months ago, followed by an eruption. Had gonor-
rhoea some years ago, and has discharge now.
Present condition, October 27, 1884. — Complains of
above symptoms and describes headache as burning in
character and occurring over front part of head. Has a
pain in his back and also in epigastric region. Appetite
poor ; bowels regular ; has no trouble in passing urine.
Walks around ward.
October 30th. — Patient is rational and seems to be
doing fairly well. Physical examination reveals nothing
except slight enlargement of liver.
November 3d. — To-day I saw patient for the first time,
having just come on the service. Patient was asleep,
was easily aroused, but was drowsy. His pupils were a
very little enlarged equally. Could shut both eyes tightly,
and either separately. Mouth could be well drawn to
either side ; tongue was protruded straight. Complained
of soreness on percussion over skull ; said that on October
27, 1884, he had fallen down stairs, striking on leftside
of head ; no fracture could be detected. The grasp of
the right hand was weaker than that of the left. Got out
of bed and walked^ without difficulty, but had hemiplegic
gait in right leg ; stood well with feet together when his
eyes were shut, also on left foot, but could not stand on
right foot. The right patellar tendon reflex was exag-
gerated, there was no ankle clonus, and the cremastenc
reflexes seemed equal on the two sides. There was
slight loss of sensation over entire right side. There was
no trouble with either bladder or rectum. Speech was slow
and drawling ; patient seemed to understand questions
perfectly.
Diagnosis. — Either meningeal hembrrhage, syphilitic
tumor, cerebral hemorrhage, or pachymeningitis hemor-
rhagica.
Treatment, — Potass, iodid., grs. x. ter. in die., to be
rapidly increased. Hydrarg. biniod., gr. ^ ter. in die.
November 5th. — Patient sleeps most of the time and
is more stupid, was delirious last night ; has difficulty b
passing urine.
November 7th, — Has had muttering delirium con
stantly since last note, continually says, " My head is
broken." Could not be aroused this morning, and died
at 3.45 P.M., just after vomiting a quantity of yellowish
fluid.
Autopsy^ by Dr. Banks, house-physician, twenty-four
hours after death. Heart, normal, weighs twelve and
one-half ounces; liver, fatty and enlarged, sixty-nine
ounces ; spleen, enlarged and soft, six and one-half
ounces ; kidneys, normal, weigh twelve ounces ; lungs,
hypostatic congestion at posterior border, otherwise nor-
mal, fifty-seven ounces. On removing scalp a contused
December 13, 1884.]
THE MEDICAL RECORD.
671
spot was seen over left parietal bone. There was no
fracture of skull. Brain was carefully removed and sent
to me. The brain is well developed, there is slight
flattening over left hemisphere. The inner surface of the
dura mater, covering the upper surface of the left hemi-
sphere, is covered by a false membrane, in the meshes of
which are extensive hemorrhages. The measurements
of this false membrane are, antero-posteriojly, six and
one-half inches ; laterally, two and one-half iriches, and
one-quarter of an inch in depth. There are punctate
hemorrhages in the meshes of the pia mater underneath
this area, and around are pigmentary spots. This false
membrane covers the posterior aspect of the first and
second frontal convolutions in front, to the comer of oc-
cipital lobe behind, and covering upper two-thirds of
ascending frontal and parietal convolutions, also parietal
lobe. There is a recent hemorrhage in the left hemi-
sphere, beneath superior and inferior parietal convolutions,
measuring, antero-posteriorly, one inch; laterally, one
and one-fourth inch, the cavity of which would hold an
English walnut This hemorrhage is situated in the
internal capsule. The arteries at the base were normal ;
no miliary aneurisms could be detected.
The severe pain in the head, the history of alcoholism,
the fall ten days before death, and the stupor with slight
paresis on right side, were points to my mind in favor of one
of the four conditions I have named, with the probability
that it was a meningeal hemorrhage, pachymeningitis, or
possibly a syphilitic tumor occurring early in disease.
Unfortunately no temperature was taken, so that cerebral
hemorrhage could not be excluded when I first saw him.
The points of interest are : the age of patient, the recency
of the syphilitic attack, the absence of any well-marked
head symptoms until three days before death, the stupor
occurring then and increasing rapidly, patient becom-
ing comatose in afternoon, and the appearance of
the haematoma — the process having been going on for
years probably. It seems to me that the cerebral hemor-
rhage occurred only three days before death, at the time
the patient became comatose, and this apoplexy was the
direct cause of death. It is very unfortunate that I
coald find no friends of deceased to obtain a good previ-
ous history. The hemorrhage was probably due to
miliary aneurisms, although none were found, and the
arteries at the base were normal, as well also the kidneys
and heart.
Dr. Seguin remarked that the case was interesting on
account of the slight symptoms connected with the pachy-
meningitis, which was in accord with what hs had seen
in two cases in which the symptom was mainly headache
of different forms — not burning pain, but severe head-
ache.
In the first case the patient became gradually comatose
without paralytic manifestations, and the autopsy showed
a thick hemorrhagic clot over both hemispheres.
In the second case the first symptom was headache,
not localized, but severe pain, and then there occurred
rather suddenly clonic spasms in the face and hand of
one side, and also paresis of that side, after which the pa-
tient became gradually more and more comatose, and
died without paralysis.
In both cases the pupils were contracted. In the sec-
ond case the quantity of blood within the cranial cavity
was so enormous that the hemispheres were concave at
the autopsy, and when the dura was pricked the blood
spurted out to a great distance ; yet there was no marked
paresis. There was no diagnosis in either case.
With reference to miliary aneurisms, it is necessary in
searching for them to sacrifice the specimen. The brain
should be placed in water and allowed to decompose,
when the blood-vessels can be brushed out and the aneur-
isms easily detected.
Dr. Peabody remarked that the case was further in-
teresting in the comparative youth of the patient It was
rather unusual for cerebral hemorrhage to occur at this
age, if the patient had normal kidneys and heart. It
had occurred to him several times to find cerebral hemor-
rhage in young persons, and in one case the patient was
a boy nineteen years of age. In that instance, however,
there was a congenital narrowing of the aorta.
With reference to pachymeningitis hemorrhagica, he
had observed that the disease may exist without producing
any symptoms whatever until a large hemorrhage takes
place. He had frequently found the lesion of pachymen-
ingitis hemorrhagica to the extent of the formation of
numerous layers up to fully formed connective tissue, in
which repeated small hemorrhages had occurred, as evi-
denced by numerous collections of blood pigment, and in
which no symptoms whatever had been given during the
life of the patient.
It had also occurred to him to find cases in which the
hemorrhage had been large, and the symptoms had been
very pronounced, but they were merely the symptoms of
pressure upon the surface of the brain.
Dr. Van Santvoord thought the traumatism in Dr.
Dixon's case should have a little more stress laid upon.it
than it had received. He remembered, when an interne
in Bellevue Hospital, that quite a large number of cases
of intoxication were admitted, presenting no symp-
toms except semi-stupor ; but the patients finally became
comatose and died without marked paresis or paralysis.
At the autopsy there was found fracture at the base of
the skull, but the fatal lesion seemed to be surface hemor-
rhage, adherent or not to the dura mater. He remem-
bered one case in particular, that of a woman, who fell
and struck her head against a hard resisting substance.
At the autopsy there was found extensive pachymeningi-
tis, with quite a recent hemorrhage under a layer of mem-
brane on both sides of the falx. Jn that case it was a
question whether the condition dated from the fall or
whether the hemorrhage only was excited by the fall. In
Dr. Dixon's specimen the pachymeningitis presented the
appearance of being of recent occurrence.
Dr. Dixon said a point against the last statement
made by Dr. Van Santvoord was the fact that there was
a good deal of pigment around the hemorrhage, which
must have been of old date, and there were several lay-
ers into which it was evident that hemorrhage had been
taking place from time to time.
Dr. Seguin asked Dr. Peabody if he had been able to
make sure that headache was not present in his cases.
Dr. Peabody said he was not entirely sure of the ab-
sence of headache, for the reason that the cases were all
hospital cases. But he was able to say that the patients
did not complain of head symptoms sufficient to attract
the attention of the house staff.
Dr. Dixon remarked that in his case the man com-
plained for some months previous to admission of only
chilly feelings followed by headache, disappearing in the
evening, and recurring on the following morning, and
when he entered the hospital he described his headache
as being of a burning character, and perhaps a little
more marked over the frontal region than elsewhere.
Dr. John A. Wyeth presented
A GOITRE REMOVED BY OPERATION,
with the following history : Theresa H , thirty-six
years of age, housewife, a native of Germany, had had a
goitre since she was ten years of age, but it never
troubled her until three years ago, when it began to in-
crease in size, and gave rise to difficulty in swallowing
and breathing. The goitre had grown principally down-
ward, across, and to the right, until it involved the whole
anterior surface of the neck. She never had exophthal-
mos or palpitation of the heart. During the last three
years she had had cough, which caused her much pain in
the goitre and in the head. There was no family history
of goitre, and the patient's previous health had been good.
On admission a large goitre was seen, extending from
one side of the neck to the other, and extending be-
hind either stemo-mastoid muscle. The narrowest part
appeared in the ro<»^««ui line, where it extended from the
672
THE MEDICAL RECORD.
[December 13, 1884.
lower part of the thyroid cartilage to behind the sternum.
The lower border dipped down behind the clavicle and
sternum. The tumor was hard, no fluctuation, and meas-
ured eight inches across, three and a half inches verti-
cally. There was some visible pulsation of vessels over
tumor. The patient's general condition was good. The
patient breathed with great difficulty. The laryngoscope
showed vocal cords close to median line.
October 23d. — The patient has stridulous, painful
cough, and breathes with much dyspnoea.
October 26th. — Operation under ether. Took the
anaesthetic badly. A crucial incision was made over the
tumor, followed by careful dissection. It was found
necessary to extend the incision to the left, dividing the
external and anterior jugular veins and the whole of the
sterno-mastoid muscle ; the right sterno-mastoid muscle
was only partially cut.
On the left side the internal jugular vein crossed the
carotid artery to the inner side and passed high over the
side of the tumor and was closely adherent to it ; it was
ligated above and below the tumor. The trachea was
pushed abruptly to ihe left by the tumor. About three-
fourths of an inch below the larynx, on the posterior
aspect ot the tumor, it was calcified and tightly adherent
to the trachea. Very little blood was lost during the
operation, which lasted four and one-half hours. It was
then found impossible to separate the tumor from the
trachea. An elastic ligature was passed about the loosened
part of the tumor and the wound left open. The patient
breathed badly throughout the operation, but her pulse
remained good. After the operation the dyspnoea in-
creased, and one and one-half hour later the patient died,
apparently of oedema of the lungs. She was stimulated
freely, and her pulse did not fail until twenty minutes
before death. The tumor was removed post-mortem,
and the part ligated off proved to be less than one-half.
The lower and back parts were hard and cartilaginous,
and contained deposits of calcific material which looked
as if cysts had undergone calcific degeneration. The
vessels on the right side were not disturbed, but on the
left side the carotid was exposed for four inches with the
pneumogastric nerve by its side uninjured. The internal
jugular was ligated above and below the tumor. Nearly
all the vascular connections of the tumor had been
ligated.
In two other cases, already reported to the Society,
Dr. Wyeth had removed the thyroid gland successfully.
Dr. Wendt asked Dr. Wyeth if in his successful cases
he removed the thyroid gland completely.
Dr. Wyeth replied that the disease occupied only one-
half of the thyroid body, which was removed with the
isthmus up to its junction on the opposite side.
Dr. Wendt said the reason he asked was because
Bruns, of Tubingen, had recently again directed atten-
tion to the fact that when the thyroid body had been
completely removed the patient developed a peculiar
characteristic cachectic condition, and had often died at
periods varying in length from six months to several years
after the operation. This observer had concluded that
complete removal of the thyroid body was therefore un-
justifiable, whether the gland was. diseased or not.
Dr. Wyeth remarked that he did not wish to be un-
derstood as favoring removal of the thyroid body by
surgical operation.
Dr. Howe thought that the application of so many
ligatures could be avoided by adopting a plan recom-
mended by Bluxom, of Charing-Cross Hospital, London,
who makes an incision in the median line, divides the
tumor into two equal parts, then ligates one-fourth of the
tumor, tying it on each side, and cuts the mass included
in that ligature completely out without special hemor-
rhage. He reports three cases of recovery without the
development of any peculiar cachexia.
Dr. Wyeth said that in his last case the tumor was
so vascular that had he split the tumor with a ligature
the woman would have died of hemorrhage at once.
^vixm S^ewB.
Official List of Changes in the Stations and Duties of Officers
serving in the Medical Department^ United States Army^
from November 30 to December 6, 1 884.
Irwin, B. J. D., Major and Surgeon. Granted one
month's leave of absence. S. O. ic 2, Department of
Arizona, November 28, 1884.
O'Reilly, Robert M., Captain and Assistant Sur-
geon. Assigned to duty as Attending Surgeon, Wash-
ington City, D. C, to date from October 20, 1884. S.
O. 284, A. G. O., December 4, 1884.
Barrows, C. C, First Lieutenant and Assistant Su^
geon. In addition to other duties, to takp charge of
the office of Medical Director, Department of Arizona,
during absence of Surgeon B. J. D. Irwin. S. 0. in,
Department of Arizona, November 28, 1884.
Kneedler, William L., First Lieutenant and As-
sistant Surgeon. Relieved from duty at Fort A. Lincoln,
Dakota Territory, and ordered to Camp Poplar River,
Montana Territory, S. O 140, Department of Dakota,
November 25, 1884.
Pilcher, James E., First Lieutenant and Assistant
Surgeon. To be relieved from duty at Camp Poplar
River, Montana Territory, and ordered to Fort A. Lin-
coln, Dakota Territory. S. O. 140, Department of Da-
kota, November 25, 1884,
McCaw, W. D., First Lieutenant and Assistant Sur-
geon. Relieved from duty at Fort Wingate, New Mexico,
and ordered to Fort Lyon, Colorado. S. O. 228, De-
partment of Missouri, November 26, 1884.
Gray, Charles C, Major and Surgeon. (Retired)
Died at Geneva, New York, November 26, 1884.
Contagious Diseases — Weekly Statement.— il^
port of cases and deaths from contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the week ending December 6, 1884 :
Week Ending
£
1
1
Ss
1
1
j
1
1
Casts.
November 29, 1884
December 6, 1884.
0
0
42
a2
%
2
8
90
155
55
75
0
0
0
0
Dtaiks,
November 29, 1884
December 6, 1884
0 1 15 14 2
0 1 io| 13 8
23
22
26
43
0
0
0
0
A French Cure for Corns. — Saturate the stockings
at the point covering the corns in a solution of phos-
phorus in olive oil (one part to three hundred) ; wear
them as usual, and in fifteen or twenty days, it is claimed,
the corns will have disappeared.
The Oldest Physician in the State. — Dr. Thomp-
son Burton writes us that Dr. Joseph Braman, of Bra-
man's Comers, Schenectady County, is the oldest Mason
(and probably the oldest physician) in the State. He
was ninety-one years old on August 30, 1884.
Hygiene and Bacteriology. — A department of hy-
giene and bacteriology has been opened in connection
with the chemical laboratory of Professor Fresenias at
Wiesbaden. Dr. K. Hueppe, who has done much work
under Dr. Koch at Berlin, has been appointed to the
charge of this department.
The Medical Record
A Weekly yournal of Medicine and Surgery
Vol. 26, No. 25
New York, December 20, 1884
Whole No. 737
©rigitmt %xXxt\tz.
DO WE PRODUCE AVOIDABLE PAIN AND
COMPLICATIONS IN THE DIAGNOSIS AND
TREATMENT OF STRICTURE CONSECUTIVE
TO GONORRHOEAL URETHRITIS?
By FANEUIL D. WEISSE, M.D.,
PSOFBSSOR OP PRACTICAL AND SUKGZCAX, ANATOMY, MEDICAL DEPARTMENT OK THE
UNIVERSITY OP THE CITY OP NEW YORK ; VISITING SURGBON, WORKHOUSE AND
ALMSHOUSE HOSPITAL, NEW YORK OTY.
The above question is put and discussed not in the spirit
of idle criticism or antagonism to orthodox practice, but
with the hope that both the question and the argument
may be weighed in the light of individual experience.
The motive of the article is to present a strong convic-
tion held that the present use of instruments in the
urethra in the diagnosis and treatment of stricture con-
secutive to gonorrhoeal urethritis does give needless im-
mediate pain, and does produce avoidable local and con-
stitutional complications. It is desired to suggest a basis
for the collection of past experience and future observa-
tions, which may lead to the accumulation of positive
evidence that will modify our use of instruments in the
urethra in these cases. Such modification will diminish
suffering and give more precision to our instrumental
procedures for the relief of our patients.
First. — The locality of stricture of the urethra consecu-
tive to gonorrhoeal urethritis does not warrant the intro-
duction of instruments interiorly to the triangular liga-
ment^ or through the membranous and prostatic portions of
the urethra into the bladder.
All authorities are agreed that the prostatic portion of
the urethra is never the seat of stricture from any cause.
The membranous portion is acknowleged as the locality
where traumatic stricture most frequently occurs. Special
statistics are wanting as to the occurrence of stritture
consecutive to gonorrhceal urethritis in the membranous
portion.
Writers upon the subject of strictu]:e of the urethra
confirm the localization of thb form of stricture exteriorly
to the triangular ligament, at times by the direct state-
ment, at others by implication, but conclusively so in
the detailed recitsd of cases, when accurate measure-
ments are given. Dr. Fessenden N. Otis ("Stricture of
the Male Urethra," p. 134) defines stricture consecu-
tive to gonorrhoeal urethritis, as follows : " Stricture in
the sense of an abnormal contraction of the urethral
calibre, at some point at or between the meatus urinarius
and the bulbo-membranous junction." At this "junc-
tion," it will be remembered, is the triangular ligament.
The most recent observations which have been made
in locating stricture of the urethra from all causes are
those of Otis and Gross ; they were made upon hving
patients, with the metal bougie a boule.
Otis (op. cit, p. 96) located 258 strictures, from all
causes, as follows : 52 in first J inch within the meatus,
€^ from \ to ij inches from the meatus, 48 from i J t02i
inches, 48 from 2^ to 3^ inches^ 19 from 3^^ to 4^ inches,
X4 from 4^ to 5^^ inches, 8 from 5^ to 6\ inches, 6 fi-om
6^ to ^\ inches. The 52 cases in the first one-quarter
of an inch within the meatus might be discarded as con-
ditions of congenitally small meati.
Professor S. W. Gross, M.D. (** Diseases of the Uri-
nary Organs,'* p. 454) located 173 strictures, from all
causes, with the following result: 49, or 28.32 per cent.,
were within 2^ inches from the meatus; 48, or 27.74 per
cent, were between 2^ inches from the meatus and i
inch from the triangular ligament ; 76, or 43.93 per cent,,
were between i inch in front and f of an inch behind the
triangular ligament.
Combining the two series of observations (less Otis* 52
cases within one- fourth of an inch of the meatus) we obtain
the following localization of 379 strictures of the urethra
in living patients, with living histories : 289, or 76.24 per
cent, were between i inch in firont of the triangular liga-
ment and the meatus ; 90, or 23.75 per cent, were be-
tween I inch in front of and J of an inch behind the
triangular ligament If the last 90 cases had been care-
fully recorded as to their locale^ so as to determine posi-
tively whether or not they were exteriorly to the triangular
ligament, a very large number of them would have been
located in the one inch in front of the triangular liga-
ment. It would be safe to say that 343, or 90.24 per cent.,,
of the ^1^ strictures were located exteriorly to the trian^
gular ligament.
It is much to be regretted that in both Otis' and
Gross' cases the causes of the strictures were not given.
The weight of evidence from daily practice will fully
endorse, and even go further than. Gross in his opinion
(op. cit, p. 452) : " Judging from my own experience,
I am convinced that at least 90 per cent, of all cases,
not traumatic, are the effect of gonorrhoea." Upon
this basis we would not be straining a point to assume
that 303, or 90.24 per cent, of the above 349 strictures
located exteriorly to the triangular ligament were consec-
utive to gonorrheal urethritis.
With these data in mind, and a case of suspected
stricture with a history of antecedent gonorrhoeal ure-
thritis, are we warranted in passing an instrument in-
teriorly to the triangular ligament (or the diagnosis of the
same ? With a stricture located by instrumental exam-
ination exteriorly to the triangular ligament, why should
an instrument be passed interiorly to the ligament ?
I hold that all cases of stricture consecutive to gonor-
rhoeal urethritis are located exteriorly to the triangular
ligament. When the urethritis passes interiorly to the
triangular ligament it may produce an epididymitis, by
continuous progress into the ejaculatory ducts, etc.,
or an attack of cystitis by progressing to the bladder,
but it does not produce stricture of the membranous
portion of the urethra.
Second. — The instruments in general use for the diag-
nosis and treatment of stricture of the urethra consecutive
to gonorrheal urethritis are calculated to produce need*
less pain and avoidable local and constitutional complica-
tions.
The instruments in general use m the treatment of
this variety of stricture are sounds and bougies ; while
the metal bougie k boule, urelhrometers, urethral divul-
sors, urethral dilators, and urethrotomes are in the hands
of specialists and a limited number of general prac-
titioners.
Authors of surgical text-books, writers, as specialists,
on male genito-urinary diseases, professors of surgery in
their didactic and clinical lectures, all concur in advising
the use of sounds and bougies in the diagnosis and treat-
ment of all cases of stricture of the urethra (making no
exception for strictures consecutive to gonorrhoeal ure-
thritis). They convey the idea, if they do not say so in so
many words, and practise it at their clinics, that a patient
674
THE MEDICAL RECORD.
[December 20, 1884.
is not examined until the sound or bougie has reached
the bladder.
The history of the artnamentarium for the diagnosis and
treatment of stricture of the urethra bears evidence of a
departure, here and there, from the use of the time-
honored sound and bougie. They are, however, only
isolated instances of a conservative appreciation of the
conditions to be treated, which have not made sufficient
impression upon the general profession to lead to their
adoption or to any modification of the prevailing methods
of practice.
After careful measurements of the sounds in general
use, as made by our leading instrument makers (for their
circumference Dr. C. H. Thomas' '* Adaptable metric
gauge " was used), the following appears :
The average length of a sound is eight and a half
inches from the handle to the tip ; its straight portion
varies from six to seven inches, its curve from one and
a half to two and a half inches ; the circumference of the
straight portion is uniform throughout and represents
the full size of the instrument ; the circumference of the
curved portion diminishes from the end of the straight
portion to the tip of the instrument, varying in the diflfer-
ent instruments. In a few exceptional instances, the
special make of the sound is such, that the circumference
of the straight portion is continued into the curve to
within an inch of the tip.
From careful measurements of flexible bougies of all
kinds, French and English, they were found as follows :
They vary in length from ten and one-fourth to thirteen
inches ; the^ have a uniform circumference, the full size
of the bougie, to within three inches of the tip ; for their
terminal three inches they diminish in circumference very
much, to expand again in the bulbous and olive-tipped
varieties.
From the shape and length of the above instruments,
as thus carefully determined, it will be seen that the
curve of the one and the length of both do not adapt
them for treatment of the six inches of the urethral
canal exteriorly to the triangular ligament. When di-
rected to be used it implies their passage into the
bladder.
The sensations of a patient when one of these instru-
ments is passed into the bladder are :
1. When a full-size sound or bougie is inserted,
an excessively painful distention of the meatus, which is
unnecessarily prolonged, because the circumference of
the sound or bougie increases from the tip. to the handle
end of the instrument ; and for six inches of the sound
(straight portion) and at least- nine inches of the bougie
the circumference is uniform and represents the full size
of the instrument.
2. Pain is always produced in passing an instru-
ment through the triangular ligament ; and a painful
sense of fulness is felt while the membranous portion of
the urethra is occupied by the instrument.
3. As the instrument passes through the prostatic
portion of the canal over the sinus pocularis or utric-
ulus, containing the orifices of the ejaculatory ducts, a
markedly unpleasant, reflex, systemic impression is pro-
duced, which is augmented by the entrance of the instru-
ment into the bladder.
Professor Gross (op. cit., p. 489) says : "It is well
known that patients, especially sudi as are very ner-
vous and irritable, occasionally suffer most violently
from the most trifling operations upon the urinary organs,
the mere passage of a bougie, sound, or catheter [pre-
sumably passed into the bladder] * inducing violent
rigors, excessive prostration, and other symptoms. In-
deed, a large number of cases are upon record in which
death was produced by this cause, even when there was
no severe disease; and there are few practitioners of
any experience in this branch of surgery who have not
witnessed the distress, local and constitutional, which
> Words in brackets are added.
healthy persons often suffer from the attempt to pass an
instrument into the bladder."
Another authority (Van Buren and Keyes, " Genito-
Urinary Diseases," etc., p. 150) says: "The miscWef
to be feared from the employment of large sounds with
force is the production of epididymitis, a common result
of violence to the urethra [prostatic portion]/ and a
complication, which suspends treatment and confines
the patient for several days or, it may be, weeks." Fur-
ther on the same authority sa^s: "In rare instances
epididymitis may come on m spite of care.*'
Add to this well-known effect of the use of instnuncnts
passed into the bladder the reflection made by the last-
named authorities upon epididymitis (p. 416) : "Qoe
particularly interesting feature of the disease is the ^
mainly brought out of late years by Gosselin, that the
chronic induration so often left behind in the epididynas
by inflammation sometimes blocks up the tubes suffid-
ently to prevent the passage of the spermatic elements,
thus entailing temporary and sometimes permanent ste-
rility, without an accompanying loss of sexual power."
Further on (p. 422) occurs the following, in speakmg of
this sterile condition of the patient after double epididy-
mitis : " He ejaculates semen resembling the healthy
fluid in quantity, smell, and color, only it contains do
spermatozoa, and consequently he is sterile."
My own experience furnishes two cases where I exam-
ined the ejaculated fluid of patients, who had previously
had attacks of epididymitis (double), where no spemia-
tozoa could be found. In one of the cases the right
epididymitis was consecutive to the gonorrhoeal urethri-
tis, while the left epididymitis was the result of the use of
instruments (sounds) passed into the bladder for the
treatment of a stricture consecutive to the gonorrhoeal
urethritis; the stricture was located exteriorly to the
triangular ligament — 3^ inches from the meatus.
Why incur all the above risks by passing instniments
interiorly to the triangular ligament when the nature of
the case does not call for it?
I hold that all instruments designed to be passed into
the bladder are not to be used in the diagnosis and
treatment of stricture of the urethra consecutive to gon-
orrhoeal urethritis, for the reason that I believe their pas-
sage interiorly to the triangular ligament is what pro-
duces all the above *' local and constitutional distress."
For the past three years I have not passed an instni-
ment interiorly to the triangular ligament for the diag-
nosis* or treatment of this variety of stricture. I be-
lieve the reason that I have not had any '' local and
constitutional distress,'' from the use of instruments for
diagnosis and dilatation of this form of stricture, has
been because my instrumental procedures were limited
to the urethral canal exteriorly to the triangular ligament
Third. — All instruments used in the diagnosis and
treatment of stricture of the urethra consecutive to gonor-
rhoeal urethritis should be so made as to meet the foUow-
ing requirements : simplicity of construction^ compatihk
with the needs to be fulfilled ; length such that they can-
not be passed interiorly to the triangular ligament; a va-
riation of circumference such as to give the least possible
continuance of pain from distention of the meatus ; ruled
so as to locate^ measure^ and treat with immediate prt-
cision the stricture or strictures present,
I would present to the profession the following per-
fected instruments, made for me by Stohlmann, Pfarre k
Co., which have been devised to fulfil the above requi^^
ments of instruments for the diagnosis and treatment (by
dilatation) of stricture of the urethra consecutive to gonor-
rhoeal urethritis.
A set of metal bougies d boule with non-flexible^ ndei
staffs (Fig. i). — These are Otis' metal bougie a boule
with a non-flexible, ruled staff, and with a bulb at either
end — giving two sizes to the one instrument Its length
is adapted for examination of the urethral canal exteriorly
> Words in brackets added.
December 20, 1884.]
THE MEDICAL RECORD.
675
to the triangular ligament — it is six and one-quarter inches
from the apex of one bulb to the base of the other. The
bulbs are scaled from 14 to 37 of the French scale. The
staffs smaller than the bulbs, has two flattened sides,
which are ruled in one-quarter of an inch spaces, so that
as an obstruction is met with the distance of its exterior
face from the meatus can be read off. Then selecting one
of the bougies, the bulb of which will go
through the strictured point tightly, pass
it beyond the stricture, and on attempt-
ing to withdraw the same the base of
the bulb will be arrested at the interior
face of the stricture, when the distance
of the latter from the meatus may in
turn be read off. The difference of the
distances from the meatus to the ex-
terior and interior faces of the stricture
will be the length of the strictured por-
tion.
A set of urethral sounds with ruled
staffs (Fig. 2). — These instruments have
a sound portion at either end — two sizes
to one instrument — and an intervening
staff portion. A sound portion is two
inches in length ; the middle, for an inch,
presents the full circumference or size
of the sound in millimetres (French
scale) ; the ends (for half an inch each)
taper through several sizes. The staff^
portion has much less circumference
than the sound portions, and it is four
and a quarter inches in length ; it is
flattened on two sides (one for each
of the end sounds), which are ruled in
inches, with the quarter-inch divisions).
The length of instrument introduced
into the urethra is six and one-quarter inches from the
tip of one sound portion to the base of the other.
A given stricture located by the bougies k boule, the
proper sized urethral sound is selected and passed, by the
ruling on the stafl*, so as to bring the centre of the sound
portion exactly at the strictured portion of the canal.
In using these instruments, the length of the urethral
canal exteriorly to the triangular ligament will be found
to vary from four and three-quarters to six and one-
quarter inches. A little experience will enable one to
recognize when the triangular ligament is reached, as it
imparts to the finger, when tapping the end of the bougie
k boule or urethral sound protrudmg from the meatus, a
peculiar sensation of elasticity, not given by the exterior
face of a stricture.
In closing I would suggest :
First, — ^That, in locating a stricture of the urethra, we
determine as to whether it is exteriorly or interiorly to
the triangular ligament.
Second, — That, in describing a case of stricture of the
urethra, we discard all terms heretofore used in locating
the same, and specifically state its relation to the triangu-
lar ligament exteriorly or interiorly. The exact distance
of the same from the meatus should be stated.
Third, — That all members of the profession contributfe
their experience toward the accumulation of statistics,
which may definitely settle the location of stricture of the
urethra consecutive to gonorrhoea! urethritis.
Fic*
Fic'a.
Dropping Fluids into the Eye.^ The inner corner
of the eye is first cleaned from all impurities, and then
thoroughly dried. While the child is in the recumbent
position, the eye is kept closed. One or two drops of
the fluid indicated in the case are then dropped into the
comer. When the child opens the lid, the drops flow
slowly into the eye. Should the child be asleep, or not
at once open the eye, the operator needs but slightly to
separate the eyelids, when the drops will immediately en-
ter.— Medical and Surgical Reporter.
ON THE NECESSITY OF PROVIDING FOR
THE BETTER EDUCATION OF CHILDREN
WITH DEFECTIVE HEARING IN THE PUB-
LIC SCHOOLS. »
By SAMUEL SEXTON, M.D.,
AURAL SUKCBON TO THB NEW YORK SYS AND EAR INnRMARY.
The purpose of this paper is to enlist an interest in our
public school systems in so far as concerns the needs of
pupils whose hearing disabilities prevent their advance-
ment along with good hearing scholars, since it is be-
lieved that this matter does not receive the attention its
importance demands.
The varieties of deafness, — ^The defective children be-
lieved to be greatly neglected in regard to their education
may, for convenience in this connection, be arranged into
three classes, namely :
1. Children defective in one or both ears, and requir-
ing close proximity and distinct utterance when taught.
Of these, deafness in both ears requires seating on front
row of benches, but when only one ear is affected the
normal ear must be toward the teacher's desk.
2. Children very deaf, who cannot distinguish ordinary
conversation in either ear when more than a few inches
from the speaker or unless the conversation tube, ot-
acoustic fan, or other aid to hearing be employed.
3. The totally deaf, in whom the auditory apparatus of
the middle ear cannot be made available. This class
admits of division into two subdivisions, viz.: «, thbse
having learned to talk previous to losing their hearing,
and ^, those bom too deaf to ever have naturally ac-
quired speech, commonly known as congenital deaf-
mutes.
Deafness in the schools from a physician's point of
view, — In considering the relations of all classes of deaf
pupils with both the public day-schools and deaf-mute
schools from the physician's point of view, it is believed
that the extent and importance of the subject may be
more fully realized than in any other way, since where
professional advice is required opportunity is allowed for
thorough examination of the hearing organs, both as re-
gards their physical condition and acoustic functions.
A very considerable experience, including observations
on a large number of specially interesting cases among
school children of the poorer class, seen in hospital prac-
tice, led the writer to believe that great injustice was be-
ing done in permitting children to struggle for an educa-
tion under the disadvantages arising from deafness with-
out the aid of methods which experience had shown to
be advantageous in such cases ; he therefore concluded
to make some efforts in their behalf, and in 1877 the
matter was brought to the notice of the Board of Educa-
tion of New York.
Its consideration by the New York Board of Education
in 1877. — The Board referred the matter to the Com-
mittee on Teachers, and in explaining the matter to them
it was shown that some children contmued on at school,
for years even, while scarcely any hearing remained,
while there were many others who heard very badly ; that
in disregarding this matter deaf children were placed at a
serious disadvantage, and that the time wasted in futile
attempts to instruct them was a hindrance to others.
Instances of special injustice were cited where (children,
defective in hearing, had made great efforts both at
school and at home to prepare themselves for promotion,
only to be put back on examination, because the princi-
pal was not aware of the child's imperfection, and there-
fore had not given his questions distinctly enough to be
heard. Other deaf children, from neglect to classify
them, were seated too far away from the teacher's desk
to hear his voice, and in consequence of inability to reply
correctly were frequently punished for inattention and
dulness. The rudeness often practised toward these un-
> A paper read before the Hospital Committee of the State Charities Aid As-
sociation, New York, December 3, 2884.
676
THE MEDICAL RECORD.
[December 20, 1884.
fortunate pupils by unthinking or unsympathetic teachers
was discouraging, and some pupils in consequence had
left school altogether.
It was not recommended at this time that the partially
deaf should be entirely separated from the hearing pupils,
yet it was advised that pupils should always be examined
in regard to their hearing, and that those found to be de-
fective should be given every possible advantage, both in
respect to seating and to distinctness of voice in teaching,
the very deaf should have some instruction apart from
others, since they often could not understand words
shouted into their ears. The writer did not expect that
the long-established order of things could be rapidly
changed, but it is believed that teachers have become
more interested in the subject than ever before, and that
instances of " inattention " and " stupidity " are less
puzzling since their true character is recognized. Com-
plaints are now less frequently made by pupils who come
for treatment of neglect in this regard, and, indeed,
teachers very often recommend that deaf children be
brought to our clinics for relief.
Its consideration by the New York Board of Educa-
tion in 1884. — During the past few months the Board of
Education has again taken this matter into consideration,
a communication on the subject from the writer having
been referred to the Committee on "Course of Studies."
The Committee met on November 12th, and on invita-
tion the writer presented some typical cases of aural
disabilities in children, and gave the results of his experi-
ence concerning deafness in the schools. The Commit-
tee have not, as yet, so far as I know, made any recom-
mendations to the Board, but it is to be hoped that some
steps will be taken in the matter soon.
Its consideration by the United States Government in
188 1. — In the meantime the subject of deafness among
school children has attracted the attention of the Educa-
tional Department of the United States Government, and
the matter bein^ considered important enough to justify
a special investigation of its causes, the' wnter was re-
quested to prepare a paper on the subject, which was
printed by the Bureau of Education for distribution in
188 1. An examination of five hundred and seventy-five
pupils made at that time showed that there were numer-
ous instances of deafness where neither teacher nor pupil
were aware of its existence, and that fully thirteen per
cent of the whole number examined had greater or less
diminished hearing in one or both ears. Of these, only
three per cent, were themselves aware of any defect
existing, and only one of them was known to be deaf by
th*? teachers.
Advantages of the study of deafness from a clinical
point of view, — A consideration of the subject of aural
disabilities should not be confined to observations on
children in the schoolroom, where the detection of deaf-
ness in many cases must be attended with difficulties,
but investigations should also be made at leisure with
favorable surroundings and apparatus for obtaining pre-
cise results. Hence the more valuable conclusions are
to be drawn from examinations in practice, ample oppor-
tunities for which may be found in private and hospital
experience. Thus from the clinical standpoint it may
be premised that a large number of persons come
through the ordeal of children's maladies and other
ailments affecting the ears either directly or remotely
with impaired hearing organs. In some the hardness of
hearing is very manifest, in others it is unrecognized,
even when considerable. Some apathetic persons disre-
gard deafness, while the more sensitive endeavor to
conceal their misfortune.
Estimate of the extent of aural disabilities in the
United States. — Careful estimates have been made, indi-
cating that no greater number than five per cent, of the
entire population have normal hearing, bat this of course
does not show the number of persons defective enough
to exclude them from the benefits of the ordinary com-
mon-school curriculum. The tenth census computes
that there are about thirty-four thousand deaf-mutes in
the United States, or i out of every 1,500. One half
of these are illiterate.
Estimate of the extent of aural disabilities in th
schools of New York City, — Nearly four thousand deaf-
mutes reside in the State of New York, and over one
thousand in this city. Of the latter, 575 are in asylums.
The number of totally deaf persons of the school age in
this city, but outside of asylums, is stated to be 163; but
this estimate is much too low, since the enumeration of
the ; census-takers is very unreliable in respect to this
class. Parents are slow to acknowledge their deaf-mute
progeny, and often the census-takers make no efforts to
get at the facts. The writer has met with a considerable
number of these children who were not enumerated, and
he doubts not that there are no less than 500 of them in
this city, of the school age, unprovided with educational
facilities.
Before the census of 1880 was taken, the question o(
ascertaining the number of very deaf people was consid-
ered by the special agent, Mr. Wines, but the scheme
was abandoned, as it was thought that any returns of this
kind would be wholly unreliable unless obtained by the
aid of expert examiners. It is, therefore, impossible to
give a very close estimate of their number ; but if one
may form an opinion from experiences in practice, the
number having more or less disqualifying aural defects
may be put down at no less than ten per cent, of the
entire school population of New York City. Thus out
of about one hundred and forty thousand pupils in at-
tendance at the public schools at the present time, some
fourteen thousand of them would be the better for classifi-
cation in respect to seating and instruction at close range,
or by means of some aid to hearing. These figures show
that we have to deal with a vast number of defectives, in
respect to hearing, and although this avenue to illiteracy,
and consequently to pauperism, was not of much signifi-
cance when the country was new, it surely demands our at-
tention now, when vagrancy and kindred evils are attract-
ing so much attention from the vastness of their propor-
tions.
The education of the very deaf and deaf-mutes in
the day-schools. — While attention has thus been drawn
to the wants of the partially deaf, strenuous efforts have
been made in behalf of the dea£-mute with a view to im-
proving his educational facilities. The labors of Professor
Alexander Graham Bell in this field have been notable,
and besides ^ving much personal attention to the work,
his contributions to the literature of the subject have
been numerous and valuable. But while the writer him-
self has mainly had in view the needs of the partially
deaf, yet in pursuing this interesting subject from his own
point of view, it is to be plainly seen that from a peda-
gogical standpoint a very considerable number of deaf-
mutes, so-called, may be more advantageously provided
for in the public day-schools than otherwise.
Day-schools for deaf-mutes have thus been established
in the United States as follows: Horace Mann Day-
school, Boston, in 1869 ; Erie Day- school, in 1874; Chi-
cago Day-school, in 1875 ; Cincinnati Day-school, in
1875 ; Portland, Me., Day-school, in 1876; Rhode Isl-
and Day-school, in 1877; St. Louis Day-school, in
1878 ; Oral Branch Pennsylvania Institution, Phila-
delphia, in 188 1 ; Scranton Oral School, in 1883;
Phonological School, Milwaukee, in 1878 ; A. Graham
Beirs School, Washington, D. C, 1883. ^^ would seem
that the systems of deaf-mute education were under-
going a transformation at the present time, since hear-
ing defects are beginning to be regarded as consti-
tuting a factor of varying importance, no longer ofifering
an insurmountable barrier, in a great number of instances^
to an education which shall enable them to hold con-
verse after the manner of hearing persons.
This leads us to express the opinion that very consid-
erable numbers who are at present being educated as
deaf-mutes could be cared for in the public day-schools
December 20, 1884.]
THE MEDICAL RECORD.
677
along with the very deaf who are at present unprovided
for, since they boUi require similar methods of instruc-
tion.
Totally and very deaf children, moreover, require tak-
ing in hand at a much earlier age than is feasible in deaf
and dumb institutions; their education should, in fact,
begin much earlier than it is commenced at present ; they
should be placed in school when four or five years old.
Children who have lost their hearing soon after acquiring
speech soon forget to talk unless means are promptly
taken to keep them in practice. The same rule would
apply with equal force to the congenitally deaf, since
valuable time is lost when instruction is neglected during
the impressible period of early childhood. It becomes a
necessity in respect to the education of children at such a
tender age that they should be provided for in schools
near their homes, an entirely practicable matter, fortu-
nately, in large cities and towns, and even in sparsely
populated districts, according to the reasoning of Bell in
his " Memoir upon the Formation of a Deaf Variety of
the Human Race."
As to disassociating very young children from home
influences, the humane impulses of parents are altogether
opposed to this ; the writer has often witnessed the dis-
may and grief of parents when informed that their deaf
children could obtain an education only in a deaf and
dumb institution. There are, perhaps, a few families
who prefer to place their children away from home, where
the responsibilities of support and training will be as-
sumed by others, but it is otherwise with our better citi-
zens, who desire to have them brought up more as other
children.
. The education of the deaf in deaf-mute institutions.
—In certain institutions an increased interest has shown
itself of late ih respect to the very considerable number
of pupils who have heretofore been treated as totally
deaf, but who are, in point of fact, conscious of more or
less perception of sound, which may be made available in
education. The results alleged to have been attained by
means of aural teaching are very gratifying. During the
year 1877 the writer visited some deaf-mute institutions
with a view to discover what number of these pupils
could hear the voice by means of a conversation-tube
placed in the mouth or ear, and he was surprised to find
a number being educated as deaf-mutes with whom con-
versation could be carried on orally by the employment
of this aid to hearing. Repeated observations subse-
quently made by teachers have confirmed the above, and
it is now believed that of all the pupils in deaf and dumb
institutions a large number could be educated through
the hearing sense by the aid of speaking-tubes and ota-
coustic fans, and that a small number hear well enough
to be taught by the unaided voice. In the Minnesota
institution it has been found that from fifteen to twenty-
five per cent, of all the pupils received can be taught by
the aural method, and that after being instructed for a
time many could hear well enough at the distance of ten
or fifteen feet to converse when elevated voice was used.
The confusion and consequent injustice to deaf pupils
arising from neglect to classify them property. — It will
be admitted, if the figures above given concerning the
deaf be approximately correct even, and it is believed
that as further examinations are made they will be found
not to be in excess of the correct number, that in so far
as educational objects are concerned we cannot separate
pupils into two great classes, one of which can hear well
and the other not at all, by an arbitrary or sudden line of
demarcation, inasmuch as the hearing disabilities of chil-
dren consist in all degrees of deafness, ranging between
slight defects and absolute incapacity.
It would seem necessary, therefore, that some prac-
tical scheme for the classification of the deaf should be
made which would not exclude any from the schools.
Under the present arrangement the only class of defec-
tives provided for has been the so-called deaf-mute class,
which leaves out of consideration entirely a laige num-
ber of partially and very deaf pupils, occupying, so to
speak, intermediate ground between totally deaf and
normal hearing persons. This arrangement absolutely
places a certain number of pupils in a worse condition
than if entirely deprived of their hearing sense, and in
consequence a great many of them find their way into
deaf-mute schools. Thus it will be seen that the classi-
fication in both the day and deaf mute schools is defec-
tive, and that in any attempt to improve matters we are
at once met by a most perplexing dilemma ; thus, owing
to the long-continued practice of forcing all deaf pupils
into either a totally deaf or good hearing class, we find
that some of the former and all of the very deaf and par-
tially deaf have been relegated to the hearing schools,
while other very deaf persons are classified with the
totally deaf and taught as deaf-mutes.
The disadvantages arising in deaf-mute institutions
from the want of classification show themselves in many
ways; thus, where no useful perception of sound has
ever been experienced by a pupil, as in most congenitally
deaf persons, there is probably an entire inaptitude for
the development of the perceptive function, and while
efiforts to arouse this dormant function must not be too
early abandoned in doubtful cases, yet it is well to con-
sider how much labor can be profitably devoted to the
task of teaching such pupils to converse orally. The
discouraging results in such cases has doubtlessly been
the means of establishing a preference for teaching the
sign language, since in overcrowded deaf-mute institu-
tions this method has the advantage of being inexpensive
— ^an important item where the corps of instructors is
small. It has been estimated that about ten per cent.*
of deaf-mute pupils belonging to this class cannot learn
to speak intelligibly unless much more attention is given
to their instruction than is practicable in any public
school.
The mediocrity of results attained is further increased
by the mental inertness of deaf-mute pupils either ad-
mitted when too old to adapt themselves successfully to
study or retained too long after reaching adolescence.
The duty of the State in respect to the education of the
deaf — The opponents of the proposed reform for teaching
these defectives in the public day-schools assert that the
policy of the State is to exclude all who cannot be re-
garded as having average mental and physical qualifica-
tions ; but no one has ventmred to define this standard.
Indeed, it would be difficult to do so ; and were all of the
average pupils selected, what should be done with the
remaining pupils ? This question has thus far been only
tentatively met by the attempt to separate all pupils into
good hearing and totally deaf classes.^
By many it is held that our public-school system has
for its principal object the prevention of illiteracy among
the poor, and if this view be correct it can scarcely be
regarded as consistent on the part of the advocates of
educating the average child only to oppose a scheme for
the promotion of the interests of a needy but uninflu-
ential class, while fostering expensive institutions for the
free education of the better-to-do, and going so far even
as to expend large sums of money in giving special in-
struction in German, French, Music, etc.
This was certainly never contemplated by those who
founded the common-school system. Nor is it humane
to leave the care of this defective class to the uncertain-
ties of philanthropic aid. The State already has abun-
dant facilities for the care of all the deaf-mutes who can-
not be educated in connection with the day system of
public schools, and inasmuch as these institutions will
soon be overcrowded by the natural increase of this class,
it would seem that facilities should be provided for
them in the day-schools without delay. There are,
already 17,000 deaf and dumb persons of the school age
in the United States, according to the census of 1880,
only 5,000 of whom were in institutions. As has been
stated, there are already in operation in various sections
of the country eleven day-schools for the deaf, nine of
678
THE MEDICAL RECORD.
[December 20, 1884.
which, at least, are under control of the the local boards,
and a bill is now before the Wisconsin legislature to au-
thorize Boards of Education to take charge of deaf-
mutes and place them in the day-schools.
The expense of educating the deaf in day-schools as
compared with their education in institutions, — The
question of reform in the education of the defective in
hearing is to a certain extent a question of expense ; that
they must receive educational facilities will not be denied.
Let us consider the result in this regard of transferring
to the day-schools what may be regarded as their legiti-
mate share of work. The outlay by the State would
probably be lessened, so far as the deaf-mutes are con-
cerned, and, on the other hand, it would be slightly in-
creased were proper methods introduced for the instruc-
tion of the very deaf and partially deaf.
At the present time it costs the State to support and
instruct deaf-mutes in its seven asylums $250 per capita
annually. It will thus be seen that were classes of ten
formed in the public schools, which is a smaller number,
I believe, than in asylum classes, and a teacher secured
at the rate of $800 per annum, there would be a saving
of $170 per pupil Where smaller classes of children
were formed, as might be done in the country, the savins
would be less. I have no exact figures upon which an esti-
mate of the number of partially deaf can be based. I know
of but one extensive examination in this direction, besides
my own ; this was made by Weil, of Stuttgart, and pub-
lished in the Archives of Otology iot 1882. It embraced
the results of an examination of the ears and the hearing
of school children of different social grades. In some
schools the percentage of those who heard badly was
as high as 30 per cent My own examinations, em-
bracing 570 pupils, were made in the intermediate and
primary grades and included some in the Roman Catholic
Parochial and in the Colored Schools of this city. It has
already been stated that about thirteen per cent, of these
had greatly diminished hearing, but it would be impossible to
estimate the number whose hearing required teaching by
special methods without a careful and extensive examina-
tion being made. From the large number met with in
practice, however, I believe the number to be consider-
able. These, however, could be taught in classes of
twenty, and the increased expense would not be great ;
such pupils are at present taught, if they attend school,
in classes with hearing children, and the increased ex-
pense in reducing the size of classes to accommodate
them may be easily computed.
There need be no expense for new buildings, the
structures at present in use for school purposes being
sufficient, since it is thought best not to separate one
class from another entirely any more than the different
grades are now taught apart Some instruction would be
common to all.
Teachers of deaf pupils, — Many teachers have already
fitted themselves for this work, and it is a significant fact
that the growing demand for better instruction of the
deaf has enabled them to find ready employment either
in families or in conducting small private day-schools,
since parents are willing to incur this extra expense
rather than place their children in deaf-mute institutions.
Where this expense cannot be borne, and parents are un-
wilhng to send their children away from home, it seems
that to exclude them from the advantages of day-schools
is to disregard their rights.
The examination of pupils in the public schools with
a view of determining their hearing power, — It will
not be denied that these disabilities among pupils should
be known to teachers in order that instruction may be
made more successful, and it therefore becomes important
to adopt some plan for correctly determining the hear-
ing power of all school children, so that where any defect
exists •pupils may be placed under the best possible
advantages. While teachers are known to often fail to
discern marked departures from the normal standard, and
children themselves cannot always give reliable infonna-
tion, yet much could be accomplished by principals and
teachers were they assisted at the start by an expert m
such matters, especially so far as the majority of pupjis
are concernedj; but where it becomes important to ascer-
tain the exact state of the transmitting apparatus of the
ear, and the condition of the nerve-tract connected with
audition, an expert examination would be required.
The importance of early training for deaf children,
— Too much stress can scarcely be laid on the value of
results obtainable in this way if early made, since the per-
ceptive power may be much quickened by training in
many instances, even where the middle ear apparatus is
defective. It would appear to be on the development of
the perceptive tract, rather than on any change in the
transmitting mechanism, that mental improvement de-
pends in the very deaf who are taught aurally. The
expert himself finds it no easy task to get at the facts in
certain cases, especially in young children who have
already been instructed as totally deaf, since they soon
come to disregard the hearing sense entirely, and it r^
mains to be determined in such cases how much the
auditory nerve has deteriorated from disuse. The pro-
fessed indifference to hearing should never prevent some
attempts being made at instruction through the hearing
organs, since a surprising amount of hearing may thus be
found to exist How many children one meets with who
are backward in learning to talk, but finally on getting to
be three or four years old gain their speech! Such
children would get on much faster in many instances, it
is believed, if regarded as partially deaf. While treating
such children professionally I have seen beneficial results
from the use of conversation-tubes, or the employment of
voice at close range. This practice cannot be too early
commenced. I have observed good results in children
as young as eighteen months. In observing these cases
one cannot but be impressed with the importance of nor-
mal hearing in the ready acquirement of speech, and
that however imperfect the hearing may be, it has its uses
in acquiring language.
The hearing that remains after injury of the ear-drum.
— Often after great impairment or destruction of the
transmitting apparatus of the ear-drums, a very efficient
passage of sound to the auditory nerve remains ; but as this
becomes more and more difficult, it deteriorates in qual-
ity, especially for long distances, until finaUy its rendition
in the very hard-of-hearing becomes so crude and inde&
nite that interpretation by the perceptive tract is difficult
or even impossible. Now, when sound ceases to be trans-
mitted in this manner, hearing may take place by means
of the passage of sound up through the tissues of the head
to the perceptive tract as propagated by means of die
otacoustic fan [placed on the tee&, or the conversation-
tube placed in the mouth. In the former instance sound
passes more directly along bone structure from the teeth,
while in the latter it ascends to the vault of the resonating
chamber at the top of the pharynx and thence up through
the tissues of the head. Voice-sounds imparted to a pu-
pil in the manner just mentioned are of very great value
in certain cases, because of their tones being natiu-al, and
the pupil's own voice is even rpore effective in this respect
since it is propagated upward with much energy by his
own vocal efforts against the moist and highly receptive
pharyngeal vault
27ie classification of the future. — No time should be
lost in taking steps in this direction ; a little classification
must necessarily pave the way to improvement in the
education of the deaf of every degree. It should be kept
in mind, however, that, in a certain proportion of the
partially deaf, the defectiveness is transient and vari-
able ; and that in some of the more difficult cases among
the very or totally deaf, repeated examination will have
to be made when any doubt as to the diagnosis remains.
Before quitting this subject I desire to mention Bell's
useful device for testing the hearing.
The audiometer arranged by Professor BelL — ^This
instrument, for all practical purposes in testing the hear-
December 20, 1884.]
THE MEDICAL RECORD.
679
ing power of the different classes of deaf persons, answers
almost every requirement, and its introduction will very
much facilitate the work of classification when used by
an intelligent and trained examiner.
CHRONIC PNEUMONIA, PHTHISIS, AND MILL
ARY TUBERCULOSIS IN THE LIGHT OF
RECENT DISCOVERIES.
By EDMUND C. WENDT, M.D.,
CURATOR TO THB ST. FRANOS HOSPITAL, NSW^YOKK.
It is the opinion of the writer that the micro-parasitic
nature of genuine tuberculosis may now be accepted as
proved by the convincing force of exact experimental
demonstration. In this direction few will to-day attempt
to dispute the correctness of Koch's well-known asser-
tions. But practical clinical investigation must needs
supplement, modify, or perhaps even disprove some of
the later claims put forward by Germany's noted mycolo-
gist In the second volume of the Mittheilungen aus
dent Reichsgesundheitsamt Koch has recently published
more extended observations, dealing principally with the
etiology of tuberculosis. One highly important statement,
to my mind, is to the effect that the repeated entrance
into the healthy human lung of small numbers of the
specific bacilli of tuberculosis results in chronic phthisis,
whereas the simultaneous admission of numerous microbes
produces acute miliary tuberculosis. This ingenious,
significant, and far-reaching hypothesis certainly requires
corroborative elucidation at the hands of careful clinical
observation before it can command universal acceptance.
Experiments upon animals will not suffice in this particu-
lar instance to decide the matter for the human family.
Above all things it remains to be shown how and when,
in the individual case, the dangerous microbes have
effected their entrance into the system. Nor can we tell
as yet why such an entrance takes place so easily in
some cases, indeed occurs in a certain proportion of
them with all the certainty of an inevitable doom.
Again we are yet ignorant of the true reason why the
same thing happens in other persons with tedious diffi-
culty, and, as it were, only after the surmounting of for-
midable opposition on the part of a struggling constitu-
tion. And finally we have but very inadequate knowledge
concerning the rationale of the well-attested fact that a
large class of persons will refuse to contract phthisis at
all, even under circumstances seemingly the most favor-
able for its acquisition.
These and other practical questions that suggest them-
selves in connection with phthisis, chronic pneumonia,
and miliary tuberculosis, merit the earnest attention of
the medical profession.
Drs. Biedert and Sigel have recently devoted much
time to studies in this direction, and the results of a
goodly series of careful clinical observations are pub-
lished by them in the current number of Virchovd s Archiv,
The cases recently published by Dr. Kinnicutt and the
writer (see The Medical Record, October ii and i8,
1884) also show that the practitioner is liable at any time
to be confronted with problems that may seem hopelessly
puzzling, unless the new light of modem pathology can
clear away the obscurity of some of their features.
Biedert and Sigel, in the article alluded to, directed
their attention chiefly to the following points : In the
first place they tried to determine the relation of the dis-
covery in the sputum of tubercle-bacilli to the different
clinical forms of consumption. Thus advanced phthisis
and the incipient variety would presumably differ from
each other, as well as from certain other pulmonary pro-
cesses partaking of the nature of chronic inflammation.
Then they wished to ascertain more definitely in what
manner the appearance of increasing or decreasing pro-
portions of bacilli, kept pace with the gross physical
changes witnessed in their patients. And again they
attempted to find out the precise conditions of the first
appearance of bacilli in the sputum of persons already
afflicted with pulmonary disease, and especially what
effects were observable in such patients while living for
long periods in the same rooms or wards with cases of
pronounced phthisis.
It will not be possible here to follow the authors through
the elaborate details of their painstaking investigations.
They had an abundant clinical material that was put to
the best possible use for deciding some of the problems
and questions here barely indicated. The conclusions
drawn from their observations may, however, profitably
engage our attention. To begin with, they cannot regard
the bacillus tuberculosis as distinguishable from all other
bacteria by the mere peculiarity of its shape. They are not
even quite certain that the color-test is sufficiently char-
acteristic to invariably prevent all error. But, on the
other hand, they fail to indicate any better method of dif-
ferential reco^ition. In pronounced tubercular phthisis,
Koch's bacilli are never found wanting from the sputum.
Indeed, the presence of these microbes is the essential and
vital point connected with that disease. Phthisis being
by no means an affection that always starts at the apex of
the lung, and being, moreover, a disease with at times
misleading physical signs, the discovery of the specific
micro- parasite is the one and only reliable and never-failing
sign of its actual presence. Obviously the importance of
this point, at least in a diagnostic point of view, can hardly
be over-estimated. It amounts to the de facto existence
of a symptom that is in the strictest sense pathognomonic.
The discovery, in a given case, of the presence of tu-
bercle bacilli would, then, according to these writers,
have all the binding force of an irrefragable mathematical
demonstration. And the diagnosis of tuberculosis would
thus be capable of absolute scientific proof, possibly long
before the grosser methods of physical examination could
have revealed it.
But there occur, as we all know, obscure cases of in-
sidious disease that are by many regarded as latent
phthisis or possibly incipient consumption. The ab-
sence of bacilli in them would show that, as yet, tuber-
culosis is not present. Indeed, non-specific pulmonary
infiltrations probably always precede the tubercular in-
vasion. And there can be no doubt that such non-bacil-
lary infiltrations may and commonly do accompany the
specific lung lesions of true tuberculosis. The prepon-
derance of one or the other of these distinct morbid pro-
cesses may, perhaps, be gauged by comparing physical
signs with the proportion of bacilli discoverable in the
sputum.
In the course of the disease the non-specific lesion
may asstune the important rdle of acting as a barrier
against the further encroachments of bacillary infiltra-
tion. On the other hand, it may happen that a compara-
tively harmless, because non-specific infiltration will
furnish suitable soil for the growth and multiplication of
the bacilli, and in that way exert a baneful influence on the
health of the patient by its subsequent conversion into
a specific infiltration.
The process which prepares the lung for the favorable
reception of the bacilli is in itself a pathological one, be-
ing characterized by distinct cellular hyperplasia. It
is noticeable that many of the new-formed cells have a
spontaneous tendency toward degeneration. Nor can they
long resist the virulent attacks of the micro-parasites. It
would seem, however, that the latter are impotent to
harm healthy cells. Indeed, they sooner or. later perish
in any conflict with normal tissue.
Biedert and Sigel further conclude from their observa-
tions that phthisis is not an infectious malady, and very
certainly not a contagious one, in the usual sense. For
consumption owes its origin not solely to the agency of
an infectious virus upon a healthy organism. It dis-
tinctly needs preparatory changes, such as a vitiated con-
stitution, lungs already damaged, or other predisposing
elements, before a bacillary invasion can take hold and
work further evil.
68o
THE MEDICAL RECORD.
[December 20, 1884.
Even miliary tuberculosis has not been clinically shown
to depend upon the introduction of large numbers of
bacilli into previously healthy human lungs. Here, too,
some morbid change must have been pre-wrought before
the accidental inhalation of specific microbes can prove
the starting-point of rapidly fatal disease.
If we accept as trustworthy the statements of these
authors, it follows that the prophylaxis and rational treat-
ment of phthisis are likely to remain in the near future,
what they have been in the near past. That is to say,
our attention must be directed chiefly toward constitu-
tional improvement, with such hygienic and local meas-
ures as common-sense will dictate.
An anti-tubercular specific does not exist, and even
should one be discovered it would be found impotent in
those frequent cases where a vitiated constitution, an
hereditary taint, lack of food, and unsanitary surround-
ings more than suffice to doom the poor human sufferer
to an early grave. We may remember in this connection
the words of Eisenmann : ** Tubercles are but the tears
of the poor shed within/* It is not the wish of the writer
to add to the length of this paper, which is based chiefly
on the article of Biedert and Sigel, by an account of his
own observations. The latter, although quite insignificant
numerically, when compared with those of the authors
mentioned, have nevertheless strengthened his belief in the
substantial correctness of their views. Certainly there is
a large field for further work here, a field rich in promise
of practical results. It is to be hoped that the ground
will not be allowed to lie fallow, and that our own coun-
try may contribute its contingent of faithful, tireless tillers
in the twin cause of humanity and science.
Th« Kensington, loa East Fifty-sevknth Street,
December 13, 1884.
AN ANOMALY OF A VERTEBRA,
With a Suggestion Regarding the Causation of
Certain Forms of Spinal Irritation.
By E. C. SPITZKA, M.D.,
PROFESSOR OP NEURO-ANATOMY AND PHYSIOLOGY IN THE NEW YORK POST-
GRADUATE MEDICAL SCHOOL.
While examining some specimens in the anatomical
collection of Professor William Darling, M.D., F.R.C.S.,
of this city, I was struck by a peculiarity of one of the
vertebrae, which, without claiming a complete knowledge
of the recorded anomalies, I believe has not been de-
scribed. At all events, attention is not directed to it
in any of the accessible handbooks.
I.— Lateral view of the specimen ; ♦, the right prong.
The specimen is in all respects a typical tenth dorsal
vertebra, as is shown by its having a demi-facet on the
upper margin of the body, and a costal facet on the
transverse process. The spiny rugosities on the upper
part of the posterior face, and the lower part of the an-
terior face of the arch, are very prominent ; the texture
of the bone appears normal.
On the anterior face of the arch, immediately above
the inferior articular processes, two powerful prongs of
bone jut downward, as if— in the recent state, when the
vertebrae were connected — to overlap the superior artic-
ular process of the next vertebra below. The disposi-
tion and dimensions of these prongs are so evident from
the accompanying drawings, which are of the natural size,
that I do not consider it necessary to tire the reader with
a list of measurements.
Regarded laterally, it is clear that these processes must
have encroached (particularly when the periosteal lining
is considered to have been added) on the calibre of the
intervertebral foramina (Fig. i). Regarded from above,
it is equally clear that they must have encroached on the
spinal canal, whose contents here consist not alone of
the cord and its membranes, but also of enormous de-
scending nerve-trunks.
Fig. 3. — Basilar view of same, slightly tilted, so as to expose the anterior Cue
of the arch.
In Fig. 2 the vertebra is represented as seen from
below, to illustrate the origin of the " prongs " from the
upper (cephalic) contour of the inferior articular pro-
cesses. Their mternal edge merges into the rugae on
the anterior face of the arch, of which they are probably
hypertrophied continuations. The dorso- ventral face of
the right prong turned toward the facet of the inferior
articular process was rough, and showed an approach to
the stalactite-like structure of the rugosities to which the
vertebral ligaments are attached. This resemblance in-
dicates to my mind the origin of these processes, namely,
an ossification extending into the ligamentous structures,
uniting the articular parts of the arches. That such a
contrivance would render dislocation of the arches im-
possible is evident, and comparative anatomy furnishes
more than one instance of a parallel proviso on the part
of the vertebral fastenings.
The left upper articular process had an extension of
bone glued to its anterior face, the separation was well
indicated by the different character of the bone, and a
daep ravine between them.
From the fact that the symptoms of spinal irritation
are often localized around a single or one or two verte-
brae, mechanical, thermal, or electrical applications to
which often suffice to modify or provoke the numerous
and variable subjective (and objective vaso-motor) symp-
toms of that disorder, it would seem plausible to connect
this state with some irritating cause operating on the
nerves at their exit, or the membranes of the cord and
nerve-roots within the spinal canal. Injuries to the verte-
bral column, notably to the coccyx — as in three cases in
my experience — are competent to provoke such symp-
toms, and it is not unlikely that such an hypertrophy of
bone tissue as that described here may accompany or—
developing spontaneously— cause this disorder. The
December 20, 1884.]
^THE MEDICAL RECORD.
681
evil and apparently disproportionate effect of spiculae
pressing on the cranial dura, is an acknowledged dogma
of neuropathology, and the analogy between that dogma
and the explanation of spinal irritation here suggested is
very great. In both cases the essential nervous tissues
are not destructively involved, the primary tissue to suf-
fer is the fibrous envelope. In both cases this fibrous en-
velope is supplied by nerves whose deep origin is in the
contained neural viscus, and in both the functional effect
is remote and usually manifests itself in the vaso-motor
realm.
Six years ago I had referred to me, by Dr. H. Knapp,
a school-teacher from the Carolinas, who suffered from
aggravated spinal irritation. I became satisfied that a
fracture or distortion of the upper part of the coccyx was
the fundamental cause of her malady, and at my sugges-
tion Dr. James L. Little removed the part below the
point of union, which latter was at right angles. The
patient returned to her home, and Dr. Knapp informed
me that she was relieved of all her nervous symptoms.
What is shown to be true of the coccyx in this case, where
the sublaid causd tollitur effecius argument was so hap-
pily illustrated, is probably true of the more important
parts of the vertebral column.
The condition of the vertebrae and their ligamentous
structures has not been studied in connection with spinal
irritation, and this very naturally, as such a study is dif-
ficult, involves much mutilation in a hurried autopsy, and
autopsies in cases of spinal irritation are at best few.
Nothing is known of the clinical history of the subject
from whom this bone was derived, nor are other parts of
its skeleton identifiable in the collection.
To Professor Darling my thanks are due for the loan
of the specimen from which the accompanying drawings
were made by the author.
i^00teBB tit p^ejfltjcal ^jcieiijce.
Tuberculosis of the Eye. — The Revue Medicate^
October 18, 1884, gives the case of a child who, eight
weeks after an injury to the eye, showed cheesy masses
on the conjunctiva near the external canthus. On mi-
croscopical examination they were found to be tubercu-
lar infiltrations. The same journal also contains the
following general remarks regarding ocular tuberculosis.
The eye niay be invaded by tubercle either primarily or
secondarily. Every part of the organ where vascular
tissue occurs may become the seat of tubercle. Thus it
has been found in the iris, choroid, conjunctiva, and once
or twice primary tubercle has been observed in the
retina. The ciliary body may also be invaded by pri-
mary or secondary tubercle, the latter usually following
a tubercular granuloma of the iris. *
A Frknch Treatment for Ulcer of the Leg. —
Dr. Vidal recommends {JO Union MSdicale, October 12,
1884) the following treatment, which he has found very
efficacious, especially for indolent' ulcers with pale base
and ichorous secretion : First, wash the ulcer with an in-
fusion of oak-leaves, then cover with a layer of subcar-
bonate of iron. A poultice of potato starch is then ap-
plied and retained by a roller bandage. Healing is
complete in from ten to forty days. The subcarbonate
of iron has an action upon the ulcer at the same time
astringent and tonic. It gives new life and activity to
the tissues. The galvanometer shows ia considerable
giving off of electricity, which explains, according to the
author, the beneficial action of the iron.
KXPERIMENTAL StUDY OF ChRONIC ALCOHOLISM. —
For the past three years Dujardin-Beaumetz and Andig6
have been engaged in studying the effects of alcohol,
chiefly upon pigs. The hog was chosen on account of
the resemblance of the alimentary system with that of
inan, and for the further reason that the alcohol could be
readily given. A variety of alcohols were experimented
with, ranging from the high grade ethylic, at one hundred
per cent, to the low grade beet-root, at thirty-four per
cent. The daily dose was from one to two drachms to
every ten pounds of live weight. This was given for
thirty months, mixed with their daily food. In the in-
toxication produced, the stage of excitement was want-
ing, stupor being the first effect The changes observed
consisted in congestion and inflammation of the intes-
tines, hyperaemia of the liver — not, however, going on to
interstitial hepatitis — pulmonary congestion, and intra-
muscular hemorrhage. Haematuria and albuminuria were
never present. The heart and kidneys were found fatty
at times, but, as Cornil has previously shown, this is an
almost constant condition in the pig. The lesions were
much less marked in those experimented upon with the
rectified and ethylic alcohols than in those given the
poorer beet-root and potato alcohols. — L' Union Midi-
caUy October 2, 1884.
The Dyspncea of Bright's Disease. — A communi-
cation on the varieties of dyspncea met with in Bright* s
disease, by Dr. Howard, of the McGill University (Can-
ada Medical and Surgical Journal^ November, 1884)^
illustrates the following points : i. That marked dyspnoea
may occur in Bright's disease not due to gross lesions in
the lungs, pleura, or heart — such as inflammation or
oedema of the lungs, hydrothorax, or pleurisy with ef-
fusion, endo- or peri-carditis, or valvular disease. 2.
That it may be a continuous dyspncea, or of paroxys-
mal character, resembling ordinary spasmodic asthma;
and that these types may occur in the same ^case, al-
though, in my experience, the continued variety is more
frequent than the asthmatic. 3. That these forms of
dyspnoea may occur as the prominent symptoms of renal
disease, and their origin may escape recognition if the
urine be not carefully examined, as well as the heart and
pulse. 4. That Cheyne-Stokes respiration is often a
symptom of Bright's disease, and that it obtains in both
acute parenchymatous and in chronic interstitial ne-
phritis. 5. That while usually an evidence that the
fatal issue is near at hand, it may occur in a chronic
form, and may occur for weeks, perhaps even for years.
6. That these several forms of dyspnoea just mentioned
are very probably due to that defective renal elimination
called uraemia. 7. That in the acute forms of Bright's
disease, serious or fatal dyspncea sometimes, but rarely,
occurs in connection with effusion into the submucous
membrane of the larynx (oedema glottidis).
Do Calcareous Concretions of the Lungs con-
tain Bacilli ? — The Paris correspondent of the British
Medical Journal writes that M. D^jerine has made a
series of researches to ascertain if the bacillus of tuber-
culosis is present in the calcareous concretions, sur-
rounded by a zone of interstitial pneumonia, often ob-
served at the apex of the lungs of old people. There are
different varieties of thes^ concretions ; some are as hard
as stone, others calcareous and cheesy, or as soft as
pulp. In veritable cretaceous concretions, M. D6jerine
only once ascertained the presence of two or three ba-
cilli ; these were used for inoculating rabbits, which, af-
ter seven months' interval, were entirely free from tuber-
culous lesion. In the calcareous cheesy masses the
cretaceous concretion is always in the centre of the
cheesy portion. M. D6jenne invariably detected bacilli
in the non-calcareous part, and they contained more
spores than the bacilli of a tuberculous lesion in the pro-
cess of evolution. These remains of an arrested disease
of parasitic origin are of special interest, as an examina-
tion may establish the distinction between the cheesy
calcareous masses of tuberculosis, and similar degenera-
tions found at the necropsies of syphilitic patients. M.
D6jerine observes that the absence of bacilli does not
necessarily prove that tuberculosis does not exist; he
has been unable to detect the presence of a single ba-
cillus, although the necropsy clearly demonstrated the
presence of tuberculosis. M. Malassez says that the
682
THE MEDICAL RECORD.
[December 20, 1884.
spores of bacilli appear or disappear according to the
coloring substance used. If fuchsine be used they as-
sume the appearance of unbroken rods ; if gentian vio-
let, of spotted rods or a row of seeds. This difference
of aspect may be interpreted in two different ways ; it is
possible that the substance which unites the seeds or
spots can be colored by fuchsine and not by gentian it
is also possible that the appearance is an optical effect
due to the nature of the coloring substance.
Nephrectomy in Infants.— At a recent meeting of
the London Clinical Society, Dr. Godlee reported a case
of nephrectomy done in an infant. The child, a boy,
aged one year and ten months, was admitted under his
care at the Northeastern Hospital for Children in August,
i^^3««B|The tumor was first noticed in June, 1883, ^"^
was growing rapidly. It was on the right side, and
measured four inches in the long diameter and about two
in the short. It was freely movable, and manipulation
caused no pain. There were no urinary symptoms at all.
The kidney was removed by the lateral abdominal (Lan-
genbuch's) incision, and was readily accomplished, as
there were no adhesions to surrounding structures. The
C3ecum and the duodenum were the only pieces of bowel
exposed. One large vein, which ran over the tumor, alone
required ligature. There was no hemorrhage of conse-
quence, and the whole operation was concluded in half
an hour. The child had no symptoms of any kind after
the operation. It ate and slept as well the next day as
before, and the temperature only rose to 99° once, the
day after the operation. It left the hospital, well, six days
later. It continued well till February, 1884, when recur-
rence took place in the right iliac fossa and rapidly in-
creased in size, passing down into the scrotum, and the
child died soon after. Dr. Godlee mentioned eight other
cases which have been recorded, showing that of them
five had died of the immediate result of the operation, two
had recovered well, but died afterward of a recurrence,
and one was well when last heard of, but notwithstanding
the unsatisfactory nature of the results he argued that,
seeing how hopeless the condition is if left alone, we
should endeavor to remove these tumors in a still earlier
stage, at all events until it is proved that even this pro-
ceeding is invariably followed by a fatal result. He
particularly, however, pleaded against attempting the
removal of the very large growths which are not unfre-
quently met with, showing that they will almost certainly
have involved surrounding structures, and that thus while
no good can follow the operation an immediately fatal
result is probable. The tumor weighed about one pound,
and was in structure a mixed sarcoma, most of the cells
being roundish or oval, but some spindle-shaped. This
is probably the usual composition of these growths, but
another class was mentioned in which striped muscular
fibres occur. The latter are probably congenital, and
often affect both kidneys, and are thus not favorable for
surgical interference.
Blood-Poisoning Following Human Bites. — The
Paris correspondent of the London Lancet reports two
cases of this kind, which serve to illustrate the danger
sometimes attending the infliction of human bites. A
lad of eighteen, employed as a waiter at a public-house,
was guilty of some misdemeanor, and while his employer
was remonstrating with him, the lad, fearing a thrashing,
took hold of the right hand of his master and bit him
severely on the thumb. The publican dismissed the lad
on the spot, had his thumb dressed, and thought no more
about the matter. But about two months after the bile
phlegmonous inflammation set in, and the patient was
carried off in a few hours, death, according to the medical
attendant, having been caused by blood-poisoning. In a
recent quarrel between two newspaper editors in Paris,
one bit the hand of the other, soon after which lymphan-
gitis set in in the arm of the wounded patient, which was
accompanied by symptoms of erysipelas, from which, how-
ever, he soon recovered.
Muscular Rupture simulating Abscess.— Dr. Pho-
cas relates, in La France Midicale^ September 25, 1884^
a case of rupture of muscles in the lumbar region which
simulated abscess and caused symptoms similar to those
of lateral curvature of the spine. The patient, a young
man, had first experienced pain in the left side. Three
weeks later he began to walk with a lintip and lean to the
left side. He was, therefore, examined for lateral curvar
ture. This was not found to exist, but a swelling to the
left of the spinal column, painful on pressure and fluctuit-
ing in its central part, was made out After repeated ex-
aminations it was regarded as an abscess and operated
upon under chloroform. Careful dissection brought to
light a rent in the lumbar aponeurosis, through which a
hernia of the mass of sacro-lumbar muscles protnded.
Underneath this hernia was a tumor covering the quad-
ratus lumborum, and adherent to its outer border, as
well as to the abdominal muscles and aponeurosis. The
tumor measured about two inches in diameter, was of a
yellowish color, of soft consistence, and fibrous aspect
Under the microscope it was found to be composed of
altered muscular and fibrous tissue. The patient made
a good recovery, and was soon able to leave the hospital,
free from any signs of curvature, lameness, or deformity.
Scleroses of the Coronary Arteries. — This con-
dition has received more attention of late from both
pathologists and clinicians, since the connection between
pathological changes in the muscular tissue of the heart
and diseases of its vessels has been better understood.
Samuelson found that cutting off the circulation in the
coronary arteries caused a notable diminution in the
force of the cardiac contractions, and a corresponding
lowering of the blood-pressure, while in some experi-
ments by Cohnheim and Schulthess-Rechberg the heart
continued to beat forcibly but somewhat irregularly and
then suddenly stopped. The diseases of these vessels
have been classified and described by Leyden upon the
basis of an extensive clinical experience. Pathologically
he distinguishes : i. Sclerosis or ossification of the cor-
onary arteries without any other cardiac lesion. The
muscular wall is not diseased, and death occurs from
some intercurrent affectioUr 2. Acute thrombotic soften-
ing or hemorrhagic infarction of the cardiac muscle fol-
lowing sclerotic thrombosis of the coronary arteries—
myomalacia cordis of Ziegler. This leads eventually to
fatty degeneration or softening of the region supplied by
the occluded vessels, which is the most frequent cause of
rupture of the heart. 3. The chronic form, fibrous de-
generation of the muscular tissue — myocarditis fibrosa—
arising from induration of the diseased vascular territoiy.
At the apex aneurism of the heart frequently arises from
this cause. 4. A combination of these several lesions.
This is the most frequent condition.
Clinically these varieties occur in a more or less acote
or chronic form. The author divides them into : i. Cases
running an acute course and ending in sudden deatL
Death occurs in syncope or after an attack of angina
pectoris. The autopsy shows sometimes very marked,
and sometimes very insignificant, anatomical changes in
the heart-walls. These are rupture of the heart, san-
guineous infiltration with efiiision of blood into the peri-
cardium, softening of the heart, or small patches of fatty
degeneration in the muscular wall. To this form belong
the cases described in the literature as embolism of ^
coronary arteries, a frequent symptom of which is a mark-
edly slow pulse, or sudden paralysis of the heart may
occur. 2. The subacute form, in which the course of
the disease embraces a period of several weeks. The
early symptoms are cough, shortness of breath, oppres-
sion, often attacks of angina pectoris, and sometimes
dropsy. A slight improvement occurs, then the symp-
toms return with great severity and death ensues. After
death we find myomalacia, sanguineous infiltration, fat^
degeneration, and old fibrous bands. 3. The chronic
cases usually described as chronic myocarditis, fibrous
myocarditis, dilatation or aneurism of the heart. In per-
December 20, 1884.]
THE MEDICAL RECORD.
683
sons of advanced age cardiac symptoms appear gradually,
having periods of abeyance. These symptoms are those
of angina pectoris or cardiac asthma. The course is al-
ways progressive, and as the symptoms become more
severe the patient presents a picture of severe heart dis-
ease. The asthma increases, dropsy occurs, and some-
times in delirium, sometimes suddenly, usually after suffer-
ing for several years, the patient succumbs.
Thus sclerosis of the coronary arteries presents itself
as an acute or chronic disease, with more or less severe
cardiac symptoms, occurring late in life, and indepen-
dently of any valvular lesions. The heart symptoms are
vital or physiological rather than physical. These are
angina pectoris, asthma, cardiac weakness, syncope, and
changes in the frequency and rhythm of the pulsations,
. the pulse being sometimes reduced to eight in the minute.
The physical sign is that of dilatation of the left ventricle,
with, usually, hypertrophy of the right. The signs on
the part of the respiratory system are cough, dyspnoea,
pulmonary engorgement, and occasionally also oedema
of the lungs. The chief cause of the disease is heredity,
although the abuse of alcoholic liquors and high living
play a certain rdle in its production. Prolonged mental
and physical exertion is also to be reckoned among the
causes, and the author lends the weight of his authority
to the popular belief of a " broken heart " from grief and
anxiety. — Centralblati fur Klinische Medicin^ No. 38,
1884.
The Etiology of Trichorrhexis Nodosa. — In op-
position to the opinion of Eichhorst, who has recently
written upon this condition, Dr. Wolffburg states that
the sole cause of trichorrhexis nodosa is the improper
care of the hair. He showed in his own person that it
could be produced in the beard on one side by rubbing
it energetically and frequently, the other side meanwhile
being normal. The following are the grounds upon which
the author bases his belief" in the mechanical causation
of trichorrhexis (Centralhlait fur Klinische Medicitiy
No. ^Zy 1884) : I. The anatomical appearances — the
hair, except for the nodules, is healthy. 2. The localiza-
tion— the affection has hitherto been observed only in
the larger hairs of the beard, and especially in those so
situated as to be most exposed to mechanical injury
when the face is rubbed, as in the beard covering the
lower jaw. 3. The explanations hitherto offered are
insufficient. 4. The supposed incurability of the affec-
tion is easily explained when one remembers that the
treatment usually recommended (frictions with alcoholic
preparations or irritating salves) only furnished new
sources of irritation to the ill-treated beard.
The Prognosis of Spinal Curvatures. — ^The fol-
lowing are the principal conclusions of M. Pravaz in a
recent article on the curability of deviations of the spinal
column {^Centralblati fUr Chirurgie^ No. 39, 1884) : Of
special importance in the prognosis of curvatures of the
spine is the condition of the general health. The exist-
ence of any dyscrasia, especially of chlorosis, renders the
prognosis less favorable. For in an individual suffering
from nial-assimilation the skeleton is not sufficiently re-
sisting to maintain the good results obtained by the use
of apparatus ; and sometimes in these cases there are
such disorders o{ circulation as to interfere with the use
of supports. In general, the younger the individual the
more easily is the deformity overcome, yet it is the rule
that the treatment must be longer continued in children
than in adolescents, as it is less easy to. adjust the appa-
ratus for them land the liability of relapses is greater.
The author opposes forcibly the widespread* error that
curvatures of the spine will disappear as the child grows
older. The curvatures following pleurisy are of unfavor-
able prognosis, as are also those produced by paresis of
the spinal muscles. Of the deformities caused by dis-
ease of the osseous system those due to rachitis present
the greatest difficulties in the way of treatment, for unless
the^deformity be overcome before the period of ebunra-
tion its correction becomes almost impossible. The
prognosis of ordinary scoliosis depends greatly upon the
amount of rotation present. When taken early in hand
a curvature of even considerable extent may be over-
come, as soon as the general health is improved. The
prognosis of a dorsal curvature is more favorable than
that of a lumbar deviation. Other things being equal, the
curvatures with a long radius offer greater chances of
cure than those with a short radius. This is because in
the latter case the individual vertebrae are m6re wedge-
shaped, and consequently are less likely to become re-
stored to their normal dimensions.
The Antidote for Resorcin. — It having been re-
marked that in resorcin poisoning the arteries were
nearly empty while the veins were engorged, Dr. Justus
Andeer proposed the use of hot baths in order to de-
plete the venous systenj. He found, however, on experi-
ment, that warm baths rather increased the severity of
the symptoms caused by the resorcin poisoning. After
casting about in several directions for an antidote, he
finally discovered that the very best was good red wine
— either Bordeaux or Burgundy. This acted equally
well in slight and severe [cases of poisoning from this
substance. The author did not approve of the practice
of giving an [emetic, since by the time the dangerous
symptoms had appeared the drug taken into the stomach
had been entirely absorbed. If, however, there were
any reason to suppose that such were not the case, the
best emetic to employ was apomorphia given hypoder-
mically. But red wine, he claims, is the true and cer*
tain antidote to resorcin. — Wiener Medizinische Presse^
No. z^, 1884.
Minute Doses of Calomel in the Treatment of
Pneumonia. — Dr. Droux de Chapois relates in the Bul-
letin General de Th'erapeutique^ vol. cviii.. No. 2, 1884,
several cases of pneumonia in which resolution was de-
layed for a very long time, where an excellent result was
obtained by fractional doses of calomel (^ grain) re-
peated every hour. He advises a recourse being had to
this treatment whenever, despite the ordinary remedies,
the symptoms grow worse instead of better, when the
tongue becomes dry, and when the skin imparts a sensa-
tion of great heat and dryness to the finger. He mixes
one grain of calomel with a teaspoonful of powdered
sugar, and after it has been thoroughly stirred for some
minutes divides it into twenty-five powders. Within
twenty four, or at most forty-eight hours, he states, the
skin becomes damp, the temperature falls, the tongue
becomes moist, and the oppression diminishes. Some-
times a liquid stool occurs after fifteen or twenty doses
have been taken ; when this occurs the dose is reduced to
-^ grain every hour. Sometimes no stool occurs, but
colicky pains are complained of. In this case it is not
necessary to withhold the drug, but only to give a little
magnesia with it.
The Chemical Poisons formed within the Intes-
tinal Canal. — Dr. Netler concludes a long review on .
this subject as follows {Archives Generates de Medecine^
October, 1884) : The presence of inferior organisms pro-
duces, in the Course of decomposition of nitrogenous
matters, toxic substances of greater or less activity.
These putrid poisons, or ptomaines, exist not 6nly in putre-
faction occurring without the body, but are present also
normally in the digestive canal, and even in the blood.
They play a very important part in pathology, and to them
may be attributed : i, poisoning by putrefactive matters,
in which the poison, formed without the body, enters the
organism by way of the intestinal canal or a wound ; 2,
putrid auto-intoxication, due to the action of ptomaines
formed within the digestive tube ; 3, the r61e of these
ptomaines is very important, though at first sight less evi-
dentj'^in uraemia and acholia due to changes in the kidneys
or liver. In these cases the alkaloids, not being excreted
by the diseased organs, accumulate in the blood, and
give rise to symptoms of poisoning.]
684
THE MEDICAL RECORD.
[December 20, 1884,
The Medical Record:
A Weekly yournal of Medicine and Surgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD & Co., Nos. 56 and 58 Ufayette Place.
New York, December 20, 1884.
THE NEW HEALTH BILL BEFORE CONGRESS.
In a previous article we called the attention of the
American Public Health Association, then about to as-
semble in St. Louis, to the importance of maturing meas-
ures thus early to be adopted and enforced in the event
of an epidemic of cholera in this country. The questions
which we raised were as to the best methods of securing
concert of action of all State and municipal boards of
health, and of bringing into active co-operation with
these boards the General Government. The Association
gave these subjects due consideration, and adopted a re-
port embodying a scheme of prevention. In regard to
cholera, the report advised the appointment and main-
tenance of medical officers of health at foreign ports,
from which cholera may be brought, whose duty it shall
be to inspect vessels bound to our ports, and give the
requisite information, as to the existence or appearance
of that disease, to the constituted authority in this
country ; a close alliance of our health authorities with
those of the Dominion of Canada; the establishment
and support of an inspection and quarantine service, like
that inaugurated by the National Board of Health ; aid
of local boards by the General Government in the ap-
propriation of necessary funds ; the removal of local
unsanitary conditions favorable to the development of
cholera ; isolation of first cases and destruction of in-
fected materials ; isolation of infected localities and
towns, and intercourse with other towns under sanitary
supervision.
Though the scheme embodies most of the precautions
necessary to be taken to prevent a cholera epidemic,
yet the plan lacks that continuity and coherence which
a body embracing the foremost sanitary thinkers and
workers of the United States ought to have formulated
With the enemy three thousand miles away, and know-
ing precisely the route and the methods of its approach
and invasion,' a practical sanitarian ought to be able to
state positively what steps must be taken to prevent, i,
the embarkation ; 2, the transit ; and, 3, the landing of
this scourge on our shores. Evidently the first, and by
far the most important duties in the scheme of prevention
must be performed by the General Government, for it
alone can regulate travel and traffic on the great ocean
highways. The Association should not only have specifi-
cally stated what those duties are, but should have taken
measures to ensure the necessary action of the Govern-
ment Cholera is not to be prevented by reports and
proclamations, but by energetic work on the part of those
who are appointed to protect the public health. To-
day the obligation to prevent the introduction of cholera
into this country rests solely with the National Govern-
ment. No member of the Association doubts that, if the
Government was thoroughly alive to its great responsi*
bility and exercised its full power intelligently, it could
prevent the importation of the germs of this or any other
foreign pestilence. But will the Government act
promptly, wisely, and effectively ? That is the all-impor-
tant question for the Association to determine, and if
that body really intends to do more than put itself on
record as proposing a few desultory and disconnected
measures against the invasion of cholera, it has an im-
mediate and pressing duty to perform. It should at once,
through a competent committee, bring its intelligence
and great influence to bear upon the Government, both
in devising measures of prevention and aiding in their
execution.
A step has been taken in the right direction by the
State Boards of Health which, during the past week,
held a Conference at Washington, reviewed the several
questions involved in the scheme of prevention, and con-
ferred with members of Congress and Government offi-
cials. This Conference did not, we believe, directly
represent the Association, but stood alone as the repre-
sentative of the State Boards of Health. The Association,
therefore, has as yet taken no active steps to secure the
adoption and enforcement of the measures of prevention
which it recommended at St Louis. Can it afford to
remain idle during an epidemic of cholera with the mere
statement of platitudes ? We believe not. It has the
necessary organization, through its executive and ad-
visory committees, for immediate and aggressive work,
and it will sadly come short of its duty and its high
prerogatives if it does not become a potent factor m
organizing and sustaining measures of defence. In this
preliminary movement of the State Boards of Health, in
holding a conference at Washington, the Association
should have been represented, in order to aid in maturing
those plans which it should co-operate in carrying into
effect.
The Conference of State Boards found an anomalous
condition of affairs at Washington, and sought to remedy
it by preparing a bill to be submitted to Congress.
This bill provides for the organization of a National
Board of Health, to be composed of one representative
from each existing State Board of Health. The re-
maining provisions of the biU are designed to render
the board the efficient agent of the Government in
the prevention of epidemics. The purposes of the Con-
ference are good and commendable, though perhaps
the objects sought might have been obtained more di-
rectly and immediately. Certainly we need — nay, must
have — a National Board of Health competent to employ
wisely and efficiently the powers of the General Govern-
ment in the protection of the public health. But those
who seek such legislation as the Conference contem-
plates should be well advised of the obstacles in their
way, and the nature of the opposition which they will
meet. There is already a National Board of Healthy
fully organized and equipped to perform all the functions
which thi» bill imposes upon a new board. Let the Con-
December 20, 1884.]
THE MEDICAL RECORD.
685
ference inquire into the history of the defeat of this board
and it will discover an agent in the Treasury Department
hostile to all further health legislation, unless such legis-
lation places under his control the public funds, appro-
priated for sanitary purposes. We refer to the chief
medical officer of the Marine Hospital Service. To this
source must be referred whatever miscarriage there has
been of proper support of the existing board by Con-
gress, and it is from this source will come the secret
influences which will tend powerfully to defeat all proper
health legislation during the present session. In under-
taking, therefore, to secure the favorable action of Con-
gress on its bill the Conference must be prepared to en-
counter and overcome the opposition which a bureau,
already in possession by artful intrigues of the funds and
the power belonging to the existing board, can wield
through the Treasury Department.
MORPHINISM DETECTED THROUGH THE EXAMINA-
TION OF THE URINE.
MoRPHioMANiA has been growing so rapidly and withal
so quietly in our country that its present proportions are
hardly realized, even by the profession. It is not alone
to the specialist, nor to the physician who has a home
and a method for the cure of the opium-habit that the
subject is of interest, the general practitioner may at
any moment meet with cases of a more or less pro-
nounced character.
The ruses resorted to by many patients to obtain their
favorite drug, and the great facilities they have of secret
indulgence, tend at times to mislead and render treat-
ment unsatisfactory.
Again, in the therapy of ordinary diseases in mor-
phine takers, our remedies may be counteracted or their
effects modified to an extent incompatible with recovery.
It may become important for us to discover, therefore, if
the drug is being taken surreptitiously.
It has been claimed by many that morphia becomes
so changed in the system that no traces of the alkaloid,
as such, are to be found in the tissues or excretions. On
the other hand, several observers hold an opposite view.
On account of the diversity of opinion in competent ob-
servers and the practical significance of the entire sub-
ject. Dr. Notta has made some careful investigations,
touching the elimination of morphia by the kidneys. He
has published the results of his research in L' Union
Midicale. At first he used Mayer's test, by the double
iodide of potassium and mercury, then that of Bou-
chardat. Both of these proved unsatisfactory, giving
positive results only where the daily quantity of urine
was small.
Thus, Mayer's test gave a characteristic precipitate
only when each quart of urine contained at least three
grains of the alkaloid. Bouchardat's test gave reliable
results when as little as one to two grains were present.
The author's own method, which he recommends as
simple, exact, and rapid, is as follows :
Treat a quart of the suspected urine with subacetate of
lead (i to 10). The precipitate is a combination of the
lead with the uric, phosphoric, and other acids existing
in the urine and the coloring matters and the extrac-
tives.
The decolorized urine then contains the morphine
combined with acetic acid, the substances not precipitable
by the sub-acetate of lead, and the excess of the lead. Now
filter and get rid of the lead by adding sulphuric acid
(i to 10), drop by drop until there is no further precipi-
tate. Filter again, add an excess of ammonia and warm
amylic alcohol and shake. The mixture soon becomes
clear and holds in solution all the morphine previously in
the urine. After this it is only necessary to shake this
solution with water acidulated with sulphuric acid in or-
der to obtain the morphia as a sulphate. This is decom-
posed with ammonia water and taken up again with amy-
lic alcohol, and after evaporation we have the morphine,
which can be tested with the usual tests.
The conclusions which Notta draws from his investiga-
tions are : that morphine is eliminated, in great part at
least, by the kidneys, provided they are not diseased ;
that Mayer's or Bouchardat's tests can be employed after
eliminating sugar and albumen, but that when these tests
fail, the one here given, or some equally reliable one
must be employed. That it is always possible to find
the drug in the urine of an habitual morphine taker pro-
vided as much as i J grain is taken per day.
Further experiments must be made to decide whether
this test discovers morphine in such cases as acute poi-
soning, or if it is only reliable in such cases as were here
tested, where the drug had been taken for a long time in
large quantities.
THE COLLECTIVE INVESTIGATION RECORD OF THE
BRITISH MEDICAL ASSOCIATION.
The Bristol Medico-chirurgical Journal is not satisfied
with the labors so far published by the British Collective
Investigation Committee, and takes the promoters of the
scheme severely to task. It makes some remarks, which
strike us as being decidedly forcible, even if not alto-
gether merited.
Referring to the second volume of this committee,
which deals principally with pneumonia, and which has
been previously noticed in our columns, it says :
** Probably no scheme for the advancement of medical
science was ever started under more favorable auspices
than this collective investigation one of the British Medi-
cal Association. Prominent leaders in the profession
praised and promoted it on platform, paper, and com-
mittee in the metropolis; and emissaries of accredited
talent and eloquence were sent into the provinces to
preach to us this new gospel of scientific research. Every-
where their doctrines have been received with a chorus
of assent. Questions in scientific medicine were to be
answered by the overwhelming mass, and not by the un-
supported individual ; the untrustworthiness of individual
labors in the closet was to be replaced by the generalized
experiences of the practitioner in public ; and the grop-
ing investigations of the medical theorist were to be sup-
plemented, or rather replaced, by the accurate records
of the practical worker, as figures, facts, and statistics.
Parturiuni monies^ nasceiur — let us see what."
The Journal then shows that from the sum expended
by the Association they had aright to expect some note-
worthy contribution to medical knowledge. It then con-
tinues as follows :
'^ We have systematized for us, under various headings,
686
THE MEDICAL ^RECORD.
[December 20, 1884.
the reports of 1,065 cases. The first thing one naturally
turns to is the trustworthiness of the reporters. The
men who are most likely to give us satisfactory answers
to the queries propounded are the various teachers in
our medical schools, the physicians to our hospitals, the
men whom, in consultation or general practice; we know
to have most experience of the complaint and most
knowledge of it We have gone carefully over the names
of those who have made the returns, and we have dis-
covered among them scarcely one which, either from
general reputation in these islands or from local reputa-
tion in our own district, deserves to be heard as of any
authority. That our hospital and consulting physicians
practically ignore these inquisitive cards there can be no
doubt. The fact is patent to any one who looks. These
are the men who see most of the disease, and know most
of the subject, and who are most competent to give re-
turns. Why do they ignore the queries ? Do they dis-
trust the process ? We fear there is no other explanation
possible. To begin with, therefore, it submits that those
most competent to answer refuse to do so, and the trust-
worthiness of the report is thus, in the first place, weak-
ened.*'
The practical outcome of the replies of all these
practitioners, in the writer's own words, is this : ** It is
manifest that the lines of treatment are so various as not
to permit of any value being attached to a comparison
of mortality. Surely this is the classical mouse of the
mountains in travail at last ! "
In conclusion, the Journal thinks that polling impres-
sions of its practitioners is not the way to promote
science. " The variables and contingencies are so numer-
ous and so important that they cannot, as in this instance,
be ignored. To ignore these is to nullify the whole work.
And even if the results of this questioning were to be
quite trustworthy, drawn up, criticised^ ana tabulated
by skilled observers, we fail to see what new truth this
galloping over the surface of disease can bring forth. We
have been galloping over disease for centuries, and the
outcomes are abundant enough in myriads of works in a
score of languages. We want nowadays to attack dis-
ease from the bottom. The work must be one of con-
centrated labor by the most penetrating intellects, with
every opportunity to study disease at the bedside and in
the laboratory, and not of vague recollections jotted
down in the midst of other pursuits by the rank and file,
and huddled into columns by committees. No doubt the
Collective Investigation Committee will soon come to a
natural and timely end ; in the meantime we would ex-
press our regret that so much money of the British Medi-
cal Association, which might go to its excellent benevo-
lent fund, should be expended on an undertaking so
palpably useless as this one."
PRECOCIOUS CANCER OF THE STOMACH.
The difficulties that at times surround the diagnosis of can-
cer of the stomach are well known. When the symptoms
are indistinct and the physical exploration unsatisfactory,
cancer is sometimes excluded on account of the youth of
the individual. For by common consent carcinoma of the
stomach is regarded as of rare occurrence before the age
of forty. Yet we are often enough surprised to find at an
autopsy a gastric cancer, where no suspicion of the dis-
ease existed during the lifetime of the patient
Dr. Mathieu, of Lyon, has recently made a special
study of carcinoma of the stomach, as it occurs early in
life.
From the literature of the subject he has collected
twenty-seven cases, most of which were observed before
the age of thirty. The author separates them into three
groups.
The first comprises those cases in which a diagnosis
was made of some entirely different disease. This hap-
pened nine times. The diagnosis of cirrhosis being made
five times, cancer of the liver, aneurism of the aorta,
tumor of the spleen, and pleurisy, each once.
The second group contains eight cases. Here the
difficulty was located in the digestive tract, its cancerous
nature, ( however, not being recognized. Pregnancy
existed in four of the patients belonging to this group,
and the persistent vomiting was regarded as that common
to their condition. Only one patient had hamatemesis,
which came on shortly before death. The disease was
put down as dyspepsia in one case, and in another as
ulcer of the stomach.
The third group finally includes those cases in which a
correct diagnosis was reached, the tumor being made out
in every instance. It would appear, therefore, that two-
thirds of these cases passed unrecognized, and were mis-
taken for diseases that had no connection with the diges-
tive tract. The course of gastric cancer of early life is,
according to Mathieu, rapidly fatal, characteristic cachexia
is commonly absent, and haematemesis quite rare. It
seems, therefore, that the disease does not fully confonn
to the usual type of cancer, as ordinarily seen later in
life.
THE CLINICAL FORMS OF HEPATIC COLIC.
Among the painful affections of the abdominal viscera
few are more distressing, and oftentimes difficult to re-
lieve, than the various forms of hepatic colic.
Dr. Olive, of Paris, has recently made a study of he-
patic colic, from a purely clinical standpoint, a review
of which is published in the Journal de M/decinCy Octo-
ber 18, 1884. Among the principal causes of hepatic
colic he finds arthritism, with its various manifestations,
such as obesity, diabetes, and calculus ; forced repose,
sadness, sedentary occupations, abuse of alcohol, a diet •
too exclusively animal or fatty, and different chronic
affections of the liver also invite colic
The immediate determining causes are those which
produce violent jars to the abdominal organs, such as
horseback riding, the jolting of vehicles, and the like.
The author describes a form of colic which he tenns
pseudo-gastralgic-hepatic colic, which he dififerentiaies
firom gastralgia by the following characteristics :
The patient suffering from gastralgia has more frequent
pains, and would not go for three or four months without
suffering, as the pseudo-gastralgic patient often does^
Gastralgia causes distress when the stomach is empty,
and at or just after a meal. The time for pseudo-gas-
tralgia to appear is usually about two hours after eating.
The pains come on suddenly in hepatic colic, less so
in gastralgia. They radiate toward the shoulder m h^
patic colic, but not in gastralgia.
December 20, 1884.]
THE MEDICAL RECORD.
687
Still there may be a reflex intercostal neuralgia accom-
panying the latter affection. After hepatic colic, even
without icterus, the urine is commonly red, and contains
biliaiy pigment. This is never the case in gastralgia
pure and simple.
FURTHER PATHOLOGICAL AND THERAPEUTICAL CON-
TRIBUTIONS TO CHOLERA.
• The number of contributions to the subject of cholera
is increasing rather faster than they can be recorded.
Professor B. Grassi, in the Gazz. degli Ospitali, states
that he has found the comma^baciUi in the stools of per-
sons suffering from choleraic diarrhcea, or cholerine. The
patient whose dejecta was examined was a soldier in a
regiment of which some members had been attacked with
cholera. Professor Grassi, together with Drs. Vivanti
and Berretta, added to the number of bacilli repasts by
swallowing dried cholera-bacilli They experienced no
ill effects. Professor Grassi believes that flies are active
and important agents in spreading cholera. Professor
Cantani, in the same journal, reports the results of some
oi his examinations of the blood in cholera patients.
He finds that with the progress of the disease the blood
lessens in alkalinity and finally at death is actually acid.
He infers from this fact (which was known before) that
if venous injections be made in treating the disease the
Hquid used ought to be more alkaline than that hitherto
employed.
Dr. Manfredi has studied the action of tannic acid upon
cholera-bacilli and finds that even in small amounts, it
kills them. He therefore recommends the rectal injec-
tion of solutions of this drug. Cantani recommends the
same method and gives the following formula :
I*. Aq. catid 2000 grammes.
Acid, tannic 5-6-10 "
Gum arab ^o "
,^ '^''•^P" 3o-5ogtt
Professor Alberta Riva, as the result of experiments
upon animals, thinks that saline injections made into the
pleural cavity, or preferably into the peritoneal cavity,
may be beneficial in cholera.
Dr. Panier, in El Sigh Medico, recommends the heroic
use of strychnine throughout the whole course of cholera.
He gives hourly about gr. ^ of sulphate of strychnia.
MM. Huchard and Dujardin-Beaumetz recommend the
hypodermic injection of caffeine dissolved in a solution
of benzoate of soda. The dose given is about gr. jss.
ILe JProgres Medicale quotes the results of the treatr
ment of cholera with injections of chloral hydrate by Dr.
Reddi6, of Partabgark, India. He employed injections
of small doses of chloral hydrate. Thirty-five per cent.
oi his cases died, while under other treatment the mortal-
ity was sixty-four per cent.
The Last New Antipyrktic is thallin, and it has
been introduced by Dr. V. Jaksch, of Vienna. It is one
of the chinolin compounds, and is a powerful antifermen-
tative. Jaksch has used it in eighty-suc cases, and found
that, although a powerful antipyretic, it is by no means a
specific.
^jextTB xvf ttce ^SK^^K
The Biologigal Department of the University of
Pennsylvania was formally opened on the 4th instant
by Provost William Pepper. Addresses were made by
Drs. Harrison Allen and Joseph Leidy.
The State Board of Lunacy of Pennsylvania
have been diligently investigating the condition of the
State Asylums since August last. As a result, says the
Medical Times, they have been able to report to the
State Board eighteen cases of alleged improper treatment
which they had investigated, in some of which gross neg-
lect and wanton cruelty had been practised. Several of
these have been already removed to State hospitals, and
new cases are constantly coming to light.
Death o^ Dr. Henry Gibbons. — We regret to an-
nounce the death of Dr. Henry Gibbons, of San Fran-
cisco, CaL, in the seventy-sixth year of his age. Dr.
Gibbons was born in Wilmington, Del. He graduated
in medicine from the University of Pennsylvania, in 1829.
In 1850 he moved to San Francisco. He established
and successfully conducted the Pacific Medical and Sur-
gical Journal, He was also one of the founders of and
teachers in the Medical College of the Pacific. He was
a member of the Society of Friends.
The Bacillus of Syphilis. — Dr. Sigmund Lustgarten,
describes a " specific bacillus of syphilis " ( Wiener Medi-
cin. Wbchen., No. 47, 1884) which he has discovered in
the initial lesions and in gummata of syphilis. It is
of about the same size and appearance as the tubercle
bacillus and lies in small groups enclosed in the some-
what swollen lymphoid cells. The organism is distin-
guished from other bacilli by its staining and peculiar
grouping. The investigations of previous discoverers of
syphilis-germs are characterized as being " tinctured with
grave errors."
The Death of Dr. James G. Thomas, of Savannah,
Ga., recently occurred under unusually painlul cir-
cumstances. Dr. Thomas was a member of the Execu-
tive Committee of the Ninth International Congress.
He took a deep interest in the success of the Congress,
and, at a considerable sacrifice, came to Washington,
November 29th, to attend the meeting for organization.
While on the way he was seized with a violent chill, and
on his arrival at once took to his bed, from which he
never again arose, the disease proving to be acute lobar
pneumonia. He may be said to have lost his life in the
service of the Congress, and it is an irreparable loss to the
Executive Committee, as well as to his bereaved family
and his fellow-citizens oi Savannah and of Georgia.
Importation of Rags. — The Treasury Department
has decided that no old rags shall be landed in th^ United
States except upon disinfection by one of the following
processes : i. Boiling in water for two hours under a
pressure of fifty pounds per square inch. 2. Boiling in
water for four hours without pressure. 3. Subjection to
the action of confined sulphurous-acid gas for six hours,
burning one and a half or two pounds roll brimstone in
each 1,000 cubic feet of space, with the rags well scat-
tered upon racks. 4. Disinfection in the bale by means
688
THE MEDICAL RECORD.
[December 20, 1884.
of perforated screws or tubes through which sulphur
dioxide, or superheated steam at a temperature of not
less than 350 degrees, shall be forced under a pressure
of four atmospheres for a period sufficient to insure
thorough disinfection.
The Presbyterian Hospital. — A lady has promised
to give $50,000 to the Presbyterian Hospital for the
purpose of erecting a new wing, provided an equal sum
is raised by other parties.
Trained Nurses for the Insane. — A special com-
mittee of the State Charities Aid Association has pre-
pared a report upon the training of nurses for the in-
sane. The committee has secured the co-operation of
the Bellevue Training School, and is now occupied in
maturing a plan by which a certain number of women
trained there as nurses for the sick may secure in one of
our lunatic asylums a special training in the care of the
insane.
Deaths of Foreign Medical Men. — The past few
weeks has witnessed the death of a number of prominent
European medical men. In France we have chronicled
the death of M. Fauvel, the distinguished Vice-president
of the Acad6mie de M6decine. We learn that Professor
Fonssagrives, of the Montpellier Faculty of Medicine has
recently died of cholera. In Germany, the deaths are
announced of Professor v. Wittich, of Konigsberg, and
Professor K. v. Vierordt, of Tubingen. Professor Kolbe»
of Leipzig, and Professor Chvostek, of Vienna, also re-
cently died.
Medical Diplomas in Australia.— A physician of
Pictou, N. S. W., has been refused a license to practise
because, although he had a degree of M.D., granted by
the University of Philadelphia^ yet it only certified to his
studying for three years. The authorities as well as the
medical journals make the mistake of thinking that the
degree and the University are all right.
Gift TO A German Hospital. — The German Hospital
of Philadelphia has recently been enlarged and greatly
improved. The sum of $600,000, which covers the ex-
pense of the changes, was given to the hospital by Mr.
John D. Lakenau, President of the Board of Trustees.
Hayem's Formula for Intra- Venous Injection in
Cholera :
Aquae distillat i litre.
Sodii chlorid. pur 5 grammes.
Sodii sulphat. pur 10 grammes.
M. Filter and give two to two and a half litres at a tem-
perature of 38° C. The time occupied in giving is twelve
to fifteen minutes.
Dr. Louis H. Steiner has just been elected librarian
of the new Pratt Free Library in Baltimore, which has
been completed at a cost of $1,000,000.
Death During a Foot-ball Match. — Another death
is recorded as occurring at a foot-ball match between stu-
dents of St. Thomas' Hospital, London. The victim was a
young man, aged twenty-three, who, while in the midst of
the game, suddenly staggered and fell down dead.
The Rabbeth Memorial. — A thousand dollars have
ab-eady been collected for this purpose.
Dr. Jay Owens retires from the editorship of the
Northwestern Lancet, He is succeeded by Dr. C. B.
Witherle.
The Loneliest Doctor in the World is the
ophthalmologist who hasn't written an article on co-
caine.
The Use of Iodide of Potassium in Large Doses.
—Dr. W. C. Dabney, of Charlottesville, Va., calls our
attention to a clinical lecture by Charcot, published in
Le Progrh M^ical for January 13, 1877, and showing
that Charcot had used potassium iodide in doses of six to
ten grammes daily since 1874.
Ovariotomy in Rome. — Dr. J. H. Thompson, of
Rome, Italy, sends us the records of a case of ovariot-
omy performed by himself recently, and regarding which
there were several points of more than ordinary interest.
He writes : " Ovariotomy in Rome has generally been
unsuccessful, I think owing to the fact that it has mostly
been performed in hospitals which were built in the
fifteenth century (persons who had the ability to pay for
home attention generally preferring to go to London).
These old buildings cannot be made aseptic." This
case was operated upon in a specially provided apart-
ment. It was complicated with pregnancy- We regret
that the report is too long for publication by us.
THE TEXT OF THE NEW HEALTH BILL.
The following is the text of the new Health Bill, pre-
pared by the National Conference of State Boards of
Health, now before Congress :
To amend an Act entitled "An Act to prevent the
introduction of contagious and infectious diseases into
the United States and to establish a National Board of
Health."
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assem-
bled. That an Act entitled, " An Act to prevent the in-
troduction of contagious and infectious diseases into the
United States and to establish a National Board of
Health," approved March 3, 1879, t>e so amended as
to provide that there shall be established a National
Board of Health, to consist of one member from each
State Board of Health now established, or which may be
hereafter established in the United States, to be appointed
by the President and confirmed by the Senate, whose
compensation, when actually engaged in the performance
of duty under this act, shall be ten dollars per diem each,
and reasonable expenses. This board shall meet in
Washington within ninety days after the passage of this
Act, and shall meet in Washington annually, and in case
of emergency upon the call of its chairman and secretary,
or upon the extraordinary call of the President of the
United States, as hereinafter provided.
The officers of this board shall be a chairman and
secretary. The secretary shall be the executive officer
of and ex-officio a member of the board, and shall devote
his entire time to the duties of the office, and may be re-
moved for cause, at any regular meeting of the board,
two-thirds of the full board voting therefor, and shall re-
ceive such salary as may be determined by the board.
The chairman with six other members, representing the
various geographical divisions of the country, shall con-
stitute the executive committee of the board, to be elected
at the first meeting of the board, and at each annual
meeting thereafter, and said committee shall, and is here-
by authorized to exercise such powers as may from time
to time be conferred upon it by the board.
Section 2. The duties of this board shall be, and ft is
December 20, 1884.]
THE MEDICAL RECORD.
689
hereby authorized and given power to make or cause to
be made, such investigations at any place within the
United States, or at any foreign port or place, and to
collect information upon all matters relating to the public
health, and to frame such rules and regulations as may
be necessary for the government of the quarantine service
of the United States ; and all the power and authority
now provided by law, or which may be provided by law,
for the control and protection of the public health of the
United States, shall be and are hereby vested in said
board, except as to the special authority vested in the
President of the United States under the provisions of
this act. The rules and regulations of this board shall
severally be executed, under the direction of this board,
through such Departments of the Government, or other
officers, as the law may prescribe or the President may
designate.
This board shall co-operate with, and so far as it law-
fully may, shall aid State and local boards of health in
the enforcement of the rules and regulations of such
boards, to prevent the entroduction of contagious and in-
fectious diseases from foreign countries into the United
States, and into one State from another.
Section 3. It shall be the duty of this board to make
such rules and regulations as are necessary to be observed
by vessels at ports of departure, where such vessels sail
from any foreign port or place to any port or place in
the United States, to secure the best sanitary condition of
such vessel, her cargo, passengers, and crew, and to pre-
pare from time to time for the consular officers of the
United States, and for the medical officers serving under
this act at any foreign port, and otherwise make publicly
known such rules and regulations, which, when approved
by the President and issued by the Department of State,
and posted in the office of the consul or other representa-
tives [of* the United States at such foreign ports for at
least ten days, shall be enforced by the consular officers
and agents of the United States.
Section 4. It shall be unlawful for any vessel from
any foreign port or place to enter any port in the United
States, except in accordance with the rules and regula-
tions made in pursuance of this act, and of the rules and
regulations made under State or municipal authority, and
any such vessel which shall attempt to enter any port of
the United States in violation thereof, shall be liable to
process in the proper district court of the United States,
and upon conviction, shall forfeit to the United States a
sum to be awarded in the discretion of the court, not ex-
ceeding $1,000, which shall be a lien upon such vessel,
to be recovered upon proceeding in the proper district
court of the United States, in accordance with the rules
and laws governing cases of seizure of vessels for viola-
tion of the revenue laws, and in all such cases the United
States Attorney for such district shall appear on behalf of
the United States ; and all such vessels shall obtain from
the consular or authorized medical officer at the port of
departure a certificate in duplicate, setting forth the
sanitary history of said vessel, and that it has in all re-
spects complied with the rules and regulations of this
board, made in pursuance of this act for the government
of such vessels, and before granting such certificate such
consular or medical officer is required to be satisfied that
the statements therein made are true; and upon the re-
quest of this board, the President of the United States is
hereby authorized to appoint proper medical officers, to
serve in the offices of the consuls at any such foreign
ports, to make the inspections and give the certificates
herein required.
Section 5. Such vessels shall observe all rules and
regulations made by this board in pursuance of this act,
in regard to the inspection, disinfection, and isolation of
the same, upon its arrival at any port in the United States,
2ind for the treatment of persons and cargo on board, so
SLS to prevent the introduction of contagious diseases into
*he United States, and it shall be unlawful for any vessel
to enter such port, to land its passengers or discharge its
cargo, except upon a certificate from the health officer of
such port, that such rules and regulations have in all re-
spects been complied with.
Section 6. In the event of any sudden emergency,
threatening the importation of contagious or infectious
disease into the United States from any foreign country,
the President of the United States is hereby authorized
and required, in his discretion, to adopt and make known
forthwith by public proclamation, such measures as may
meet the emergency, cither by suspending the introduc-
tion into the United States by land or sea, of any specific
merchandise calculated to be a vehicle for the communi-
cation of contagion, or by prohibiting the entry into the
ports of the United States of vessels coming from infected
countries or having contagious or infectious disease on
board. And in case the President shall at any time exer-
cise the authority hereby conferred upon him, he shall,
at or before the time of issuing such proclamation as
aforesaid, convene the National Board of Health, to
meet at Washington in special session within ten days
from the date of such notice of convention, and the said
board shall thereupon advise such measures as it may
deem sufficient to meet the emergency ; and upon the
taking effect of such measures, with the approval of the
President of the United States as herein provided,
the President's proclamation aforesaid shall cease to have
effect. It shall be the duty of this Board at all times to
give prompt attention to any question in sanitary science
which may be submitted to it by the President.
Section 7. It shall be the duly of the Department of
State to obtain from the consular officers at foreign ports
or places all available information in regard to the sani-
tary condition of such ports and places, and to transmit
the same to this board ; and it shall be the duty of this
board to obtain from the State and municipal health au-
thorities throughout the United States, and from all other
available sources, weekly reports of the sanitary condi-
tion of ports and places within the United States, and
reports and other matters relating to climatic and other
conditions affecting the public health, and it shall pre-
pare, publish, and transmit to State and other authorities,
and other proper persons, weekly abstracts of such re-
ports, consular reports, and other useful information re-
lating to the public health ; and it shall make to the
President, for transmission to Congress, an annual report
of its transactions, with such recommendations as it may
deem important to the public health ; and the necessary
printing of the board shall be done at the Government
Printing Office, upon the requisition of the secretary of
such board, in the same manner and subject to the same
provisions as other public printing for the several De-
partments of the Government.
Section 8. The President of the United States is au-
thorized, when requested by this board, and when the
same can be done without prejudice to the public service,
to detail officers from the several Departments of the
Government, for temporary duty, to act under the direc-
tion of this board in carrying out the provisions of this
act, and such officers shall receive no additional compen-
sation, except for actual and necessary expenses incurred
in the performance of such duties.
Section 9. To meet the expenses incurred in carrying
out the provisions of this act, the sum of $500,000, or so
much thereof as may be necessary, is hereby appropri-
ated, to be disbursed under the direction of the board ;
and the board shall have authority to appoint such dis-
bursing agents as it deems necessary, who shall give bond,
as in other cases, for the faithful performance of their dnties.
Secijion 10. All acts and parts of acts in conflict with
any of the provisions of this act shall be and are hereby
repealed.
Exonerated. — We are pleased to state that the phy-
sicians who were censured by the Coroner in the Jaeger
case have been fully exonerated. Thus ends what might
have proved to have been a professional scandal .
690
THE MEDICAL RECORD.
[December 20, 1884.
^jexrijemB un& ^oticjes.
The Principles and Practice of Gynecology. By
Thomas Addis Emmet, M.D., LL.D., etc. Third
edition, thoroughly revised. With 150 illustrations.
Philadelphia : Henry C. Lea's Sons & Co, 1884.
The originality and amplitude of resource which charac-
terize the operative procedures of the author are faith-
fully mirrored in the goodly volume before us.
The first and second editions of this book are so well
known to the profession that it would be an act of super-
erogation to enter into a discussion of the merits of the
third edition, were the latter merely a reprint of the
former. We have essentially an almost new work be-
fore us.
Honesty of purpose, truthfulness of clinical descrip-
tion, love of his art, tempered by judicious fairness —
these qualities speak in every chapter of the book. It is
seldom that the personal character of an author is so
correctly reflected as we find it in Dr. Emmet's writings.
To read his description of cases and commentaries is
almost equivalent to seeing, hearing, and knowing him.
Those who enjoy the latter privilege are satisfied that
the teachings of our author are based upon sincere con-
viction, deduced from an ample clinical material. If
some of these teachings are at variance with the accept-
ed views of the majority of gynecologists, it behooves the
latter to bear in mind the character of the author as a man
and physician, and to study with more than usual care the
new doctrines and operative measures which he pro-
pounds with all the earnestness of his nature. Dr. Em-
met simplifies the treatment of diseases of women mate-
rially in that he not only asserts *^ that pelvic cellulitis is
by far the most important disease with which woman is
afflicted," but that he refuses to recognize the distinc-
tions usually made by authors between the various in-
flammatory conditions in the vicinity of the uterus.
" The terms perimetritis and parametritis are not ap-
plicable, as they express a theoretical distinction only,
and the difference cannot be recognized clinically."
These dicta mark a decided departure from established
doctrine and raise Dr. Emmet to the dignity of founding
a new school in gynecology. Without entering into the
argument, chiefly clinical, by means of which he seeks to
establish these radical views, it may be granted that, if
the generalization of utero-pelvic inflammation does not
accrue to the detriment of patients suffering from these
diseases, we cannot demur with justice. A fine analyti-
cal diagnosis is " a thing of beauty," but it is not ** a joy
forever " if it conduce not to the recovery of the patient.
In this respect the aim of science is fulfilled by Dr.
Emmet's classification. The management of these cases
is greatly simplified, and its success is vouched for by the
logic of facts. The clinical history of cellulitis, its eti-
ology and treatment, are drawn with a master pen ; but
nowhere in this volume does the author's cautious atten-
tion to minute details, which is the key to his success,
appear more pronounced than in the enunciation of the
lines of treatment. Prolonged hot water injections in
the early stage, and less abundant injections continued in
the later stages, are the chief reliance.
The question arises : Will Dr. Emmef s radical views
on cellulitis as a fundamental agency in uterine troubles
be accepted by the profession ? Our answer is, that
these views have already received practical indorsement,
and are thus daily accepted by every gynecologist, when
he prescribes hot-water injections. That the latter is
the most universal remedy in uterine disease, is a well-
recognized fact. Its recommendation by Dr. Emmet
rapidly introduced it ; its success, as a chief or auxiliary
measure, has maintained its position. It is Dr. Emmet's
chief remedy in all shades of cellulitis, and he has thus
ingeniously, perhaps unintentionally, brought the profes-
sion to a recognition of the correctness of his views in
the most practical manner.^
One of the distinguishing features of the present edition
of the work, is the fact that several new operations are
described, one of which, at least, is destined to win for
itself a lasting place among restorative procedures in
plastic gynecology. This is, we believe, true of Dr.
Emmet's new operation for restoration of the posterior
wall of the vagina in the " so-called rupture of the peri-
neum." The author claims that it is " exceedingly
doubtful if the perineum can be lacerated without the
tear extending through the sphincter ani." He recog-
nizes the latter alone as a true rupture of the perineum,
for which the well-known operation, described in former
editions, is still recommended. The larger number of
" perineal lacerations," however, are " due to overstretch-
ing of the pelvic fascia, or to laceration at some point of
fascia and muscle." To remedy the damage inflicted
by this complication of labor, Dr. Emmet gives the pro-
fession a new operation which appears to be perfect in
its immediate result, viz., the restoration of the normal
configuration and dimensions of the vagina. Upon this
point we speak from actual 'observation. We find the
new operation not difficult of execution, and the claim
that it contributes to the diminution of pain in the period
of healing, seems to be substantiated. It is to be re-
gretted, however, that it will be difficult to comprehend
the steps of this operative procedure from the illustra-
tions in the book. Two additional diagrams, viz., one
representing the process of denudation in its prop>er
line, and another showing by dotted lines wherein the
new operation differs from and is superior to the old
operation, would materially facilitate its comprehension^
It is to be hoped that in the next edition, if not in a
separate paper. Dr. Emmet will favor the profession with
a drawing whic^ will be as superior to Fig. 67, in the
delineation of the new operation for restoration of the
posterior vaginal wall, as is Fig. 89 of the last edition
superior to Fig. 83 of the first, in the illustration of the
operation for lacerated cervix.
The new operation, when finished, leaves the vagina
in an almost virginal state, with the fourchette sloping
inward, while the old operation builds a dam in front of
the vagina, which sooner or later yields in many cases.
If space permitted, we would be glad to enter into a
more detailed discussion and description of this opera-
tion, as we have seen it under the hands of its skilful
designer.
Another decided advance brought prominently for-
ward in Dr. Emmet's last edition, but foreshadowed in
the second, is the ** button-hole operation " for the re-
lief of those distressing urethral and bladder troubles
which are the bane of many a woman's life, and the
despair of many a doctor. The illustration of this opera-
tion is simply perfect, as is also the description of the
steps of, and the indications for, its performance. The
author claims more for it than we would at the pres-
ent time be willing to admit. But there is no doubt that
the great benefits which this ingenious procedure opens
out in hitherto incurable cases, will very soon be appre-
ciated. The beautiful imitation of the ordinary button-
hole, which prevents irritation of the wound edges, to-
gether with the fact that incontinence of urine does not
result from the mutilation of the urethra, mark this pro-
cedure as one of the most brilliant achievements of surgery.
The recognition of cellulitis as a dominant element
in gynecic troubles; the introduction of hot-water
douches for their treatment ; the operation for lacerated
cervix ; the button-hole operation in urethra and blad-
der ; the ingenious and effective operation for repair of
injuries in the posterior vaginal wall — these original and
practical contributions form a pedestal upon which Dr.
Emmet's fame must securely rest. If his fertile brain
and skilful hand furnish naught else to the profession
but these, he may be content in the knowledge that he
has created an era in practical gynecology to whose open-
ing future generations of physicians will ever turn with
reverence and gratitude.
December 20, 1884.]
THE MEDICAL RECORD.
691
We have dwelt briefly upon the chief distinguishing
characteristics of this third edition of Dn Emmet's work,
and we have, therefore, been forced to omit mention of
many valuable features. Altogether, the work before us is
an inexhaustible fountain of clinical information, which no
practitioner who has the interest of his clientele at heart
can afford to miss from his library. Its practical teach-
ings render it indispensable to the general practitioner,
while its novel views and operations commend it to the
progressive gynecologist. It is almost a new book, for,
as the author tells us, " The chapters on The Relation
of Education and Social Condition to Development;
those on Pelvic Cellulitis ; on the Diseases of the Ovary ;
on Ovariotomy, and on Stone in the Bladder, have been
nearly rewritten. The chapters on Prolapse of the Va-
ginal Walls ; on Laceration of the Vaginal Outlet and
through the Sphincter and Perineum ; on the Methods
of Partial and Complete Removal of the Uterus for Ma-
lignant Disease ; on the Surgical Treatment of Fibrous
Tumors ; on Diseases of the Fallopian Tubes ; and on
Diseases of the Urethra, are essentially new, containing
the views and experience of the author in a form which
has not been presented to the profession before.''
^^'- The type is clear, although somewhat condensed to
make room for additional matter ; the illustrations in the
main are good.
The Formation of Poisons by Micro-organisms.
By G. V. Black, M.D., D.D.S. 8vo, pp. 178. Phila-
delphia : P. Blakiston, Son & Co. 1884.
The author of this little work possesses in an unusual
d *gree the faculty of seizing the main points of an argu-
ment and presenting them clearly and forcibly. He lays
no claim to origmality in his facts, and if he has made
any investigations of his own on the subject, he does not
obtrude them in his book, but gives the history and pres-
ent standing of the subject in a concise and yet compre-
hensive manner, such as no other work with which we
are acquainted furnishes. That part of the treatise in
which he endeavors to explain the modus operandi of the
bacteria and their congeners by the poisonous effects of
their waste products is a truly delightful piece of logical
reasoning, and will do much to enable the reader to ob-
tain an understanding of the deadly work of the micro-
organisms. The author argues d priori by analogy, and
having, by a general consideration of the laws of diges-
tion and assimilation, made out a probability for his
theory, he proceeds to substantiate it by the facts as far as
known. We have no hesitation in pronouncing it the
best book for students, physicians, and scientists, who
desire to have in a clear and condensed fonn a knowl-
edge and understanding of the germ theory of disease.
A Pharmacopceia for the Treatment of Diseases
OF THE Larynx, Pharynx, and Nasal Passages.
By G. M. Lefferts, A.M., M.D. Second Edition,
Revised and Enlarged. New York and London : G.
P. Putnam's Sons. 1884.
Dr. Lefferts' little volume forms a convenient collec-
tion of the commoner formulae requisite for treating the
diseases of the upper air-passages. It is a work that the
general practitioner will at times consult with profit to
hinnself and his patients.
The Kar: Its Anatomy, Physiology, and Diseases.
' A Practical Treatise for the Use of Medical Students
and Practitioners. By Charles H. Burnett, A.M.,
M.D. With One Hundred and Seven Illustrations.
Second Edition, Revised and Rewritten. Pp. 585.
Philadelphia : Henry C. Lea's Son & Co. 1884.
Sbvkn years have elapsed since the publication of the
first edition of this work ; in this time the advances in the
science of otology have been rapid and of an eminently
practical character, so that in the work of revision for
this second edition csf the treatise the author found many
alterations necessary; portions of the book had to be
entirely rewritten, whilst much material found to be ob-
solete was omitted.
Dr. Burnett seems to have entered on the laborious
task of giving the profession a complete treatise on the
ear at a most auspicious moment, since he brings to the
work a ripe experience both as practitioner and writer ;
and by acknowledging his indebtedness to both the valu-
able contributions of his American confrlresy and of the
accumulated knowledge of German, English, French, and
other laborers in the field of otology the conceit of writ-
ing-a book merely/rom the narrow standpoint of individ-
ual experience is notably absent.
The author informs us in the preface that special atten-
tion has been given in the present edition to the follow-
ing subjects, namely: the abnormalities of the auricle,
otomycosis, the treatment of aural polypi, and the diag-
nosis, etiology, and treatment of aural vertigo. The work
is divided into sections as follows :
Part I. — Anatomy and physiology of the external ear,
comprising the auricle, the external auditory canal, and
the membrana tympani. The middle ear : The tympanic
cavity, the Eustachian tube, and mastoid portion. The
internal ear: The labyrinth and auditory nerve, and
scheme of relationship between the middle and inter-
nal ear.
Part II. — The examination of patients, the necessary
instruments and their employment, the consideration of
sound, hearing, and tests of the latter, organic defects of
the auricle, and its cutaneous affections, including mor-
bid growths and injuries, diseases of the external auditory
canal, foreign bodies in the external ear, and the results
of inflammation and injury, afifections of the membrana
tympani, including acute and chronic inflammation, in-
juries and morbid growths.
Under the section devoted to the middle ear are con-
sidered acute and chronic catarrhal inflammation of the
middle ear and their treatment, functional disturbances,
noises in the head, etc., and organic disturbances. Chap-
ters are assigned to acute and purulent inflammation of
the middle ear, their course and consequences.
Section VI. is devoted to diseases of the internal ear,
and Section VII. to deaf-mutes, and partially deaf chil-
dren, the methods of their relief and education.
While the otologist might differ from the author in
many minor points of theory and practice, the student
and practitioner will find this work fully up to the pres-
ent time in all of the subjects of which it treats, and a
safe guide to follow in practice. The various topics per-
taining to otology have been handled with unwearied
zeal and patience; indeed the literature of the subject
has been so exhaustively brought forth that the reviewer
is at a loss to know just where to take up the thread of
the text for practical criticism. Perhaps it might be said
the author has introduced some instruments for the ex-
amination of the ear which cannot be practically adopted
by the specialist even ; but, after all, this has a certain in-
terest as showing what efforts have been made to increase
our means of finding out more about the diseases of the
ear. The author adheres to the employment of the hard-
rubber nose-piece in inflation of the tympanum by means
of the air-bag ; this appliance has long fallen into disuse
in New York, whfere a glass bulb is used to close up the
meatus of one nostril, a method less disagreeable to the
patient and more cleanly than the insertion of a long
slender tube into the nose. The above are trivial matters,
after all, and one would scarcely be warranted in taking
up further space in an analytical examination of all the
points of interest, since the work is likely soon to be in
the hands of every one interested in the subject.
Otologists must thank Dr. Burnett for taking a step in
advance in the matter of aural nomenclature, and, al-
though there is yet some room left for improvement in
this respect, he has left a better state of things than pre-
viously existed. The book is well made up, and the
illustrations are good in the main ; the economy of the
publishers, however, in producing inferior pictures o^
692
THE MEDICAL RECQRD.
[December 20, 1884.
the human face, as shown in the explanatory cuts, can-
not be commended.
On the whole this treatise will be an invaluable acqui-
sition to the library of the American practitioner ; the
subjects are conveniently arranged for reference, and the
index will be found unusually complete.
The Physician's Visiting List for 1885. Phila-
delphia : P. Blakiston, Son & Co.
This i opular visiting list appears in its thirty-fourth
year. There are no changes in the plan of its arrange-
ment.
Micro-organisms and Disease. By E. Klein, M.D.,
F.R.S. London : Macraillan & Co. 1884.
This little volume is a reprint of a - ei ies of articles that
were published in the London Practitioner, It is by no
means a complete treatise, but may serve as a conveni-
ent introduction to the study of microbes in their relation
to disease.
A Text-book of Pathological Anatomy and Patho-
^ genesis. By Ernest Ziegler. Translated and Edited
"for English Students by Donald MacAlister, M.A.,
M.B. Part IL Special Pathological Anatomy, Sec-
tions 1-8. Pp. 365. New York : William Wood & Co.
1884. Wood's Library of Standard Medical Authors.
The editor and translator of this work, Dr. MacAlister,
states that he had expected to make the present volume
the concluding one. Owing to the great demand for the
first sections, however. Professor Ziegler was unable to
complete his work as early as expected. The present
volume does not, therefore, finish the work. It takes up
the various branches of special pathology, beginning
with blood and lymph and ending with the alimentary
tract and the liver and pancreas. The kidneys, lungs,
and nervous system remain yet to be treated of.
We can hardly praise too highly this volume. It treats
every branch of the subject with a most satisfactory com-
pleteness, yet it is not prolix, nor does it deal in hy-
potheses or superfluous discussion. Numerous biblio-
graphical references are given. The illustrations are
excellent and vastly superior to what we are accustomed
to find in this series. The work when completed will
take its place as the best pathological text-book in the
English language.
The Elements of Physiological and Pathological
Chemistry: A Handbook for Medical Students and
Practitioners, containing a general account of Nutri-
tion, Foods, and Digestion, and the Chemistry of the
Tissues, Organs, Secretions, and Excretions of the
Body in Health and Disease, together with Methods
of Preparing or Separating their Chief Constituents,
as also for their Examination in Detail, and an Outline
Syllabus of a Practical Course of Instruction for Stu-
dents. By T. Cranstoun Charles, M.D. Illustrated
with 38 engravings on wood and a chromo-lithograph.
8vo, pp. 463. Philadelphia : Henry C. Lea's Son &
Co. 1884.
The very ample title-page which is given above gives so
full an idea of the scope of the author's work that an
analytical review is hardly necessary. Dr. Charles, as
his title-page would almost indicate, is fully impressed
with the importance and practical reach of his book. A
perusal of its contents, or rather of selected portions
thereof, shows that the author's confidence in himself is
not misplaced, and that he has not only got hold of an
important branch of medical science, but has treated it
in a competent and instructive manner. The physician,
however, must be impressed, in reading this as well as
many other of the works that are pouring so rapidly from
the medical press, that his work of acquiring knowledge
is never done, and that the fields in which he can and
perhaps ought to acquire technical skill are rapidly multi-
plying. If he chooses to take up physiological and
pathological chemistry we cannot recommend a better
work than the present. In fact it fills a gap in medical
text-books, and that is a thing which can be rarely said
nowadays.
Physiological chemistry generally means in practice
urinary analysis. In accordance with this fact. Dr.
Charles has devoted much space to the elucidation of
urinary mysteries. He does this with much detail, and
yet in a practical and intelligible manner. In fact, the
author has filled his book with many practical hmts, as
well as with recondite formulae and complicated reactions.
It is needless to say that the volume is published in the
best style.
On Sclerosis of the Spinal Cord : Including Loco-
motor Ataxia, Spastic Spinal Paralysis, and other Sys-
tem Diseases of the Spinal Cord, their Pathology,
Symptoms, Diagnosis, and Treatment. By Julius
Althaus, M.D., M.R.C.P. With nine engravings,
pp. 394. New York: G. P. Putnam's Sons. 1885.
The physician in general practice is doubtless some-
times a little puzzled at the extradorinary amount of at-
tention bestowed upon locomotor ataxia by neurologists.
It is a rare disease. Among a million of people only
two or three die from it annually, and the country prac-
titioner sees only two or three cases in as many decades.
But tabes dorsalis is, scientifically, a most interesting af-
fair, and, practically, when it does occur it means years
of distress and agony to the patient No one will find
fault, therefore, at the attempts to secure more knowl-
edge of its nature and more skill in its treatment. Dr.
Althaiis' book is really a treatise on locomotor ataxia,
with a few chapters on the other scleroses added for
completeness. It embodies some of the articles that
have already appeared in English medical journals.
Taken altogether, it is a most interesting and practical
contribution to the subject. The author is of the opin-
ion that a great deal can be done for tabes if taken early,
and he is especially earnest in urging that the general
practitioner be made familiar with the premonitory symp-
toms of the disease.
Dr. Althaus believes thoroughly in the great impor-
tance which syphilis plays in the etiology of the disease.
For this reason he makes iodide of potassium a promi-
nent drug in his armamentarium. He commends ergot
and electricity highly. Nitrate of silver is spoken of
with more caution.
The book is written in a plain and non-technical style,
and will be found attractive and instructive by all classes
of medical men. .
Henke's Atlas of Surgical Anatomy. Translated
and Edited by W. A. Rothacker, M.D., Pathologist
to the Cincinnati Hospital and Lecturer on Pathologi-
cal Anatomy in Miami Medical College. 4to, with
81 plates and 123 figures. Cincinnati : A. £. WLlde&
Co. 1884.
The well-known German Atlas of Henke, on regional
and surgical anatomy, has now for the first time been
reproduced in this country. It comes to us in a form
worthy of the original, the acknowledged excellence of
which has rendered changes and additions unnecessary.
As the American editor implies in his preface, it is
essentially a working Atlas, and will be found valuable by
the busy practitioner, as a convenient book of anatomi-
cal and surgical reference.
Treatment of Diseases of Women, Puerperal and
Non-Puerperal. By Charles H. Goodwin, M.D.
Second Edition. New York : C. H. Goodwin. 1884.
A SECOND edition of Dr. Goodwin's Treatment of Dis-
eases of Women has just appeared. The work, it is
stated, has been revised, but differs in no material respect
from its first issue. It is a compilation of the late views of
many of New York's most eminent obstetricians and g3aie-
cologists, and as such commends itself to those who have
either not the time to read these various writers in ex*
tenso or to whom their original contributions are inacces-
sible. We cannot commend it too highly.
December 20, 1884.]
THE MEDICAL RECORD.
693
Reports at ^ocUtus.
NEW YORK ACADEMY OF MEDICINE.
SECTION IN OBSTETRICS.
S^afeti Meeting, November 28M, 1884.
Alexander S. Hunter, M.D., Chairman.
ANTEFLEXION OF THE UTERUS AND ITS ASSOCIATED
PATHOLOGICAL CONDITIONS — THEIR PREVENTION AND
TREATMENT.
Dr. W. Gill Wylie read a paper on the above sub-
ject, which was the coDtinuation of a paper previously
published in Xh^ American Journal of Obstetrics. The
present paper referred especially to the prevention and
treatment of anteflexion.
Prevention, — The true etiology of the disease indicates
the steps to be taken to prevent it. As long as delicate
children are born and are able to reach maturity, women
will suffer with small, imperfectly formed and/legenerafed
genital organs. We might expect to find anteflexed uteri
among these children, although born of healthy parents.
To prevent anteflexion or imperfect development and
degeneration of the generative organs children with good
constitutions should be kept in good health until fully
matured, and delicate and stunted children should be so
treated as to increase their physical strength and have
a surplus force for the development of the organs of
generation. •
Local treatment, if given at all, should aim "at stimu-
lating healthy development.
Treatment. — These cases usually seek medical advice
on account of dysmenorrhoea or irregular menstruation.
Yet not unfrequently a woman will bear with the pain for
years, and finally consult a physician for sterility.
Dr. Wylie rarely makes a local examination in unmar-
ried women for either dysmenorrhoea or amenorrhoea
without first trying the eff"ect of general treatment. By
far the most common type among the well- to-do classes
is that where imperfect development is plainly indicated.
In Sims' position, with his speculum in place, a properly
curved sound can be readily passed to the os internum ;
at this point tliere may be some resistance, and as the in-
strument passes the patient usually complains of sharp
pain. The fundus may be found sensitive to the touch
of the sound, and not unfrequently its withdrawal is fol-
lowed by blood, although it may have been passed with
the greatest care. He usually begins the local treatment
of such a case by inserting a small piece of borated cot-
ton, saturated with pure glycerine, against the anterior
lip of the cervix, crowding it somewhat back into the
vagina. The cotton rolls into a ball which tends to dis-
place the cervix backward and lift the fundus. A string
is attached to the cotton, by means of which the patient
can remove it, which she is instructed to do in twenty-
four hours. The pledgets are put in two or three times
a week until the patient bears the vaginal examination
without pain. The patient is also instructed to use hot-
water- vaginal douches during the intervening days. If
the case is complicated by peri-uterine congestion or
subacute inflammation, the simple glycerine pledgets are
replaced b^ similar pledgets saturated with a mixture of
alum, one part to pure glycerine fifteen parts, and suffi-
cient carbolic acid to act as a disinfectant, usually one
drachm to the pint. The size of the pledgets is grad-
ually increased. As a rule an ordinary case will change
much in two or three weeks by this preparatory treat-
ment. Occasionally six or eight weeks of such treatment
will be required before the next step can be safely under-
aken.
£>ilatation. — The patient being in Sims' position, the
vagina is sponged out with a solution of i to 3,000
of bichloride, or i to 2c of carbolic acid. All in-
struments are kept in a solution of carbolic acid.
Then the Sims* uterine dilator is inserted into the
uterine canal. The dilator when properly curved can
be passed almost as easily as the sound. The blades
should be forced apart about two lines. The amount
of force required for this amount of dilatation will vary
very greatly, but usually in old cases it is considerable,
especially those of an imperfectly developed type. This
procedure causes more or less, and in some cases, in-
tense pain. The dilator is withdrawn and the cervical
director introduced to the os internum. The applicator,
previously wrapped with cotton, is dipped into pure car-
bolic acid, the free acid having been rubbed off", and is
passed through the tube of the director directly to the os
internum, and thoroughly applied by turning it about and
slightly withdrawing the tube and applicator. About
twenty grains of iodoform are blown against the cervix as
the speculum is withdrawn. In some cases the pain is
immediately relieved. Rarely, the patient complains of
pain for several hours. When properly performed, as
directed above, and if antiseptic precautions were used,
he had never seen any harm from this treatment. The
first dilatation can be made at the patient's home, and
she is kept in bed for the rest of the day, or until all'dis-
turbance hasTceased. As a rule, it is best to allow at
least a week to pass before the dilatation is repeated.
The glycerine pledgets can be inserted as usual in the
meantime. Sometimes he repeats the dilatation three
times between the menses, but usually twice is sufficient,
and if the dilatation can be carried to a point where the
blades are four lines apart at the os externum, the dys-
menorrhoea is relieved in the majority of cases where
there is no active endocarditis, or endo-cervicitis, and in
the majority of cases it is the beginning of a permanent
cure.
In married women, if nothing is done to prevent im-
pregnation, sterility will often be cured by this simple
treatment, but in certain cases the method causes only
temporary relief, and it becomes necessary to resort to
Sims' operation, which is division or divulsion and in-
cision, with the use of a glass-plug or some pessary, or,
what he liked better, a hard rubber drainage-tube con-
taining deep grooves.
Dr. Wylie performs Sims' operation with some modi-
fication. He divides the posterior wall of the cervix
in the median line for half an inch or more, according to
the length of the infra-vaginal part. The lining mem-
brane is divided the full length of the cervix, and the
muscular walls are also divided for some distance under
the external mucous membrane covering the infra-vaginal
cervix. He regarded it as a mistake to divide all the
muscles, and especially the vaginal mucous membrane of
the cervix as far as to the vaginal junction. After this
incision the dilator is introduced and the os internum
freely divulsed. Dr. Sims always divided the anterior
wall at the os internum, . but Dr. Wylie had lately
trusted to the dilators to overcome all of the constriction
at this point, for he had never seen a full-sized plug in-
troduced after incision as far as the os internum without
the free use of the dilator. The dilatation should be done
slowly so as to give time for the tissues to stretch and
not to tear.
Dr. WyUe had never believed in the necessity of the
bilateral operation. In those cases where Dr. Sims re-
commended it he would dilate or divulse and keep open
with a drainage-tube. If the dilatation is imperfectly
done the relief is only temporary, but when thoroughly
done and repeated, say twice in two or three months, it
will often effect a permanent cure in cases of even ten
years' standing. Child-bearing is the best means of
complete development and making a permanent cure in
such cases.
Sponge-tents, — For .more than ten years he had not
used tents in these cases.
Dilatation by sound, — The uterus is too movable and
elastic to permit of the use of sounds to the best advan-
tage, and many cases have been sounded up to the os in-
694
THE MEDICAL RECORD.
[December 20, 1884.
ternum and not beyond. Still he had to confess that
we could more easily dispense with the uterotome than
with uterine dilators, but dilators could do serious harm
when dilatation was carried too far, and if one use a
screw to force open the dilators the risk was greater than
when he used his hand or hands to regulate the amount
of dilatation.
If the use of pessaries in anteflexion had never been
taught, much harm would have been averted, and more
progress made in the right direction. As to the use of
stem-pessaries for straightening the canal they may do
good by stimulating development, but many of them are
dangerous instruments. In some cases he used a drain-
age-tube of hard rubber with one or more deep grooves
in it, the object being to keep up perfect drainage, but
not with the idea of using a splint on the fractured or
bent uterus.
Dr. Wylie then spoke of the complications, and gave
the following conclusions to which he had arrived :
First — There is undoubtedly a certain number of
cases in which a marked degree of anterior curvature
gives no painful symptoms.
Second. — Anterior displacements are the result rather
than the cause of pathological changes in the uterus.
They may add to, and sometimes intensify, disease, but
are rarely, if ever, the primary cause.
Third, — Dysmenorrhoea with anteflexion is rarely, if
ever, chiefly and directly due to the flexion, but the latter
in some cases may aggravate the pathological conditions
which are the real cause of the pain.
Fourth, — The attempt to correct anterior displacements
by the use of pessaries is rarely, if ever, sufficient to ef-
fect a cure unless the cervix is dilated at the same time,
or other pathological conditions are treated. The use of
mechanical supports may give some relief, but they are
often merely palliative, and, as used by many, they fre-
quently do harm.
Fifth, — The true morbid condition of the uterus in most
cases of anteflexion is one of imperfect development,
while the uterine canal is more or less stenosed by the
degeneration and contraction of the uterine tissues, and
the mucous lining is degenerated and atrophied, often
hyperaesthetic, especially in that part of the organ where
the circular fibres are most powerful and contracted,
namely, at the os internum.
Sixth. — If the above is true, the treatment obviously
would be to stimulate development by improving the
general health and by the local use of electricity, to re-
lieve the stenosis by dilatation, or division and divulsion,
to effect drainage, and to bring about a healthy condition
of the mucous lining.
Dr. H. T. Hanks said he was certainly very thankful
to T>r. Wylie for his excellent paper upon this subject,
especially because it was a subject worthy ol considera-
tion by gynecologists. He had been very much inter-
ested in the statement made by Professor Thomas in his
address before the New York State Medical Association,
namely, that there was such a thing as curing anteflexion
and dysmenorrhoea by rapid and forcible divulsion, and
he thought many of us had yet to learn that this procedure
could be resorted to with almost uniform benefit. Dr.
Hanks believed that four-fifths of all cases of anteflexion
which needed treatment could be cured by rapid and for-
cible dilatation. The results of treatment in his cases
had been the same as Dr. Wylie had reported ; that is, he
had effected cure in thirty-three or four out of thirty-five
cases. He had found the hard-rubber dilators to which
his name had been attached as serviceable, in the majority
of cases, as any instrument which could be employed.
He had used the instruments recommended by Dr. Ball,
Dr. Sims, Dr. Goodell, Dr. EUinger, and others, and they
were excellent instruments.
One reason for resorting to this method of treatment
was the fact that there was no deformity after rapid and
forcible divulsion, and there was no doubt that a new
condition of the tissues was established as a result of the
thickening which took place after the operation, and which
in some cases requires some little ame to remove. If the
canal is dilated to fifteen or eighteen, American, scale, it
will not contract, as some had supposed.
With reference to after-treatment, he always kept his
patients in bed for six or eight days, and more or less
under the influence of opium. It might not be necessary
but he had always done it, and had not had pelvic peri-
tonitis develop until his patients had gotten up and been
about the house, and it was evident that the pelvic in-
flammation was due to some indiscretion.
With reference to instruments he thought that Dr.
Ball's, if it could be bent, would be betterthan any which
had been devised.
There was one peculiarity which he wished to naen-
tion, and it was that dilatation was apparently done by
pressing the hands together, but it would be noticed that
the points of the instrument within the internal os did
not always dilate so much as was supposed.
He did not claim so much for the hard-rubber dilators
as formerly, but he always knew when one passed through
tha internal os, and the operator always knew just how
much the internal os was dilated. He thought that this
was one of the advantages which the hard-rubber dilator
had over the Sims or the Peaslee sound.
Another advantage which the hard-rubber instrunaent
gave was that it could be turned over and retroflexion of
the uterus produced. In this manner the anterior wall
of the cervix was stretched somewhat, which he had
thought was of some advantage. However, either in-
strument could do the work well in the hands of skilled
operators.
The Chairman had been especially pleased to hear
Dr. W^lie direct attention in his paper to the necessity
of havmg the patient in a good general condition before
resorting to any operation. Some years ago he per-
formed rapid dilatation in many cases, and produced
pelvic cellulitis in many instances, and in some pelvic
peritonitis, and while Dr. Hanks had expressed the ur-
gent desire that the teaching of the treatment by rapid
dilatation should be repeated frequently, the Chairman
hoped that with each instruction there would be given
the caution that the pelvic organs should be in as healthy
a condition as possible under the circumstances, before
resorting to any operative procedure, as he had become
abundantly satisfied that the ill results which followed in
his cases were due to the lack of this preparatory treat-
ment.
With reference to instruments, he thought a good deal
depended upon the dexterity of the operator. A man
was very poorly qualified to dilate the cervix if he was
unable to say whether or not the instrument had entered
the OS internum.
Some years ago he devised an instrument for dilating
the OS internum, and thought that it, more than any other
instrument, was capable of entering that portion of the
canal with the greatest ease, and it had the capacity of
dilating the interhal os to any extent desired.
Notwithstanding, he thought he had gained a great
deal in the way of the dilator, it seemed to him that the
best dilator was the circular wedge, especially for the
uterine canal.
With reference to the point made by Dr. Hanks con-
cerning the capacity of the instrument to r^troflex the
uterus, it was a question whether that manipulation
would be allowable in very many cases, because the vio-
lence don^ in the dilatation of the os internum was about
as much as could safely be endured at one sitting, par-
ticularly if the patient was not under an anaesthetic.
Dr. Hanks thought no judicious surgeon would at-
tempt to dilate the uterine canal without thoroughly
anaesthetizing his patient. With regard to sounds, no
one should attempt to use an instrument larger than a
small Simpson sound, if he wished to dilate without an
anaesthetic.
The Chairman directed attention to two other points
December 20, 1884.]
THE MEDICAL RECORD.
^95
which Dr. Wylie had mentioned. First, Dr. Wylie sel-
dom makes an incision in the anterior wall of the cervix,
and in that he departs from the method employed by Dr.
Sims and does so without giving his reasons. It would
seem that if the incision was necessary at all it would
be necessary at that point.
The Chairman also suggested whether it would not be
well to introduce a smaller pessary with an olive bulb to
prevent union after the incision had been made.
The author of the paper also made reference to the
rubber stem pessary with a groove in its side. The chair-
man supposed the preference for the hard rubber was the
fact that the groove could not be made in glass. Other
things bein§ equal, he should prefer glass. The chairman
then exhibited several glass lubes which he had used,
having a hole through the centre, and they had been
made so strong that it was impossible to break them with
the fingers.
Dr. Sell said that if there was any comparison to be
made between divulsion in the cervix uteri and the same
procedure in the urethra of the male, he would say that
the plan advocated by Dr. Wylie was very much the
best.
He could not exactly say that we had reached the time
when dilators, such as Peaslee's, should be altogether
thrown aside. He had used them when divulsion was
not in vogue, and had . succeeded in curing his patients.
He had been pleased to hear that the best method of
treatment was pregnancy, and he had succeeded in many
cases with the introduction of Peaslee's sound ; sometimes
he used a tent, occasionally slightly nicking the cervix
just sufficiently to admit the probe, in establishing a con-
dition which permitted pregnancy and cure of the patient.
He was especially pleased with the remarks made by Dr.
Wylie concerning the preparatory treatment, but did not
hear anything especial with reference to medical treat-
ment, as such, in these cases. Dr. Sell then spoke of
the beneficial effects produced by the internal adminis-
tration of certain remedies, such as helonias, caulophyl-
lura, cimicifuga, nux vomica, etc. With reference to the
use of pessaries, he thought that they could be used, not
to abuse the patient and set up inflammation, but as tam-
pons are used with reference to special conditions. He
believed in preparatory treatment, and, when the patient
had reached a certain point, a pessary could be used with
advantage, and then by the internal administration of
remedies the dysmenorrhoea could be overcome, the
leucorrhoea relieved, and a cure would follow in very
many cases.
Dr. a. M. Jacobus had seen Dr. Wylie operate upon
a large number of cases with and without anaesthetics,
and had seen most excellent results follow. It might be
better to resort to an anaesthetic, but there were very
many cases in which divulsion could be practised safely
without an anaesthetic. He had not seen a patient die
after divulsion, and he had seen a fatal result follow very
slight dilatation and with a steel sound. He thought
that after the patient had passed two or three years of
menstrual life without being relieved, local treatment
should be begun to develop the uterus, and that the
patient in consequence would be less likely to require
future treatment for the dysmenorrhoea and sterility.
He did not believe that there was a single anteflexion
pessary which could be used with safety. Of all the in-
struments which he had employed, or seen used, he pre-
ferred that used by Dr. Wylie to any other.
With regard to preparatory treatment, it was exceed-
ingly important, as had already been mentioned by Dr.
Wylie. He thought that the uterus could be straightened
up considerably by means of the tampon, so much so
that the divulsor could be used later without special
difficulty.
Dr, WviiE, in closing the discussion, said that he had
not ha.d a single case of cellulitis occur as a result of
operative procedure in private practice. P'urther, that
he had no special faith in the efficacy of remedies, any I
more than that they might improve the general condition,
and in that way help a weak organ. He thought prob-
ably that electricity would do more good than any special
remedies which might be administered internally. His
faith in treating symptoms had not been very great As
to the use of pessaries, he was satisfied that practically
they were of but little value, although he was aware that
some of our very best men employed them k great deal.
The great trouble was that when a gynecologist was thor-
oughly interested in a pessary he was very apt to make
the patient fit the pessary instead of the pessary fitting
the patient. He also thought that glass was preferable to
hard rubber for the plugs as a general rule, but it being so
much more difficult to obtain he had substituted the hard
rubber.
The reason why he had not performed Dr. Sims'
operation was because he had found that by slightly
dilating the canal, merely enough to give free drainage,
the circulation of the mucous membrane had been im-
proved, and then by the application of remedies the
development and improvement of its general condition
had been so great that it had been unnecessary to resort
to further procedure. He had not found it necessary to
give an anaesthetic unless the tissue of the cervix was
very hard.
Dr. Wylie's reasons for not cutting the os internum
was because he looked upon it very much as a sphincter,
and if he wished to remove its spasmodic action he did
not cut it, but dilated it a little, and then tore the tissues
beneath the mucous membrane. Besides, he had seen
Dr. Sims cut and then fail to introduce the glass plug.
Again, when he found that he could accomplish with the
divulsor what Dr. Sims had endeavored to do with the
knife first and then using the divulsor, he had ceased to
use the knife. The ease with which the cervix elongates
had caused him to use the divulsor, holding the cervix
firmly with the tenaculum.
When he dilates, as he called it, he did it only after he
became perfectly familiar with the case, had given it
preparatory treatment, and had learned the complications.
If it was a case which did not need divulsion then he
dilated. He resorted to divulsion or the use of the knife
in not more than one in six, perhaps ten, cases where
ten years ago he would have resorted to these measures,
simply because he had found that dilatation would ac-
complish all that was desired. When he divulsed it was
in cases in which. he had resorted first to preparatory
treatment and then to dilatation, and finally adopted
divulsion because dilatation did not effect a cure. When
he divulses he generally does it with the patient under
the influence sf ether, and he would put them to bed and
keep them there, not for thtee or four days, but for two
weeks. He never allows them to rise from the bed with
the stem pessary or drainage-tube in position, unless it is
absolutely necessary. He prefers, as a rule, to have the
patient wear the tube after one menstruation ; that is,
remove it during menstruation and wear it afterward.
Dr. Sell said he had used electricity, and had found
it an excellent method of treatment. He would further
remark that dispensary treatment was somewhat different
from that which could be adopted in private practice,
and thought it well to have medicinal means to resort to
independent of operative procedure.
The Chairman referred to one point which he had
noticed in seeing Dr. Wylie operate, namely, that the
pressure made upon the handles of the divulsor was
intermittent, and that the instrument was turned slightly
at short intervals, so that the intra-uterine pressure was
brought to bear upon all parts of the circumference of the
cervical canal.
The Swallowing of a Shawl-pin. — Dr. F. W.
Smith, of Syracuse, N. Y., writes that he was called to
see a woman who had accidentally swallowed a shawl-pin
four and a half inches long. She passed it by rectum
three days later, without suffering any inconvenience.
696
THE MEDICAL RECORD.
[December 20, 1884,
FIFTY-SEVENTH MEETING OF GERMAN NAT-
URALISTS AND PHYSICIANS,
(Special Report for Thk Medical Record.)
A LARGE number of scientists and physicians from all
parts of Germany attended the fifty-seventh annual meet-
ing of the Association, at Magdeburg. They were greeted
at the opening session by Dr. Gaehde, who delivered
an eloquent
ADDRESS OF WELCOME.
He reviewed briefly the history of the Association,
which had been the parent of many other illustrious
bodies, such as the Surgical Congress, the Congress for
Internal Medicine, the Public Health Association, etc.,
and had been the model and exciting cause of many of
the existing international congresses. But while, the
speaker continued, this Association might indeed be
proud of her children, yet it should be remembered that
there was danger to her own strength in so many child-
births. He counselled his hearers therefore to stand by
their old mother and see that she was not injured by the
rivalry of her progeny.
THE SECOND ADDRESS
was by Professor Hochheim, who recalled the scientific
glories of Magdeburg, and dwelt upon the appropriate-
ness of its selection as a meeting-place for German nat-
uralists. The first medical paper was by Dr. Rosen-
BACH, of Gottingen, and was upon the
RELATION OF MICRO-ORGANISMS TO WOUND INFECTION.
The paper was a most interesting one, but was chiefly
historical and critical in character, and contained little
that is not already known upon this subject.
The next paper of interest to physicians was by Dr.
Schwartz upon the
RELATION OF HYGIENE TO PRACTICAL MEDICINE.
In spite of the great advances made in recent years in
the study of public health and of the actual results al-
ready obtained, there yet remained much, very much, to
do. Hygienists should not think of rest untQ the last
dark and unventilated bed-chamber had been destroyed,
the poor man's table had been covered with nourishing
and unadulterated food, and the modern scourge of
brandy had been driven back. Unfortunately but little
assistance was obtained from the people themselves ; it
was necessary in many instances to iforce them to be
dean. The practising physician could aid the hygienist
greatly by seeking, whenever possible, to impress upon
his patients the necessity of light, ventilaljon, and per-
sonal cleanliness.
The general session was then closed, and the scientific
labors of the members were continued in the several
sections.
SECTION FOR INTERNAL MEDICINE.
Professor SeeligmIJller, of Halle, presented a
communication upon
CARDIAC DEBILITY.
The author pictured the group of symptoms, usually
called cardiac neurasthenia, as follows : After a period of
cardiac disturbance, palpitation, pain in the precordial
region, there ensues a condition of general weaJcness, ex-
pressed by fatigue after slight exertion, insomnia, forget-
fulness and distraction, and a depression of spirits. At
the same time, despite a good appetite, sometimes even
boulimia, there is a falling away in nutrition, the extrem-
ities are cold, and there is at times a feeling of formica-
tion. In the absence of any organic changes, the author
was inclined to refer these symptoms to anomalies of in-
nervation, especially as they occurred most frequently
after psychical disturbances, as prolonged sexual excite-
ment, severe mental labor, combined with broken rest.
etc. Rest, warm baths, good nourishing food, sea or
mountain air, and quinine in small doses often exerted a
favorable effect.
Dr. Wagner spoke of the difficulty of diagnosis at the
first examination in these cases. In all heart affections
where there were no apparent physical disturbances,
especially in those of advanced years, disease of the
coronary arteries should be suspected. The speaker
had seen cases similar to those described by the author
of the paper in women who had borne many children or
who suffered from certain forms of uterine disease. This
condition was caused in those cases by an overloading
of the abdominal organs with blood, and was much bene-
fited by wearing an abdominal supporter.
Professor StrIJmpell, of Leipzig, then followed with
a paper on
acute encephalitis of CHILDHOOD.
This affection resembles in nearly every particular in-
fantile spinal paralysis. It occurs with greatest frequency
during the first and second years of life, seldom later.
There is usually an initial stage of fever, vomiting, and
convulsions, followed after a varying period by paralysis.
This is usually nearly complete on one side of the body.
It diminishes after a time, but usually leaves more or
less impairment of motion and of growth in the parts.
Sometimes the affection is followed by motor irritative
symptoms, such as epilepsy or athetosis, or by impair-
ment of the intellect or power of speech. The sensi-
bility of the paralyzed side is unaffected. The disease
is located in the cortical substance. The speaker thought
it possible that poliencephalitis and poliomyelitis might
be essentially the same conditions, the disease being
located now in the gray substance of the cord and again
in the corresponding portion of the encephalon. In an-
swer to a point raised in the discussion of this paper, the
author said that he made a diagnosis of acute encephalitis
only in those cases in which there was an acute initial
stage followed by a stationary cerebral paralysis.
Professor Ebstein, of GSttingen, followed with a
communication on
THE treatment OF TYPHOID FEVER.
His conclusions were based upon an experience with up-
ward of two hundred and fifty cases seen within a period
of seven and a half years, and were as follows : i. The
so-called abortive treatment with calomel is useful, and
therefore to be recommended. 2. A treatment based
upon etiological grounds is impracticable, and the man-
agement of the disease must be regulated by a careful
study of all the symptoms. The diet requires special
attention. 3. The struggle to reduce a long-continued
high temperature is necessary only when there are
threatening symptoms on the side of the heart or nervous
system or both, or when the fever itself reaches a dan-
gerous height 4. The author's experience led him to
assert that the best results were obtained when reliance
was not placed exclusively upon cold baths or any other
so-called strictly antipyretic method. As regards an-
tipyresis from drugs he had met with success in the use
of salicylate of soda.
Professor Koebner, of Berlin, read a paper on'the
THERAPEUTIC USE OF THE LOCAL ANTISYPHILITIC ACTION j
OF MERCURY.
The author related a number of instances showing the
value of mercury locally applied, either endermically or
hypodermically, in syphilitic affections. In the former
case the mercur}' acted by direct absorption through the
skin, and not through the inhalation of mercurial vapor,
as was supposed by Kirchgasser. The speaker urged a
more general employment of the local or regional ap-
plication of the drug in connection with its internal ad-
miniscration. Whenever, after the general treatment of
syphilis, there remain any indurations either of the primary
sore, of the neighboring glands, or of any of the tissues,
December 20, 1884.]
THE MEDICAL RECORD.
697
we must seek to cure them by the local application of
mercury. In this way we get rid of future centres of in-
fection. Thus the occipital and cervical mastoid glands,
which are usually passed by, should be treated for a long
time by mercury endermically, the applications being in-
terrupted from time to time in order to obviate the lia-
bility to inflammation of the skin and consequent impedi-
ment to absorption. Of course in such cases it must
first be determined that the enlarged glands are not due
to some local irritation within their lymphatic district,
as for example when the glands of the neck are enlarged
by reason of ulcerations in the posterior nasal region.
The author, after trying various preparations, found that
the most effectual as well as the least irritating was
freshly prepared ointment of the gray oxide.
Dr. Anfrecht, of Magdeburg, read a paper of con-
siderable length upon
CROUP AND DIPHTHERIA.
He regarded these two affections as absolutely identical.
The bacteria were the same in either case and the
anatomical differences were only apparent. In croup
the membrane is separated entire and expectorated in
the form of a tube, while in the faucial affection this does
not happen. In diphtheria the mucous membrane is
sometimes the seat of ulcers, but this, the speaker main-
tained, is the result of local treatment. It has been stated
that the membrane in the pharynx could be removed
only by force, while that in the larynx often became
loosened spontaneously, but Dr. Anfrecht said that the
mistake had been made of comparing the disease in the
two parts at different stages of its progress. The path-
ological process begins in an exudation of fibrin from
the blood-vessels of the mucous membrane excited by
the presence of the bacteria. This fibrin is poured out
between and upon the epithelial cells, and the strength
of the attachment of the false membrane is dependent
upon the depth to which th« fibrin has penetrated the
epithelium into the mucosa. The author did not believe
that any advantage was to be derived from a local treat-
ment of the disease. In the Magdeburg Hospital during
the past four years two hundred and twenty-five cases of
diphtheria had been treated, and but one death had oc-
curred, and that was in a case in which a local treat-
ment had been pursued. Cold compresses were ap-
plied to the throat and a gargle of chlorate of potassium
was used. In children who could not gargle, small doses
of the drug were given internally.
Some discussion followed, in which the author's views
were in general subscribed to. The discussion was par-
ticipated in by Drs. Schwalbe, Rindfleisch, and Ro-
SENBACH.
Professor Ackerai ann then read a paper on
cirrhosis of the liver.
- What is usually understood by cirrhosis of the liver,
the interstitial hyperplasia of the connective tissue, is,
strictly speaking, not the morbid process, but rather the
expression of a secondary salutary process. The pri-
mary process is nothing else than a necrosis of the liver-
cells induced by the presence of some poisonous sub-
stance (alcohol, phosphorus, and sometimes, also, it
would seem, micro-organisms), which necrosis seems to
be accompanied always by a deposit of fat in the cells.
The cells are destroyed, and then follows a new forma-
tion of connective tissue proceeding from the interlobu-
lar substance. This is not a true inflammation, as there
is no hyperaemia nor exudation of white corpuscles from
the blood-vessels. There is, however, from the begin-
ning a new growth of capillary vessels. But the inter-
stitial new growth is not confined to a development of
the connective tissue and blood-vessels, but embraces,
also, the biliary vessels. This is a conservative measure,
for otherwise the excretion of bile would be so greatly
impeded as to destroy the life of the patient. The exist-
ence of these enlarged blood- and bile-vessels speaks
against the view that the atrophy of the organ is due to
a contraction of the newly-formed connective tissue.
The atrophy is really due to an excess of cell-destraction
over the new production of interstitial tissue. When,
however, the new formation is in excess we And hyper-
trophy of the liver, a condition which is very common,
especially at the commencement of the disease. There
is another affection, probably identical with what has
been called cirrhosis glabra^ in which there is hyper-
trophy of the organ due to a diffuse hyperplasia of the
inter- and intra-cellular connective tissue. This, how-
ever, has nothing in common with ordinary cirrhosis of
the liver. There is no new formation of blood-vessels,
but the old vessels remain normal and potent, and there
is in consequence no ascites. The liver remains en-
larged throughout the whole course of the disease, and
the cells become atrophied from pressure of the sur-
rounding connective tissue and not from a primary de-
generative process.
After some discussion on this paper. Dr. JOrgens, of
Berlin, presented a communication upon the
ANATOMICAL CHANGES IN ADDISON's DISEASE.
The true seat of the disease lies, the speaker said, in
the splanchnic nerve-trunks. The degeneration of these
nerves may occur as a protopathic affection. In such
cases there is a simple degeneration of the supra-renal
capsules without any inflammatory manifestations in
these or the neighboring organs. A deuteropathic dis-
ease of the splanchnic nerve following a primary af-
fection of the supra-renal capsules or pancreas, is of
much more frequent occurrence. But in all cases of dis-
ease of the supra-renal capsules, or of the pancreas, in
which there is no bronzing of the skin, the splanchnic
nerve-trunks are found intact.
NEW YORK PATHOLOGICAL SOCIETY.
Stated Meeting y November 12, 1884.
R. E. Van Gieson, M.D., Vice-President, in the
Chair.
PYELO-NEPHRITIS REMOVAL OF THE KIDNEY BY ABDOMI-
NAL SECTION.
Dr. H. C. Coe presented a specimen with the follow-
ing history : The patient entered the Woman's Hospital
two months ago with a tumor about the size of the foetal
head in the right iliac region, and rather movable. The
tumor would disappear at intervals, and just previous to
its disappearance the patient would pass large quantities
of urine. No clue to the character of the disease was
given by the examination of the urine. An exploratory
incision was made, and hydronephrosis encountered, and
the sac was removed. The patient developed peritonitis
and died on the eighth day. After the operation there
was never more than a slight trace of albumen and a few
casts in the urine.
At the autopsy it was found that the stump had been
secured, but the ureter had slipped and was blocked up
with a clot, and some of the veins had also retracted be-
neath the peritoneum, giving rise to slight hemorrhage.
The opposite kidney was not especially abnormal.
The particular point of interest in the case was that
two days before death the woman had begun to menstru-
ate, and the picture of the pelvic organs was very inter-
esting. The uterus was retroflected, and all the pelvic
organs were very much engorged with blood. The fim-
briated extremities of the Fallopian tubes resembled
dilated veins. The uterus was congested, and was like a
sponge, blood flowing freely from all the sinuses. There
was a corpus luteum in one of the ovaries.
On opening the uterus the mucous membrane was
covered with a thin film, which could be raised with the
forceps, and on examination, microscopically, it was
found to be a layer of epithelial cells and blood under-
698
THE MEDICAL RECORD.
[December 20, 1884,
going fatty degeneration. The appearance seemed to
confirm the theory of denudation of the mucous mem-
brane in menstruation.
The ureter was perfectly normal, as also was the
bladder. There was no mechanical obstruction between
the kidney and the meatus urinarius, and the only ex-
planation which he was able to give concerning the cause
of the hydronephrosis was that there was merely a valve-
like fold at the ureter as it opened into the cyst.
An interesting question arose ; namely, Was there any
uraemic element in the case ? Twelve hours preceding
death the patient passed only about two ounces of urine,
which had a specific gravity of 1.020, exhibited a trace of
albumen and a few casts, but no blood.
Dr. Peabody thought that too much stress was laid
upon urea as a cause of uraemia, for the condition
known as uraemia had been proven to be independent of
any retained urea in the economy. He thought it had
been shown that more urea can be injected into the veins
of a dog than any human being can retain in any process
of disease of the kidneys, and without producing any such
symptoms as are passed under the name of uraemia. He
did not think that urea had anything to do with uraemia.
Dr. Seguin remarked that he had been of the same
opinion as Dr. Peabody, but Grdhant and Quinquand com-
municated to the Acadetnie des Sciences^ on August 25,
1884, the results of recent experiments in which they
produced artificial uraemia by the hypodermic injection
of urea in animals. Perhaps, therefore, the question had
not yet been entirely settled.
Dr. Wendt thought that probably Dr. Peabody went
too far when he said urea plays no rdle at all in the pro-
duction of uraemia. He thought that the retention of
(urea was certainly one of the factors in the production of
uraemia, although it might not be the only one.
Dr. Peabody said that one of the strong points in
favor of the theory which he had mentioned was the fact
that urea is excreted in large quantities by the mucous
membrane of the intestines. It had been shown that by
tying the ureters in roosters the urea, being unable to
make its exit through the ureters, is found in large quan-
tities upon die mucous membrane of the alimentary
canal, and the conclusions to which he alluded were
based upon experiments of this character. It would
seem to be irrational, therefore, that urea should not find
its way out of the human economy in the same way when
it can do so in other animals, and that it can da so in
other animals has been proven without doubt
ANESTHESIA OF THE LEFT TRIGEMINUS, WITH SO-CALLED
TROPHIC ULCERATION OF THE HELIX.
Dr. Seguin presented a patient, a man forty years of
age, with the following history : He had had partial
anaesthesia of the left trigeminus, left occipitalis major
and minor nerves, of left superficial cervical plexus, and
of left ulnar and median distribution for a year. The
external ear is almost totally insensible. A few weeks
ago a small " blister" appeared on the left external ear,
in the lower third of the fossa of the helix. This has be-
come an ulcer, which my colleague at the Manhattan
Eye and Ear Hospital, Dr. Pomeroy (by whose courtesy
he had seen the case) designated perichrondritis and
chrondritis with perforation. There are no signs of
ordinary haematoma. Under a dressing with bichloride
of mercury lotion the ulcerative process has been arrested
and repair is progressing. The only other symptom pre-
sented by the patient is paralysis of the left vocal cord,
dating back six years to an attack of hoarseness. The
man had never had syphilis, and the pathology of his
anaesthesia (which certainly is not hysterical hemi-anaes-
thesia) was, he confessed, quite obscure. From the ab-
sence of neuralgia he was disposed to exclude disease of
the trunk of the trigeminus or of the Gasserian ganglia.
The ulcerations of the cornea (and phthisis bulbi) co-
existing with trigeminal anaesthesia are well known, though
rare. To his present knowledge this case was unique.
It has been claimed that the ulcerative keratitis of tri-
geminal anaesthesia, and the peripheral ulcerations after
sections of nerve-trunks were active " trophic processes,"
the direct result of injury to ** trophic " nerve-fibres con-
tained within the affected nerve-trunks. The experi-
ments of von Gudden and of Snelling have shown this
theory to be untenable as regards the trigeminus. These
experimenters found that by protecting tihe cornea (Gud.
den by artificial ankylo-blepharon, Snelling by sewing a
rabbit's ear over the eye) there might be complete an«s.
thesia of the trigeminus with a perfectly clear, healdiy
eyeball. Long before them, however, Brown-S6quard
had demonstrated that a guinea-pig's foot might be kept
indefinitely healthy after section of the sciatic, by care
and cleanliness. The conclusion reached by these
physiologists, and the view now held by most neurolo-
gists was, that the keratitis or ulcerations of the foot was
traumatic and infectious, the anaesthesia acting only as a
predisposing cause by allowing injury, and by (in the case
of the cornea) preventing the normal reflex protecting
movements.
" In the case before us I believe that the ulceration '
was caused by scratching and subsequent sepsis of a
little spot on the helix, the analgesia rendering the initial
injury and subsequent extension of disease easy and
rapid. In other words, had this anaesthetic ear been
fully protected from injury and bacteria it would have
remained sound. The healing under antiseptic dressmg
and protection, while the analgesia persists, is a proof of
this view. Let me add that I know of one fact in ex-
perimental patholofly somewhat analogous to this case.
Years ago Brown-S6quard showed that after wounding
one of the restiform bodies of the medulla in guinea-
pigs the external ear on the same side often showed gan-
grenous ulceration at the tip and edges. May it not he
that the wound in the medulla extended deeper than in-
tended by the experimenters, and injured the ascending
root of the trigeminus, thus causing anaesthesia of the
affected car?" ,
Dk. Levi thought it was not absolutely necessary that
injury should always occur in order that ulceration should
exist, because when the nervous supply is interfered witii
the normal power of repair is diminished. He did not
think it was ever pretended that by doing away with the
nervous supply of a part it would necessarily die, although
it had much less blood to produce that reparative process
which is going on in healthy parts. He would like to ask
Dr. Segum whether or not this was a case of ulceration
due to interference with the nervous supply of the part.
Dr. Seguin replied that the anaesfiiesia acted indi-
rectly as a predisposing cause only ; that in the anaes-
thetic condition injury occurred more easily because of
the insensibility of the patient to traumatic influences?
INGUINAL KIDNEY SIMULATING HERNIA,
Dr. E. C. Wendt presented a specimen of inguinal
kidney removed from the body of a woman who had
died of various senile disorders at the age of eighty-six.
On admission to the St. Francis Hospital she affirmed
positively that she had never known serious illness of
any kind. She had for a number of years, how many
she could not say, worn a truss for a supposed inguinal
hernia. She died soon after admission to the hospital
At the autopsy the right kidney was found connected
by a firin band with the uterus, and was also situated in
the inguinal canal, the portion protruding externally be-
ing that which had been mistaken for a hernia. It was
evidently a congenital condition, and the kidney had no
visible pelvis. The ureter was very much shortened.
The kidney on the opposite side showed no special
change. The renal artery in the inguinal kidney did not
spring from the abdominal aorta ; it probably arose from
the iliac artery. There was no suprarenal capsule con-
nected with the kidney removed from the inguinal ring,
although it might be that one existed above.
December 20, 1884/J
THE MEDICAL RECORD.
699
ENDARTERITIS OBLITERANS.
• Dr/Peabody presented a part of the circle of Willis,
showing chiefly the basilar artery, together with some of
the smaller arteries from the pia mater, removed from
the body of a man, thirty-eight years of age, who died
with peculiar symptoms. He was brought into the New
York Hospital November ist, unable to speak. He was
bright and intelligent, and there was no paralysis of mo-
tion or sensation detected at the time of admission.
There was exaggerated patellar reflex on the right side.
The aphasia was distinctly ataxic, and at the same time
the patient was unable to move the tongue. On the fol-
lowing morning there was complete right hemiplegia,
the patient soon became unable to swallow, was nour-
ished artificially, developed a rise of temperature in the
evening after two days, and on the fourth day he had a
succession of attacks of pulmonary cedema, in one of
which he died. The urine was normal. The pulse and
respiration were normal at the beginning, but toward the
end they increased in frequency. At the time of death
the temperature was 108° F.
At the autopsy it was found that the lumen of the
vessels at the base of the brain, especially that of the
basilar artery, was very much interfered with; that it
was due to a growth in the interior of the vessels, and
exhibited the lesion of arteritis obliterans. Dr. Peabody
exhibited microscopical sections. There was a small
spot of softening in the left corpora striatum and internal
capsule, and the blood-vessels in these regions, upon
both sides, were distinctly calcareous. The softening
was localized. The convolutions were all normal. The
other organs throughout the body were substantially nor-
mal, except old fibrous indurations at the apex of each
lung, and in one kidney there were two small, old ab-
scesses.
Dr. Seguin asked concerning the condition of the left
Sylvian artery.
Dr. Peabody remarked that he examined this artery
with special care, and there was apparently nothing
wrong with reference to it.
aneurism of the arch of THE AORTA — LOBAR PNEU-
MONIA.
Dr. Beverley Robinson presented specimens accom-
panied by the following history, furnished by Dr. J. M.
Mabbott, of St. Luke's Hospital : Nicholas B , fifty-
three years of age, married, native of Switzerland, was
admitted to the hospital July 14, 1884. The patient's
family history was negative. He had a venereal sore in
1854, not followed by suppurating bubo. An eruption
appeared upon the legs a few months afterward. In 1857
he had acute rheumatism, but suffered firom no cardiac
symptoms following the attack. He had pleurisy on the
right side one year ago. He has indulged freely in alco-
holics and tobacco. During his stay in the hospital the
patient presented symptoms of aneurism of the arch of
the aorta, which gave rise to marked difficulty in inspira-
tion and expiration, but no other evident S3rmptoms, so
£ax as the pulse was concerned, and no paralysis of the
vocal cords. On the evening of October 30th the pa-
tient had a slight chill, followed by excessive dyspnoea and
very severe pain in the right side. On the following
morning his temperature was 103.5° ^'j pulse 126, and
the pain and dyspnoea continued. The breathing was
laborious and the respirations were not increased in fre-
-quency. The patient died November 2d.
At the autopsy a few old adhesions were found over
the apex of the left lung. The middle lobe of the right
lung was in a ^tate of red hepatization, and the pleura
oovering it had a large amount of recent fibrin upon its
surface. The upper and the lower lobes of the right lung,
ajid the whole left lung, were in a condition of em-
physema.
The heart was of normal size, the valves competent,
the muscular tissue of good consistence. The aorta was
markedly atheromatous, especially the ascending portion
of the arch, where was a large aneurismal sac, arising from
the arch just at the origin of the right innominate artery,
extending upward and forward, and pressing against and
becoming adherent to the sternum. It was as large as
a man's fist, and contained recent clots. There was a
second aneurismal sac, extending backward and some-
what to the left, arising just below the origin of the left
carotid and subclavian arteries. The innominate, left
common carotid, and left subclavian arteries were ^so
atheromatous.
The kidneys and liver were congested, the spleen was
soft and friable. The stomach and intestines were con-
gested.
From a clinical point of view the case was interesting
because of the absence of the radial pulse, the presence
of two considerable aneurismal sacs, the absence of any
disturbance of the larynx although the trachea was con-
siderably compressed. Although there was a distinct chill
with complaint of pain in the right side nothing was found
on physical examination which enabled him to say that
pneumonia or pleurisy existed. There was no sputum.
The primary cause of death was aneurism ; the second-
ary, pneumonia.
Under such circumstances Dr. Robinson thought that
one could only presume the existence of the pneumonic
condition, without being able to say positively that it
existed.
TUBERCULAR MENINGITIS— OLD CATARRHAL PHTHISIS.
Dr. Van Gieson presented specimens which illustrated
in a remarkable degree the conservative and curative
processes of nature, unaided by the physician's skill or
art. They also illustrated the aphorism of Niemeyer,
that the greatest danger to which phthisical subjects are
placed is that of becoming tubercular. They were re-
moved from the body of a man, fifty years of age, whom
he first saw November 5th. At that time the patient was
somewhat actively delirious, without special elevation of
temperature. On .physical examination there was found
evidence of solidification of the apex of the right lung,
and he was somewhat inclined to take the view that it
was a case of low-grade pneumonia. At the next visit
the delirium had increased, and Dr. Van Gieson suc-
ceeded in obtaining a history, which was that the patient
had had vomiting more or less for several days, intense
headache, and had had a staggering gait. The man be-
came violent, and he was sent to SL Catherine's Hospital
on Thursday, ancf died on the following Monday night.
During his stay in the hospital there was no elevation of
temperature. He died in a state of partial coma, varied
with active delirium. At the autopsy the brain presented
the typical appearances found in tubercular meningitis.
After removing the lungs, the right was found entirely
adherent posteriorly as far down as the diaphragm, and
was so firmly attached to the diaphragm that it was neces-
sary to cut off a portion of that muscle before it could be
removed. The left lung was adherent to the chest-wall
by a slight band posteriorly. The upper portion of the
right lung was filled with calcified material, and the left
lung also contained more or less of calcified nodules.
The patient had not had a sick day, nor lost a day's work,
during the last thirteen years. Dr. Van Gieson regarded
it as probable that during the middle period of this man's
life he had what had been called catarrhal phthisis, from
which he had recovered. He would ask if it was com-
mon to find, post-mortem, such extensive evidence of
previously existing destructive disease of the lungs ?
Dr. Peabody replied that he had not had an oppor-
tunity to examine the specimens presented by Dr. Van
Gieson, but he did not think it was common to find ex*
tensive evidence of phthisis which had been latent for
years. To find occasional nodules was not uncommon,
and it was sufficiently common also to be unworthy of
special consideration to find extensive pleuritic adhesions.
The Society then went into executive session. .
700
THE MEDICAL RECORD.
[December 20, 1884.
^ovttspowSUnce.
TRACHEOTOMY IN CROUP AND DIPH-
THERIA.
To THB Editor op Ths Medical Rbcord.
Sir : In The Medical Record of December 6th I am
pleased to find an interesting communication from Dr.
S. S. Jones, criticising my paper on " Tracheotomy in
Croup and Diphtheria." Permit me a word in reply.
Dr. Jones says that I " advocate an early operation,
giving as a basis for my argument the clinical histories
of three cases." Herein he entirely misapprehends the
purport of my paper. The latter was written after hear-
ing the essay of Dr. Winters, which is so replete with
historical and statistical information that I would have
deemed it absurd to dase any argument by which I de-
sired to second his views, on statistical evidence from my
own personal experience.
Those who have done me the honor to read my con-
tributions to medical literature are aware of the fact that
I am in the habit of fortifying my views by large and un-
assailable statistical data obtained from all available
sources. The latter having (in this case) been already
furnished by Dr. Winters, I desired only to aid in com-
bating the unreasonable prejudice which seems to exist
against tracheotomy among physicians as well as laymen.
With this view I cited three recent cases, as an iUustra-
iion that <' one successful tracheotomy (in this instance
performed by Dr. A. Jacobi) would do more to neu-
tralize groundless apprehension than all the statistics,''
eta
As " two of these cases were circumstanced precisely
alike, being of the same age and in the same social
grade," and occurring in the same epidemic, I utilized
them to contrast the result of an early operation with
that of a late one. If I had wished to enter into details I
might have stated that in this epidemic of laryngeal diph-
theria, which swept away quite a number of children (I
have not yet obtained the exact figures from the attend-
ants, being myself only called in council in a few cases),
the only recovery was in the case I cited as being tracheal-
omized, and I might have furnished other details, which I
reserve for future discussion. It was not my intent to
write an essay, but simply to arouse an interest in the
discussion, and I am glad that this result has been at-
tained.
Dr. Jones has also misunderstood my position with ref-
erence to an early operation. If he will read my paper
carefully he will find that I say " it is the duty of the
attendant to operate early in the first indication of abid-
ing laryngeal stenosis." Cases may, as he says, appear
" threatened by asphyxia and yet recover." It is for
the attendant to decide whether the stenosis is abiding
or only paroxysmal. I have myself watched a case of
laryngeal stenosis an entire night, while instruments and
table were in readiness for tracheotomy, which was found
unnecessary when the morning dawned.
Dr. Jones says : " I cannot but dissent from the con-
clusion of the author, because I believe that if tracheot-
omy were generally performed early in croup many
children would be unnecessarily subjected to it, and cures
which would have been either spontaneous or the result of
medical treatment attributed to it " (italics mine).
To one who, like Dr. Jones, is *' actuated in operat-
ing more by the desire to relieve the patient, if only
temporarily, than inspired by any great hope of saving
life," the fear that tracheotomy may get the credit of
a cure without deserving it, may seem an insuperable ob-
jection to the operation. But if I mistake not the tem-
per of most practitioners, such an argument would not be
regarded a moment when a human life is to be saved.
Nor would Dr. Jones* statement that deaths are some-
times attributable, "worst of all, to the accidental stop-
ping of the tube," weigh against the operation, carefully
done and watched over in the after-treatment.
It is just this prejudice against tracheotomy which has <
impaired its usefulness, and to dispel which Dr. Winters'
paper and my brief contribution have been written.
There exists no more baneful nor more universal enor
among medical men, especially when our experience is
not large, than the habit of making deductions from that
small experience for our own guidance. It would surely
be far more rational and just to temper our egotism by
utilizing as guides the published experience obtained by
others from large clinical material— //kj our own experi j
ence. Under such treatment Dr. Jones* seven tracheot-
omies with one successful result, would lead him to recog.
nize that he is in error, when he regards his own experience
in tracheotomy as compared with the results of non-
operative management as unfavorable. Dr. J. Lewis
Smith has told us that, according to his experience and
observations, about one in eight recover by inhalation,
which he regards as the best treatment. Now, Dr. Jones
has had the good fortune to save one in seven tracheot-
omied cases, even when he treated the operation in a
kind of " stepmotherly " manner. Hence he should be
encouraged by this comparison to look with more favor i
upon the operation, especially if he will study withut
prejudice, the statistics, '*from which it appeared that
from twelve to thirty-nine per cent, had been saved by
the operation, and, under improved methods of operating,
it might be expected to save one in three by tracheotomy"
(J. Lewis Smith). Indeed, this favorable result is nearly
attained in the aggregate of the cases referred to in Dr.
Jones' letter and my paper ; for here we have three rt-
cover ies in eleven cases (Dr. Jones one, Dr. Jacobi one,
and Dr. Baruch one). Dr. Jones recommends "equal
parts of powdered alum and sulphur to be blown into the
throat at the moment of deep inspiration as often as
asphyxia threatens." This treatment will, I think, find
little favor with pracdtioners. "The child,** says Dr
Jones, " struggled through the next thirty-six hours^ ex-
pelling shreds of membrane after the insufflation at fre-
quent intervals, until at length on the fourth day^ the
respiration, though somewhat difficulty was much deeper
and freer'* (italics mine). Aside from the apparent
cruelty of this procedure, no physician bearing in mind
the fact that in diphtheria there is great danger fi-om
heart-failure, would have the temerity to subject the
little sufferer to the struggle incident to this suffocating
process, <* used, if used at all, freely and energetically."
One of the chief advantages of tracheotomy in laryn-
geal stenosis, and one which has not been sufficiently
emphasized, is the tranquil condition of the patient re-
sulting from the majority of operations. With proper
care of the tube and skilled supervision of the after-
management, the little sufferer is at once transposed
from " a bed of thorns to a bed of roses,'* as it were.
The natural (not carbonic oxide) sleep, the renewed
facility of taking nutriment, medicines, and stimulants,
the vitalizing influence of free ingress of oxygen to the
lungs — ^all these conspire to change the whole aspect of
the case. No statistics are required to demonstrate this
fact ; it is within the experience of most practitioners.
Let each one divest himself of all prejudice at this
time, scan all the arguments and statistics brought for-
ward in the discussion of last March, and in the present
renewal, then add his own experience without fear and
without favor. The result will be a triumphant vindica-
tion of the life-saving properties of tracheotomy, when
performed as soon as abiding laryngeal stenosis is rec-
ognized, and carefully watched in the after-treatment.
Simon Baruch, M.D.
43 East Fifty-ninth Stxbxt, December 7, 1884.
The Most Powerful Antisuppurative, according
to Trastour, is Lugol's solution, or iodide of calcium.
He gives the former in doses of 3 iij.- 3 iv. daily.
The Medical Record
A Weekly Journal of Medicine and Surgery
Vol. 26, No. 26
New York, December 27, 1884
Whole No. 738
^J^dflitmt %xX\tVtz.
SPINAL DISEASE AND SPINAL CURVATURK*
By MEIGS CASE, M.D.,
LATB SURGEO^^ FORTY-THIRD NBW YORK VOLUNTBBR8 ; LATB PRBSIDBNT OTSBGO
COUNTY, N.Y., MWJICAL SOOBTV.
In the production of diseases or deformities of the spine
mechanical causes predominate. It is nearly safe to
say that they are all due to some mechanical cause.
Any undue shake, twist, or forcible flexion of the eighty
articulations of the spine ; any direct or indirect violence
or contra-coup ; any bruise or extravasation into the com-
plicated bony or intervertebral tissues, any disturbance
or dislocation upon each other of the seven distinct cen-
tres of ossification that compose each vertebra in the
young, may be an original cause of disease or curvature.
The precise location of the injury, and the consecutive
effect of the weight of the superincumbent parts, from
which there is no escape without extension, determine
the character and form of disintegration or deflexion
which ensue by slow inflammatory processes superin-
duced by continual repetitions and aggravations of the
original hurt. To this is added as the disease advances
and pain is developed the well-known destructive influ-
ence of muscular spasm or unremitting vise-like com-
pression, produced by nature's instinctive effort ta limit
motion and thus allay friction of the diseased joint.
This effect is not unlike the process by which bedsores
are produced by arrest of circulation.
Incessant and unvarying pressure, by its destructive
strangulation of nutrient vessels, completes with abscess
the disaster of Potf s disease, '
The mechanical causes of lateral curvature are natu-
rally those that impair muscular counterpoise. Any local
debility or enforced unnatural attitude aided by gravita-
tion may give rise to all the varieties and exaggerations
of this deformity. "Any constant pressure on the spine
will produce curvature,'* according to Von Swieten.
A trifling deviation at the beginning, perfectly curable
by a few weeks' treatment, becomes, when neglected, a
serious calamity, " painfully embittering after life," " for
of all the varieties of deformity none so greatly detract
from the beauty of the human carriage as distortion of
the spine."
It therefore follows that every aberration or injury to
the spine should be considered worthy of |minute atten-
tion and subjected to careful treatment at the earliest
possible moment.
The unfortunate fact that not one case of spine dis-
ease in a thousand is detected and treated as such from
the beginning is very discreditable.
Parents discover this and say : '' The doctors cannot
decide what is the difficulty." Mistaken treatments for
malaria, rheumatism, gastrodynia, colic, indigestion, grow-
ing pains, and worms, usually employ very considerable
time before the serious character and injurious possibili-
ties of the prime injury are plainly diagnosticated by the
occurrence of actual deformity.
This period of doubt and incertitude would be abol-
ished with the deformity it perpetuates, if an acceptable,
convenient, and ever-ready means of treatment of ac-
knowledged efficacy and utility were at hand ; but if the
^ An addrtM ddiTered befinre't
daon County, N. J.,|MediG«l Society.
disease remains undetected and untreated until deformity
is reached, a great opportunity has been lost, for preven*
tion here, as elsewhere, is better than cure.
It is evident, however, that any treatment sufficiently
well devised to relieve, modify, or benefit the most ad-
vanced stages of these diseases ought to cure, when early
and properly applied in the forming stage.
This brings us to the consideration of , the means of
treatment in use by the application of some. of the forms
of so-called "rest."
Among these are ** fixation" and "absolute immobili-
ty" splints, terms which sufficiently describe popular
treatments by "braces" and "jackets."
The number and variety of these devices, all intended
by lateral compression, or crutches resting on the hips,
to support the weight of superincumbent parts, is appall-
ing. Their production has become " a great American
industry." Some of them like the "jury-mast," contain
the merest suggestion of spinal extension, upon which
alone valid claims to favor could rightfully be based, but
accomplish it so imperfectly and indifferently, by means
so disadvantageous and indirect, as to have compelled
me to adopt a more simple and effective method by
which " elastic extension" is furnished without compro-
mising entire freedom of action.
My apparatus consists of a four-wheeled carriage, with
parallel bars for the hands, surmounted by two upright
spars and cross-piece, from which depends a powerful
spiral spring, and below this a swivelled bar, carrying suit-
able soft leather suspensory rests to embrace the chin
and occiput. The elevation is regulated by a screw, and
can be increased as tolerance is manifested in the use of
the apparatus and the patient gains in height.
In dorsal and lumbar curvature, a corset or waist sus-
pension is added, arranged with large wood rings, through
which the arms are passed, so as to avoid any of lifting
the shoulders or limitation of their movements in any
direction.
The patient can turn around and move freely to and
fro, walking or running in the suspension at will, and a
pleasing change of position is accomplished by an adjust-
able seat. Action or continual change of position is
thus rendered not only possible, but agreeable and pleas-
urable.
The proper adjustment of the suspension is directed
by the patients themselves.
The spring accompanies every movement and is strong
enough to support the entire weight when required. Thus
all restriction is practically done away with. I have found
it useful in all cases where spinal extension is indicated,
and those comprise nearly all spinal affections, not only
Pott's disease and all of the forms of lateral curvature,
but muscular debility and chronic fatigue of the erector
muscles, with or without paraplegia or spinal irritation.
H. Heather Bigg,* the celebrated English orthopraxist,
sufficiently illustrates the requirements of treatment in
these cases when he deplores the fact that " every form
of instrument with which I was aquainted before I de-
signed these (a new brace with rubber attachments)
limited or entirely suspended muscular motion."
He previously alludes to "M^ necessity that appeared
to exist for such an application of mechanical power to
the treatment of spinal curvature as would admit of com-
plete bodily freedom.*' In this we claim to have suc-
ceeded, for the apparatus not only does not impede but
t> H. H. Bigg : Orthroprazy, page a8a« London, 1877.
702
THE MEDICAL RECORD.
[December 27, 1884.
greatly facilitates movement, and fortunately does not
add weight to a patient already orerweighted by disease.
A plain reason why the traction is more efficient
than any other is that it is not monotonous, but changes
with every movement, from a few pounds to the entire
weight.
The apparatus furnishes appropriately the most agree-
able and beneficial " spinal exercise " for treatment of
lateral curvature. It is only by suitable extension that
the retraction and wasting of the spinal ligaments and
muscles, the absorption of the vertebral tissue, the for-
mation of antagonizing or compensatory curves, or the
lateral horizontal movement known as ** rotation " can
be prevented or permanently corrected.
It is thus more " according to nature " than any form
of straitjacket, brace, or "absolute immobility splint"
with which I am acquainted. Observing a patient with
Pott's disease you will notice that by trying to support
the weight of the head on his hand, or leaning across his
mother's lap, or sitting with both hands resting on the
chair, or walking with a stiff and unnatural gait with both
hands on his knees, he is constantly furnishing unmistak-
ably the indications for treatment by extension.
The principal joints of the lower limbs are half bent,
to prevent vertebral concussion, the projecting chin and
elevated shoulders are held stiffly by rigid spasm of all
the dorsal and intercostal muscles.
Movements are executed with automatic precision.
Stooping is impossible in the ordinary manner and is ac-
complished by bending the hips, then the knees, then
sliding awkwardly to the floor.
The muscular movements of the heart are directly in-
terfered with by the unnatural spasmodic rigidity of the
thoracic compression. It flutters like a bird in its cage,
while the respiration, equally embarrassed, is short and
grunting. Cyanosis and the peculiar facial expression
are thus produced. It is suggestive that no child asks
its nurse to compress its chest for temporary rest, or other
reason, but if you tentatively lift the head by placing the
" elastic extension " of your hands under the chin and
occiput, a smile of grateful relief comes over the sufferer's
face, and he says, ** That feels good."
Now if you take the little patient at his word, and put
him in this apparatus, you will find that he will indicate
unmistakably its relief. He will breathe easier, the char-
acteristic facial expression of the hunchback will disap-
pear, and all bodily movements %ill be better performed.
Soon his height will increase ; and by pursuing a life of
constant activity and exercise, a cure or a most gratifying
improvement in vigor and form will take place.
What is " rest" for the spine? I define it as a com-
plete reversal of the ordinary function of the spine by
active extension.
A treatment by traction and free motion is thus di-
rectly indicated and is far more curative and beneficial to
the spine itself than inaction or recumbency. A healthy
resistance is imparted to the entire section, effectually
preventing abscess, and when it has occurred, greatly
promoting resolution and the processes of repair.
The injustice to sound articulations, which involves
them in treatment and pseudo-anchylosis intended for
disease is avoided.
If "rest" can be accomplished without interfering with
the normal motion indispensably essential to the health
of joints, so much the better. A joint deprived of motion
is already diseased ; condemned to inaction and loss of
function; its "occupation gone," the conditions most
favorable to abscess and disintegration are filled. The
demand of the joints for motion is as incessant and in-
satiate as that of the lungs for air, or the heart for blood.
•* Immobility," "constant fixation," any form of "motion-
less restriction," or rigid extension is not rest.
The governing principle of this treatment is too well
known in its application to analogous diseases of other
joints to require any extended comment
The researches of Henry G. Davis, whose little work
on conservative surgery is one of the roost original, sub
gestive, and instructive that the practical surgeon c^
place upon his table, were the first to show the universal-
ity of the great curative principle of "elastic extension'"
in the treatment of all diseased joints. He ** was the first
to point out, as an always present factor in their destruc-
tion, the existence of unremitting; pressure as effected by
contraction of the muscles passing over the joints cans-
ing constant forcible apposition of the surfaces within the
joint." He gave to the world the principle of ** elastic
extension " and applied it indiscriminately to the spine
hip, knee, or ankle.
In my opinion this discovery entitles him to atf emi-
nence not less than that accorded to the discoverers of
anaesthesia or vaccination. I fully believe that if his
humane suggestions could be practically carried out, by
the instant application of " elastic extension " in all ap-
propriate cases, the hideous deformities arising from the
causes under consideration would exhibit a curability at
variance with the professional belief.
His apparatus for hip extension and suggestions for
treatment have been almost universally adopted by the
profession, relieving as they do all pain and spasm, and
permitting free motion and recovery without deformity.
" Elastic extension and motion " have robbed this dis-
ease of most of its " terrors," as Davis said they would.
The terrors of joint disease are pain and deformity.
" As a profession we are not sufficiently aware of the
ultimate eflect of continued suflering, of how many lives
are lost that might have been saved had their surround-
ings been so arranged as to enable the patient to rest
quietly, and to move free from every irritating cause ; loss
of sleep and rest, loss of appetite and nutrition ; them-
selves sufficient to destroy life " (Davis).
In regard to the spine, he says : " The rational way to
treat curvatures is to relieve the spine of the weight of
the head and shoulders." But the application of the
principle of " elastic extension " to the treatment of the
diseases of the spine has never (as in the case of hip-
joint disease) passed into general medical practice. The
mechanician and specialist " hold the fort " with innumcr-
able restrictive appliances fastened to the wretched bodies
of these patients, illustrating all the evils of an ingenious
but empirical system of mechanical therapeutics in all
the varieties of worthless simplicity, cumbrous complex-
ity, and injurious restriction ; in faet, the treatment is
practically unchanged since the Hippocrates of France,
Ambrose Par6, in the sixteenth century, first suggested
the " repouss6 jacket " or body splint, beaten out of thin
metal and carefully fitted by the skilful armourers of those
days. Park's breast and back plate below sufficiendy
illustrate the antiquity of restriction.^
It is strange " that this earliest piece of mechanism in-
tended to be worn for the relief of a distorted spine"
was lighter, better ventilated, less cumbrous, thinner,
more easily removable and adjustable than the modem
jacket of plaster-of-Paris, while it answers every require-
ment of restriction as fully as can be desired. The com-
plicated arrangement of modern braces and jackets, and
' From the *' works of that famous chinurarion, AmtmMe Parey, translated ootfit
Latine, and compared with the French by Thomas Johnson. London : Printed bf
£. C, and are sold by John Qarke, at Mercer'slChappelJ, in Cheapside Kcatc
ye Great Conduit. 1665."
December 27, 1884.]
THE MEDICAL RECORD.
703
the constant changes required to keep these defective ap-
pliances in order, as' well as their notorious inutility and
danger, have compelled careful physicians who wish to
retain the perfect confidence of families to abandon the
" responsibility " of treatment of these cases by methods
in vogue; but it has been readily sought and assumed
by the specialist. An imperfect appliance always needs
a good deal of engineering to supplement radical de-
fects which a good apparatus does not require. Enu-
meration of the appliances restricting and encompassing
the entire trunk in abortive attempts to give support to
the spine is simply impossible. Their great number
proves their inutility. But the most eminent recent
authorities refer to them all as follows : " Mechanical
contrivances are much vaunted, and are much employed.
I confess, however, to having little faith in their value as
curative agents. They tend to cause atrophy of the mus-
cles instead of strengthening them and thus to make the
deformity a permanent one " (Bryant).
" All the instruments at present so generally used,
making direct lateral pressure on the convexity of the
curves, must tend to increase the mischief " (" Lectures
on the Pathology and Treatment of Lateral and other
Forms of Curvature." Second edition, page 296. Will-
iam Adams, London).
But the principle of ** elastic extension " is just as im-
mutable as it is curative. It is just as appropriate for
one joint as it is for another, and by its thorough applica-
tion, unembarrassed by restriction, not only all pain and
soreness is relieved, but every indication for mechanical
treatment is fulfilled, without peril or discomfort. Every
indispensable condition and prerequisite to recovery is
thus furnished in a direct and simple manner.
It is evident that if any improvement can be made, it
must be in the directness by which the indications for
treatment are fulfilled at the precise point where the
efifect is demanded without compromising normal action
or function of neighboring parts.
The natural variability of the spine and the small size
of its muscles as compared with those surrounding the
hip-joint furnish conditions which render continuous un-
remitting extension far less imperative. Accordingly it
has been demonstrated by careful trials that any sup-
posed necessity for " night treatment " is obviated by
daily active extension, and that improvement is more
rapid when the natural sleep is not interfered with by any
form of restriction or compression.
It is to be regretted that the attention which the mag-
nitude of the misfortune of spine disease must have com-
pelled from physicians in all ages has been so largely
devoted to discussions of their supposed strumous or
tubercular origin.
In the quest for a cause of the progressive ravages of
maladies that contain in their peculiar location all the
conditions of perennial disease in the constant attrition
of the diseased surfaces or the cumulative action of its
producing causes, the simple fact that no irritated or
abraded joint surface can recover when subjected to con-
stant spasm or pressure is forgotten in the wild and profit-
less search for an original sin of scrofula or tuberculosis.
Regarding so-called " Pott's disease " and so-called
'* hip disease " as identical in their causes, course, and
general characteristics, I intend to supply, for similar
reasons, an identical treatment purposing to answer the
universal indication for elastic extension, appropriate to
any stage, but especially intended for convenient and
ready fulfilment of all requirements at the outset of the
disease in accordance with scientific authority and sound
pathology. There is, therefore, no longer any reason
why every practitioner should not undertake the treat-
ment of these cases as of any other lesions that come
under observation in the ordinary routine of practice.
There is abundant reason why he should adopt such a
course. It is only by immediate, persistent, and early
attention to the requirements that deformity can be pro-
hibited or its development arrested. Hence the neces-
sity for recognizing, as a part of the general practitioner's
duty, a thorough acquaintance with the early manifesta-
tions of these diseases, and the instant or earliest possible
application of elastic extension by comfortable, efficient,
and unobjectionable apparatus.
330 Wkst Fifty-ninth Strsbt, Nbw York.
A CASE OF CYSTICERCUS IN THE VITREOUS.
By JAMES L. MINOR, M.D.,
pathologist and assistant StntGBON TO THB NEW YOKK BYB AND BAR IN
FIRMARY.
During the past summer a patient consulted me at the
New York Eye and Ear Infirmary for impaired vision,
and I made the diagnosis of cysticercus in the vitreous.
The extreme rarity of such cases — not a single authen-
tic case, so far as I am aware, having been observed in
America, although Graefe found eighty cases of cysticer-
cus in the deeper tissues of the eye, among eighty thou-
sand patients seen by him in Germany — caused at first
much doubt in my mind ; but the patient has been fre-
quently and carefully observed since he was first seen,
and I am now confident that the diagnosis was correct.
And I am strengthened in my conclusion by the opinions
of some of my confreres of the New York Ophthalmo-
logical Society — where the patient was shown — who have
seen cases of cysticercus in the vitreous in the European
clinics. The patient has repulsed all overtures pointing
toward an operation for the removal of the entozoon, and
I simply desire to place the case on record, with the
hope that I may, at some future time, add the result of
the operation thereto.
J. M , aged sixty, male ; seen in July, 1884, when
the following notes were made : Ten days ago suffered
great reduction in vision in the right eye, which has re-
mained almost unchanged since. Vision in right eye =^^7^^,
with excentric fixation, vision being possessed only in
the temporal half of the visual field. The ophthalmo-
scope shows detachment of the retina throughout the
temporal half of the fundus. Far forward in the supero-
temporal quadrant, just behind the ciliary body, is a cyst,
nearly transparent, of ovoid form, which contains (?) a
cylindrical mass, apparently about one-half of an inch
long, and one-eighth of an inch thick, that terminates in
a free, somewhat pointed extremity. Just behind the
tip, on either side, is a small black dot — hooklets — and
behind these, a slight constriction — the neck — above
which, after gradual enlargement, the tongue-like process
reaches a point so far forward that it cannot be seen.
Two parallel bands of delicate whitish tissue can be
traced from the neck up to the point at which the whole
object is lost to view. The upper part of the cyst is lost
to view at the same point. The retina, as it approaches
the cyst, assumes a wavy and
wrinkled outline, and presents a
mottled appearance, being in-
terspersed with a number of
small grayish spots (see figure).
The obliquity of the eye neces-
sary for a proper view is such as ^
to make it difficult to distinguish
between movements of the ^
globe as a whole and individual
movements of objects in its in- as seen by the ^/r^^/ method of
terior. Yet I hava satisfied my- examination,
self — as others have done — that the tongue-like process
does possess individual movements. I have observed slight
lengthening and shortening, a little lateral movement
and tremulousness of the process. The position of the
entozoon is such as to make it impossible to establish
the exact relation of parts. The junction of the neck
with the cyst-body cannot be seen, and the cyst is so
transparent that it cannot be positively said whether the
head and neck are contained therein, or whether they lie
free in the vitreous, just in front of the cyst I am in-
704
THE MEDICAL RECORD.
[December 27, 1884.
dined to think that the latter is the case ; for with the
inverted image a marked parallax can be obtained, which
not only shows considerable depth to the cyst-cavity,
but that the head and neck lie well forward, in the ante-
rior part of the cyst, or entirely in front of the cyst- wall.
3x Park Avbnub.
A NEW METHOD OF MAKING INTRAVESI-
CAL INJECTIONS, AND ITS VALUE IN THE
TREATMENT OF CYSTITIS.
By C. W. ROBBINS, M.D.,
MARINBTTB, WIS.]
Some three years ago, while practising in Milwaukee, I
was called upon to treat a case of gonorrhoeal cystitis in
a young man. The case was aggravated and chronic ; it
had already existed seven weeks, and persisted for ten
days longer in my hands without improvement with the
usual remedies and rectal suppositories. The urine
showed, on standing, a large amount of pus and mucus.
In bulk the sediment was about one-fourth of the whole
amount of urine in bottle (a four-ounce bottle full). Hav-
ing no instrument for injecting the bladder, I decided to
try a Davidson syringe and inject directly into the blad-
der per urethra. I first injected warm salt-water into my
own bladder to test the feasibility of the plan. The fluid
passed in nicely, halting only for two minutes at the
sphincter. I then, the next time my patient came, in-
jected his bladder with a solution (100° F.) of potassium
chlorate and permanganic acid, injecting ten ounces of
the fluid, without causing my patient the slightest pain or
discomfort. The patient held the fluid about one minute,
and the injection was repeated. In all, the bladder was
thoroughly washed out four times at this sitting. The
same treatment was practised the next day, and again on
the following day, with the result of curing my patient
entirely in the three days. At least all symptoms dis-
appeared, and my patient had no relapse. About that
time 1 removed from Milwaukee to the country and have
only had two similar cases to treat since, in both of which
the resulting cure was rapid and permanent; one case
being cured in three sittings and the other m five sittings.
The injection used is the one I have always used in
gonorrhoea.
As I use it |it is entirely unirritating. I use from one
to three drachms of the permanganic acid to a half-satu-
rated solution of potassium chlorate, | xvj. The perman-
ganic acid I made myself after the followingjormula :
9 • Potass, permanganate grs. ix.
Aqua destil | j.
Solve et adde
Sulphuric acid, C.P • . . . . TRiij.
This is not strictly a permanganic acid solution, but it
will do.
In this brief note I have not gone into details because
I am not at all sure that the title at the head of my paper
will hold good upon investigation.
If this method of treating cystitis is new and original,
I ask of you to give this paper space in your columns,
hoping that some of you New York surgeons will test the
treatment thoroughly.
Micrococci of Pneumonia associated with Scarlet
Fever and Diphtheria. — Dr. Lumbrosa concludes, from
the examination of four cases, and culture experiments,
that the micrococcus found in broncho-pneumonia occur-
ring in scarlet fever, diphtheria, and croup, although iden-
tical in form with that of true pneumonia, is not biologically
the same. He was never able to reproduce the disease
from the pure cultures. He believes that in infectious
diseases the pneiunonia coccus has altered properties. —
Le Progrls MhiiccUe^ October 18, 1884.
THE IMMUNITY OF THE NEGRO FROMTRA-
CHOMA,
By BENJAMIN L BALDWIN, M.D.,
BX-HOUSB SUKGBON OP THB MANHATTAM SYB AMD BAIt HOSPITAL, NKir VOK'
SUXGBON TO THB MOMTCOMBKY BVB, BAR, AMD THBOAT nfratUAIV. '
In the last issue of the Archives of Ophthalmology
there was a good paper by Dr. S. M. Burnett on "The
Frequency of Eye Diseases in the White and Colored
Races of the United States." The susceptibility and
insusceptibility of the negro race to certain diseases is
well known in the South. I will not attempt to give
a reason for this, nor could I do so in many instance!
The principal point which Dr. Burnett makes is the im-
munity which the negro enjoys from trachoma, and my
object is to add my experience to his on that subject
The city of Montgomery is the centre of the great coUon
belt of Alabama, and the country which surrounds the
city is low and flat, and the soil very rich. This peculiar
kind of soil in the South is cultivated almost entirely by
the negro, so that we have around us an immense negro
population. During the past eighteen months I have
treated four hundred and eighty cases of eye diseases
among the negroes, and I have yet to find a genuine case
of tenement-house trachoma among them. I have kept
an accurate history of all my cases, both in private and
dispensary practice, and I believe that my data are of
some help to Dr. Burnett in establishing an interesting
clinical fact. I have seen many cases of papular con-
junctivitis due to the lack of proper treatment of ordi-
nary '' sore eyes," but this is easily accounted for, as the
race is careless about such mild troubles, and medical
attention is not easily obtained in remote rural districts
in the South. I do not care to discuss the nice distinc-
tions which some analytical writers impose upon us, but
that there is a great difference, clinically, between tene-
ment-house trachoma and papular or granular conjuncti-
vitis, due to a mild, protracted inflammation of the con-
junctiva, I think, will not be denied. Dr. Burnett says:
*' If it should turn out that the negro does not suffer
from trachoma, even when the surrounding conditions
are such as usually develop it in other races, we have a
new element th^it must be taken into account in studying
that most important eye affecrion." Ah I this an impor-
tant point to look into. Has Dr. Burnett ever found the
negro living in large numbers under the same conditions
which develop trachoma among the poor white element
of our large cities ? I think here is the place we may
go astray in our statistics, if we do not reason carefully.
To my mind, the lack of trachoma among the large num-
ber of negroes treated by me is explained by the fact
that they have been among a class who have had a boun-
tiful supply of fresh air, abundant sunlight, and plenty of
exercise. Given a constitution free from any taint, widi
these elements, together with sufficient and proper diet, 1
challenge the invasion of trachoma, come what may.
My opinion is, and will be till some good argument con-
vinces me that I am wrong, that in all trachoma there is
to be found, as a fundamental cause, a dyscrasia. It is
true that the negroes of the South are poor, and they
are often found greatly crowded in their cabins ; yet these
cabins are so constructed that there is never a lack of
ventilation. I do not contend that trachoma is never
found in the negro, for I saw one case during my term
of service at the Manhattan Eye and Ear Hospital, bat
I do say that they enjoy a wonderful immunity from it,
and I will reiterate that I have yet to find a true case of
trachoma among the negroes in* my locality in the South.
MONTGOMBSY, AlA.
Hydrocele and Cysto-sarcoma Cured by Opera-
tion.— Dr. J. M. Adams, of Spencer, Wis., reports a case
of a patient, set. 38, suffering from an enormous hydrocele,
the scrotum reaching below the knee. Twelve quarts of
fluid were removed from the sac. Incisions were then
made, and a tumor attached to testes and tunica, weighing
2^ lbs., was removed- The patient made a good recovciy.
December 27, i884,]
THE MEDICAL RECORD.
705
TREATMENT OF CHRONIC HYDROCEPHA-
LUS BY TAPPING— A SUCCESSFUL CASE.
By J, G. PALMER, M.D.,
OAKBOWBRYy ALA.
I WISH to report a case of successful treatment of con-
genital hydrocephalus. The patient was a negro baby,
seven months old. I was called to see the child in July
last. I diagnosticated the case as one of congenital
hydrocephalus, and told the parents that the only hope
for cure was in tapping. To this they would not consent.
The accumulation continued until the head reached
the enormous size of twenty-six inches in circumfer-
ence— the bones of the head having become very thin
by reason of the pressure from within. There was a space
of two inches between the bones. The eyes were turned
up under the upper lids from pressure upon the brain.
In consultation with Drs. Garison and Spratling the im-
portance of tapping was urged and the parents consented.
A small hydrocele trocar was inserted at the posterior por-
tion of the anterior fontanelle, the head having first been
shaved at the place of insertion of the trocar.
The fluid flowed freely. About eight ounces were drawn
off, the trocar withdrawn, and a piece of absorbent cotton
placed over the place of puncture, and held in place by a
piece of adhesive plaster. The bones of the head were
pressed into position, and held in place by a tightly fitting
bandage.
Next day bandage, plaster, and cotton were removed,
and more fluid was allowed to drain off, though much
had done so during the night by the plaster's coming oflf
and the cotton being moved out of position. The fluid
was allowed to drain off at intervals until all was removed.
The child was then put upon iodide of potash, which
was kept up for several weeks. The eyes soon regained
their normal position. The child nursed well and fat-
tened rapidly. There were some febrile symptoms for
several days after the operation, but they soon subsided.
The head is yet big from the large size of the bones,
they being very thin. The bones seem to be rapidly
uniting, and the child is still fattening and growing.
SUBSTITUTES FOR SAYRES' PLASTER-OF-
PARIS JACKETS.
By J. W. KALES, M.D.,
FRANKUNVILLB, N. Y.
In a recent number of The Medical Record Dr. S. W.
Smith brings forward a substitute for plaster-of-Paris for
the- construction of spinal supports, and urges some ob-
jections to the use of Say res* admirable and original
apparatus. The writer having had considerable experi-
ence, and having used many kinds of material in the con-
struction of spinal supports, fails to comprehend wherein
lies the superiority of Dr. Smith's instrument. How
it could have warded off the sad termination of Case I.,
or have produced less constriction of the chest-walls in
Case II., as quoted by the doctor, is not quite clear, pro-
vided the surgeon had properly applied the plaster-of
Paris splint.
The writer has in his possession a spinal support which
was constructed four years ago, and exhibited at the July
meeting of the Cayuga County Medical Society in 1880.
This support is constructed of narrow strips of tin. It
was built over a cast of plaster-of-Paris procured in the
usual manner. Part of the strips of tin were placed
vertically upon the cast, the remainder of them horizon-
tally, and were soldered at the points of intersection. A
wire was run around the edges of the splint, thus forming
an almost exact counterpart of Dr. Smith's instrument.
This support is easily and cheaply constructed by any
good tinsmith ; is light, elastic, appears well on paper,
looks well when exhibited before a medical society, and
when lined with chamois and covered with some fine mate-
rial, as silk and lace, up in front, pleases the eye of pa-
tient and friends. But having constructed several they
have been abandoned. They are metal. The slightest
imperfection soon acts like a nail that projects through
the sole of a shoe, and it is very difficult to avoid such
imperfections. The perspiration attacks the metal, and
the oxide of iron attacks the clothing ; the patient can re-
move the splint, and soon it is relegated to the garret.
Such has been my experience with metal spinal supports.
If we are to use anything except plaster-of-Paris, we
would suggest leather. Leather splints are easily con-
structed by first thoroughly soaking the leather in water
and then stretching it over the plaster cast When dry,
remove it from the cast and apply it to the patient.
Any imperfection can then be easily corrected. Having
secured 2^ perfect "fit," finish the support by perforating
it to any required extent, line and cover it with any desir-
able material, lace it in front, attach jury mast, head-
rest, or other desirable attachment. In the writer's
hands leather has proved very satisfactory. When the
disease is located in the lumbar region the plaster-of-Paris
splints do not work as satisfactorily as when the dorsal
region is affected.
In one case where the lumbar region was seriously
affected, and Sayres* jacket, after many trials, had proved
inefficient, and where a splint constructed by one of New
York's best instrument-makers completely failed to give
adequate support, the writer applied a leather jacket.
By extending the lower edge of the jacket over the
crests of the ilia and down quite to the greater tro-
chanters, the body of the pelvis formed a fixed point of
support. This jacket has been worn for more than a
year. The patient has steadily improved, and her friends
confidently expect complete recovery.
OCTOBBR 32, 1884.
Professor Frerichs on Diabetes. — The compre-
hensive work of Frerichs on diabetes forms the most
valuable recent contribution to the literature of the sub-
ject. A summary of the author's views is given in the
Centralblatt fur die Medizinischen Wissenschaften^ No.
41, 1884. The author distinguishes three prinicpal vari-
eties of glycosuria, i. Glycosuria after poisons, which
constantly occurs after poisoning by curare, carbonic
oxide, amyl-nitrite, ortho-nitro-phenyl-proprionic acid, and
methyl-delphinin. It occasionally occiu"s after large quan-
tities of morphia, chloral-hydrate, hydrocyanic acid, sul-
phuric acid, mercury, and alcohol. Glycosuria after in-
fectious diseases is allied to the above ; e.g.^ cholera,
anthrax, diphtheria, typhoid fever, scarlatina, and malaria.
In the last-named disease it was only found once in several
hundred cases. The appearance of a copper-reducing
substance in the urine, observed by different authors after
the introduction of various substances into the body,
does not rest on the presence of sugar.
2. Glycosuria from digestive derangements. While, as a
rule, in healthy persons the ingestion of large quantities
of sugar does not cause glycosuria, exceptional cases oc-
cur, in which even small quantities have this result. Apart
from this, glycosuria is found occasionally in connection
with gastric catarrh, especially in those who inherit a gouty
disposition. It chiefly occurs during the intervals of
gouty attacks. Experiments on the introduction of sugar
in cases of phosphorus-poisoning, cirrhosis of the liver,
and portal obstruction, gave only negative results as to
the presence of sugar in the urine.
3. Glycosuria from nervous derangement This in-
cludes glycosuria after psychic excitation, neuralgia, cere-
bral disturbance, injuries of the head and spinal column,
and, finally, cerebral hemorrhage and cerebro-spinal men-
ingitis.
Diabetes mellitus is distinguished from glycosuria by
the appearance of extensive derangements of the tissue-
changes generally, which lead to general deteriora-
tion, to many local diseases, and usually to death. In
7o6
THE MEDICAL RECORD.
[December 27, ii%^
speaking of the results of diabetes, twelve cases of cure
are given. It often passes into some other grave disease
— nephritis, diabetes insipidus, arterial sclerosis, and
their consequences. But death is far the most frequent
result j and, of 250 fatal cases of the author's, 18 died
from exhaustion, 34 from phthisis, 7 from pneumonia (4
of these with gangrene of the lungs), 8 from nephritis, 7
from carbuncle, and 9 from complications (6 of these
from cancer). In all the other cases symptoms of cere-
bral paralysis appeared, in 10 from hemorrhage, in 2
from softening, in 3 from cerebro-spinal meningitis, and
in the rest from coma without local alterations within the
skull. Fifty-five cases are reported, together with their
necropsies. Passing over the causes, immediate and pre-
disposing, of diabetes, we come to the treatment, which
is not so powerless as is often assumed, for the author has
had cases under treatment for ten years up to eighteen
years, and one case for twenty years. A proper mental
and bodily diet is of the greatest importance, and mus-
cular exercise carefully conducted is most beneficial.
Milk was found unfavorable, especially Donkin's treat-
ment by skimmed milk. Many alkaline waters were
found very useful (Carlsbad, Neuenahr, Vichy), when
taken at these places. Among narcotics, opium is im-
portant, as it often lessens thirst, urine, and sugar, while
the body-weight increases. As to the experience, usually
negative, of many so-called specifics, lactic acid had no
result, and glycerine was harmful. Salicylic acid, salicy-
late of soda, and iodoform deserve further trial. All
weakening influences and cutaneous irritants are to be
avoided.
Infectious Osteomyelitis, — Dr. Rodet has found
that when the micrococci of the pus in cases of osteo-
myelitis are injected into the venous system of rabbits,
and therefore free to choose their seat, they show a
marked preference for the bones, and more especially for
those parts which are in process of active growth, where
they set up a severe suppurative or necrotic form of
osteitis analogous to osteomyelitis in man.
Sleep, Trance, and Death. — Occasionally we meet
with instances in which death is simulated by some deep
degree of stupor. The case of a laborer, living at Bridge-
water, which was lately recorded, appears to have been
one of this kind. The trance-like state developed quite
suddenly, and was mistaken by the relatives for death.
Some slight degree of warmth in the apparent corpse in-
duced the clergyman in attendance to refuse burial in
spite of the decided wish of the relatives that it should
take place. After eight days, the signs of animation were
re-established, and the subject of this singular experience
slowly recovered. In all such cases, there is an element
of mystery ; and one cannot always decide how much of
this is due to physiological or pathological conditions, or
to some external agency. The British Medical Journal,
in commenting upon the above case is led to make the
following remarks : " The relationship between sleep, *the
cousin of death,' and death itself, is probably real as well
as apparent. The distance which separates them is
great, but there are intermediate connections, grades of
dissolution as of development. Among these the similar
states of trance and hibernation are worthy of special
notice. For sleep and for trance one cause, the exhaust-
ion chiefly of nervous matter, but more or less of every
organ and tissue, is assignable. The hysterical stupor is
the sleep of nerve-centres, worn out with the assault and
conflict of stormy reflex action. Healthy sleep is the rest
of physical elements wearied with the same strain applied
more gradually. Cases have been recorded in which
somnolence, continuing for days without cessation, has
resembled tratice in its duration, while preserving all the
ordinary features of natural sleep. Various facts support
us in associating the hibernation of animals with the
same train of organic or functional changes as the other
unconscious states which we have been considering. It
comes hke a habit ; it has, one may say, annual return ;
its apparent cause is the oppression of external cold, and
the animals it affects are mostly those which, fi:om their
bodily structure or habits, are subject to great periodic
variations of temperature. Vital tissue is exhausted, and
function is in part suspended, probably because the
numbness of cold has taken hold upon the radicles of the
outer circulation, and of that of the brain-surface which
is connected with it by numerous anastomoses. In such
a case anaemia would seem to be the cause of the winter
sleep, as there is evidence to show that it is also the
cause of that temporary starvation of brain which lulls
without arresting its action, in the natural repose of each
night. We may even regard the lethargy, ended by
death, into which man falls when exposed to great cold,
as a short and mortal hibernation. The same influence
acts upon him as upon the bear or fish, but the power of
its shock is greater on his finer and less accustomed
senses than on their comparatively coarse organization.
So, likewise, in other regions and forms of life, in the weari-
ness, paralysis, atrophy, and gangrene of limbs, in the
leafless hibernation of trees, and in their decay, begin-
ning in the terminal twigs, the same teaching is evident,
that vascular nutrition, in its periodic variations, is the
parent of activity, and of rest, as its absence is of death."
Adenoma of the Liver in a Child Twenty Months
Old. — A remarkable instance of this rare disease is found
in the yearly report of the St. Joseph Children's Hospital
in Vienna. A female child had suffered for three months
with loss of appetite, emaciation, and swelling of the ah-
dompn. The right side of the abdomen was occupied by
a tumor reaching from the sixth rib to the iliac fossa, and
on a line with the umbilicus from the linea alba to the
vertebral column. Palpation showed elevations over the
surface of the liver from the size of a horse-chestnut to
that of a child's fist They appeared soft when pressed
against the resilient liver. There was also enlargement
of the spleen, and the urine showed albumen. At the
autopsy the liver was found to weigh over three pounds.
Its surface was covered with knobby tumors of various
sizes. Section showed the liver substance to be entirely
replaced, with exception of its periphery, by a soft yel-
low mass sprinkled with numerous hemorrhagic points.
It was separated from the resistant liver tissue by a thin
capsule. Connective tissue septa ran through the mass,
indicating that it had been formed from a number of con-
fluent tumors. There were, besides this large mass, tu-
mors from the size of a pea to that of a walnut scattered
over the periphery. Some were so soft that they almost
fluctuated. Careful microscopic examination showed the
growth to be an atypical adenoma. — Wiener Medisin-
ische Wochenschrift^ No. 43, 1884.
Sudden Death in Labor and Childbed. — In the
course of some remarks on the above subject. Dr. Lusk
{Journal of the American Medical Association, October
18, 1884) observes that modem pathological investigation
refers the phenomena of shock to a reflex paralysis of
the vaso-motor, and especially of the splanchnic nerves,
whereby the great mass of the blood is withdrawn from
the surface, and collects in the lar^e trunks of the coeliac,
the mesenteric, and the renal veins. Hence the skin
becomes cold and is devoid of color, save at the points
where a bluish hue is imparted by the stagnant blood
still lingering in the veins ; the muscles deprived of blood
become enfeebled ; and the empty vessels of the brain
explain the sluggish intelligence, the nausea, the vomit-
ing and the indifference of the patient ; finally, during
the diastole, the heart, pale and contracted, receives but
little blood, and the radial pulse fades to nothingness,
because a corresponding small amount of fluid is pro-
pelled during the systole into the arterial vessels. From
works on military surgery we learn that it is in the de-
feated army among homesick soldiers, at the close of a
wearisome war after great exertions and deprivations,
that shock is developed in its severest forms ; that the
finer the organization, the more readily the manifesta-
December 27, 1884.]
THE MEDICAL RECORD.
707
tions occur ; that they are promoted by sudden losses of
blood, and are in a special degree evoked by abdominal
injuries. It certainly would be singular if similar condi-
tions in childbed were not followed by corresponding re-
sults. After prolonged labor, the woman has her nervous
system depressed by pain, starvation, and deprivation of
sleep. The sudden emptying of the uterus is followed by
a recession of blood to the venous trunks of the abdomen.
Hemorrhage subsequent to parturition is followed by
syncope, and the wonder is, not that the circulation
should occasionally show the evidences of marked and
even fatal disturbance, but that the nervous system, at-
tacked from so many directions, should, as a rule, triumph
over the adverse forces. In the old days of torture,
shock often mercifully put an end to the victim's anguish.
Women in childbirth are at times subjected to pam ex-
ceeding that of the rack and the thumb-screw. Now it
is not sound pathology to ignore these facts, and to ban-
ish as unworthy of consideration a well-established path-
ological condition, simply because in the days of igno-
rance the terms exhaustion and'shock were indiscriminately
employed to explain a multitude of cases, which, with our
present enlightenment, we know are due to the entrance
of air into the circulation and to pulmonary embolism.
As the nervous organization of women loses in powers of
resistance as the penalty of a higher civilization and of
artificial refinement, it becomes imperatively necessary
for the physician to guard her from the dangers of exces-
sive and too prolonged suffering. Especially I would
raise my voice in warning against the current opinion
that the length of the first stage of labor before the rupt-
ure of the membranes is a matter of indifference, a
teaching which I believe has cost the lives of many
women ; in a few, death resulting from shock ; in more,
the exhausted condition in which the woman is left after
childbirth rendering her an easy prey to the perils of the
puerperal state. J
Lipoma of the Arachnoid. — Dr. Braubach records a
case of lipoma of the^arachnoid of the cervical cord, ex-
tending to the point of exit of the fourth and fifth dorsal
nerves. The cord was completely compressed and dis-
placed to the left side. Below the region of compression
there was descending degeneration of the ]iyramidal
columns. lipoma is very rare in this situation. Very
few such cases have been recorded : one by Obr6, one
by Athol Johnson, one by Virchow, and a case of myo-
lipoma by Gowers. The paraplegia of the lower limbs,
their anaesthesia, the bladder weakness, the extreme con-
traction of both lower extremities, the increase of their
tendon reflexes, need no comment. They depend partly
on the compression of the cervico-dorsal cord, partly on
the descending secondary degeneration of the lateral
pyramidal tracts. Of greater interest is : i. The fact
that, in spite of the extreme compression and degenera-
tion of the affected part of the cervico-dorsal cord, the
conduction through it, at any rate of intense impressions
of pain, was still retained. 2. The fact that, in spite of
the great degeneration of the compressed parts, the roots
on the right side that came off from these affected regions
showed only very slight degeneration, the roots on the
left side none. 3. The fact that the left upper extremity
could be moved as in health, without any paralysis or
contraction ; while the right arm was paralyzed and ex-
tremely contracted. The latter symptom was, doubtless,
due to the great amount of stretching of the right spinal
roots, in consequence of the displacement of the cord to
the left ; and a permanent state of irritation was present
throughout, which gave occasion to conic contraction of
the right upper extremity, — Archiv fur Psychiairie\und
I^ervenkrankheiten}^
Bony Tumor of Brain. — ^The formation of true bony
growths in the substance of the brain is believed to be of
rare occurrence. It is possible that the apparent rarity
is due to the infrequency of post-mortem examinations of
the cranial cavities of senile individuals. M. Witkowski
has placed on record some of the particulars of an ex-
ample of osseous tumor of the brain. The morbid
growth was of the size of a walnut and occurred in the
left hemisphere at its occipital part ; it was quite inde-
pendent of the pia mater or ependyma, being surrounded
on all sides by brain matter. Its shape was like that of
two pyramids set together at their bases ; its surface was
studded with a number of spicules, points, and folds, the
last of which had a certain resemblance to the convolu-
tions of the brain. The tumor was encased in a fibrous
capsule, and presented many excavations filled with
brownish or yellowish soft material, which was discovered
on microscopical examination to be of the same structure
as the marrow of hope. The fibrous capsule or perios-
teum of the tumor was composed of a dense connective
tissue, calcified in parts. After the tumor had been de-
calcified by treatment with chromic and nitric acids, a
hyaline ground substance was brought into existence, and
lamellae with bone corpuscles and Haversian canals were
to be seen. The tumor was connected with the ner-
vous substance by means of a delicate connective tissue
strewed with amyloid corpuscles. There were no other
osseous formations in any part of the central nervous
system. The brain on the same side as the tumor was
certainly more consistent than the right hemisphere, and
the microscope exhibited an increase in the amount of
connective tissue and stellate cells. The cerebral arte-
ries were extensively thickened, and many small foci of
the brain were in a state of softening. Some degree of
internal and external hydrocephalus was found, and the
ependyma was thickened. The brain was that of a man,
aged seventy-nine years, who had never shown any S3mtip-
toms of brain mischief during life. No accident could be
assigned as the cause of the formation, which does not
appear to have been an ordinary psammoma. — London
Lancet,
Fatal Puerperal Infection in the Male, — Dr.
Gandor reports this case in the Revue de M'edecine^ No. 9,
1884 : A healthy man waited on his wife after her con-
finement. The woman died of puerperal septicaemia ; the
man developed a lymphangitis, preceded by chills, simul-
taneously, in one arm and leg. Sqon all the symptoms
of septicaemia appeared, and the patient rapidly sank,
but rallied at length and made a tedious recovery. No
wound or scratch of any kind had existed on his hand or
foot to account for the origin of the lymphangitis. The
author concluded, therefore, that the case was one of
puerperal infection in the male. But he fails to explain
in what manner the poison entered the system.
The Rose-colored Eruption not Characteristic
OF Typhoid Fever. — Dr. Juhel R6noy relates in the
Archives Centrales de M^decine for October, 1884, two
cases in which the typical rose-colored eruption was pres-
ent, but in which there was no typhoid fever. In one
case there was diarrhoea and fever, but the temperature
curve was not that of typhoid, and at the autopsy no
typhoid lesions were discoverable. The author con-
cludes, therefore, that the presence of the rose-colored
lenticular spots is not necessarily a sign of typhoid fever,
since the eruption may occur in other febrile conditions.
He suggests that possibly the eruption is due to some
derangement of the cutaneous secretion.
A Point in the Differential Diagnosis of Variola
AND Varicella. — Dr. C. Bareggi withdrew a little of the
fluid contents of variolous papules and pustules, and
having made dry preparations in the ordinary way, and
stained them with methylene blue, examined them under
the microscope. He found large numbers of cocci, like
those described by Klebs as characteristic of variola.
The author was unable to find these microbes in papules
or pustules of any other origin. They were absent in
chicken-pox, which fact would tell against the theory of
the identity of varicella and variola, and might also be
of value in the differential diagnosis of these two dis-
eases.— Centralblatt fur Klinische Medicin, No. 38, 1884.
7o8
THE MEDICAL RECORD.
[December 27, 1884
The Medical Record:
A Weekly yournal of Medicine and Surgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD & Co., Nos. 56 and 68 Lafayette Place.
New York, December 27, 1884.
IS BLOOD-TRANSFUSION JUSTIFIABLE?
The history of transfusion illustrates very forcibly the
quick rise and fall in popularity of measures that do not
rest on the sure basis of exact knowledge. It is within
the memory of even the younger members of the med-
ical profession that the transfusion of blood was regarded
as one of the most important operations of modern sur-
gery. Of scarcely a single other procedure was it said
with such positive assurance that it constituted a grand
life-saving triumph of the healing art. Yet to-day blood-
transfusion is about to be relegated by unerring science
to that still extending limbo of futile, if not harmful sur-
gical interference. Professor v. Bergmann (London Med-
ical Record^ November 15, 1884) * has recently published
a critical survey of the entire subject, but more particu-
larly of the history of transfusion within the past decade.
He starts out with some general observations concerning
the commendable prevalence among physicians of habits
of keen inquiry and searching investigation. The practical
and fruit-bearing discoveries in modern medicine — espe-
cially as regards surgery — rest, he thinks,on the safe foun-
dation of biological knowledge. This is as it should be
For whenever serious medical action does not conform,
to what is really known, mistakes are sure to happen.
Transfusion shows this very well. The author recalls the
fact that centuries before physicians had any knowledge
of the circulation of the blood, they tried by this bold
measure to supply new vital fluid to the human body.
According to the then prevalent idea, blood was equiva-
lent to life and soul. Almost complete ignorance of the
true function of blood made them attribute to that fluid
all the mysterious manifestations of life.
It is not surprising, therefore, that we find in the seven-
teenth century not only individual physicians, but whole
colleges and other learned bodies, seriously discussing
the question whether a dog would get wool and horns af-
ter taking sheep^s blood, and whether the disposition of
sanguine or choleric persons could not be improved
through the agency of gentle lamb's blood. Transfusion,
it was also thought, could rejuvenate the aged. The in-
troduction of the blood of one animal into the circula-
tion of another was carried out in a variety of ways in
the eighteenth century. Experience gained by this means
showed that an animal nearly dead from loss of blood
may be resuscitated, at least for the time being. But
> Die Schicksale der Transfusion im letzten Decennium. Berim, 1883.
human transfusion was rarely done until about the second
half of our century, when for a short period it suddenly
rose to rather startling frequency. The operation was
not confined to cases of sudden loss of blood. On the
contrary it was often performed for all kinds of acute
and chronic diseases. Patients were also bled to rid
them of vitiated blood, and thus prepare them for the in-
troduction of healthy fluid. Pulmonary and renal affec-
tions, dyspepsia, pyasmia, typhus, and cholera were treated
by this method. No wonder, then, that grave mistakes,
often fatal in their consequences, soon brought transfu-
sion into discredit.
In 1859, its successful employment by Martin, of Ber-
lin, in lying-in cases, once more revived its popularity,
until about ten years ago it was looked upon as a univer-
sal panacea for the greatest variety of human ailments.
But to-day this kind of unstinted enthusiasm has died a
natural death. The more or less complicated apparatus
of the transfusionist has been quite generally set aside.
Perhaps it will soon be found only among the historical
relics of a past era in medicine. Certain it is that we
know much more about haematology than we did even a
few years ago. And the mistakes that have been asso-
ciated with the practice of transfusion arc not likely to
be again repeated.
In any great and sudden loss of blood, the arterial
blood-pressure sinks so low that the movement of the
blood is stopped. F or a time the heart still works on, but
ineffectually. It is like an empty pump, and ceases to draw
and propel the column of blood. In the vascular system
there is stagnation. Were the blood which the vessels
still contain put again into motion, it would be sufficient
to support life. Hence, as Kronecker first pointed out,
in such cases a simple infusion of a saline solution is
sufficient to save life. By this means the contents of the
vascular system become increased in volume. This in«
tensifies the intra-vascular pressure and re-establishes the
working of the heart. Now we understand why in so
many cases transfusion has saved life ; why Lower's and
Boyle's rudimentary experiments on dogs were success-
ful. What was required was to fill the elastic tubes of
the vascular system with fluid, not necessarily with blood.
Again, after considerable loss of blood the proportion
of blood-corpuscles remaining in the blood becomes less
and less, and for a variable time after the bleeding has
ceased the diminution still goes on. Subsequently to
the transfusion of a large quantity of blood the blood-
corpuscles seem to be increased, but only for a rime.
Very soon their number diminishes, while the urea and
alkaline elements of the urine, and the deepened color of
the latter, betoken the ruin and disintegration of the
blood and its corpuscles, which have been conducted in
excess into the system.
The scientific study of the subject was much advanced
by the counting of blood-corpuscles, but even more so
by the results of the direct transfusion of animal blood
Supported by the apparently remarkable cures of Hasse,
it quickly became a favorite measure. It seems scarcely
credible how tenaciously physicians clung to this form of
the operation even up to the close of the last decade.
After every transfusion with lamb's or dog's blood, the
patients develop a series of morbid symptoms. First there
is dyspnoea, followed by a feeling of being over-full, then
December 27, 1884.]
THE MEDICAL RECORD.
709
sickness, and afterward sinking and uncontrollable stool-
pressure. There are also headache, dizziness, and even
short periods of unconsciousness. From ten minutes to
an hour after the transfusion a chill will set in, often in-
creasing to a violent shivering fit, then a stage of heat,
with very high temperature. The haemaglobinuria al-
ready mentioned is the direct result of the dissolution of
red blood-corpuscles. We can scarcely understand • to-
day how many observers, in the face of such serious dis-
turbances, could disregard the manifold dangers of trans-
fusion with foreign blood. Their only apparently justifiable
reason seems to have been, that one case after another
of transfusion with lamb's blood seemed to be successful,
or more correctly speaking, that the patients did not
quite die.
The injurious effects of transfusion with foreign blood
were attributed by Prevost and Dumas to the unequal
size of the blood-corpuscles in different kinds of animals.
As the blood-corpuscles of a sheep are smaller than
those of man, they were considered harmless. To Pon-
fick must be given the credit of showing how erroneous
this was. It is not the mechanism of the different-sized
corpuscles that makes foreign blood injurious, but rather
important chemical changes, which, when a certain quan-
tity is transfused, makes the blood of a sheep a deadly
poison to a dog, and vice versa. A complete answer
has been given to the question as to what the harmfiil-
ness of foreign blood consists in. And henceforth, v.
Bergmann thinks, this kind of transfusion should disap-
pear from the stock of surgical remedies.
Long before Panum pressed upon the attention of phy-
sicians transfusion with defibrinated blood, Magendie had
found by his experiments on animals that su;:h blood
caused decided disturbances, such as quick breathing,
diarrhoea with tenesmus, and bloody effusions into the
peritoneal, pericardial, and pleural sacs. Accordingly,
he warned the profession against its use. It is easy to
understand why physicians did not altogether follow him,
because in direct transfusion there are the namerous
risks of coagulation attending the use of syringes and
canulse. Virchow, in his work on " Thrombosis and Em-
bolism," did not in connection with transfusion set forth
these dangers, or else he under-estimated them. At the
present moment, they form the principal objection to
the only permissible form of blood-transfusion, namely,
that with human ];)lood intact.
The idea of plethora with increased blood-pressure
after transfusion for the cure of certain diseases gave
rise to the practice of bleeding the patient before the op-
eration. Especially in treating septicaemia in this way,
a large quantity of blood was taken from the patient in
order that it might be replaced with new blood ; doubt-
less a double injury to the patient, first by the blood-let-
ting, and secondly by the transfiision. These operations
nearly always proved fatal. But, at any[rate, they showed
the non-existence of increased blood-pressure as a cause
of the fatal ending.
Whenever transfusion with blood has saved life, it has
done so by starting a sluggish or stagnating blood-cur-
rent to quicker motion, and not through any reviving
respiratory action of the blood-corpuscles. It is owing
to two things that transfusion has often passed off with-
out danger, and has even been endured without much
disturbance. The first is the small quantity of blood,
usually not much exceeding one ounce, that was em-
ployed. With this they tried to cure phthisis, chlorosis,
and chronic intestinal catarrh. The second is the power
of resistance of the organism against the effects of the
fibrine-ferraent. If, however, transfusion carries with it
grave dangers, we are forced to the conclusion that we
are on the wrong track. All that can be effected by the
operation can be effected by other and simpler means,
namely, by infusing into the veins a solution of common
salt It has been established by numerous cases that,
when transfusion of a solution of common salt is used it
revives the patient and causes the heart to beat. It is
conceivable that a patient may be revived by something
injurious. But if it can be done by something that is
harmless, we should welcome the latter. There is only
one kind of blood-transfusion that can really be justified :
the transfusion of blood from the artery of one man di-
rectly into the vein of another.
Experiments have been made to convey fluids to the
blood by other means than transfusion. But they have
proved barren of lasting benefits. Thus, when it became
known that fluids are sometimes rapidly absorbed by the
peritoneum, the attempt was made to replace transfusion
by flooding the peritoneal cavity with defibrinated blood..
The lymphatics seemed%to eagerly absorb notable quan-
tities of it. But haematic icterus resulted, and the urine
soon showed the presence of uro-obilin. Intraperito-
neal transfusion is, therefore, unjustifiable.
If we accept v. Bergmann's teaching, and certainly he
makes out a strong case, it would seem that blood-trans-
fusion is really a thing of the past. On the other hand,
the introduction of some saline solution into a vascular
system threatened with profound stagnation, would be a
substitute that is free from the manifold dangers insepar-
able from the older method of transfusion.
THE ATTACK UPON DR. FORDYCE BARKER.
It is witli the profoundest regret that we chronicle the
proceedings of the New York Academy of Medicine of
last week. The wanton attack upon the venerable
President furnished an exhibition of impotent spite and
stupid malevolence quite without parallel in the medical
annals of this city. A distinguished physician, who has
practised his profession blamelessly for thirty years, whose
high qualities of character have drawn about him an
ever-increasing troop of fiiends, whose professional at-
tainments have won for him the most ^distinguished
honors at home and abroad, who has been justly looked
upon as one of the best types of American physicians,
and who in his later years has, by self-sacrificing and
assiduous efforts, raised the Academy of Medicine to be
the foremost medical society of the country — this man is
at last made the victim of a baseless charge that he has
been a life-long hypocrite, that he is not legally a doc-
tor ! The infinite pettiness of mind which could trump
up these accusations, so easily proved false, is quite past
comprehension.
Neither can we understand how men, who have been
posing as representatives of a high professional morality,
should so [blindly give the lie to their pretensions by
devising and giving publicity to a contemptible slander
yio
THE MEDICAL RECORD.
[December 27, 1884.
upon a brother physician ; for it is not alone that the
character of Dr. Barker was impudently assailed— that
gentleman has been too long known and too widely
honored to be harmed by the slander brought against him —
but the profession itself has been injured by the publicity
given to a disgraceful and unnecessary quarrel.
The medical profession at large will hear and judge
who best represents the true standard of professional
honor. Dr. Fordyce Barker or those who have again so
wantonly fomented discord, excited bitterness of feeling,
exposed our dissensions to the world, and maliciously
attempted to injure a physician than whom no one more
deserves to be honored at our hands.
THE THERAPEUTICAL VALUE OF ELECTRICITY.
Two papers of interest, by Dr. Hughes Bennett and Dr.
W. E. Steavenson, respectively, were read at the last
meeting of the British Medical Association. They treated
of the somewhat hackneyed subject of electro-thera-
peutics, but the points made in them and the discussion
which followed drew out some thoughts which deserve
attention. They showed for one thing that in England
as in this country the general practitioner knows very
little about electricity, and does not trouble himself with
ij much in his daily practice. Further, Dr. Steavenson
expressed the opinion that the cost of an electro-thera-
peutical "plant," the expense of keeping it in order, and
the time occupied in applying electricity would in time
throw a large part of electro-therapeutical work into the
hands of specialists, or of electricians who would rank
with cuppers and masseurs, doing just what was directed
and no more.
Such an arrangement will be slow to occur in this
country because, even if it were desirable, our sick pop-
ulation is too scattered to support " electricians," except
in the large cities.
Nevertheless, there is unquestionably a tendency in
this direction of electro-therapeutical specialization.
Physicians in general practice, who have batteries, and
who know perchance how to use them, are generally too
busy to make applications as they should be made. A
call of ten minutes must be extended to half or three-
quarters of an hour, and his patient will not pay him in
proportion to the time expended. The consequence is
that nine out of ten of the medical batteries of the gen-
eral practitioners throughout the country are at the pres-
ent moment rusting in the closet, the fluid evaporated,
and the zincs eaten up.
But there is a wide-spread belief among the commune
vulgus that " electricity is life.'* The buzz, the thrill,
and the flashes of the battery sustain this biological con-
viction, warm the imagination, and excite confidence and
hope, even if they do not really cause a cure. The
doctor must often have a battery to satisfy his patient ;
and he can actually help him by its psychical effects.
There is probably a steady increase in the use of elec-
tricity among American physicians. Instrument-makers
inform us that they sell more batteries every year. An
intelligent knowledge of what electricity will do has not,
however, kept pace with the highly profitable industry of
making and mending batteries.
Consequently electro-therapeutics in the hands of
many touches on the borders of charlatanry. The claims
made for it, even by reputable physicians, are often pre-
posterous. Absurd theories as to its action are ad-
vanced, and its practical applications are made without
discrimination or skill.
Those who have written most carefully and conscien-
tiously upon electro-therapeutics have shown that its
usefulness is more limited than was first believed, but that
within its limits it has a remedial power which is un-
equalled. Scientific investigation has also shown that
electricity in diagnosis gives us a precision and help at-
tainable in no other way ; and electro-diagnosis'is a field
which charlatanry does not care to touch.
In practical medicine electricity is of most value as a
counter-irritant, a mechanical stimulant and a general
tonic. In rheumatic pains and certain forms of neural-
gia and in functional asthenic states it does its best work.
In paralysis it is a mere symptomatic remedy, much over-
rated, and generally disappointing. Its power to modify
in the slightest degree organic cerebro-spinal diseases is a
thing still subjudice.
The teachers of medicine in our medical colleges are
generally men who are too busy to use electricity, and
consequently they know little about it, even its diagnostic
value. It would be a wise thing for the colleges to give
more of practical instruction regarding the subject, if only
to warn students against in future *' listening with cre-
dulity to the whispers of fancy or pursuing too eagerly
the phantoms of hope."
Successful and honest electro-therapy means an Ex-
penditure of money, time, and skill.
Dishonest, though perhaps successful, electro-therapy
means the indiscriminate buzzing of a vibrator in the ears
of every credulous and hypochondriacal visitor.
THE VALUE OF LOCAL MEDICAL JOURNALS.
A Southern contemporary complains that Southern men
subscribe for Northern journals, but that Northern men
do not subscribe for Southern journals. Granting that
this is true, we would say to our Southern brother that
men will go where they can get the most and the best for
their money, and that no complaints or grumbling can
alter the law of supply and demand. Medicine is a cos-
mopolitan science — it knows no South or East or West
The human race is one, and the laws governing its dis-
eases are the same everywhere. An inflammatioD, a
cancer, a colic, affect alike Hindoo, Hottentot, and, in
all respect, our Southern medical editor. The true phy-
sician, therefore, will encourage whatever tends best to
help along his science and art, and will not hamper
progress for the sake of gratifying local pride.
At the same time, we fully believe in the great value
of local medical journals, and would urge their generous
support (if they are worthy) by the profession. For it is
true that somewhat different diseases prevaU in one
country from those in another, and that race, climate,
and other factors may modify slightly the physiognomy
of the same disease. Local journals may be of service
in interpreting these differences. But, more than that,
the local medical journal has an important function in
uniting the physicians of a State, in making them known
to each other, and in organizing and helping forward
movements for the improvement of the profession.
If our contemporary would ask for support upon
December 27, 1884.]
THE MEDICAL RBCORD.
711
grounds such as these, instead of appealing to sectional
prejudice and complaining of others' success, it would
doubtless receive, and would certainly deserve, a hearty
response.
THE NEW YORK ACADEMY OF MEDICINE.
It must now be apparent to all that hostility to this most
important institution has been nearly as strong a moving
force in causing the recent attempt of a half-dozen mal-
contents as the bitter hatred of its President. Very
many who were dragooned, by specious pretence and
plausible fallacies, to attend the meeting of the Academy
in April, 1883, and vote for a measure which would have
stopped its work and its usefulness, from the conviction
that they were thus doing their best to maintain the
National Code, have expressed not only their regret but
their deep disgust, when they have come to see that they
were not working for principle but for the gratification
of personal malice. The few words from the President,
on resuming the chair, tell the whole story, and were so
devoid of personal feeling, and in such excellent taste,
that we deem them worthy of being again repeated in
this connection : ** The Academy will now resume its
scientific work, which it has so zealously, efficiently, and
harmoniously carried on for thirteen months, until now
interrupted by this supreme effort to elevate the char-
acter of the medical profession."
THE MEDICAL PROFESSION OF THIS CITY.
The question is often asked by those from other parts of
the country, *' How is it that such fights axh going on in
your city, which shock us who do not comprehend them ?
There is the same diversity of opinion in regard to the
necessity and utility of the National Code as with you,
but it has never assumed such proportions as with you.
It does not break personal friendship, nor do any of us
think that sound ethics, the honor of the profession, or
its standing in the community, can be best promoted by
personal abuse, detraction, or calumny." Some good
always comes out of evil. The reproach will now be
wiped out. The audacity of four or five, in assuming to
be leaders of the City and State in all active movements,
speciously but avowedly for the support of the National
Code, has now shown them to be the most notorious and
conspicuous violators of its spirit. The President of the
Academy has, and always has had, as warm friends in this
city among the avowed advocates of the Old as of the
New Code. In other cities and other parts of the coun-
try it is probable that a majority of the prominent men
in the profession, who are his friends, are pronounced
advocates of the Old Code. The mask of honest pur-
pose has now been torn away from such dangerous
leaders, and the true visage of implacable, unrelenting,
and unprincipled malignity has been revealed in all its
hideousness. We feel assured that among the two
thousand (?) physicians of this city and Brooklyn not
fifty can be found who are not in hearty accord with this
view.
It is, perhaps, worthy of mention that not one of the
leaders in the recent events, which have so stirred the
profession of this city, is known as an active, much less
as a prominent, practitioner of medicine.
BELLEVUE HOSPITAL MEDICAL COLLEGE.
The announcement of the Faculty of this College for
two years past has conspicuously inserted this sentence :
** The standard of Medical Ethics recognized by the
College is embodied in the Code of Ethics of the Ameri-
can Medical Association."
No other colleges, so far as we have noticed, have felt
it necessary thus to advertise their goodness. It was a
novel bid for students. As a matter of taste, it seems as
absurd as it Would be for a lady of good social position
and unblemished character to inform all that she met
that she was virtuous.
It was undoubtedly believed to be a politic move ;
whether it has proved so or not can only be determined
by comparing the number of students of two years past
with the number the two years before, and also compar-
ing these numbers with those in the two other colleges
of this city during the same period.
But the question is now asked, whether this standard
is intended to apply only to students, or is to have equal
force in regulating the Faculty. Tacit acquiescence in
the conduct of one of their number, who, by his extraor-
dinary and unparalleled efforts as a volunteer police
detective in a foreign country, obtained a kind of nega-
tive evidence which would never have been admitted 81
any court of law in proof of a charge, but would, if not
refuted, have a kind of moral force to tarnish the reputa-
tion of another member, who is at least the peer of any
member of the Faculty, will answer the question. If the
Faculty are in doubt in regard to the matter, they may
perhaps study with profit a very able commentary on
Ethics by another of their number, which first appeared
in the New York Mediccd Journal^ and was afterward
published in a separate volume.
THE FIRST TOTAL REMOVAL OF THE CEREBELLUM
IN A DOG.
Professor Luciani has succeeded, by infinite care and
the strictest application of modern surgical principles, in
totally removing the cerebellum of a dog without destroy-
ing life. This single success seems likely to sweep away a
world of carefully built hypotheses regarding the function
of the cerebellum. During the stage of healing and irri-
tation incoordination symptoms appear, similar to those
usually observed in birds. As recovery advances, how-
ever, these disappear, and a kind of muscular asthenia or
loss of tone takes its place.
The experiment confirms apparently the views of Her-
bert Spencer, Jackson, and Ross, as to the ** tonic " in-
nervation of the muscles by the cerebellum.
The description of the effects of the operation is well
given in the British Medical Journal^ which says :
'< When healing is finished, the so-called inco-ordination
(contractures and pseudo-paralytic debility) disappears,
the animal can walk for longer and longer distances with-
out falling. What strikes the observer is the deficient
proportion, firmness, and tone of the individual muscular
contractions, and their want of fusion ; in a word, a kind
of 'cerebellar ataxy,' difficult to describe accurately.
This disorder of the movements is not, as the ' inco-ordi-
nation ' of the first period, sufficiently serious to prevent
the animal from effecting its various voluntary acts ; and.
712
THE MEDICAL RECORD.
[December 27, 1884.
upon closer investigation, resolves itself into a kind (not
of paralysis nor paresis, but) of motor ' asthenia.' For
instance, if, instead of walking, the dog were made to
swim in a pond, then its movements were perfectly nor-
mal Not the least sign of want of equilibration was no-
ticeable ; the four limbs acted with ease, the animal being
propelled in the water just as it had been noticed to do
before the operation, showing a full co-ordination and
adaptation of the individual movements necessary to the
performance of the action. But, on arriving at the edge
of the pond, the dog was unable to get a footing, in spite
of its efforts. Professor Luciani lays stress upon the
great difference between the normal behavior of the dog
while swimming, and its disturbed motility when perform-
ing acts requiring a greater development of muscular
energy ; and concludes .that the * cerebellar ataxy ' just
described, is merely a manifestation of a kind of motor
asthenia, that is to say, of the insufficient muscular tone,
or influence exercised by the nerve-centres upon the vol-
untary muscles."
THE ALLEGED "VACCINE" AGAINST YELLOW FEVER.
The Daily Times gives as news some account of the dis-
coveries of Dr. Domingos Freire regarding the discovery
•f a yellow fever germ and yellow fever vaccine ; and
our contemporary wonders why the discoveiy does not
attract more attention. Some of our medical contem-
poraries have also been heralding the discovery as some-
thing very new. The fact is, however, that Dr. Freire
wrote a very full account of his work to the Sanitary
News several months ago, and long before M. Bouley
presented the subject to the Academic de M^icine. At
an earlier time we gave an abstract of his conclusions,
and added the opinion, which we still hold, that Dr.
Freire has yet to win a reputation as a trustworthy ob-
server. Some of his previous " discoveries " in bacteri-
ology have turned out to be no discoveries at all.
THE \. C. E. MIXTURE, NITROUS OXIDE, AND ETHER.
In one of the periodical discussions upon anaesthetics
which recently took place before the London Medical
Society, some more than ordinarily useful facts and con-
clusions were drawn out. These may be formulated as
follows :
First, — British surgeons are giving up the routine use
of chloroform, except perhaps with children.
Second, — The A. C. E. mixture was shown to be safer
than chloroform, and almost as safe as ether, while more
convenient. This mixture is composed of one part, by
measure, of alcohol to two parts (measured) of chloro-
form and three of ether. This mixture should be made
afresh just before being required for use. A drawback
to its employment, though a small one, is that, in prac-
tice, it is found to act a little less rapidly than chloro-
form in the production of insensibility. It requires no
complicated apparatus for its use, being doled out drop
by drop on a napkin ; and, as an accumulating experi-
ence of many years in several metropolitan hospitals
appears to testify, it is superior in point of safety for
adult patients to chloroform alone. The exhilarating
effects of the three parts of ether appear, in practice, to
counterbalance the properties of the two parts of chloro-
form as a cardiac depressor.
One surgeon, Mr. Estes, uses chloroform for young
children and the A. C. E. mixture for persons between
the ages of six and eight and sixteen and eighteen.
Third, — For safety no anaesthetics equal ether and
nitrous oxide.
Fourth, — For both safety and rapidity, no other anaes-
thetics equal nitrous oxide gas and ether given together.
The only objection to this combination appears to be
connected with the apparatus that has to be employed.
It is bulky, and demands a larger initial outlay than
practitioners throughout the country, who seldom require
to administer ansesthetics, would be disposed to incur.
Still, for all who can employ them, nitrous oxide used
with ether possess advantages not found in any other
single anaesthetic agent, or combination of agents, at the
present day known.
%zms tit titje '^SSLtt\i.
Medico-Legal Science in New York City.— At the
last meeting of the New York Medico-Legal Society,
Professor R. Ogden Doremus was elected President
At the last meeting of the Society of Medical Jurispni-
prudence. Dr. Frank H. Hamilton was elected Presi-
dent. Both of these Societies have been working hard
during the past year, and have succeeded in attracting a
good deal of attention to medico-legal subjects. The
Society of Medical Jurisprudence is the result of a pro-
test against, 'and a " bolt " from, the Medical-Legal So-
ciety and its management ; and is hampered only by its
youth. The Medico-Legal Society has been seriously,
if not irretrievably, injured by the fatuous ambition of a
lawyer who seems to have no other aim in life than to be
its president and manager. It is much to be hoped that
under Professor Doremus the Society may regain some
of its lost prestige.
AsEPTOL, A New Antiseptic, says M. E. Transer, has
for its scientific name orthoxyphenyl — sulphurous acid
It is an acid phenol, capable of neutralizing ammoniacal
bases. It is said to be preferable to phenol as an anti-
septic, because it possesses the decided advantage 0!
not being poisonous.
In the Death of Dr. Edward Jarvis, which oc-
curred recently, in the eighty-first year of his age, the
medical profession has lost one of its most useful and dis-
tinguished members. From an interesting account of
his life in the Boston Medical and Surgical Journal^ we
learn that Dr. Jarvis was one of the members of the Cor-
poration of the Perkins Institution for the Education of
the Blind ; he was Superintendent of the School for Fee-
ble-Minded Youths ; Trustee of the Worcester Lunatic
Hospital; Consulting Physician to the New England
Hospital for Women and Children, and for nearly a third
of a century President of the American Statistical Asso-
ciation. Dr. Jarvis was the earliest petitioner to the
Legislature for a State Board of Health. He labored
year after year, early and late, for its establishment, and
he did his best to support it by zealous work. His enu-
meration of the insane in Massachusetts (Report of 1354),
December 27, 1884.]
THE MEDICAL -^RECORD.
713
his essays on political economy, social science, and sta-
tistics, and his valuable contributions i to the United
States Array Reports, gave him well-deserved reputa-
tion as a statistician in this country and in Europe. As a
kind-hearted citizen and philanthropist. Dr. Jarvis was
ever ready with sympathy and help for every person and
good cause that needed them, and his public spirit was
shown to the last in the gift of his valuable collection of
books and reports to Harvard College, the American
Statistical Association, and the public libraries of Con-
cord and Boston. He also gave $500 each to Harvard
' College and the Statistical Association.
The Ohio State Sanitary Association holds its
second annual meeting at Columbus, O., February 5
and 6, 1885. The Secretary is Dr. R. Harvey Reed, of
Mansfield.
Antipyrin is said to be the most popular of i *w
antipyretics, and has been the one most imported.
The First Enucleation of the Eye Under Co-
caine.— Dr. S. A. Hazen, of Youngstown, O., writes that
Dr. Davis, of the same place, enucleated an eyfe under
cocaine about the first week in December^ and was the
first to perform that operation with the help of the new
anaesthetic »
Cultivation op Leprosy Bacilli, and Vaccina-
tion FOR Leprosy, — We learn from California exchanges
that Hawaiian physicians have been studying the para-
sitic origin of leprosy. Experiments are being carried out
with the bacillus, and an efifort has been made to culti-
vate it, so that vaccination for leprosy may be practised.
An experiment is now being tried in the case of a con-
demned criminal, who has been inoculated, and whose
case will be carefully studied, in the hope that something
definite may be learned concerning the dread disease.
So much attention has been given to the subject in Hon-
olulu, and the disease is spreading so fast, that the white
Ix>pulation has become aroused to the necessity for
doing something to protect themselves.
Death op Dr. Charles Clay, one of the Revivers
OF Ovariotomy. — We learn that Dr. Charles Clay, of
Manchester, England, has recently been stricken down
by paralysis at the age of eighty-three, and is not ex-
pected to live. Mr. Lawson Tait writes of him : " So
far as has yet been discovered, the first ovarian tumor
removed in England was by the hands of Dr. Charles
Clay, on September 27, 1842 ; all others, with the ex-
ception of one by Houston, and another by Lizars, in
Scotland, were clearly parovarian cysts. In 1843 ^^*
Aston Key removed both ovaries, and Mr. Bransby
Cooper also tried the operation in that year, but it was
not till 1844 that there was a successful case in London,
operated on* by Dr. Frederick Bird, followed by one in
the practice of Mr. Lane. In the provinces, however,
many successful cases had been done. In June, 1848,
X>r. Charles Clay published a series of 32 cases with 10
deaths, and in 1857 he had completed 77 cases with 24
deaths, and he continued to operate for many years, un-
til he had performed 395 operations, with 10 1 deaths,
his total mortality being fractionally above twenty-five per
cent. The only revival of ovariotomy which Sir Spencer
Wells can lay any claim to, is after its temporary decad-
ence for two and a half years in London in the hands of
Mr. Baker Brown ; and even upon this point the evi-
dence is by no means satisfactory. But if it is to be con-
tended that, firom the time of McDowell till 1857, there
was nothing done in ovariotomy, and that the revival
took place in that year at the hands of Mr. Spencer
Wells, I say it may as well be claimed for him that he
revived the moon. To Dr. Charles Clay is due the
credit of having established ovariotomy in England, and
carried it through its early struggles. His practice was
a mistaken one in the use of the long ligatures, but its
results were certainly no worse than those obtained by
the clamp. Dr. Clay, unfortunately, did not know of the
results obtained by Nathan Smith from the use of the
short ligature. Had he done so, abdominal surgery
would have been half a century in advance of its present
position, for then it would have been impossible for the
clamp ever to have made its appearance. Baker Brown
re-introduced Nathan Smith's principle, and Keith has
brought it to perfection."
The Therapeutic Effect of Prayer. — Dr. L. A.
Wohlfarth,.in the Medical Index^ reports a very excellent
result from prayer. His patient was a woman who, two
weeks before, had been delivered of a child. She suf-
fered from great mental excitement and a delusion that
she must die. He says : ** Acting on a hypothesis of
psychological therapeutics, and thinking that a ' prayer '
offered by an old, respected, and much desired friend
like Mr. Davis, possibly might have a salutary influence
on a diseased mind to dispel the ^ notion of dying,' ac-
companied by Mr. Moses, I called on Mr. Davis and
requested him to see Mrs. Thomas, and ' if occasion
should offer,' to give prayer, but to formulate the lan-
guage of his prayer in a hopeful and inspiring tone. The
old gentleman consented, and at my next visit I found
the result of his * prayer ' almost miraculous. The * no-
tion of dying ' had nearly left my patient.; she was doing
well The puerperal mania was cured, but the patient
subsequently died from hypostatic pneumonia."
Fewer Medical Students. — Reports seem to show
that in most of the larger medical colleges the number
of students this year is somewhat below the average. If
this is a fact, it is to be attributed to the hard times, and
to the very universal opinion among non-teaching doctors
that there have been too many students in the past.
Suicide of a Physician accused of Malpractice.
— Vienna medical circles are excited over the suicide
of a Dr. Spitzer, who was charged with maltreatment of
a case, his applications to an injured limb having ap.
parently been the cause of acute gangrene. During the
course of his trial, Dr. Spitzer disappeared, and his body
was subsequently found in the Danube.
Renal Calculus Caught in the Urethra, Reten-
tion OF Urine, Convulsions, Urethrotomy, Cure. —
Dr. E. D. Coonley, of Mariner's Harbor, Staten Island,
was called to see a boy, aged twelve, suffering from severe
pain in the side. An opiate was given and relief followed.
Three days later the doctor was called again and found
the boy in convulsions and apparently dying. He had
not passed water for two days. An obstruction was
found in the urethra near the junction of the scrotum and
perineum. External urethrotomy was performed, and an
ovoid uric acid calculus, weighing 13 grains, was extracted.
The boy recovered.
7H
THE MEDICAL RECORD.
[December 27, 188^
^epoxts of ^ocUtUs.
NEW YORK ACADEMY OF MEDICINE.
Seated Meetings December 18, 1884.
FoRDYCE Barker, M.D., LL.D., President, in the
Chair.
The President appointed Drs. H. D. Nicoll aiid S. F-
Morris, who, with the Assistant Secretary, shall cunstitute
a Board of Inspectors at the next annual meeting, to be
held January 15, 1885, the first Thursday in the month
falling on the first day of January.
The President then called Dr. R. F. Weir, First Vice-
President, to the Chair.
Dr. Weir announced as*the next order of business
REPORT^ OF THE COMMITTEE ON ETHICS, ON CHARGES
PREFERRED AGAINST A FELLOW.
Dr. Ellsworth Eliot remarked that it had been
customary, and moved that the hearing of the report be
postponed until after the scientific business of the even-
ing. Lost.
Dr. W. T. White said it had been customary, and
moved that the Academy go into executive session, which
would exclude the representfitives of the daily press that
had no right to the proceedings, and also remove med-
ical students and others who had no right to participate.
Dr. E. D. Hudson, Jr., opposed the motion on the
ground that one side of the question, namely, that pre-
sented by the accusers, had already in some mysterious
way, perhaps not so mysterious after all, found publication
in some of the daily papers, and now all the proceedings
should be open and above board The Academy should
not countenance any *• star-chamber" inquiry.
Dr. F^ V. White favored an executive session because
it was improper for the Academy to wash its " dirty linen"
in public, and besides it was contrary to the spirit of the
by-laws and constitution of the organization.
The motion was put and lost.
Dr. Andrew H. Smith, Chairman of the Committee
on Ethics, then read the unanimous report of the Com-
mittee, reached as the result of repeated sittings con-
ducted with all possible precautions at every step of the
entire investigation. It was that the charges against a
Fellow, of having claimed a degree of M.D., which he
never possessed, and of having falsely signed his name
upon the signature book of the New York Academy of
Medicine, also upon the register of physicians at the
office of the Clerk of the County of New York, in 1880,
and at divers times and places, were unsustained, the
Committee finding them to be without foundation and ab-
solutely untrue.
The report was signed by the Chairman and the other
members of the Committee, Drs. V. P. Gibney, C. A.
Leale, H. E. Crampton, and C. D. Varley, Secretary.
The report was received with immense applause, and
was accepted and adopted without a dissenting voice.
Dr. C. R. Agnew moved that the report of the Com-
mittee of Ethics be spread in full upon the minutes of
the Academy. Carried.
Dr. J. W. Howe remarked that it appeared from the
report of the Committee that the signature of the accused
in the book of signatures of the Academy had been tam-
pered with, probably falsified, and he therefore moved that
a Committee of Three be appointed by the Chair to inves-
tigate with reference to the source of the mutilation of
the records, and to report to the Academy. Carded.
The Vice-President announced that he would ap-
point the Committee subsequently.
Dr. John C. Peters directed attention to the point
that it was the duty of the accusers to have complied
with the by-laws, first notified the accused that the charges
were to be made, and then called for a court medicale^
in which efforts could be made to adjust the differences
by arbitration ; that only when efforts had failed in this
direction to accomplish the desired end, were the accus-
ers justified in t)ringing the subject before the Academy.
He therefore moved a vote of censure for the accusers
because they did not observe the rules of professional
courtesy laid down by the State Medical Society and tbc
by-laws of the Academy.
Dr. Roosa moved to amend by asking the Fellows
who signed the charges to send in their resignations.
Dr. Peters accepted the amendment
Dr. Jacobi was willing to vote to censure the Fellows
who signed the charges, but was not ready to vote for
Dr. Roosa's amendment, which, if carried, would be
practically an expulsion.
Dr. Wylie thought it perhaps not exactly fair to ask
all the Fellows who signed the charges to resign.
Dr. Poolev moved as an amendment that the Fellows
who signed the charges be expelled.
Dr. Henry supported Dr. Pooley's amendment with
a vigorous speech, in which he claimed that not a sod-
tilla of testimony had been adduced by the accusers
which would be admitted as evidence in a court of law,
and that every one, from the giant of the outrage to the
babies who signed with him, deserved expulsion. There
was not a club or association of gentlemen anywhere in
the world that would not expel any member for the
same offence, and without another word being said io
their condemnation other than that which nad appeared
in the most admirable report of the Committee.
Dr. J. C. Dalton thought that after hearing the ohd.
plete, thorough, and exhaustive report of the Committee
on Ethics, the Fellows should be satisfied that the ques-
tion had been set at rest. The report was exactly what
the Academy wanted, and he felt that the Fellows should
be content to adopt the report, because they could net
have anything that was better, and it was very easy to
have something worse. He therefore moved to lay upon
the table all the motions and amendments offered after
the unanimous adoption of the report.
The President was allowed to say that he most
heartily approved of the sentiments expressed by Dr.
Dalton; that he felt satisfied with the action which tiie
Academy had taken, and that he thought it would bcm-
jurious to resort to any extreme measures.
The motion and the amendments were then withdrawn,
and the Academy proceeded widi the regular order of
business.
The President, on resuming the chair, said : ** Heie
endeth the second lesson. The Academy will not
resume its scientific work, which has been continued har-
moniously for thirteen months, until interrupted by tte
supreme effort to elevate the character of the medial
profession."
At the request of the author, the reading of Dr. Gis^
par Griswold's paper on " Electricity as a Cardiac aixl,
Respiratory Stimulant," was postponed until some fiitare
meeting.
Dr. a. M. Jacobus introduced the following rcsota-
tions, with a preamble, which were adopted.
medical education and a state board of EXAMnfBi
Resolved, That the Committee on Medical EducaW
of this Academy be instructed to inquire into the quoaij
whether it be advisable to have a "State Board ot&-
aminers," and also as to the import of any proposed lis
and such other matters pertaining to the general subject
as to. them shall appear pertinent.
Resolved, That the Committee be directed to report at
the stated meeting of the Academy, to be held JanBaj.
i5i 1885, and that such report be made one of the special
orders for that meeting.
The Secretary, Dr. Katzenbach, read a letter I^
ceived from Dr. S. T. Hubbard, in which he withdrcf
his name from the list of nominations for President
The resignation of Dr. Horatio Gomez was aacpte^
and the time for Dr. Woolsey Johnson to sign ihebp
laws extended, after which the Academy adjourned.
December 27, 1884.]
THE MEDICAL RECORD
715
MEDICAL SOCIETY OF THE COUNTY OF
NEW YORK.
Stated Meetings December 22, 1884.
Daniel Lewis, M.D., President, in the Chair.
THE physiological AND THERAPEUTIC EFFECfS OF THE
COCA LEAF AND ITS ALKALOID.
Dr. William Oliver Moore read a paper on the above
subject in which he reviewed the literature of the drug,
and gave an account of the various uses which have been
made of it. Especial attention was directed to its gen-
eral tonic eflfects, its use in the treatment of affections of
the larynx, pharynx, and tonsils, and in the treatment of the
opium habit, where it had been reported to be of service.
Attention was then directed to the use of the alkaloid
cocaine, its first effect being to produce anaemia, and sec-
ondy anaesthesia of the parts to which it is applied, the
effect being especially marked on mucous membranes.
Instillations into the eye of the affected side had proved
very serviceable in cases of hemicrania, and Dr. Moore
suggested that the alkaloid might afford relief in sea-
sickness. In operations involving the skin the effect of
the alkaloid was very much enhanced by first removing
the epidermis.
The discussion was opened by Dr. Roosa, who thought
that the enthusiasm of the ophthalmologists might be ex-
cused, even in the glare of the luminous remark in The
Medical Record concerning "the lonesome man,"
since it had been established beyond doubt that in a very
large number of operations heretofore requiring the use
of general anaesthetics, the smothering cone, and not only
that but, what was more important, the pain, had been
done away with, a triumph which no one was better
qualified to appreciate than the editor of The Medical
Record himself.
The only disappointment which Dr. Roosa had to
record was concerning the value of cocaine in otology,
where he was not as yet at all satisfied as to its true
place as a therapeutic agent. It should be remembered,
however, that to determine the true therapeutical effect of
drugs was a much more difficult problem to solve, than
to merely learn what the effects were which these drugs
produced when applied locally.
Dr. Willlam M. Polk, with reference to gynecolog-
ical practice, had found that the best method of using
cocaine was by hypodermic injection. For example, in
several cases of laceration of the cervix, he had been able
to operate without pain to the patient, by injecting four
minims of a four per cent, water solution into the tissue
of the cervix on each side shortly before beginning with
the knife. In certain patients belonging to this class,
therefore, he believed it had a limited application.
In the removal of the wire sutures after ordinary peri-
neorrhaphy, he had found it especially serviceable. He
had also used it successfully before applying the actual
cautery to carcinoma of the cervix extending to the
vagina, and also before using caustics in the treatment of
chancre and chancroid.
With the assistance of Dr. Le Fevre, of Bellevue Hos-
pital, the hypodermic use of cocaine behind and in front
of the cervix uteri, had mollified the severity of labor
pains very markedly.
A curious fact sdso obtained in those cases, namely,
there was anaesthesia of the cornea.
In one case he had performed hepatotomy, for hydatid
cyst and abscess, with the aid of cocaine applied locally.
The local ^anaesthetic was used, because of the bad
general condition of the patient, which contra-indicated
the use of either ether or chloroform.
Dr. Knapp had noticed that dilatation of the pupil,
ad maximum^ was not produced by cocaine.
Dr. Pooley thought the use must be abandoned in a
certain number of cases occurring in children, because of
the fright and agitation which occurred without the use
of a general anaesthetic. He also regarded the method
of injecting the orbital tissues as a procedure liable to be
attended with disastrous consequences, hence should be
adopted only with the greatest care.
In one case he had noticed marked toxic effect of the
drug ten minutes after a single instillation of a four per
cent, solution into the eye. There was pronounced ver-
tigo, and the pupil in that case was apparently dilated
ad maximum. He had relieved the patient in one case
of hemicrania, by a single instillation into the eye upon
the affected side.
Dr. Hope spoke of the efficacy of cocaine as a local
anaesthetic in a case of laryngeal growth.
Dr. F. a. Castle referred to points in the literature
of the subject and also in the modes of obtaining the
alkaloid. He also directed attention to the local anaes-
thetic effects produced by certain other drugs, as can-
nabis indica, kola-nut, etc., with which experiments were
being made.
Practically, he had used cocaine in a case of urethral
stricture, which he was able to dilate without producing
very much pain, and also in a case of sensitive nipples^
with considerable benefit.
Dr. W. F. Mittendorf thought that the peculiar ef-
fect of cocaine was produced by its action on the capil-
laries, first causing anpemia about the terminal nerve-fibres,
and that this anaemia was the principal factor in develop-
ing the local anaesthesia.
With reference to the mydriatic effect, he believed it
to be due to the action of the alkaloid upon the sympa-
thetic nerve-fibres. He did not agree with Dr. Pooley,
and thought that the best effects of the drug were ob-
tained in the treatment of children. The pressure of the
eye-speculum sometimes complained of, he had been able
to overcome by the use of his own instrument.
Dr. J. Leonard Corning spoke of the effect pro-
duced by coca in the central nervous system, and had
found it especially serviceable in the treatment of anae-
mic, hysterical, neurasthenic females, the spinal concus-
sion of Erichsen, etc.
Dr. William H. Thomson, from a tolerably large ex-
perience in both hospital and private practice, had
reached the conclusion that the value of coca as a medi-
cine was about equal to that of boneset ; not quite so
good as fresh boneset. This, however, did not at all
militate against its value as a local anaesthetic.
He had used cocaine as a local application in the
treatment of pruritus vulvae, with exceedingly satisfactory
results.
Dr. Sell spoke of the use of avena sativa in the treat-
ment of the opium habit.
The Secretary read the following communication
from Dr. A. P. Meylert, which had a bearing upon the
question of the therapeutical value of coca, and also of
the value of the coca and its alkaloid, in the treatment of
the opium habit :
" So much has been written about the value of this
drug in cases of opium habituation that I have many
times endeavored to use the various preparations of
coca leaf in this disorder, but little advantage has re-
sulted therefrom. Alcoholic preparations were contra-
indicated in many cases complicated with chronic alco-
holism, and in my judgment were hazardous in other
cases from the tendency in habit cases to inebriety. The
fluid extract of coca in small doses was without apparent
effect, and in large doses was nauseating. The solid ex-
tract in pill form seemed almost inert.
*' It was therefore with gladness that I read of the new
anaesthetic — the cocaine alkaloid — and hastened to give
it a trial as a substitute for morphia in habit cases.
'< I have used it both by the mouth and subcutaneously,
using a solution of sixteen grains in the fluid ounce, being
one grain in thirty minims.
*' I will give the general results briefly so far as ob-
served, reserving details for the future.
'* Administered alone in doses of five to ten minims,
there was no effect which I could fairly attribute to the
7i6
THE MEDICAL RECORD.
[December 27, 1884.
drug. In doses of fifteen to twenty minims, equal to one-
half to two-thirds of a grain, there was little if any relief
from pain or from the hyperesthesia and general uneasi-
ness of the patient, but the face became pallid, the pulse
small, and a sense of exhaustion followed. From this,
however, the patient quickly rallied on administering the
usual dose of morphia.
" When the alkaloid was administered subcutaneously
with 2l solution of morphia, the only perceptible effect of
the cocaine was to enhance somewhat the exhilarating
effect of the morphia. It did not, however, prolong the
period of quiescence induced by the dose of morphia,
nor could a less quantity of the narcotic satisfy the
patient.
** On the day subsequent to the administration of the
cocaine, however, a larger reduction of the morphia was
easily tolerated.
"The above doses are doubtless large, exdept for those
taking five to thirty grains of morphia daily.
"I am therefore pursuing these investigations with
great interest, and hope to hear the experience of other
observers in this field."
The discussion was closed by Dr. Moore, after which
the Society adjourned.
^jexa %usXxumtnXs.
FLEXED SPLINTS.
Dr. W. D. Kearns, of Pittsburg, Pa., introduces, in a
paper read by him before the Allegheny County Medical
Society, somewhat of a novelty in the form of "flexed
splints." In presenting them to the profession, he has
been encouraged and sustained not only by personal
tests, but also by the approval of recognized authority,
in regard to the soundness and feasibility of the princi-
ples evolved, especially referring to Colles' fracture.
Dr. Kearns reviews the several varieties of splints
usually employed, condemning some, and calling atten-
tion to the incompetency of the straight padded splint to
secure the necessary angles of flexion of the wrist-joint
and metacarpo-phsilangeal articulation ; at the same
time suggesting the congruity of a flexed splint. He
considers the latter less complicated than the padded
straight splint^ inasmuch as the bend of the \vTist and
hand is at once pennanently fixed. Whether, he ad-
vises, the fracture of the radius is transverse, oblique,
more or less longitudinal, or more or less comminuted,
the conditions governing the form of the retaining splints,
after complete reduction, are equally exacting, and are
best subserved by flexed splints, through their greater ef-
ficiency in forestalling the formidable impairment of the
functions of flexion, extension, pronation, and supination.
He also directs attention, comparatively, to fractures
of the radius and ulna, and the necessity, after complete
reduction, of maintaining relaxation of the several mus-
cular tendons, fasciae, and ligaments, and that the con-
tinued maintenance of this relaxation is also of para-
mount importance in connection with fractures of the
wrist ; and it is claimed that flexed splints will admit
and secure correlative relaxation. Flexed splints, he
finds, propose a ready, comfortable, and efficient main-
tenance of all appreciable required muscular relaxation
of the extensors and flexors to their insertions along the
phalanges, and of the muscles and fasciae of the hand
and thumb ; and, also, may claim a great advantage in
securing the more early, free, and full use of the hand.
The insertion of thin, narrow, interosseous pads are
employed, and materially control the displacing influ-
ences of the pronator quadratus and the supinator longus.
Interosseous pads, he finds, will also fully compensate
the pistol-shaped splint of Ndaton, in preventing the ap-
proach of the fragments to the ulna. Short splints, or a
short palmar splint and a long, straight dorsal splint, he
considers inadequate to immobilize the proximal joint.
An "immediate" bandage, if loosely and intelligently
applied, will advantageously subserve its purpose in pre-
venting muscular contraction.
He observes that the angle of flexion of the dorsal
splint (Fig. i) is made studiously sharp at the wrist,
carefully evading pressure on the carpal bones. This
angle should also be of degree sufficient (about 122''
Fig. i), by the backward bend of the hand, to se-
cure complete relaxation of the posterior muscular ten-
dons; while the anterior relaxation is effected by the
partial closing of the hand. The splints admit a slight
drooping of the hand (the natural curve of uncontrolled
muscular action).
The accompanying woodcut traces the anterior edge
of the palmar splint (Fig. 2) as a continuous line fully
over the muscular prominence of the three flexors of the
palmar surface of the thumb, preserving their full uncon-
straint, whence it inclines underneath the thumb along
the index finger, restoring the width of the splint to that
of the hand. Wooden splints, which can now be readily
sawn, he considers practically the best. They can,
however, be constructed of sheet zinc, which, judging
from the specimens sent us, would also serve an excel-
lent purpose.
Official List of Changes in the Stations and Duties of Officers
serving in the Medical Department^ United States Army^
from December 7 to December 20, 1884.
'"4HAMMOND, John F., Colonel and Surgeon. Retired
from active service, by operation of law, on December 7,
1884, under provision of Act of Congress approved June
30, 1882. S. O. 287, A. G. O., December 8, 1884.
McKee, J. C, Major and Surgeon. Leave of absence
still further extended one month. S. O. 288, A. G. 0.,
December 9, 1884.
Porter, Joseph Y., Captain and Assisuut Surgeon.
Sick leave of absence extended four months, on surgeon's
certificate of disability. S. O. 286, A. G. O., December
6, 1884.
Kane, John J., Captain and Assistant Surgeon. From
Department of the East to VVillet's Point, New York. S,
O. 286, A. G. O., December 6, 1884.
Banister, J. M., Captain and Assistant Surgeon (Fort
Adams, R. 1.). Granted one month's leave of absence, on
surgeon's certificate of disability. S. O. 251, Department
of tihe East, December 9, 1884.
Gray, Charles C, Major (retired). Died at Geneva,
N. Y., November 22, 1884, instead of November 26th, as
heretofore announced. Circular Orders, A. G. O., De-
cember 8, 1884.
Lauderdale, John V., Captain and Assistant Surgeon,
Fort Sully, D. T. Granted leave of absence for one
month, to take effect about December 20, 1884. S. 0.
146, Department of Dakota, December 9, 1884.
December 27, 1884.]
THE MEDICAL RECORD.
717
CoMEGYS, £. T., Captain and Assistant Surgeon.
Granted leave of absence for one month. S. O. 234,
Department of the Missouri, December 8, 1884.
PiLCHER, J. E., First Lieutenant and Assistant Surgeon.
Ordered to Fort Custer, M. T., for duty. Order as-
signing him to duty at Fort A. Lincoln, D, T., amended,
S. 0. 145, Department of Dakota, December 8, 1884.
Official List of Changes in the Medical Corps of the U. S,
Navy, during the week ending December 13, 1884.
Craig, T. C, Passed Assistant Surgeon. Detached
from Alliance and placed on waiting orders. December
6, 1884.
Curtis, L. W., Assistant Surgeon. To the Naval
Hospital, Chelsea. December 9, 1884.
Gaines, J. H., Passed Assistant Surgeon. Present
duty continued.
Green, E. H., Passed Assistant Surgeon. Special
duty at Museum of Hygiene, Washington. December
II, 1884.
Meurray, J. M., Passed Assistant Surgeon. Detached
from Naval Hospital, Chelsea, to the Flagship Hartford.
December 9, 1884.
Woolverton, T., Surgeon. To the Shenandoah. De-
cember 6, 1884.
([^OXXitSVOXiiitXitt.
CARD FROM DR. FORDYCE BARKER.
To THS Editor or Thb Medical Rxcord.
Sir : Will you allow me a small space to express the
deep feeling which has touched my heart by the recep-
tion of a great number of letters since*last Friday morn-
ing?
As from members of the medical profession of this city
and Brooklyn, I have already received more than two
hundred, and very many letters and telegrams from other
places, it is quite impossible for me to send an acknowl-
edgment to each writer, I must pray my friends to ac-
cept my thanks through the medium of your journal.
FoRDYCB Barker.
34 East TmirTY-BiGHTM Stkrbt,
Monday evenings Deoember aa, 2884.
piedicaX Items.
Contagious Diskasss — ^Wsskly Statsmsnt. — Re-
port of cases and deaths from contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the week ending December 20, 1884 :
Week Ending
Cases.
December 13, 1884.
December 20, 1884.
Deaths.
December 13, 1884.
December 20, 1884 .
70
106
h
I
I
118
130
The Practice of Medicine in Russia. — A recent
number of the Aerztliches Vereinsblatt contains an
interesting article on " Medicine in Russia," written by a
German physician practising in that country. The num-
ber of physicians in Russia, according to the official sta-
tistics for 1883, is 15,231. Most of these are collected
in the cities, while the country is so poorly supplied that
there are districts as large as Saxony or Bavaria where
there is but one physician. There are medical faculties
in Kief, Kazan, Charkov, Moscow, Warsaw, Helsingfors,
and Dorpat, the first five of which give instruction in the
^ Russian language, while at Helsingfors Swedish is spoken,
and at Dorpat German. There is, besides, an army
medical school. In the Russian schools there is a five-
years' graded course with yearly examinations. At the
end of this course an examination must be. passed for the
title of physician, after which, if it is so desired, the can-
didate may pass on to the doctorate examination. In
Dorpat there is no graded course, and but two examina-
tions are held. The first, called the examen phylosophi-
cuniy is passed usually after two or three years* study,
and embraces the subjects of chemistry, physics, botany,
mineralogy, zoology, anatomy, physiology, general pa-
thology, and dietetics. If a student allows four years to
elapse after his philosophical examination before coming
up for the rigorosuniy he is obliged to pass the former
over again. It sometimes happens that students who
become interested in some special subject pass this ex-
amination three or four times before coming up for their
final. At the final examination, the examen rigorosum,
the student chooses whether he will try for the title of phy
sician or of doctor. In order to obtain the latter degree
a more exact knowledge of theoretical subjects is neces-
sary, and in addition the candidate must write two theses,
on given subjects, in Latin. If he is thus far successful
he must attend and take part in a dissertation. A doc-
tor ranks as eighth in the classes defined by the State,
while a physician is one step farther down the scale.
No one can receive an appointment as head physician
in a hospital or become a " privat-docent " unless he
possess a degree of M.D. Russia has a paternal govern-
ment, and her medical sons are not neglected, but are
placed under the care of the Minister of the Interior.
The business of the medical division of the Department
of the Interior is defined to be to keep an eye " on the
industry and scientific ability of the physicians, and to re-
port thereon yearly." It also takes them under its pro-
tection when they are subject to unjust attacks. It has
further to see that the sick are treated only by physi-
cians of proved skill, and must warn the people against
the dangers of employing charlatans. One article of
the medical law provides for the punishment of those
who employ quacks. The law also gives the depart-
ment authority to transfer physicians from one place to
another as occasion may require : thus in case of an epi-
demic in a place where physicians are scarce, the Minis-
ter of the Interior can send others from places where
they are more plentiful. In the matter of fees the law
is also explicit, and as the law was framed in 1 789 and
has never been altered, it may readily be understood
that the lawful fees are not exorbitant. For a visit in the
city a doctor's legal charge is 30 copecs (24 cents) if he
gives a prescription, and 15 copecs (12 cents) if he
writes no prescription. For a visit outside of the city
he is allowed to ask 60 copecs (nearly half a dollar).
A consultation is held to be worth $1.20. A physi-
cian's fee is set down at 12 cents with or without a pre-
scription. For applying a blister or giving an enema he
is allowed to ask the enormous sum of 6 cents, and a
venesection is held to be of equal value. Wet cups are
to be applied at the rate of 2 J cents each. An obstetri-
cian who has assisted at a difficult labor may demand
$1.20 for his valuable services. These charges are for
attending people in moderate circumstances, and the
rich are expected to pay a little more. This is the law
as it stands upon the statute book, and which can be en-
forced at any time, but practically, of course, it is a dead
letter, in its good features as well as in its bad ones.
There are plenty of quacks who enjoy a lucrative prac-
tice, just as is the case in other countries, yet occasion-
ally one of these gentry comes to grief. Not long ago a
most elegant gentleman settled in St. Petersburg, pro-
fessing to be an ardent disciple of Hahnemann, and by
reason of his fine presence and engaging manners soon
acquired a large practice, some of his patients being
7i8
THE MEDICAL RECORD.
[December 27, i8
members of a grand ducal family. Before long, how-
ever, it was discovered that his sole right to practise
consisted in the possession of a diploma from the Uni- .
versity of Philadelphia, and he was quickly escorted over
the border and earnestly recommended to stay there.
The number of homoeopathists in Russia is small, yet
those who are there are divided into two parties, each call-
ing the other a company of charlatans. Their experience
with hospitals was not encouraging. Three years ago
they started a hospital for the treatment of diphtheria,
which for some time had no inmates. Finally, on the
advice of a homoeopathic general, a soldier sent his
child there for treatment. The child very promptly
died, and the hospital received no more cases of diph-
theria. Russian medical societies are not very flourish-
ing, owing, the writer says, to an every-man-for-hiniself
spirit that exists among the physicians there. The old-
est is the Society of Russian Physicians, founded in 1833.
The members of this society are intensely national in
their feelings, as was evidenced in one of the addresses at
their semi-centennial celebration, when the speaker con-
gratulated his hearers that at last Russian medicine had
thrown off the German yoke. This feeling was also ex-
hibited in an order recently promulgated by the Minister
of War, to the effect that not more than four per cent, of
the army surgeons should be Jews. There are five other
societies, one of them composed chiefly of German physi-
cians, in St. Petersburg, and seventy-three in the prov-
inces. In addition there are several mutual aid and bene-
fit societies among medical men. Considerable progress
has been made in the last decade in medical journalism.
The leading journal is the Vratch (the Physician), founded
by Manassein in 1880. Next to the Vratck comes the
Russkaya Medicina and the Meditsinski Vestnik. An-
other excellent journal, composed principally of ab-
stracts, but containing also some original aricles, is the
Mediisinskoyc Obosrenoyc, The organ of the German
physicians is the St, Pctershurger Medicinische Wochcn-
schrift The writer says that medical journals are not
subject to the censorship of the press, but this seems to
be an error, for the last-named journal always bears the
imprimatur of the censor. At one time there were many
female medical students attending a college of their own,
but lately they have been frowned upon by the Govern-
ment (probably by reason of the Nihilist fright), and now
their college is in a fair way of extinction. The students
for the most part lived a miserable life, half starved and
half frozen, and their condition was not much improved
after they had finished their studies. They had no as-
sured standing among physicians, and usually practised
in the country districts and among the poorest classes.
The Properties of Crotalus. — Crotalus, the poison
of the rattlesnake, is obtained from the crotalus horridus.
Physiological action : Inoculation causes ecchymoses and
hemorrhages, by putting an end to the coagulating power
of the blood, with febrile heat, anorexia, injected con-
junctiva, etc. Therapeutical uses : It was originally in-
troduced by homoeopaths, and has been employed for
malignant hemorrhagic scarlatina on the principle " similia
similibus curantur." Preparations and doses: The poi-
son-bag. is removed from the living vipers, and then
mixed with glycerine as a preservative. Crotalus is pre-
pared in decimal strengths, the menstruum used being one
part of glycerine to three parts of proof spirit ; the three
decimal dilution is chiefly used. Dr. Havard, of I^iver-
pool, prescribed three drops in a spoonful of water every
three or four hours in malignant hemorrhagic scarlatina.
It is also used hypodermically in doses of one to three
minims.
The Abuse of Tonics. — Dr. Alfred W. Perry, of San
Francisco, Cal., writes : ** The abuse of tonics is most
notably seen in rather stout persons over forty years old.
Such persons, without any serious organic disease, com-
plain of weakness or fatigue after slight exertion, pains
in the limbs, vertigo, and perhaps of shortness of breath ;
and as they are frequently rather pale, tonics and stimu.
lants are prescribed for them. The appetite, and thereby
the body-weight, majr be increased, but the symptoms
complained of remain or are aggravated. Let us take
up each symptom and analyze it. Normally fatigue is
due, according to late researches of Voit and Petten-
koffer, to an accumulation in the muscle of the products.
of destructive metamorphosis (lactic add, creotine add,
phosphate of potassium, sarcosine) produced by exercise,
and partly to a decrease of the oxidizable muscular sub-
stance. By rest, normally, the blood-current washes
out these waste products, and the more nearly the blood
approaches a standard healthy condition, the more quickly
does this take place. The amount of food consumed by
an adult should be just what is required to keep up an
average body-weight (in proportion to height), and will
vary with the work performed. An excess of food
digested and absorbed produces a blood too rich, thick,
and imperfectly oxidized. This condition is generally
marked by a deposit of reddish urates in the urine when
cooling. An addition to the blood in such a conditioD
of large quantities of water (by drinking) enables it lo
dissolve more easily these waste-products of muscle, and
so produces a feeling of renewed strength. Witness the
increase of uterine action in labor after drinking freely
of any kind of tea ; the vigor produced in the plethoric
or gouty by drinking freely any kind of mineral water,
and using low diet ; the undoubted benefit of the present
fashion of drinking freely of hot water has the same ex-
planation. The muscular pains are a slight kind of
cramp or muscular rheumatism, which is, as Anstie (in
his work on neuralgia) defines it, ^pain produced in a
muscle obliged to work when its structure is imperfecUj
nourished or impaired by disease,^ The short breath d^
pends on a relative insufficiency of the heart's action.
The heart, without being at all diseased, is often incapabk
of maintaining the circulation properly with its incidental
variations. Let us take the example of a man five feet
eight inches in height, one hundred and fifty pounds in
weight, and let him increase in weight to two hundred
pounds while performing a moderate, and perhaps a de-
creasing amount of labor. His heart is unable to propel
the blood properly through the area of two bundled pounds
of body-weight, involving about twenty-five per cent, more
work, because the heart-muscle has not increased in bnlk
and vigor at all. If this man's weight had increased while
performing hard work, we might be sure that the cardiac
muscle had grown in proportion. Any sustained increase
of tension of the circulation causes a physiological hyper-
trophy of the heart. But where the body-weight increases
with a decrease of labor, and an increase of food or
alcoholic stimulants, we may be sure that there has been
no physiological cardiac hypertrophy. The vertigo often
met with in these cases may be the result of a cere-
bral anaemia. This when conjoined to pallor is usually
an indication for tonics and iron. There is no poverty
of the blood or general anaemia, the surface is pade from
insufficient filling of the capillaries from want of heart
vigor. The conditions above cited need a treatment en-
tirely opposed to a tonic one. They need alkalies to
assist in breaking down tissue, plenty of water to carry !
away the broken-down tissues, and a little increase in '
exercise with a restricted diet." i
Harvey as a Student of Nature. — In the Harveian !
oration for this year Dr. Reynolds lays stress upon the
fact that Harvey was always studying and seeking to
interpret nature. ** He was one of her keenest and most
devout interpreters ; in reverence he knelt before her,
and asked her questions ; he cross-examined her, but in
no unfriendly tone. Nature to him was a perfect verity, ,
the one witness that could never be absorbed or shaken,
the one witness in whom there could be no false way,
the one witness who could not lie. And by such a
method only must science ever be advanced ; it is thus
that great discoveries are to be achieved, thus that we
must seek to leave our footsteps on the sands of Time."
INDEX.
Abdominal section, 383.
Abortion, 574 ; and nitrite of amyl, 621. '
Abscess, muscular rupture simulating, 682 ;
of frontal sinus, 163 ; of the cerebellum,
404; of the liver, 580; orbital, 162;
perinephritic, 23.
Academy of Medicine of Paris, 77, 107.
A. C. £. mixture, the, nitrous oxide, and
ether, 712.
Acid, borophenylic, 38; carbolic, in rheu-
matism, 10 ; hydriodic, in hay asthma,
259; hydrobromic, 222; lactic, 191;
osmic, in epilepsy, 317; oxalic, 222;
picric, 222 ; salicylic, in lupus, 541 ; va-
lerianic, 222.
Accommodation and presbyopia, 586.
Acetabulum, fracture of, 576.
Acne, 628.
Actinomycosis, 26.
Adams, the late Dr. J. G., 18.
Addison's disease, 697.
Adenitis, strumous, treated by nitrate of aH-
▼er. 375.
Adenol3rm phangitis, uterine, 333.
Adenoma, of the liver, 706.
Adenopathies, scrofulous, 10.
Adonis vemalis, 192.
Agnew, Dr. C. K., hydrochlorate of co-
caine, 438.
Air-passages, foreign body in, 552.
Ankle clonus and patellar reflex, 403.
Albumen, in urine, delicate tests for, 94.
Albuminuria, functional, 305 ; hepatic, 124 ;
in pr^;nancy, 331 ; physiological, 10 ;
regiilatory, 601.
Alcohol* 378.
Alcoholism, chronic, 681.
Alimentary canal, nervous origin of some dis-
orders of, 481.
Alt, Dr. Adolph, notice of book by, 299.
Althaus, Dr. Julius, notice of boolc by, 692.
Alum, 139.
Amaurosis, unilateral, 66.
American Academy of Medicine, 411.
American Gynecological Society, 382; no-
tice of transactions, 1883, 244.
American Laryngologiod Association viewed
from the outside, 308.
American Ophthalmological Society, 161.
American Otological Society, 105.
American Public Health Association, 406,
439-
Amidon, Dr. R. W., notice of manual by,
495-
Ammonia, muriate of, 307.
Anmioniac, gum, 221.
Ammonii, boras, 139 ; phosphas, 139.
Amyl, nitrite of, and abortion, 621 ; nitrite
of, in anamoniacal urine, 12 ; nitrite of,
in opium-poisoning, 13 ; nitrite of, in-
ternal use of, 308.
Anaemia, essential, 431 ; following hemor-
rhage, 301 ; pernicious, 301 ; pernicious,
in children, 293; iron albuminate in,
140.
Anaesthesia, of the trigeminus with trophic
ulceration of the helix, 698 ; rectal, 72 ;
surgical, 378.
Anaesthetic, whiskey as an, 588.
Anaesthetics, in St. Petersburg, 42.
Andrews, T>r. Joseph A., jequirity ophthal-
mia, 596.
Aneurism, aortic, 263, 699 ; inguinal, 166 ;
miliary of the stomach, 97, 293.
Angeiomatous growths, treatment, 28.
Angina pectoris, 559.
Anteflexion of the uterus, 693.
Antipyrin, 56, 245, 303, 713; exanthem fol-
lowing the use of, 317; in diseases of
children^ 293.
Antipyresis, 493 ; by inunction, 37.
Antipyretic, 515.
Antisuppurative, 700.
Aphasui, from indigestion, 543 ; peculiar
forms of, 12 ; sensory, 556.
Apocynum cannabinum, 6^.
Apomorphia, 139 ; and epilepsy, 598.
Arachnoid, lipoma of, 707.
Army surgeons, shall they practise outside ?
. 475.
Arsenic, m generalized sarcoma, 431.
Arteries, coronary, sclerosis of, 682.
Arteritis, obliterous, 99 ; syphilitic, 599.
Arthropathies, multiple spinal, 67.
Aseptoi, a new antiseptic, 600, 712.
Asphyxia, 56.
Asthenopia, 390.
Astringents, in ophthalmic practice, 482,
499.
Ataxia, hereditary, 67 ; locomotor, 265.
Atropine, at the beginning of convergent
squint, 389.
Auricles, cardiac, function of, 575.
Averill, Dr., tridiinosis, 14a
B
Baby- farming, 154.
Bacilli, cultivation of, 56 ; in calcareous con-
cretions of the lungs, 681 ; tubercle, in
the urine and kidneys, 191.
Bacillus of syphilis. 687 ; tuberculosis, 274.
Baird, Dr. W. T., electricity in pleuritic
effusion, 476.
Baker, Rev. Geo. S., correspondence, 446.
Baker, Dr. Henry B., age of greatest risk
from consumption, 235.
Baldness, 84.
Baldwin, Dr. B. I., immunity of the n^;ro
from trachoma, 704.
Baldwin, Dr. D. A., dysentery, 433.
Barker, Dr. Fordyce, 709, 717.
Barnes' dilator, modification of, 529.
Baruch, Dr. Simon, 224; tracheotomy in
croup and diphtheria, 534, 700.
Baths, carbonic- water, 13 ; cold, in the
treatment of puerperal fever, 333 ; for
the poor in winter, 409 ; for use during
the year, 418.
Beard, Dr. Geo. M., book notice [posthu-
mous MS.], 300.
Bell's law discovered by Magendie, 600.
Bellevue Hospital Medical College, 711.
Bemiss, Dr. Samuel M., notice of death of,
« 571.
Benzoin, 168.
Bergh and Pasteur, 18.
BerUn Society of International Medicine, 52,
191, 245.
Billings, Dr. Frank S., book notice, 216.
Billings, Dr. John S., book notice, 524.
Binnie, Dr. John, artificial feeding of infants,
287.
Binz, von, Prof. C, notice of book by, 19.
Biological Society of Paris, 78, 108, 193,
246.
Black, Dr. G. V.. notice of book by, 691.
Blackweli, Dr. FJizabeth, book notice, 495.
Bladder, aspiration of, 236 ; cider as a pro-
phylactic in stone of the, 10 ; extraction
of foreign bodies from, 184 ; exstrover-
sion of, 362; foreign bodies in , 432 ;
injections of, 269 ; local use of ether in
the, 25 : nitrate of silver injections of
the, 501.
Blindness, fulminating, 161 ; in infancy, 10.
Blood, condition of, in hydrophobia, 266;
transfusion of peptonized, 108 ; trans-
fusion of, is it justifiable? 708.
Blood-poisoning from human bites, 682.
Blood-vessels, physio-pathology of the, 69.
Bodenhamer, Dr. William, the rectum a re-
ceptacle for excremental matter, 309.
Body, human, motor power of, 476.
Bones, brittle, la
Borax, in contagious diseases, 266.
Borcheim, Dr. L. E., tape-worm, 429.
Bosworth, Dr. F. H., a new therapeutic use
for cocaine, 533 ; the three tonsils, 365.
Bow-legs, 612.
Boyland, Dr. G. Halsted, Florida climate,
109.
Brachydactylus, symmetrical, 377.
Bradner, Dr. Wm. B., climate of Florida,
83.
Brain, abscess cavities in the, 235; bony
tumor of, 707 ; cortical lesions of the,
237; fourth ventricle, 249; pressure, in
public schools, 402.
Breast, tubercles of the, 39 ; tumor of, 554.
Breath^g, buccal, 565.
Breech, cases, 579.
Bright' s disease, dyspncea of, 681 ; of malarial
origin, 237.
British Medical Association, 126, 131, i6o^
217.
Bronchitis, 542.
Brown, Dr. R. Wood, dead teeth in jaws,
« 564.
Browning, Dr. William, pseudo - bulbar
paralysis, 487.
Buboes, suppurating, 376.
Buck, Dr. Albert H., deafness of supposed
syphilitic origin, 257.
Bundy, Dr. A. D., death from the introduc-
tion of a stomach-tube, 504.
Burke, Dr. John, 251.
Burnett, Dr. Charles H., notice of book by,
691.
Bums, 97.
Burq, Dr., death notice, 241.
Caesarean section, 329.
Caffeine, 191, 491.
Calculi, renal, removal by manipulation, 587.
Calculus, biliary, passed by the rectum, 599 ;
impacted in the ureter, 541.
Calomel, in diphtheria and croup, 36 ; in
diseases of the eye, 38 ; m the treatment
of pneumonia, 683.
Campbell, Dr. S. E., 306.
Cancer, early recognition of, 135 ; from ci-
catrices in the stomach, 270; of the
breast, 670; of the pancreas, 532; of
the stomach, 385, 469 ; of the stom-
ach and pancreas, 593 ; statistics in Eng-
land, 223; vaginal hysterectomy for, 3814.
Canfield, Dr. H. A., 448.
Cannibalism, is it necessarily murder ? 531.
Capsule, internal (brain), 477.
Carcinosis, general, 552.
Cardiopathy, of menopause, 347.
Carman, Dr. J. H., opium-smoking, 501.
Carotid, ligation of common, 456.
Carhart, Dr. J. W., correspondence, 475.
Case, Dr. Meigs, special disease of spinal
curvatures, 701.
Cataract, artificial maturation of, 388 ; nat-
ural history of, 162.
Catarrh, chronic intestinal, 573; intestinal,
432.
Catheter, passage of, 456.
Cauldwell, Dr. C. M., manaca in rheuma-
tism, 31.
Caustics, in ophthalmic practice, 482, 499.
Cauterizations, punctate, 51.
Cephalhydrocele, traumatic, 236.
Cerebellum, abscess of, 404; the first total
removail of, in a dog, 711 ; morphologi-
cal status of the, iii, 249.
Cerebral localization, 146, 232, 342, 458,
536.
ebrun
Cerebrum, an^miantsand hyper6miants, 112.
Cesspools, 10 1.
Chamberlain, Dr. C. W., death notice, 241.
Chamberlain, Dr. William M., correspond-
ence, 664.
Chancre, excision of, 36a
Chapman, Dr. Henry C, book notice, 216.
Chapin, Dr. Henry Dwight, the prevention
of summer complaint, 87.
Charles, Dr. T. Cranstown, notice of book
by, 692.
Cheesman, Dr.. W. S., supernumerary tes-
ticles, 196.
720
INDEX.
[December 27, 1884.
Chesney, Dr. J. Portman, book notice, 244.
Children, convulsions in, 543.
Childs, Dr. S. B., dysentery, 223.
Chill, in pneumonia, 13.
Chloroform, dosimetric administration of,
39 ; for tape-worm, ii2, 308, 475, 601 ;
narcosis maintained for eight days, 108.
Chloral, oleate of, for pruritus, 543.
Chloral-quinine, 196.
Chlorosis, 301.
Cholecystotomy, $16.
Cholera, Asiatic, 73, 100, 130, 156, 245, 260,
440, 522, 548, 550, 589, 661 ; and cholera
nostras, 604 ; and the comma-bacillus,
53, 241, 267 ; and its prevention, 40 ;
and rags, 571 ; and syphilis, 385 ; and
the Cabinet, 98 ; and tubercle bacillus,
31 ; at Suspension Bridge, 1854, 556;
bacillus, Koch^s defence of, 602 ; cause
of, IX ; copper as a prophylactic, 5x2 ;
French commission, 467 ; further contri-
butions to, 687 ; germ, 211, 350 ; infan-
tum, 357 ; influence on, by syphilis and
mercury, 447 ; in Europe, 16 ; in India,
255 ; in Toulon, 107 ; intravenous in-
jections in, 688; limitations of knowledge
regarding, 570 ; microbe of, 295 ; pre-
vention of, 167; quarantine in, 570;
sulphuric acid in, 386 ; the germ and its
destruction, 251.
Chordee, 6co.
Christian, Dr. E. P., placenta praevia, 89.
Cider, as a prophylactic in stone of the blad-
^!|;der, 10.
Cinchonidia, 532 ; sulphate of, 72.
Circulation, discovery of the, 224.
Cirrhosis of the liver, 697 ; of the pancreas,
505.
Civil service and the medical profession, 407.
Clavicle, fracture of, 527.
Clay, Dr. Charles, one of the revivers of
ovariotomy, 713.
Clitrophobia, 403.
Club-foot, 277.
Coca, 491.
Coca-leaf and its alkaloid, 51a
Cocaine, muriate of, 153, 417, 438, 534, 550,
577, 604, 656, 715 ; a new therapeutic
use for, 533 ; early employment of, 659 ;
failures, 658 ; first enucleation of the
eye under, 713 ; history of properties of,
5x8; in dentistry, 657; in general sur-
gery, 657 ; Knapp's experiments, 461,
463 ; in gynecology, 489, 658 ; in intra-
nasal surgery, 654; in minor surgery,
582.
Cold, in therapeutics, 397, 414.
Colic, clinical forms of hepatic, 686.
Collodion, iodized, in erysipelas, 517.
Color-perception, 96.
Colotomy, 97, 541, 542.
Column of GoU, 478.
Coma, diabetic, 9 ; d3rspeptic, 516.
Comma-bacillus, 240, 260, 381, 416, 436.
Compensation of physicians, law governing
the, 626.
Concussion of the spine, 6x7, 634.
Congestion, cerebral, during mental work,
308.
Conjunctivitis, 482; purulent, 266.
Constipation, 43 x ; ergot in, 37.
Consumption, prevalence of, at different
ages of life, 527 ; when is the risk from,
greatest ? 36, 194, 235, 335.
Consumptives, North Carolina climate for,
364
Contagiousness, duration of, after acute in-
fectious diseases, 573.
Contusions, decoction of valerian in, 598.
Convulsions, in children, 236, 543 ; of the
tongue, 509 ; puerperal, 46, 576.
Cook County Hospital, 401.
Copper and cholera, 512.
Copper-colored spots on the forehead, 56.
Cord, umbilical, tying of, 166.
Cornea, local anaesthetic to the, 417 ; result
of great loss of substance of, 389.
Coming, Dr. J. Leonard, book notice, 216.
Corns, cure for, 672.
Corpulence, book notice, 524.
Corrosive sublimate, 196; solutions, 168;
tolerance of small closes 9f, 3x2.
Coryza, X3.
Cough, vapor of glycerin^ for, 403.
Country doctor, 464, 473.
Cowan, Dr. George, modification of Barnes'
dilator 529.
Crawcour, Dr. J. L., iodide of ]X)tassium,
584.
Cremation, 140, 571 ; in London, 28.
Cretinism, in adults, 302.
Crime and madness, 547.
Croom, Dr. J. Halliday, notice of book by,
2a
Crotalus, 7x8.
Crothers, Dr. T. D., acute impulsive ine-
briety, 289.
Croup, 357 ; calomel in, 36 ; diphtheritic,
580, 697 ; tracheotomy in, 643, 645, 665,
700.
Crudeli, Dr. Conrad Tommasi, address at
the International Medical Congress,
Cuirass, for Potts' disease, 13.
Cuming, Dr. James, address, British Medi-
cal Association, 1884, X69.
Curette, uterine, 578.
Cyr, Dr. Jules, book notice, 216.
Cysticercus in the vitreous, 703.
Cystitis, 545 ; intravesical injections for, 704 ;
naphthaline in, 597.
D
DaCosta, Dr. J. M.,- notice of book by, 19.
Dacro-adenitis, X64.
Dana, Dr. C. L., concussion of the spine,
6x7.
Dana, Dr. S. W. , delirium following the use
of morphine, 64.
Dandruff, 376.
Daniell, Dr. Alfred, book notice, 244. •
Davis, Dr. G, G., corrosive sublimate, 196.
Deafness, new apparatus for the relief of, 38 ;
sudden, caused by mumps, 517 ; sudden,
of supposed syphilitic origin, 257.
Death, 706; diagnosis of apparent, 293;
sudden, in chUd birth, 36 x.
Death-rate, of New York, X5.
Decapitation, does it cause instant death?
531.
Deformities, rachitic, of the lower extremi-
ties, 612.
Deliriimi following the use of morphine, 64.
Delirium tremens, paraldehyde in, 39.
Delusions, therapeutical, 379.
Dentistry, 43.
Dermatology at Vienna, 56.
Deutsch, Dr. Solomon, book notice, 299.
Diabetes, 231, 580, 600, 705 ; coma of, 9.
Diabetics, expired air of, and iodoform, 515.
Diaphragm, rupture of, 402.
Diarrhoea, 575 ; chronic, sea voyage in cer-
tain cases of, 5x2 ; naphthaline in, 597;
nervous, 12 ; treatment of, 99.
Dickinson, Dr. D., ascites, 588.
Diet, infant, X4.
Digitalis, X9X ; physiological action of, 5x6.
Dignity, professional, 586.
Diphtheria, and croup, 697 ; calomel in, 36 ;
experimental, 544 ; tracheotomy in, 700.
Diplomas of the United States Medical Col-
lege, 249.
Disease, causes of, X69.
Disease germs, 451.
Dissection, the laws of, 486.
Doctor, in fiction, X82.
Doughty, Dr. S. W. H., cocaine in gyne-
cology, 658.
Drinking-water, purification of, 236.
Drops, the weight of, 377.
Druggist and drug appraiser, 26.
Drugs, explosive, 599.
Dugas, Dr. Louis A., notice of death of,
468.
Dumm, Dr. S. C, plea for the country prac-
titioner, 473.
Dupuytren*s finger contraction, 276, 375.
Dwight, Dr. Francis M., hospital report,
264.
Dysentery, 223 ; homoeopathic treatment of,
433 ; micrococci of, 404.
Dyspepsia, dietetic treatment of, 575 ; treat-
ed with hot water, 563.
Dyspnoea in Bright's disease, 681.
Dystocia, from cervical fibroids, 383.
Ear, diseases of, 3; external, X19, 173; j^.
fluence of dental irritation on the, 107 •
practical observations on the human!
X49 ; quacking sounds in, 130 ; ulcera.
tions of, with anaesthesia of the trigem*
inus, 688.
Ears, pain in, due to irritation in thejavs,
374.
Earle, Dr. Charles W., cirrhosis of the paa.
creas, 505.
Ecchymosis, of nervous origin, 403.
Eczema, and trophic centres, 485.
Edson, Dr. Benjamin, morphia in cardiie
disease, 40X.
Edson, Dr. Cyrus A., new spray-producer
306.
Education, of children with defective hetr-
ing, 675.
Effusion, pleuritic, 598.
Electricity, in elephantiasis, 598 ; in hydnr-
throsis, 69 ; in treatment of pleuritic
effusion, 476 ; the induced current in
pleuritic effusions, 266; the therapeuti*
cal value of, 710.
Electrolysis, in stricture, 94, X95, 250; m
treatment of uterine tumors, 329.
Elephantiasis, and electricity, 598; scroti,
629.
Ellingwood, Dr. Finley, tape-worm, 82,
Elliott, Dr. A. A., injury from a pitchfork,
429.
Emmet, Dr. T. A., notice of book by, 69a
Encephalitis, acute, of children, 696.
Endarteritis, ulcerative, 50.
Endocarditis, ulcerative, 554.
Enterotomy, 6ox.
Epery, Dr. F. W., 225.
EpUepsy, and apomorphia, 598; osmic add
iOi 3*7 ; puerperal, 351 ; treatment, 213.
Epileptics, the pupils in, 39.
Epley, Dr. F. W., cancer of the ponaeU)
532.
Epithelioma, of the auricle, 107.
Ergot, in constipation, 37.
Ether, acetic, 22 x ; formic, 222 ; hydiiodic,
22 X ; hydrobromic, 221 ; hydrochloric,
221 ; inhalation of, 64.
Etherization, rectal, 224. 252, 326, 346.
Etiquette, breach of professional, 588.
Ethmoid, disease of, 106.
Evans, Dr. S. A., menstruation in animalSi
588.
Extracts, fluid, 92.
Extra-uterine pregnancy, 224, 33X.
Eye, artificial, 389 ; calomel in diseases of,
38 ; changes in, immediately after death,
163 ; dropping fluids into, 675 ; fiist
enucleation of the, under cocaine, 713;
tuberculosis of, 681.
Eyeball, staphylomatous, 93.
Fable, a medical, 587.
Faradization, in obstetric practice, 544.
Farcy, 107.
Feeding, infaiits, 351.
Feet, sweating of, 97.
Fever, chlorotic, 37; intermittent, excited
by intestinal worms, 3x7 ; malarial 327;
malarial, morbid anatomy, 68 ; p1lHp^
ral, X4X ; puerperal, cold baths in, }^;
puerperal, in Denmark, 332 ; pucrpeni,
prophylaxis in, 38; substitute for tic
cold bath in, ii ; typhoid, 696 ; typhoid,
and syphilis, 385 ; typhoid, grave ncrroas •
symptoms in, 517 ; typhoid, mild fonns
of, 404; typhoid, polyuria in coonkS'
cence, 265 ; typhoid, rational Ireatmat
of, 629 ; typhoid, rose^colored enptin
not characteristic of, 707; typhoid,
symptomatic treatment of, 597; tf
phoid, the apyretic form of, 97 ; typho-
malarial, 327; typhus, 339; yellow, 7»
264 ; yellow, at Panama, 509 ; yellow,
micro-organisms of, 168; yellow, the
origin o^ 435.
Fibroids, cervical, as a cause of dystocia, 3S3.
Fibro-sarcoma, naso-pharyngeal, 455, 46^
Fisk, Dr. Samuel Aug. Loomis, on CoIondB
climate, 526.
December 27, 1884.]
INDEX.
721
Fistula, in ano, 539.
Florida, as a heidth resort, 502 ; climate of,
83, 109, 280, 308.
Foetus, gastric secretion in, 376.
Food for the febrile, 95.
Forceps, a new bullet, 419 ; in breech pre-
sentations, 308; the obstetric, in breech
presentations, 607.
Forearm, rotation of, 599.
Formulary of unofficinsd preparations, 21.
Foster, Dr. Joel, Obltnary, i8.
Fothergill, Dr. J. Milner, affections of the
heart, i, 29, 57, 86.
Fowler, Dr. George B., a plea for the use
of delicate tests for albumen in urine,
94; "The Haemorrhoid Quack," 527.
Fowler, Dr. George R. , neurectomy for re-
moval of facial neuralgia, 368.
Fracture, of the acetabulum, 576; of the
clavicle, 527.
Freckles, 432.
Free, Dr. Spencer M., hysteria in the male,
346.
French, Dr. C. JEi., maternal impression, 140.
Fresh air supply for cities, 560.
Fright, mental states induced by, 530.
Fuller, Dr. Fraser C. , rattlesnake-poisoning,
137.
Fuller, Dr. S. £., pseudo-bulbar paralysis,
487.
Furuncle, 68.
Galentin, Dr. C. B., notice of book by, 299.
Galvanism, in tubal pregnancy, 337. .
Gant, Dr. F. J., notice of book by, 2a
Gardiner, Dr. Henry K., 308.
Garrigues, Dr. H4 J., tubal pregnancy, 446.
Gas, illuminating, poisoning by, 291.
Gastraljgia, malaxial, 288.
Gastritis, chronic, 54a
Gastrostomy, 95.
Gatchell, Dr. Edwin A., the North Carolma
climate for consumptives, 364.
Geddings, Dr. W. H., indigenous leprosy,
177.
Gelsemiiun, in tetanus, 34.
Genu valgum, 276.
German Naturalists and Physicians, 696.
Giddings, Dr. W. P., 251.
Glioma of the retina, 163.
Glycerine, vapor of, 644; vapor of, for
cough, 403.
Glycosuria, 230.
Goitre, present status concerning treatment,
602 ; removed by operation, 671.
Goldsmith, Dr. Middleton, cancer of the
stomach and pancreas, 593.
Goll, column of, 478.
Gonorrhoea, 77, 600; potassa chlorate in,
272 ; stigpmata maidis in, 280.
Goodwiiiie, Dr. D. H., a simple stomach-
pump, 305.
Goodwin, Dr. Charles H., notice of book by,
692.
Greaves, Dr. Thomas, correspondence, 584.
Greely, Lieut., rescue of, 206.
Green, Dr. Edward H., medical history of
L,ady Franklin Bay expedition, 254.
Green, Dr. T. Henry, book notice, 300.
Groat, Dr. F. A., eczema, 485.
Gross memorial professorship, 239, 33a
Guarana, 4.91.
Gums, the landng of children's, 615.
H
Hallucinations, bilateral, 108.
Hamamelis, Virginiana, 53.
Hamilton, Dr. Allan McLane, iron albumi-
nate in anaemia, 140.
Hanks, Dr. H. T., notice of day-book by,
46.
Harlan, I>r. A. W., "dead teeth in jaws/'
-♦73- ^ . , .
Harris, Dr. R. B., veratrum of gelsemmm
in tetanus, 34.
Harris, Dr, M. L», diaphragmatic hernia,
40 !•
Harvey, as a student of nature, 718.
Hawes, JDr. Jesse, scrotal compressor, 529.
Hay-fever, 59, i6S^ 225, 259, 427, 476; in
an infant, 503.
Hseraatoma auris, 3, 119.
Haemoglobin, changes of, 628.
Health bill, 684, 688.
Health exhibition, international, 603.
Hearing, defective in public schools, 675 ;
rapid loss of, 106.
Heart, affections of, i, 29, 57, 86 ; beats of,
600 ; dilated, 263 ; iodoform in organic
disease of, 541; raorp&ia in disease of
the, 401 ; punctured wound of, 542 ; the
weight of, in cancerous affections of the
uterus, 265; ventricles, centre of co-
ordination for, 358.
Heat in therapeutics, 397, 413.
Heineman, Dr. H. N., was human flesh eaten
by any of the Greely party ? 216.
Heinmiiller, Dr. R. J., resolutions on death
of, 321.
Hematocele, pelvic, 376.
Hemiplegia, hysterical, 96.
Hemorrlmge, post-partum, vinegar in, 66.
Hemorrhoids, 448, 543; congenital, 584;
strangulated, 597.
Henry, Dr. Morris H. , fistula in ano, 539.
Hepatica, a useless drug, 153.
Hepburn, Dr. N. J., cocaine, 534.
Hermaphrodite, 633.
Hernia, after laparotomy, 543; congenital
diaphragmatic, 401 ; cured by sneezing,
246; inguinal kidney simulating, 698;
of the lung, 489 ; strangulated, 591, 609;
traumatic diaphragmatic, 503.
Heuel, Dr. Franz, inhalation of ether, 64.
Hiccough, 31.
Hip, diseases of, 168.
Hippocampus vs. hypocampa, 335.
Histories, medical, at St. Luke's Hospital,
New York, 419.
Holden, Dr. Edgar, when are we at the
greatest risk from consumption ? 36 ;
the period of greatest risk from con-
sumption, 335.
Holidays for physicians, 348.
Holt, Dr. L. Emmet, traumatic diaphrag-
matic hernia, 503.
Honey, for small-pox, 293.
Hooper's vade mecum, book notice, 524.
Hoppin, Dr. Samuel B. , notice of dictionary
by, 20.
Horton. Dr. W. P., Jr., cocaine in dentistry,
657.
Horwitz, Dr. Lloyd Norris, t3rphus fever at
the Philadelphia Hospital, 339.
Hospitals Medical Society, Paris, 134, 193,
385 ; special departments in, 155.
Howe, Dr. J. Morgan, *'dead teeth in
jaws," 444.
Hubbard, the late Dr. William Hustacc, 18.
Humphreys, Dr. C. H., multiple pregnancy,
26.
Hunter, Dr. James B., heat and cold in
therapeutics, 397.
Hurst, Lulu, 43.
Hutchison, Dr. J. C, book notice, 524.
Hydrarthrosis, and electricity, 69; chronic,
51 ; of the knee-joint. 404.
Hydrocephalus, chronic, 705.
Hydrophobia, 239; condition of blood in,
266.
Hyperhidrosis of the feet, 420.
Hypnotics, action of, on the cerebral circu-
lation, 54t^
Hypnotism, artificial, 632.
Hysterectomy, vaginal, for cancer, 165, 384.
Hysteria, gastric, 268, 448 ; in the male,
346 ; relations with scrofula and tuber-
culosis, 629.
Imperial Medical Society of Vienna, 52, 79.
Induction coil, the, 513, 558, 585.
Inebriety, acute impulsive, 289.
Infancy, blindness in, 10.
Infanticide, 41.
Infants, artificial feeding of, 287; feeding,
528 ; feeding with cow's milk, 474; the
question of feeding, 112, 351.
Infarction, embolic, of muscles, 291.
Infectious diseases, 303.
Injections, intravesical for cystitis, 704.
Insane, pauper, 209.
Insanity, 578, 586.
Insomnia, 84.
Instinct, perverted sexual, 70.
Insurance, life, 25.
International Medical Congress, 182, (187,
213, 247, 273. 301, 306, 329. 357,,3«7,
624. .M
Intestinal obstruction, 326 ; from twisting
of gut, 196.
Intiestine, chronic catarrh of, 573 ; perfora-
tion of. 304.
Intestines, chemical poisons formed within,
683.
Inula, campana, in leucorrhoea, 524.
Investigation, collective, of the British Medi-
cal Association, 685 ; of disease, 349.
Iodine-poisoning, acute, 387.
lodism, acute, 265, 587.
Iodoform, 515 ; in gonorrhoeal ophthalmia,
376; in organic disease of the heart,
541.
Iridectomy, cocaine in, 658.
Iron, albuminate of, in anaemia, 140.
Isolation, in the infant hospitals in Paris,
ij
Jarvis, Dr. Edward, death of, 712.
Jarvis, Dr. William C, cocaine in intra-na-
sal surgery, 654.
Jaws, dead teeth in, 379, 444, 473, 521, 525,
564, 650.
Jequirity, 162, 388, 562 ; in Parisian prac-
tice, 68; ophthalmia, 596.
Jews, as physicians, 644.
Joints, disease of, and tuberculosis, 578;
stramonium leaves for painful affec-
tions of, 316 ; sublimate injections in dis-
eases of, 631 ; syphilitic diseases of, 133;
tuberculous diseases of, 275.
Jones, Dr. H. McN., notice of book by,
299.
{ones. Dr. S. S., tracheotomy in croup, 643.
udkins, Dr. William, hay asthma, 259.
Kales, Dr. J. W., substitutes for plaster-of-
Paris jackets, 705.
Kelly, Dr. J. D., correspondence, 584.
Keratitis, 388.
Kesteven, Dr. W. Henry, book notice, 300.
Kidd, Dr. George H., address on obstetric
medicine, 141.
Kidney, extirpation of, 79; inguinal, simulat-
ing hernia, 698.
King, Dr. Samuel T., hospital report, 540.
Kinnicutt, Dr. Frank P., tuberculous croup-
ous pneumonia, 399.
Klein, Dr. E., notice of book by, 692.
Klingensmith, Dr. I. P., calomel in diphthe-
ria and croup, 36.
Knapp, Dr. H., cocaine, 461, 656, 662.
Knee-joint, acute inflammation of, 433 ; ex-
cision of, 578 ; hydrarthrosis of, 404 ;
removal of foreign body from, 403.
Knock-knee, 612.
Kola nut, 53.
Kortright, Dr. James L., rupture of the.dia-
p£-agm, 402.
Kretschmar, Dr. Paul H., tape-worm, 82.
Labor, sudden death in, 706; the third
stage, 331, 608.
Lady Franklm Bay Expedition, 254.
Laparomyotomy, 370.
Laparotomy, foreign bodies in the abdomen
after, 382 ; hernia after, 543.
Lancaster, Dr. R. A., 280.
Laryngitis hemorrhagica, 9.
Laryngismus stridulus, 292.
Larynx, gangrenous inflammation of, I9l{;
resorcin in affections of, 543.
Lata, 601.
Lawn^tennis, pathology of, 464.
Lead-poisoning, 621, 637.
Leake, Dr. Henry K., nitrate of silver injec-
tions within the bladder, 501.
Lefferts, Dr. George M., notice of book by,
691.
•J 2'.
INDEX.
[December 27, 1884.
Leg, increase in the length of, after rhennuu-
tism, 10 ; ulcer of, 68 1.
Lemniscus, the anatomy of the, 393, 421,
449. 477.
Leonard, Dr. William R. A., new bullet for-
ceps, 410.
Leprosy, 156; indigenous, 177; bacilli, and
vaccination for leprosy, 713.
Letter, Cincinnati, 582 ; London, 24, 54,
80, 13s, 166, 220, 248, 333, 390, 416,
443. 5«>i 558. 581, 615, 640; Paris, 54,
136, 334, 442, 559.
Leucxmia, 301.
Leucorrhoea, 52J.
Lewis, Dr. Daniel, endorsed diplomas of the
United States Medical College, 249.
Lichen, ruber planus, 133.
Life, value of human, 644.
Lime, muriate of, 288.
Lincoln, Dr. R. P., naso-pharyngeal fibro-
sarcoma, 455, 469.
Lipoma, of the arachnoid, 707; of the
neck, 47.
Listerism, 277 ; and craniotomy, 493, 643.
Lithotrity, extraordinary, 545.
Liver, abscess of, 580 ; adenoma of, 706 ;
affections of, in syphilis, 544 ; anomalies
of, 50 ; cirrhosis of, 697 ; hydatid cyst
of, 375.
Localization, central, 232, 342, 458, 536.
Locomotor ataxia, 265.
London Pathological Society, notice of
transactions, 20.
Loomis, Dr. Alfred L., book notice, 412 ;
Professor Alfred ll, on Colorado cli-
mate, 526.
Lovage, 42a
Lung, calcareous concretions of, bacilli in,
6S1 ; hernia of, 489 ; sarcoma of, 441.
Lupus, 359; salicylic acid in, 541.
|M
McCoy, Dr. George T., opium in mitral in-
sufficiency, 585.
Mackenzie, Dr. John N. , hay-fever, 59 ; hay
asthma, 427.
McLean, Dr. L«roy, oesophagotomy, 281.
Mackenzie, Dr. Morell, hay fever, 225.
Madness and crime, 547.
Major, Dr. George W., buccal breathing, 565.
Malaria, and osteopathics, 266 ; as a defence
in a suit for rent, 318 ; natural produc-
tion of, 197 ; pernicious, 262 ; prophy-
laxis of, 208 ; the germ theory of, 597.
Male, hysteria in, 346.
Malpractice, suicide of a phjrsician accused
°^'7i3- . . ^
Mammary atrophy, 10 ; tumors, acatnx after
removal, 12.
Mammer, Dr. Ernest, item, 601.
Manaca, in rheumatism, 31.
Mania, acute, at the menstrual period, 347.
Manton, Dr. W. P., notice of book by, 2a
Marsh, Dr. £. J., period of greatest risk
from consumption, 194.
Marshal], Dr. John S., " dead teeth in jaws,"
445-
Marvin, Dr., 280.
Mastoid, indications for opening, 105.
Materia medica, modem progress of, 573.
Maternal impression, 140, 225.
Maxilla, inferior, fracture of, 405.
Measles, German, 515.
Medical advertising, 490.
Medical charity, abuse of, 352 ; abuse of in
the South, 109.
Medical chemistry, 140.
Medical department during the Revolution,
447-
Medical education abroad, 494.
Medical education and practice, 546.
Medical journals, German, 71.
Medical manners, ancient and modem, 348.
Medical practice in Missouri, 570.
Medical rhymes, 547.
Medical Society of Berlin, 78, 133.
Medical Society of the County of New York,
363» 495» 607, 715 ; committees, 608.
Medical Society of Virginia, 323.
Medical students, fewer, 713.
Medicine, and medical men in Denmark, 27 ;
practice of, in Russia, 717.
Medico-Legal Science in New]|York City,
712.
Meier, Dr. G. C. H., electrolysis in strict-
ures, 195.
Melanaemia, 291.
Meningitis, simple and tubercular, 37 ; tu-
bercular, 48, 49, 358, 699.
Menopaue, cardiopathy, 347.
Menstrual period, acute mania at the, 347.
Menstruation, 297 ; condition of ovaries in,
293 ; in animals, 588 ; the wave theory,
318.
Mercury, bichloride, solution of, 168 ; in
the urine, 405; tannicum oxydulatum,
84.
Metaplasia, Virchow's address, 294.
Methyline, bichloride, death from use of, 75.
Metritis, chronic, 134.
Michigan State Medical Society, 21.
Microcephalus, 522.
Midwifery, antiseptic, 372.
Midwives, 212.
Migraine, in tabes, 597 ;• prophylaxis of, <55.
Milk of pregnant cows unfit for infants, 601 ;
peptonized, 80, 364, 447; peptonized,
objections to, 363.
Millard, Dr. H. B., prevalence of consump-
tion at different ages of life, 527.
Minor, Dr. James ll, cysticercus in the
vitreous, 703 ; hydrochlorate of co-
caine, 439.
Miryachit, 601.
Mitchell, Dr. S. Weir, book notice, 299.
Moore, Dr. A. M. , yellow fever on the U. S.
steamship Portsmouth, 7.
Moore, Dr. William O., coca leaf and its
alkaloid, 5 10 ; hydrochlorate of cocaine,
438.
Morphia, in cardiac disease, 401.
Morphinism, and pregnancy, ii ; detected
through examination of the urine, 685.
Mouth, hygiene of, in the new-bom, 377.
Mouth-breathuig, 565.
Mulhane, Dr. John D., 112.
Mullen leaves in phthisis, 319.!
Mumps, as a cause of sudden deafness, 517.
Mund6, Dr. Paul F., tubal pregnancy treated
with galvanism, 337.
Murmur, encephalic bellows in children, 403.
Murmurs, cardiac, ii.}.
Murray, Dr. R. , 244.
Muscle, rupture of, simulating abscess, 682 ;
striated, histology of, 358.
Muscles, embolic infarction of, 291 ; inter-
costal, action of, 38.
Musk, 223.
Myasis, 347.
Myocaiditis, chronic fibrous, 5a
Myomata, uterine, 329.
Myxoedema, 231, 302, 61 5. |
Myxofibroma, at the basis cranii, and its ef-
fect upon vision and hearing, 106.
N
Naphthaline, in diarrhoea and C3rstitis, 597.
Naphthol, in scabies, 403.
Needle, a new, for continuous or interrupted
suture, 419 ; the vagaries of a, 251.
N^roes, why they are black, 431.
Nelson, Dr. C. E., **dead teeth in jaws,"
445.
Nephrectomy, 165 ; for calculous pyelitis,
569 ; in infants, 682.
Nephritis, chronic parenchymatous, 179.
Nervous diseases, disturbances of the urine
in. 375.
Nervous exhaustion, 307.
Nervous impression, 69.
Nervous origin of some disorders of the
alimentary canal, 497.
Nerves, reunion of divided, 97.
Neuralgia, epileptiform, 237 ; facial, 368 ;
syphilitic, 12; tubercular, 39.
Neurasthenia, relation of, to concussion of
the spine, 617. \
Neurectomy, 368.
Neuroses, cardiac, 86.
Newcomb, Dr. J. E., hospital report, 263.
New York Academy of Medicine, 415, 471,
556, 612, 665, 711, 714; section in
obstetrics, 693.
New York Eye and Ear Infirmary, 374.
New York Hospital, 264.
New York Neurological Society, 497, 614.
New York Pathological Society, 47, X
441, 469. 5S2i 670, 697; noticeof tt^
actions, 20.
New York State Medical Association to*
570, 572. "^
New York State Medical Society, 465.
Nicotinism, acute, 376.
Nipple, Paget's disease of, 153.
Nolan, Dr. E. M., Florida as a health r.
sort, 502.
Nomenclature, in obstetrics, 330.
North, Dr. N. L., the untrustworthintB of
fluid extracts, 92.
Northwestern Medical and Surgical Society,
499. 637.
Nose, the relation between diseases of, od
nervous afiiections, 235.
Noyes, Dr. H. D., correspondence, 417.
Nutrition, disorders of, related with affec-
tions of the nervous sjrstem, 203, 226.
Nux vomica as a galactagogue, 82.
Obesity and the sexual function, 279; pt.
thology of, 183.
Obstmction, intestinal, 470.
CBsophagotomy, 95, 281.
CEsophagus, stricture of, 95, 278, 543.
Officers of the Army, shall they engage it
private practice? 194.
Ohio State Sanitary Association, 7x3.
Oliver, Dr. N. E. , peptonized miUc, 363.
Oliver, Dr. N. E., removal of benign tinion
without mutilation, 139.
Omphalo-mesenteric remains, 235.
Ophthalmia, contagious, in asylums of Nev
York City, 496 ; gononrfaceal, iodofom
in» 376; jequirity, 596; ncomtonoi,
358; phlyctenular, m.
Ophthalmology, light sense in, 387.
Opii acetum, 139.
Opium, as a heart tonic, 585.
Opium-poisoning, nitrite of amyl in, 13.
Opium-smoking, as a therapeutic meiare,
317 ; danger of, as a therapeutic mcu-
ure, 501.
Orbit, rare tumor of, 13.
Orchitis, malarial, 347.
Ord, Dr. William M., address in me&iae,
203, 226.
Osteopathics, and malaria, 266.
Osteotomy, for genu-vaigum, 276.
Osteomyelitis, 706.
Otis, Dr. F. N., large doses of potassia
iodide in syphUis, 641.
Otitis media, acute, atropine in, 517; diy
treatment, 21 ; suppurative, 106.
Othematoma, 4, 121.
Otoscope, new electric, 616.
Ovaries, condition of, during menstraatioa,
293-
Ovariotomy, and Listerism, 493, 643 ; en?
performance of, 331 ; in Rome, 688;
in the corpulent, 251.
Oxygen and its congeners, 283, 313.
Ozena, 403.
Ozone, in rheumatism, 601.
Pachymeningitis, hemorrhagica, 670.
Paracentesis thoracis, 574.
Paraldehyde, as a hypnotic, 317 ; in dE&iaai
tremens, 39.
Paralysis, from use of crutches, 599 ; inin-
tile, resection of muscles in, diS; paodo-
bulbar, 487, 498; reflex, 12; witbotf
anaesthesia, 3&
Paraphimosis, 403.
Paraplegia, acute painful, 377, 519; nriniiyi
230.
Page, Dr. A. C, antiseptic midwifov, 37*
Page, Dr. R. C. M., lead-p9isoning, 621-
Paget^s disease of the nipple, 153.
Palato-graphy, 380.
Palmer, Dr. J. G., chronic hydrocephaH
705- . ,
Pancreas, cancer of, 532, 593; cirrhossff
the, 505.
December 27, 1884.]
INDEX.
723
Panam, Dr. P. L., address at International
Medical Congress, 203.
Paris Academy of Medicine, 51.
Park, Dr. G. C, extra-uterine pregnancy,
224-
I>arlc, Dr. Roswell, electric otoscope, 616.
Parker, Dr. J. B., acute iodism, 587.
Parker, Willard, M.D., LL.D., in memo-
riam, 189.
Parker, Dr. William S., quacking sounds in
the ear, 139.
Parker, Dr. w. Thornton, 181 ; tube for in-
jecting and measuring the uterus, 305.
Parks, Dr. N. O. D., malarial gastralgia, 288.
Parmenter, Dr. John, local use of ether in
the bladder, 25.
Partridge, Dr. Edward L., notice of transla-
tion by, 494.
Patella, fractured, 265.
Patellar tendon reflex, 1 1 ; and ankle clonus,
403. ^
Pathology, gastnc, 630.
Paul, Dr. Constantine, notice of book by,
19.
Peck, Dr. Edward S., astringents and caus-
tics in ophthalmic practice, 482.
Pellctierinc, 81.
Penis, fracture of, 549.
Pension, psycho-pathology of application for,
140.
Pepsin, 272.
Peptones, 195.
Peptonized milk, 138.
Percy, Dr. Samuel R., cocaine, 55a
Perimeter, M. Hardy's, 389.
Perimetritis, 333.
Periostitis, rheumatismal, 598.
Periproctitis, simulating typnoid fever, J77.
Peritonitis, from diseases of the vermiform
appendix, 600 ; tubercular, 47.
Perry, Dr. A. W., the abuse of tonics, 718.
Peters, Dr. John C, muriate of lime, 288';
Warburg's tincture, 63.
Pharmacology, 663.
Philadelphia Hospital, 179.
Phlebitis and rheumatism, I2.[
Phosphorus, action of, on the foeins, 293;
dosage of, 380.
Phthisis, death-rate of, 69; in the light of
recent discoveries, 670; mullen-leaves
ii^t 3^9 f ^c^ remedy for, 9 ; old catar-
rhal, 699; transmissibility of, 193;
treated by overfeeding, 66.
Phymosis, without operation, 599.
Physician, the oldest, in the State, 672.
Physicians, holiday seasons for, 348 ; visit-
ing list, 692.
Phjrsiology, address in, 113; every-day, 588;
temperance, 42.
" Physyke" a good general rule, 27.
Pinkney, Dr. Howard, natural sidphur wa-
fers, 539.
Pitchfork, injury from, 429.
"Pidgen" English, 72.
Placenta, adherent, 27.
PUcenta pnevia, 89.
Plaster-of-Paris jackets, 428 ; substitutes for,
705.
Pleurisy, with effusion, electricity in, 476.
Pleuritic effusions, the induced current in,
266 ; exudations, the tuning-fork in the
diagnosis of, 11.
Pleuro-pneumonia, 271.
Pneumonia, and cold bath, 543 ; acute, and
tuberculosis, 430 ; acute lobar, 434 ;
calomel in the treatment of, 683 ;
chill in etiology of, 13 ; chronic, in the
light of recent discoveries, 679 ; cocci
of, and organumis of salivary septicaemia,
140; iodide of potassium in, 13; sub-
acute, 304; subclavicular tympanitic
resonance in, 266; tuberculous croup-
ous, 399.
Pneumonotomy, 223.
Pneumotherapy, application to diseases of
the heart, 124.
Podophyllum, poisoning by, 345.
Poison labels, 319.
Poisons, chemical, ^formed in the [^ intestinal
canal, 683.
Polk, Dr. W. M., cocaine as a]j1ocal} anaes-
thetic in gynecology, 489.
Polycoria, 164.
Polypi, nasal, 189.
Polypus, naso-pharyngeal, 387.
Polyuria in typhoid fever, 265.
Poore, Dr. Charles T., book notice, 356.
Post-mortem specimens, temporary preserva-
tion of, 560.
Potash, bichromate of, antiseptic properties
of, II.
Potassium, iodide of, 492, 584; in pneu-
monia, 13 ; in S3rphilitic deafness, 257 ;
large doses, 688 ; large doses in sjrphllis,
641.
Potts* disease, 13.
Practitioners' Society of New York, 361,
413, 609.
Prayer, the therapeutic effect of^ 713.
Pregnancy, and morphinism, 1 1 ; diagnoas
o^ 330; extra-uterine, 362; 383,466,
577 ; false, 69 ; morphine in vomiting
of, 237 ; multiple, 26 ; protracted,
584 ; tubaL 96, 445 ; tubal arrested by
galvanism, 392 ; tubal, galvanism in,
337 ; vomiting of, 624, 664.
Prendergast, Dr. P. J,, continuous suture,
616.
Prepuce, dilatation of, 599.
Presbyopia, and accommodation, 586.
Prostate, enlarged, 10, 293; hypertrophy,
treated without catheterism, 22.
Pruritus, oleate of chloral for, 543.
Pseudarthrosis, 292.
Psoriasis, 431.
Pupils, the, in epileptics, 39.
Puerperal infection of the male, 707.
Purpura, cachectic, 264 ; varieties of, 517.
Pustule, malignant, 542.
Pyelitis, calculous, nephrectomy for, 569.
Pyelo-nephritis, 697.
Quarantine, in cholera, 570.
Quebracho, alkaloids of, 599
Quinan, Dr. John R. , notice of book by, 2a
Quinine, amorphous borate, X12; contra-in-
dications m the use of, 66 ; hydrobro-
mate of, 222 ; hypodermics of, in differ-
ential diagnosis, 265.)
Rabies, 92 ; in birds, 96.
Rachitis, 139.
Rape, rights of defendant, 279.
Rattlesnake-poisoning, 137.
Rectum, a receptacle for excremental matter,
309 ; imperforate, 97, 541 ; malignant
affections, operative treatment of, 274.
Redfem, Dr. Peter, address in physiology,
"3-
Refraction, new method of determining, 388.
Reese, Dr. John J., book notice, 299.
Resorcin, antidote of, 683 ; for whooping-
cough, 551 ; in laryngeal affections, 543.
Respiration, effect on, produced by com-
pressed air, 122.
Respiratory medicaments, 122.
Reynolds, Dr. Walter B., poisoning by po-
dophyllum, 345.
Rheumatism, and phlebitis, 12; carbolic
acid in, 10 ; gonorrhoeal, 229 ; manaca
in, 31 ; ozone in, 601.
Rhinelander, the case of, 520.
Richmond, French compliment for, 27.
Rickets, 357.
Riley, Dr. F. C, failures with cocaine, 658.
Riley, Henry A., Esq., the laws of dissec-
tion, 486 ; the law regulating the com-
pensation of physicians, 626.
Roane, Dr. James, veratrum viride, 586.
Roberts, Dr. F. T., book notice, 299.
Robbins, Dr. C. W., intravesical injections
for cystitis, 704.
Rockwell, Dr. A. D. , notice of book edited
by, 300; the induction coil, 513, 558,
585 ; tubal pregnancy arrested by ^-
vanism, 392.
Rodenstein, Dr. L. A., 305.
Rogers, Dr. Robert* E., obituary, 30a
Roosa, Dr. D. B. St. John, correspondence,
391 ; cocaine, 463. '"' "^
Roosevelt hospital, 263.
Rose-cold, 420.
Rotation of the forearm, 599.
Rothacker, Dr. W. A., notice of book by,
692.
Rowe, Dr. Frank H., tape- worm, 56.
Royal College of Surgeons, 81.
Sarcoma, generalized, 431 ; of the mediasti-
num and lung, 441.
Saundby, Dr. Robert, examiners at the
Royal College of Surgeons, England,
8i.
Scabies, naphthol in, 403.
Sciatica, 265 ; treated by congelation, 347.
Sclerosis, following infectious diseases, 293 ;
of the coronary arteries, 682.
Scrofula and tuberculosis, 376.
Scrotum, a compressor for, 529.
Scudder, Dr. H. Martyn, cholera in India,
255.
S^e, Professor Germain, respiratory medica-
ments, 122.
Seguin, Dr. E. C, notice of book by, 21,
Semple, Dr. Armand, notice of book by, 19.
Septicaemia, masked, 375 ; puerperal, 292.
Sero-sublimate, 548.
Serpent-poisoning, 408.
Sewers, ventilation of, 49J.
Sexton, Dr. Samuel, deadf teeth in the jaws,
525 ; defective hearing in the public
schools, 675; diseases of the external
ear,"3,ii9, 149, 173, 374,
Shafer, Dr. J. P., renal calculi, 587.
Shawl-pin, swallowing of, 695.
Sheardown, Dr. T. W., the abuse of medi-
cal charity in the South, 109 ; the treat-
ment of dyspepsia by hot water, 563.
Shears, Dr. C. H., cocaine in dentistry, 657.
Shillock, Dr. P. T., intestinal obstruction,
196.
Shirk, Dr. J. K., notice of book by, 46.
Shrady, Dr. George F., strangulated hernia*
. 591. .
Siamese twms, 39.
Sickness, the cost of, 586.
Silver, iodide of, 644 ; nitrate, in adenitis,
375 ; nitrate of, injections of, in the
blaidder, 501.
Simon, Dr. W. , book notice, 524.
Slzer, Dr. A. B. de S., congenital hemor-
rhoids, 584.
Skene, Dr. A. J. C, book notice, 356.
Skin, ethics of, 167 ; specific sensibility of
the, 359 ; treatment of diseases of, at
Vienna, 532.
Skull, osteitis of, 386.
Sleep, 706.
Small-pox, honey for, 293; susceptibility to,
181.
Smiley, Dr. D. B., correspondence, 448.
Smith, Dr. Andrew H., catheterization, 456;
the tolerance of small doses of corrosive
sublimate, 312.
Smith, Dr. Eugene, cocaine in indectomy.
Smith, Dr. F. W., the swallowing of a
shawl-pin, 695.
658.
Smith, Dr. H. Lyle, tape-worm, 82.
Smythe, Dr. G. C, pelletierine for tape-
worm, 81.
Smith, Dr. J. Lewis^ peptonized milk, 80^
138.
Smith, Dr. Samuel W., plaster-of- Paris jack-
ets. 428.
Snake-bites, 404.
Soda, bicarb., in tonsillitis, 153.
Sodium iodide instead of potassiumjjiodide,
112.
Sohlin, Dr. Charles, jequirity, 562.
Somnambulism, partial, 247.
Soul-blindness, 536.
SpermatophobA, 238.
Spermatorrhoea, 238.
Sperry, Dr. S. B., hay-fever in an infant,
503-
Spina-bifida, injections in, 292.
Spine, concussion of, 617, 634; disease and
curvatures of, 701 ; progno«s of curva-
tures of the, 683.
Spiraea ulmaria, in enlarged prostate, lo.
724
INDEX.
[December 27, 1884,
Spitzka, Dr. £. C, anomaly of a vertebra,
680 ; gross anatomy of the fourth ventri-
cle, 249 ; hippocampus vs. hypocampa,
335 ; morphological status of the cere-
beUum, 1 1 1 ; the anatomy of the lem-
niscus, 393, 421, 449, 477.
Spleen, extirpation of, 84, 166.
Splenectomy, 37.
Splints, flexed, 716.
Sponge, artificial, 9; Mr. Gamgee's, 108.
Sprains, 112.
Spray-producer, 306.
Squint, atropine in convergent, 389.
St. Catherine's Hospital Report, 402.
St. Luke's Hospital, medical histories of,
446.
Stammering, 601.
Stanton, Dr. John G., correspondence, 279 ;
shall officers in the army engage in pri-
vate practice? 83.
Sternberg, Dr. George M., book notice,
495 ; disease germs, 451 ; pneumonia
cocci and organisms of salivary septi-
csemia, 140.
Stevens, Dr. B. N., correspondence, 448.
Stewart, Dr. Jacob H., obituary, 300.
Stickler, Dr. J. W. , cocaine in general sur-
gery, 657 ; sea-voyage and chronic
diarrhoea, 512; traumatic tetanus, 288.
Stimson, Dr. J>wis A., laparomyotomy,
370.
Stockard,|Dr. C. C. , fibro-cyst of the uterus,
177.
Stomach, cancer of, 385, 469, 593, 686 ; dila-
tation of, 431 ; dilatation of, in children,
489 ; gun-shot wound of, 224 ; irriga-
tion of, 540 ; miliary aneurisms of, 97,
293 ; pathology of, 630 ; swashing sound
in, as a symptom, 264.
Stomach-pump, 305.
Stomach-tube, death from the introduction
of, 504.
Stone, Dr. R. M. , glass wound, 456 ; gun-
shot wound of the stomach, 224.
Strabismus, latent, 389.
Strsunonium, leaves of, for painful joint af-
fections, 316.
Strecter, Dr. F. B., 420.
Streeter, Dr. H. W., electrolysis in strict-
ure, 94, 250.
Stricture, urethral, 673; treated by mas-
sage, 96 ; electrolysis in, 94, 250.
Strictures, of the oesophagus, 278, 543.
Sugar as a food, 139 ; bismuth-test for, 491.
Summer complaint, 87.
Summer vacations, 16.
Supra-renal capsule, 545.
Surgeons, army, shall they practise outside
of their posts ? 83.
Surgery, pulmonary, 641.
Surgical aid to children, 373.
Surgical Society of Paris, 165, 386.
Suture, continuous, 616.
Symptoms, value of certain, in diagnosis of
diseases of children, 67.
Syphilide, acute phagedenic pustular, 441.
Syphilis and cholera, 385 ; and mercury and
cholera, 447 ; bacillus of, 687 ; inherited,
affections of the liver in, 544 ; initial
sclerosis, excision of, 360 ; treatment by
inunction, 360.
Tabes, migraine in, 597.
Tait, Dr. Lawson, 643.
Tape-worm, 56, 81, 232, 251, 308 ; treaiccl
with chloroform, 112, 429, 475, 601.
Tattoo-marks, removal of, 598.
Tauszky, Dr. Rudolph, correspondence, 418.
Taylor, Dr. W. H., rectal etherization, 346.
Teeth, dead, in the jaws, 379, 444, 473, 521,
525. 5641 6S9 ; loosening of, 432.
Teller, Dr. S., fracture of the clavicle, 527.
Tendon, reflex, patellar, 11.
Testicles, superntmierary, 196*
Test-papers, urinary, 140.
Tetanus, 34 ; following Heaton's method
for the cure of hernia, 64; infantum,
631 ; traumatic, 288.
Thallin, 687.
Thayer, Dr. C. C, hepatic albuminuria, 124.
Theme, 491.
Therapeutical Society of Parb, 53, j86.
Therapeutics, artificial hypnotism m, 632 ;
dogmatic, 588; heat and cold in, 397,
413 ; medicinal and non-medicinal, 579.
Thermometry, aural, 489.
Therpyline, hydrate of, 545.
Things to try, 420.
Thompson, Dr. John H., chloroform and
tape- worm, 601.
Thorax, funnel-shaped, 30.
Throat, an instrument (ox pencilling chil-
dren's, 377 ; typhoid ulcerations of the,
405.
Thumb, dislocation of the first phalanx, 578.
Thymol, in treatment of cholera, 296.
Thyroid gland, function of, 266 ; removal
of, 375.
Tibia, ununited fracture, 205.
Toe-nail, ingrowing, 96.
Tongue, convulsions of, 509 ; gummy tumor
of, 403.
Tonics, the abuse of, 718.
Tonsils, hypertrophied, 598 ; the three, 365 ;
their structure and function, 415 ; tu-
berculosis of, 292.
Tonsillitis, 153.
Tonsillitome, Marconi's, 616.
Tonsillotomy, 597.
Tosswill, Dr. Louis H., notice of book by.
Tooth, death following extraction of, 97 ;
replantation of, 84.
Tracheotomy, in croup and diphtheria, 534,
643* 64s* 665, 700.
Trachoma, in the negro, 704.
Trance, 706.
Transfusion, 572.
Transplantation, without pedicle, 161J
Trichinosis, 14a
Trichorrhexis nodosa, 683.
Trineural fasciculus, 450.
Traumatism and tuberculosis, 376.
Tubercle bacilli in the non- tuberculous, 138.
Tubercles, of the breast, 39.
Tuberculosis, 302, 317 ; and acute pneumo-
nia, 430; and joint disease, 578; and
traumatism, 376; and scrofula, 376;
general, 189 ; miliary in the light of re-
cent discoveries, 679 ; of the eye, 681.
Tumor, bony, of the brain, 707 ; gummy, of
the tongue, 403.
Tumors, removal of benign, 139.
Tuning-fork, in the diagnosis of pleuritic ex-
udations, II.
Tyson, Dr. James, chronic parenchymatous
nephritis, 179.
U
Uhler, Dr. J. R., cocaine in general surgery,
657.
Ulcer, of the leg, 681.
Ulna, luxation of, with Colles' fracture, 279.
Unchastity, 531.
Ureter, closure of, 52.
Urethra, stricture of, treated by massage, 96.
Ursemia, 246 ; and urea, 698 ;
Urea, 69.
Urethritis, gonorrhoeal, 673.
Urine, albuminosc or peptone in, 350; am-
moniacal, 12; detection of morphinism
by examination of, 685 ; disturbance of,
in nervous diseases, 375 ; mercury in,
405.
Uterus, anteflexion of, 693 ; cancerous affec-
tions of, 265; fibro-cyst of, 177, 470;
inversion of, 382; latero-positions of,
332 ; tube for measuring, 305.
Vaccination, 173 ; insusccptibiUty to. 661^
susceptibility to, 181. ^'
Valentine, Dr. Samuel M., notice of detd
of, 436. ^^
Valerian. 4»:oction, in contusions, 508.
Valvulitis, cardiac, 29.
Variola and varicella, 707.
Venesection, in puerperal convulsions, 576
Veratria, in muscular tremors, 272.
Veratrum viride as a prophylactic agaiast
peritonitis after surgical operations, 586-
m tetanus, 34. ' '
Vermiform appendix, peritonitis from, 6oa||
Vidal, Dr. Etienne C, correspondence, 474
Vinegar, in post-partum hemorrhage, 6(5.
Vision, cerebral centres for, 342 ; improved
by hyperbolic lenses, 163.
Vitreous, cysticercus in, 703 ; remo?aloffor.
eign bodies from, 164*
Vivisection, 46,,
Vomiting, in children, 38 ; in pregnaac^, 62/
W
Wackerhagen, Dr. G., a new needle, 419.
Wallian, Dr. Samuel S., oxygen as a reD«>
dial agent, 283, 313.
Warburg's tincture, 63.
Ward, Dr. E. B., 415.
Warts, 432.
Water, hot, therapeutical effects on nervov
diseases, 471.
Waters, natural sulphur, 539.
Weber, Dr. Leonard, nervous origin of som
disorders of the alimentary canal,
497,
Webster, Dr. David, enucleation of 1 s(i
phylomatous eyeball, 93.
Weigert's method of staining the bnm and
spinal cord, 628.
Weisse, Dr. Faneuil D., pain, in stnctut
after gonorrhoeal urethritis, 673.
Weld, Dr. G. W., cocaine in dentistry, 657,
Wendt, Dr. E. C, cholera and bactai-
oscopy, 589 ; chronic pneomonia ind
phthisis in the light of recent discover-
ies, 679 ; tuberculosis and acote poa-
monia, 43a
Whiskey, as an anaesthetic, 588.
White, Dr. Leonard D., 448.
Whitla, Dr. William, notice of book by, ^.
Whooping-cough, resorcin for, 551.
Wilfert, Dr. H., tape-worm, 82.
Wilder, Dr. Burt G., themorphologiola.
tus of the cerebellum, 249.
Williamson, Dr. C. H., yellow fever at S*
ama, 509.
Wilson, Dr. F. M., cocaine m milJfS8^
gery, 582.
Winters, Dr. Joseph E., trachettoajii
diphtheritic croup, 645, 665.
Wise, Dr. A. T. Tucker, book notice, #
Woakes, Dr. Edward, notice of book by, i^
Woodward, J. J., M.D., obituary, 215,14^
Wound, abdominal, 415.
Wounds, antiseptic treatment of, 357.
Wylie, Dr. W. Gill, vomiting in pregMKS
624.
Wyman, Dr. Hal C, stramonium law It
painful joint aflFections,^3i6.
Yellow fever, the aUeged "vaccine'* agsiit,
712. '
Yeo, Dr. Gerald F., notice of maniiillifr
495.
Zenner, Dr. Philip, cerebral localiatioii,??*
342,458, 536; the centres for viaoi,
Ziegler, Dr. Ernest, notice of book by, ^
41.A32
6 Date Due \
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